In the wake of the events at the Boston Marathon and the subsequent shootout and stakeout in Watertown, there has been much discussion of the strength and resilience of the Boston community.  Our Mayor crowed, “Boston will overcome,” and our president uttered his somber words, “they picked on the wrong city," and, "make no mistake about it, we will finish the race.”  The phrase “Boston Strong,” has gone viral.  Even our busses flash this slogan after their LED banners show the number of the route, as if, no matter what bus you get on, we are all headed toward this same impregnable fortress.  And indeed, many of the runners, even among the injured, have pledged that they will run next year, even if on new fiberglass limbs.  Such a display of strength in the face of such terror is both admirable and simply human.  We endure because we have no choice.  But, what of those who don’t feel this sense of strength, whose sense of safety has been so shattered that they are experiencing far greater disturbances than can be addressed with simple slogans of an imagined bravery?  What if they cannot fathom running the marathon again, or even, running again?  What do we say to them?

    The subjective nature of trauma.  The first thing to say is that trauma is an entirely subjective experience.  Just because you weren’t there, doesn’t mean that you weren’t traumatized.  The images of the explosions and the descriptions of the wounds were repeated so often by the media that we all had a very vivid pictures of the horrific event imprinted in our minds.  Some people can seem to regroup relatively quickly, while others--particularly runners and marathon participants--might feel that their universe has become so inverted that they just cannot imagine returning to their pre-event peace of mind.  The important thing to remember is that there is nothing inherently wrong with either response.

    Know the signs of acute traumatic stress.  The second thing we might offer them is to recognize that certain reactions to trauma, though distressing, are normal and can be overcome.  Professionals often break down trauma symptoms into clusters, the most common of which are: re-experiencing (flashbacks, nightmares, hightened sensitivity to reminders of the event), avoidance (social withdrawal, difficulty having or naming feelings, avoiding stimuli or activities associated with the event, difficulties with memory), andhypervigilance (an edgy feeling of always being on, of always thinking the event is going to happen again).  Experiencing these symptoms can often make a person feel as though they are going crazy, when in fact, they are part of the body's natural protection system that went into overdrive during the event.

    Grounding exercises.  One good way to help yourself if you are experiencing any of these symptoms is to first recognize that this is what they are.  Then, you can practice some fairly simple grounding exercises to help you through.  If you are having re-experiencing symptoms, it is important to stop the thought or wake up from the dream and say something to yourself like, "It's over.  It's not happening now.  It was only a flashback/dream.  I'm safe."  If you are having some social withdrawal, try to make yourself do something socially that maybe stretches your comfort zone but isn’t impossible.  Ask a friend to do something that feels pretty easy and then expand from there.  And if you are experiencing some hypervigilance, practice some grounding exercises like some deep breathing (exhaling twice as long as your inhale), guided meditation, or even some physical exercise that gets you out of your head and into your body.  One thing that you will notice about these grounding exercises is that they attempt to give you back some control that was lost during the traumatic event.  Loss of control is one of the signal aspects of trauma and by addressing these symptoms yourself you are taking back some of what was lost.  

       Yet another thing that was lost in a traumatic event is some basic trust in the universe, our faith that bad things like this shouldn't happen.  In that regard, trauma represents a spiritual injury as well as a physical and psychological one.  For this sort of injury, I might suggest that running does offer the best bet for a return to spiritual health.  Your running has been a spiritual exercise for you, a time when mind and body synchronize with your surroundings and gave you that sense of transcending the here and now and participating in something larger than yourself.  Thus, running can be a way to re-harmonize what has gone so badly out of tune.  Recognizing and treating the signs and symptoms of acute stress rather than pretending they're not there might just be one way for you to put those shoes back on to begin the long journey back to the starting line.  But, if some of these symptoms are particularly severe or last longer than a few months, don’t hesitate to contact a mental health expert with some experience working with traumatic stress.