Boston bombings highlight lasting effects of anniversary trauma

By Christina Bucciere

New York writer Christine Skopec ran her first Boston Marathon the year after the bombs exploded.

Instead of a day shrouded in grief, though, Skopec, 26, found herself joining thousands of other runners and cheering fans for a day-long celebration of community.

“The general atmosphere was jubilant,” Skopec said. “Everyone was really emotional, but not in an upset way. Some people said they didn’t care how fast they ran, they were just excited to run on the anniversary.”

Today is the second anniversary of the Boston Marathon bombings as convicted bomber Dzhokhar Tsarnaev, 21, faces sentencing and a possible death penalty.

But on anniversaries of traumatic events, many people relive the pain in an anniversary reaction, a psychological and physical response to the anniversary of a traumatic event as the person essentially re-experiences it.

Boston Marathon_Christine Skopec
Exhausted after running 26.2 miles in the Boston Marathon, Christine Skopec met up with her family on the first anniversary after the 2013 bombings. (Christine Skopec/Courtesy)

Entire communities, like Boston, can encounter anniversary reactions, too, and Boston’s response has been largely rooted in strength and togetherness.

A community’s reaction often revolves around the way it responds to the actual day of the event, says Dr. Sujata Swaroop, a Boston-based clinical psychologist who has worked with Boston bombing survivors.

For instance, just before the first-year anniversary of the bombings, many people in Boston focused on security questions about who was running in the marathon and how the same runners might feel again one year later, Swaroop says.

In general, the community responded to the anniversary by coming together to heal. For the individual, an anniversary can be isolating and can be a symptom of post-traumatic stress disorder, or PTSD.

People who experience a negative reaction year after year often overlook the connection between their symptoms and an anniversary of a traumatic event, Chicago psychology experts say.

I was one of those people.

Not until this month, almost four years after I nearly died from a case of bacterial meningitis, did I begin to realize that the feelings of increased anxiety and depression I experience around this time of year might be linked to the anniversary of the day I fell ill.

Bacterial meningitis infects the membranes surrounding the spinal cord and, if not treated quickly with antibiotics, can cause serious complications such as brain damage, hearing loss, amputations and death.

Within 24 hours, I went from feeling flu-like symptoms to an ICU bed as the bacteria clobbered my immune system, resulting in the amputation of both of my legs below the knees and my fingertips.

During the spring and summer months since my illness, I have experienced severe lows and anxiety. But until I discovered the term anniversary reaction, I thought the lows had more to do with the superficial concerns of the change in how I experience the warm summer months. Now, I know there may be more going on.

When recognized, anniversary reactions can become less frequent with treatment and coping techniques, experts say.

“What’s never failed to amaze me is that a lot of the people who do have PTSD, haven’t made the connection that the anniversary reaction that they’re having is actually tied to the calendar,” says Dr. John Mundt, a clinical psychologist and PTSD expert at the Jesse Brown VA Medical Center  in Chicago.

Our minds are good at blocking things out so we aren’t forced to re-live traumatic events, but there’s a part of our brains that does remember, Mundt says.

Anniversary reactions can be linked to PTSD, which is a long-lasting response to trauma, but may also be independent of it, Mundt says. Trauma doesn’t always lead to PTSD. It’s just one possible outcome.

Trauma, Mundt says, is a “deeply distressing or disturbing experience that is often beyond the range of normal human experience,” and can have repercussions for a person’s worldview. It could be an accident, an illness or witnessing a horrific event.

Experiencing an anniversary reaction to trauma is another possible outcome, which can cause feelings of anxiety, fear, anger, depression or irritability, as well as physiological responses such as changes in breathing or heart rate, Mundt says.

And the reaction most often spans longer than just the singular anniversary day, experts say.

Mundt says it tends to be associated with the specific time of year looming ahead and then passing away, comparing it to the way a wave picks you up from the sand, rolls over you and sets you back down again.

The way the trauma is experienced is integral to how people respond to it, says Meg Kelleher, a licensed clinical social worker at the Center for Grief Recovery and Therapeutic Services in Chicago.

When the trauma is communal in nature, community becomes an important part of the healing process because it can offer a sense of meaning and shared significance to survivors, Kelleher says.

When the trauma is experienced individually, the residual effects are likelier to be isolating, Kelleher says.

Experts offer several strategies to allow individuals to heal but first they have to make the connection.

Making the Connection

The reason people often don’t recognize they are responding to a traumatic anniversary is because of the way trauma is recorded in the brain, says Ashley Seewald, director of program development at Counseling@Northwestern, a graduate program at Northwestern University.

Seewald is also a “NeuroCounselor,” which means she incorporates an understanding of the brain into her treatment.

The brainstem is the back portion of the brain responsible for sensing danger and controlling reflex processes, like breathing and blood flow, instantaneously. When trauma occurs, people become overwhelmed and rely on this part of the brain to interpret what’s happening, Seewald says.

The problem with this is that, during traumatic experiences, the brainstem doesn’t communicate with the prefrontal cortex—the frontal portion of the brain responsible for applying logic and a narrative to experiences. That means the memory is encoded with feelings, not logic, Seewald says.

So when the anniversary of the event comes around, the brain interprets the memory using the initial feelings of danger, but it’s unable to interpret what they mean or where they come from, Seewald said.

Learning to Cope

When people realize they are reacting to the anniversary of a traumatic event, either on their own or with the help of a trained clinician, the best way to manage the symptoms is to help the survivor process the event, Mundt says.

A highly used two-phase method of PTSD treatment can help people experiencing anniversary reactions, Mundt says.

First, the person learns distress tolerance skills to accept feeling uncomfortable around the anniversary. Second, the person must process the trauma, which usually involves repeatedly talking about it, Mundt says.

One way you can help people recognize when they may be responding to a traumatic anniversary is to help them understand the way their body changes in response to trauma, Seewald says.

When people experience trauma and can’t flee, fight or change what’s happening, they tend to become immobile. This shut down can make them feel lethargic and depressed, Seewald says. Those same feelings can resurface around the anniversary of the event.

Helping people understand how to recognize these symptoms is key to helping them feel the emotions rather than letting them go unresolved, she says.

“The whole point in helping people feel is to help them recognize what they didn’t get to feel and what they didn’t get to do when it first happened, and as you start to identify those pieces, the goal is to help them feel them in the present trigger,” Seewald says.

Once people are able to recognize and work through the emotions as a temporal response to trauma, the symptoms may lessen as time passes, experts say.

Seewald says getting people to feel the emotions is not about reducing the reaction to the anniversary, but to “allow the feelings to flow smoothly year by year so they’re able to feel whatever they need to instead of shutting down.”

Silver Lining

After making the connection between my symptoms and my anniversary, I feel better equipped to navigate the coming months as my brain remembers the weeks I spent in the hospital.

It might not make the emotions go away, but I feel more comfortable exploring them—­riding out the wave instead of gasping for air and floundering for solid footing.

Even though traumatic anniversaries are often an unwelcome reminder of past hardships, they can also be transformative, Swaroop says.

“Anniversaries bring up a lot of trauma and experience of loss, but they’re also a time of immense healing, when individuals and communities can recognize their survival and strength they’ve garnered the past year,” Swaroop said. “It allows for reflection on the trauma and healing process, as well as the growth.”

Photo at top: Two years after the bombings at the Boston Marathon, runners and witnesses may be dealing with residual responses to the trauma without knowing it. (hojusaram/Creative Commons)