Introduction:
The word “trauma” has grown increasingly prominent in the public consciousness in recent years. Even outside the field of the mental health, many people are employing this term with increasing to frequency to describe deep emotional struggles. With the proliferation of online communication and information, along with the continuing evolution of our own language, it can be easy to lose track of the history behind this singular word as well as its actual meaning in psychology. This article is not meant to be in-depth analysis on the nature of trauma, but a basic overview in laymen’s terms for easy reference.
History and Definition:
The word “trauma” is Greek in origin and originally saw use around the seventeenth century as a term which meant “wound.” The associated nature was physical, as well as similar to other Greek words at the time which meant “to wound” or “to pierce.” While the term saw plenty of use in describing the physical toll of battle, the association with mental health did not begin until much later after the Vietnam War in America when the term “Post Traumatic Stress Disorder” (PTSD) was first conceived as a means to diagnostically label the emotional and behavioral struggles of veterans, following their return from combat.
The full transition occurred soon after when clinicians like Dr. Bessel Van Der Kolk began observing the same kinds of symptoms indicative of PTSD in individuals with no military history: children from abusive homes, victims of assault, survivors of near fatal car accidents, natural disasters, etc. As a result, PTSD and by proxy, “trauma” began to take on a new association, referring to collective wounds that were emotional rather than physical in nature. Today the word, “trauma,” can be succinctly defined as the emotional physiological wound brought about by an experience involving (at minimum) a dangerous loss of control.
What Happens in the Brain:
The key phrase in the above definition is “a dangerous loss of control.” When we encounter a situation where our body senses a danger that we cannot naturally overcome, the brain makes a quick calculation whether to 1) Fight through the danger 2) Flee or run away from the danger 3) Freeze and disassociate to endure the danger. The brain makes its choice by taking into account everything we have experienced up to this point in our life and weighing this collective resilience against the danger. It then selects from the three options whichever response it deems to have the greatest chance of allowing us to survive. The brain does all of this in seconds and completely involuntarily, without any conscious input.
Whichever response is chosen, the brain also responds to the danger by activating a certain feature of it’s emotional center (called the amygdala) which allows this part of the brain to bypass its normal emotional reaction process in order to activate the Fight-Flight-Freeze survival instinct laid out above. An analogy might be an airplane pilot taking over full control during a storm. Normally the autopilot can do most of the work, but during a crisis only the pilot with total control can steer the craft to safety. During a trauma response, a special enzyme gets activated within the amygdala’s neural feedback centers and it is this which allows the bypass to occur. What is more important is that this enzyme does not automatically go away after the danger has passed.
Symptoms and Behavior:
After surviving the event, the emotional wounds of trauma can manifest in many ways and at different degrees of severity among individuals. Some of the more common symptoms include: nightmares or intrusive thoughts about what happened, low tolerance for anxiety or frustration, acting withdrawn or distant, avoiding talking about what happened, or becoming upset or experiencing physical health issues for no apparent reason. This last one in particular is critical to understanding how trauma affects our brains and bodies.
Recall the enzyme and its role in changing the brain’s communication process. Because this does not recede, even after the danger has passed, as a result whenever we encounter something that reminds us of the trauma – no matter how vague – that same Fight-Flight-Freeze instinct gets immediately reactivated again. This is what we call a “trigger.” It is also the reason why many traumatized individuals often find themselves suffering from ailments like crying spells, depression, panic attacks, high blood pressure, or stomachaches without any obvious explanation. The trigger can be something as trivial as a glass of water, but if it is reminiscent of the trauma (e.g. nearly drowning in a flood) our stress response will be the same.
PTSD vs Trauma:
Post Traumatic Stress Disorder (PTSD) is sometimes used almost interchangeably with Trauma, however, it is a mistake to conflate the two. As previously mentioned, PTSD was the name of the first Psychiatric diagnosis to clinically categorize the trauma symptoms of war veterans. Today, even by the current standards of the DSM-V (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition), PTSD still requires multiple specific criteria to be met in order to qualify for a diagnosis. These criteria do not account for all kinds of trauma or traumatic experiences. It is possible for a persona to have trauma and/or symptoms of trauma but not necessarily PTSD. To put it another way, PTSD is a shorthand referral for only one type trauma out of several (see next section) and is used primarily by mental health clinicians for diagnostic clarification, rather than by everyday people for emotional explanation.
Complex, Chronic and Big T vs little t:
Every trauma is terrible to the person experiencing it. There is no universal scale to effectively determine which trauma is the “worst.” Each deserves validation and healing. There are, however, different varieties of trauma, some of which can manifest overtime, and it is important for clinicians and non-clinicians alike to be able to recognize them.
Complex trauma refers to when a person experiences multiple unresolved traumatic experiences in succession. For example, surviving a plane crash, then being diagnosed with a life-threatening illness. The emotional stress and symptoms may differ between the two, but when the initial trauma goes unresolved its consequences can both overlap with and exacerbate those of the second. In the above example, the symptoms of the illness may present as more severe than normal, or the person may find it difficult to focus their full attention on addressing it because they are still struggling to process the effects of the plane crash (or vice versa).
Chronic trauma – often abbreviated as CPTSD – on the other hand refers to a recurring pattern of similar traumatic experiences, which may be big or small, but continue over a long period of time, sometimes years or even decades. There is no official standard for the duration or frequency, however, the key word is “pattern.” A child growing up in a household with an abusive parent might experience chronic trauma as a result of being shouted at or hurt on a repeated basis. The incidents themselves may be short or minor and taken individually might not be enough to feel traumatizing, however, together the collective impact of so many can lead to long-term suffering and significant emotional problems down the line. Complex and chronic trauma are also not mutually exclusive.
“Big T” and “little t” are relatively recent labels which have been used to distinguish traumatic experiences in terms of severity. “Big T” typically applies to experiences which are severe enough to cause intense suffering on a daily or near-daily basis. They noticeably diminish a person’s basic ability to function. With “little t” trauma on the other hand, a person may still experience triggers or symptoms, but these are both less frequent and not nearly as severe. Often, a person with “little t” trauma is still able to live their life and go about their day without excessive hindrance. There are many different examples to illustrate either type and it is important to remember that no official standard currently exists for them. The two labels may be helpful for people struggling to clarify or express their own traumas and it is important to respect their interpretations and not to generalize in comparison to others. One person’s “little t” may be big for someone else.
Healing:
Just as there is no universal standard for feeling traumatized, there is also no single way to heal. Unfortunately, because it is easy for traumas to remain unaddressed and even accumulate on top of one another, the journey to recovery is often a long one. There are several options which survivors might benefit from depending on their own needs and experiences. Five examples include:
1) Talk Therapy: Individual talk therapy can be helpful because it allows a person to slowly practice giving voice to their experience in a safe environment under the supervision of a trained professional. Simple as it may seem, being able to talk about trauma is important because the act of choosing to verbalize out loud what happened allows us to regain some of the control that was lost during the event.
2) Group Therapy or Community Meetings: One of the most common forms of suffering after a traumatic event is feeling alone in our experience and pain. Even if we are not ready or interested in talking about what happened, there is still healing to be found in spending time with others who have been through something similar. Being in the presence of those who understand an individual’s pain because they too have experienced their own equivalent creates bonds of solidarity and is akin to shouldering the burden together.
3) EMDR (Eye Movement Desensitization Reprocessing) Therapy: A relatively new form of treatment, EMDR focuses on specifically addressing the issue of the brain’s stress response to psychological triggers. While results can be mixed, properly administered, the technique is very effective at “deprogramming” the brain from automatically going into a stressful state as a result of being triggered. What is also notable about this approach is that it does not require a person to openly share details about their traumatic experience.
4) Trauma Informed Yoga or other Physical Activities: Thanks to breakthroughs in neuroscience, we know now that the mind and body are far more interconnected than was previously assumed. Depending on the circumstances, it is possible for trauma to physically disrupt how the nervous system communicates with the brain. This affects the stress response and can lead to both physical and emotional problems. Trauma informed yoga and exercise facilitates healing the mind-body connection through a conscious rebalancing of the nervous system by means of guided breathing and muscle stimulation.
5) Exposure Therapy: Healing trauma through exposure involves a traumatized individual deliberately exposing themselves to the source of the original incident, or something very similar that is a known trigger – but this time in a safe, controlled, and often supervised, manner in order to facilitate a different outcome than the last time. Doing so allows the brain to experience the same circumstances that were initially traumatic, but are now different. Thus the brain learns to make new associations with the source and overwrite the trauma-danger response (analogous to changing the ending of a novel in a subsequent draft). In practice, one example might be a person returning to the location where they were hurt or scared and engaging in a calming and pleasurable activity with family or other safe supports.
Further Reading:
The Body Keeps the Score – Dr. Bessel Van Der Kolk
Trauma and Healing – Judith Herman
Achilles in Vietnam: Combat Trauma and the Undoing of Character – Dr. Jonathan Shay
Scared Sick – Robin Karr-Morse, Meredith S. Wiley
The Deepest Well – Dr. Nadine Burke Harris
DSM-V (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) – American Psychiatric Association
Written by William Haddad, LMFT #133140