There isn’t one single definition of what trauma is as it can come from multiple causes and has different effects on the body mind and soul.
I’m just going to talk to you through a few people’s definitions of trauma including my own and we’ll talk a little bit about PTSD as well.
Have you all heard of Bessel Van Der kolk?
“Trauma is specifically an event that overwhelms the central nervous system altering the way we process and recall memories. Trauma is not the story of something that happened but then it’s the imprint of the pain, horror or fear living inside people.”
That’s important because it’s not about the story, it’s about what that event or series of events does to the brain.
Gabor Mate Is an American PhD psychologist and psychotherapist who has written a brilliant book about trauma called The Body Keeps The Score. He worked for years in slum areas with drug and alcohol addicts. He knows a lot about the causes of trauma and how addictions are one of the symptoms of trauma. He says:
“Trauma is a psychic wound that hurt you psychologically that interferes with your ability to grow and develop. It pains you and now you’re acting out of pain. It induces fear and now you are acting out of fear. Trauma is not what happens to you it’s what happens inside you as a result of what happens to you. Trauma is the scarring that makes you less flexible, more rigid, less feeling and more defended.”
Judith Lewis Herman wrote an amazing book in the 80s called Trauma and Recovery.
“Psychological trauma is an affliction of the hypothalamus. At the moment of trauma, the victim is rendered helpless by overwhelming thoughts. When the force is that of nature we speak of disasters, when the force is that of other human beings we speak of atrocities. Traumatic events overwhelm our ordinary systems of care that give people a sense of control, connection and meaning. Traumatic events are extraordinary, not because they happen rarely but because they overwhelm ordinary human adaptations to life. They confront human beings with the extremities of helplessness and terror and evoke the responses of catastrophe.”
She wrote her book 40 years ago and she was one of the first to write a comprehensive book on what trauma is. She focused very much on female victims of domestic abuse and soldiers coming back from war. What she was talking about, particularly with female survivors of abuse, is that they became powerless people. That was her area of specialism. She was the first one to say that trauma is still trauma whether it’s a female victim of abuse or a soldier returning from war. She was the first person to make that link that trauma can affect lots of different people in lots of different ways but she still said it was an affliction of the powerless. However, somebody who was in a car accident may not have been powerless in their life before the car accident but could still be deeply affected by the trauma, particularly if they went on to recover from that trauma and had to have multiple operations (which would be traumas in themselves). People are not necessarily powerless before they are traumatised.
My definition of trauma is anything that is experienced as threatening can generate trauma-like symptoms and harm our day-to-day interactions and activities and we may not recognise that what we are experiencing is trauma symptoms.
I do explain to clients the complex and varied symptoms of trauma and I psycho-educate clients so that they understand more of what is happening to them. That alone is part of the recovery process because a lot of people think they are going mad. They can’t understand the changes that occur in their mind body and heart so I work with mind, body, heart and soul holistically because the whole of the system is affected by trauma. I use psychotherapy, healing and inner-child work to prepare for the world. I’m essentially offering a reparenting process.
My definition is anything that is too-much-too-soon or too fast for our nervous system to handle. For example, an event or series of events that was overwhelming physically, mentally and/or emotionally to the individual and deemed to be a threat to their survival. The depth of the trauma will be directly synonymous with the severity of the traumatic events. Trauma is something that happens to us and lodges in the body.
Different things will traumatise different people in different ways. You may have somebody present to you and what they have experienced seems mild to you. To them, however, it is not. Therefore you have to listen to them where they are at that moment.
If it’s trauma to them then it is trauma and their body mind and heart will be affected the same.
Going into what other medical definitions of trauma are then we start looking at Post-Traumatic Stress Disorder in the DSM (Diagnostic and Statistical Manual) which is an American publication published every 8 years, Psychiatrists and representatives of drug companies decide what the definitions of mental disorders are. It’s arbitrary because there are no diagnostic criteria for mental disorders.
In the DSM there is a definition of PTSD which is:
‘The person was exposed to death, threatened death, actual or threatened serious injury or actual or threatened sexual violence in the following ways: Direct exposure – witnessing the trauma, learning that a relative or close friend was exposed to trauma, indirect exposure to details of the trauma – usually in the course of professional duties, for example, first responders and medics’ [and therapists].
So as a therapist that specialises in trauma, I have to take very good care of myself to make sure I don’t suffer from PTSD because I’m exposed to trauma all the time.
We have probably also heard of complex PTSD. This definition is not in the DSM. I imagine it will probably be introduced in the next edition so in theory it is not accepted as a mental illness by the medical professionals and psychiatrists although I’m sure there are well aware of it. Complex PTSD is by definition more complicated to work with than PTSD and is generally the result of a series of traumas.
So Complex PTSD is a condition where you experience some symptoms of PTSD along with some additional symptoms such as:
- Difficulty controlling your emotions
- Feeling very hostile towards the world
- Constant feelings of emptiness or hopelessness
- Feeling as if you are permanently damaged or worthless
- Feeling as if you are completely different to other people
- Feeling like nobody can understand what’s happened to you
- Avoiding friendships and relationships (or finding them very difficult to maintain)
- Experiencing disassociative symptoms such as depersonalisation or derealisation
- Regular suicidal feelings
I work with the term ‘trauma’. I wouldn’t diagnose anyway as only a psychiatrist can do that so I would not diagnose PTSD, but I find that the word trauma is confusing because there is no formal definition.
You will hear things like PTSD, developmental trauma (which is accumulated through childhood), chronic trauma (like domestic abuse, child abuse), acute trauma (which is a single incident of trauma, for example, a car crash), collective trauma (when several or many people are traumatised by one incident) and vicarious trauma (so this is a trauma worker or helper experience is trauma from empathic engagement with traumatised clients and their reports of traumatic incidents).
The symptoms are very similar and have not yet been formally categorised into different types of trauma the only form of trauma in the DSM is PTSD.
There are probably other terms you will hear. This is just to give you an idea of the variety of places where trauma can come from. The symptoms are very similar but different people will manifest different symptoms from different types of trauma. For example, two people can be present at the same trauma and manifest different symptoms or even have no symptoms at all.
Dr Arielle Schwartz makes it clear that trauma is a normal response or adaptation to abnormal life conditions that may be in a person’s history.
“You are not broken, in need of fixing rather you are deeply hurt, in need of care”.
What differentiates between what psychiatrists will often do is diagnose a mental health condition and prescribed drugs sometimes without investigating whether it’s in response to trauma. So things like depression and anxiety are very often a response to trauma and, personality disorders certainly can be a result of trauma, so it is a complex subject.
The types of events that can cause trauma include
- Childhood abuse neglect or abandonment
- Ongoing domestic violence or domestic abuse
- Repeatedly witnessing violence or abuse
- Being forced to become a sex worker
- Torture, kidnap, slavery, being a prisoner of war and witness in incidents of warfare
You’re more likely to develop trauma if you experienced trauma at an early age, the trauma lasted for a long time, escape or rescue was unlikely or impossible, you have experienced multiple traumas or you are harmed by somebody close to you. That’s why children are so deeply affected by trauma because they are dependent, often on the person who is traumatising them, for example, parents or a family member or in school etc…
What can happen is maybe you experienced several traumas in your childhood and they might be relatively minor (so not necessarily abuse), but several things might have happened to you and you forgot about them They get stored in the back of your mind then, as an adult, you experience perhaps a major trauma like a car accident or the death of a close friend and that can trigger you (almost like a collective response) and you suddenly drop into PTSD and become quite severely traumatized. It is as though trauma has a cumulative effect. Some people can live a perfectly normal life for years and years and suddenly something will happen and they will have PTSD.
Traumatic symptoms are how we adapt to what has happened to us
Joanna Beazley Richards says:
“The traumatic event is over, but the person’s reaction to it is not period the intrusion of the past into the present is one of the main problems confronting the trauma survivor. often referred to as re-experiencing, this is the key to many of the psychological symptoms and psychiatric disorders that result from traumatic experiences. This intrusion may present as distressing intrusive memories, flashbacks, nightmares, or overwhelming emotional States.”
(Joanna Richards is a trauma therapist and does trauma workshops).
Possible symptoms of trauma:
- Exaggerated jump reflex at the slightest noise
- Nightmares often of the traumatic events
- Disassociation the feeling response disappears the person feels numb and can’t respond emotionally very well
- The ‘feeling brain’ and ‘thinking brain’ part company, intellectual capacity can be reduced and memory can be lost
- The digestion ceases to function well and IBS and other digestive issues can manifest
- People can become frightened to leave the house
- People can become easily distracted and can’t concentrate will be fully present in the moment
- Anxiety and nervousness
- Panic attacks something can trigger these such as a loud noise a smell associated with trauma
- Mood swings trouble regulating emotions getting aggressive or angry very easily can lose friends and alienate their family
- Intrusive thoughts and flashbacks of the trauma or the trauma feelings can be so strong that the person behaves as though they are in the traumatic memory for example attacking the wife as seen as an attacker from the past
- Insomnia the body is flooded with cortisol and triggers over alertness
- Substance abuse is used to calm and soothe for example alcohol drugs or binge eating disorders
- Sexual promiscuity could be from child abuse for example having inappropriate boundaries around sex or avoiding sex altogether
Longer-term symptoms are:
- Chronic fatigue syndrome
- Dissociative identity disorder (what used to be called multiple personality disorder)
Trauma responses can look like this:
- Feeling responsible for other people’s happiness
- Saying yes because you’re afraid of losing security
- Not being able to say no
- Chronic feelings of emptiness
- Giving In to reckless impulses and not caring for personal safety
- Seeking constant escapism
- Negative worldview
- Dwindling Trust for others and yourself
- Feeling on guard all the time
- Agreeing to things just to keep the peace
- Craving control (I need to stay in control or everything will fall apart)
Trauma does a lot of things to our brain.
(This graphic shows more clearly the different impacts of trauma.) – Courtesy of Echo Training.
The first thing that the therapist works on is the sense of ‘loss of safety’. It can sometimes take a year or longer to establish a feeling of safety in the client in therapeutic work. I wouldn’t even go near the details of the trauma at the beginning for fear of retraumatizing them. It’s one of the reasons why anybody who has severe trauma should see a trauma specialist because very often a therapist’s reaction to distressed people is to get them to talk through what is causing the distress. In the early stages of recovery from the trauma, it’s the worst thing you can do because you may take them back into the trauma response and re-instigate all of their trauma responses to a higher level. So, the very first piece of work is safety with the client.
People may have no sense of what is dangerous and will regularly put themselves in harm’s way (because nothing is as dangerous as the trauma). They will lose trust in other people or stop understanding human relationships very well (depending on what happened to them). For example, a child that’s abused by a parent will still love their parent but the parent is hurting them. This causes confusion and anxiety and this means that the young person can grow up into an adult with no sense of who to trust, their boundaries don’t exist.
There’s often a huge shame, particularly again with child abuse. Children feel that it’s their fault or partly their fault and an abuser will often tell the child that “you’ve enticed me to do this”, “it’s because of the way you look”, “it’s because of you that I want to do it this”.
They may even lose the capacity to be intimate (with sexual abuse but also with other types of trauma).
They will get a loss of a physical connection to the body in dissociation and may lose all sense of living in their body (like their floating above themselves). That’s why most of the beginning work starts in the ‘safety zone’ and works with gradually getting the client to re-embody and get into contact with the sensations of their body, both physical and emotional. Because of that people often lose any sense of self, they no longer know who they are, why they are or what their purpose in life is. Loss of self-worth is a common consequence here.
The meeting then opens to the discussion:
It was asked if it’s necessary to know what the time is to start the work if you don’t visit the trauma in the beginning. Linda said that yes, in the second stage, once you sense that your client can feel safe (and have a safe place in their mind), that your therapy space is a safe place to come, they can begin to relax with you. Then you move to the second stage and start to visit the trauma and get them to talk it through. Talking it through helps them to process, but they can’t do that while they’re still in ‘trauma brain’ and feel unsafe. It’s impossible. What you’re doing in the safety period is rewiring the brain, breaking some of the links that have been made in the neurons and creating new ones (the polyvagal system – the nervous system) so that as soon as they start to talk about the trauma, they are not triggered back into it. That’s the second stage of recovery, where you would start to talk it through.
A question was asked about the ‘thinking brain’ vs the ‘feeling brain’ and the disassociation (and where it can stop you from being able to learn). Some clients feel that they may have a learning disability where it’s trauma. It may depend on how the learning difficulty manifests as to whether you can trace it back to the trauma or not.
There was then some good discussion about therapists recognising their trauma in themselves to avoid transference. Also, the research that has been done about addiction and how the mind and body works as well as the mechanisms for coping with the trauma for example addictions.
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