As the language of mental health continues to infiltrate our daily lives, the concept of trauma seems to have become mainstream. While a few decades ago the idea of talking openly about trauma may have been taboo, now traumatic events and survivors’ attempts to heal from them are the subject of news headlines, television shows, and therapy on TikTok.
Prince Harry said in his documentary series with Oprah Winfrey that addressing the trauma of his mother’s death was essential to his own well-being and the health of his marriage. Earlier this year, Rep. Alexandria Ocasio-Cortez spoke about how the trauma she has experienced as a survivor of sexual assault and the Capitol riots combine with each other. People of color demand greater recognition for the physical and mental toll that racial trauma has on their lives. The COVID-19 pandemic has been a series of traumatic events.
It’s a political act to talk about trauma because so much exploitation, perpetration and victimization was hidden and unrecognized for so long, said Emily Sachs, a clinical psychologist who specializes in trauma. The people who were subjected to it were blamed for their problems. And that still continues today.
While some people are working to raise awareness of the prevalence of trauma, others are inadvertently diluting the term, often using it in a hyperbolic way – I’m traumatized by what I ate last night or accidentally killed my plant and now I’m traumatized.
I think it’s a double-edged sword because entering these terms into our vernacular is almost normalizing to talk about these things, but at the same time it absolutely minimizes the true effects of these disorders, said psychotherapist Janel Cubbage. Talking about mental health and all these conditions is good, but how we talk about it really matters.
Trauma is both what happens to a person and their reaction, Sachs said. Generally refers to intense and overwhelming experiences that involve loss, threat or serious damage to the physical and / or emotional well-being of a person.
Many trauma experts define the term broadly in their work as a way of offering patients agency to identify trauma in their own lives.
It’s valuable to exclude some things from what could be trauma … but at the same time, I think we can’t have too narrow a definition in which we deny the reality of a person’s experience, said clinical psychologist Seth Gillihan. It is valuable to be as inclusive as possible without diluting the term so much that it later stops making sense.
Cubbage said that sometimes people combine trauma with post-traumatic stress disorder (PTSD), which has its own clinical definition and describes specific groups of symptoms. Not all people who experience trauma will experience PTSD, but that doesn’t mean they won’t have a prolonged difficulty functioning.
Many physicians also argue that the definition of PTSD in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), whose criteria begin with exposure to actual or threatened death, serious injury, or sexual violence, is limiting. Cubbage said it does not address certain types of racial and relational trauma.
If you think of someone who was cheated on by her partner, that can be very traumatic for people, but that would not meet the criteria for PTSD, Cubbage said. Repeatedly watching videos of someone who looks like you being killed by police officers or experiencing hate crimes can be traumatic, but … it wouldn’t meet the criteria for PTSD. Therefore, there are many problems only in terms of the way that trauma has been clinically conceptualized.
Our body’s response to trauma is normal. It is an adaptive reaction, a characteristic of the system. But due to the overwhelming nature of a traumatic experience, trauma produces a bio-psychosocial response that can change the way we react to things in the long run: loud sounds, crowded trains, the opposite sex.
Trauma is written in our experience, in our heart, in our mind, in our body. And really what we’re experiencing is not the original event, but the trail it leaves, Gillihan said.
During trauma, the body’s emergency response system releases chemicals to keep you safe, but when that is too intense or prolonged, or happens many times, it can cause a permanent change in the way the body produces chemicals and works.
Trauma impacts memory, as memories of the traumatic experience are sealed with great intensity and accessed differently. Trauma cognitively and emotionally changes our understanding of the world, about what we can expect of other people and our environment.
Sachs said that anything that causes severe panic, fear, helplessness and horror produces a similar chemical reaction in our bodies, because we are programmed to keep ourselves safe. But it is also true that different types of trauma affect people differently. Interpersonal traumas, like rape, are the most toxic in terms of chemical response and also in terms of the way it changes our meanings and expectations about the world and our relationships.
There is a difference between experiencing the trauma of a natural disaster and the trauma of interpersonal violence. There is also a difference between a single acute traumatic event, such as a car accident, and a chronic or complex trauma.
Chronic trauma is ongoing, and complex trauma generally refers to traumatic experiences in early childhood, such as abuse or neglect. Cubbage said in his practice that he has yet to meet someone who has only experienced a single traumatic event.
There are types of events that can shake anyone’s bio-psychosocial foundation, things that are intensely shocking and universally scary.
At the same time, you can have six people experience the same event and some will be able to quickly return to homeostasis and find a sense of security again, while others will develop symptoms of long-term trauma or even PTSD.
Gillihan said his close friend was violently assaulted and did not appear to flinch. Gillihan had a similar experience, but said that he had typical post-traumatic reactions, such as feeling insecure and being constantly nervous.
People are wired differently, and it’s easy to blame ourselves if we’re someone who struggles harder after trauma. But we can’t really predict who’s going to get in trouble and who’s not, and it doesn’t seem to be a function of who’s tough and who’s not, who’s scared or who’s not. There are some correlations that we can identify, but generally we don’t know who will recover after trauma and who will experience it the longest and perhaps more deeply.
Sachs said that comparing two people’s reactions to trauma is also complicated by the fact that many trauma survivors experience a late onset of trauma symptoms. While it may appear that two people have very different reactions, it could actually be that one person has a delayed response and develops clinically significant traumatic pathology weeks, months, or even years later.
If two people experience trauma and one recovers while the other struggles, there is sometimes a misperception that one person is more resilient. But experts say resilience isn’t something that stops you from having mental health problems. A resilient person can also be traumatized or experience PTSD.
What resilience does is prepare you to access the right kinds of aftercare after trauma. It can help you know how to take care of yourself after a traumatic event. It can help protect you from corrosive or toxic things in your environment that can make you more vulnerable to trauma. Part of resilience is also having the financial resources to access care and the people around you who can validate your experiences.
A lot of times when people think of resilience, they think, ‘Oh, you know it’s just that person’s innate ability to handle things that happen to them.’ But much of what fuels our ability to handle what life throws at us is external supports, Cubbage said.
Part of well-being is knowing that we belong. When we experience trauma, we may feel out of the group, either from the belief that no one could understand what we are going through, or because we have been socially rejected.
One of the most comforting things for people to hear is, ‘yeah, this really happened. Yes, your reaction is normal. Yes, this happens to other good people. Yes, there is a way you can be okay. ‘ And yes, other people do care, if relevant, about fairness, Sachs said.
It is also important, experts say, that trauma survivors give themselves permission to hurt and heal, to recognize that they are not weak to fight. Not everything that happens after trauma is degenerative. Trauma survivors are capable of post-traumatic growth, where they become stronger and their lives become richer and more meaningful in the wake of the consequences.