E1 - What is Trauma?
Hey there friend, and welcome to the Trauma Mama podcast where we talk about
What is trauma?
How does it happen?
What does it do to us?
What can we do about it?
I’m your Trauma Mama and host Alexandra Pratt. I want to thank the producer of our theme-song Bae Window and singer and song writer from the San Francisco bay area. In this episode we’re going to talk about the history of trauma, the different types of trauma, what type of events can be traumatic and briefly review some of the psychological and physical responses that occur from it. Before we get into the meat of this episode, I’d like to share with you some background on myself, to show you where I’m coming from and explain why this topic is so important to me.
About me
I’ve spent years on my recovery, working to overcome trauma from childhood and adulthood experiences. First diagnosed with PTSD when I was 15, didn't understand what that meant but was an explanation for why I had panic attacks and fainted. The first time that showed up in my life, I was in 5th grade. I was in a sex ed class and they put on a video about Aids. Something started happening to my body and as I tried to exit the classroom, I collapse on the floor and blacked out, in front of everyone. These episodes continued to occur throughout my childhood, adolescence and young adulthood. In middle school and high school, I was excused completely from taking classes that would trigger these panic attacks. I graduated high school with honors without ever taking health, sex Ed, biology or anatomy. This is just of the one of the ways trauma had taken over my life.
As an adult I realized that behaviors I learned in order to survive no longer served me, in fact they were quite harmful and destructive. I was perpetuating detrimental behaviors and staying stuck in toxic relationships. For long periods of time, I’ve felt incapacitated by the draining discomfort of daily anxiety and the heavy weight of depression. I spent most of my time in bed, the only place I felt comfortable.
In my lifetime I have been diagnosed with PTSD, panic disorder, OCD, and major depressive disorder. I’ve been in and out of therapy since I was 11. Talk therapy, EMDR (eye movement desensitization and reprocessing), CBT (cognitive behavioral therapy) and most recently DBT (dialectic behavioral therapy. I have read a myriad of self help books and participated in a 12 step support group. For years I was participating in therapy but as I got older it felt like I was getting increasingly anxious and depressed. I was in therapy, so why wasn’t I resolving the trauma and finding peace and happiness? It was DBT that helped me to transform my life.
In this podcast we’ll talk about numerous paths to recovery, but you’ll find I will often refer to the DBT approach because of how practical and effective it’s been for me. I am not a dr, or a professionally trained therapist. I am speaking from personal experience and research. I’d like to share what I’ve learned in hopes of educating, validating and inspiring others who are suffering.
After a year of intensive Dialectic Behavioral Therapy, (graduated from it this summer 2019 woo!) for the first time in my life I find myself living life in the light, on the other side of the all-consuming darkness of pain and terror that seemed to control and dictate most of my behaviors and perceptions. I'd like to share about what I've learned on my mental health journey in hopes of informing, validating, and offering hope to those who are struggling to recover and heal. These are tough conversations to have, in fact, they are so tough, you may find that others in your life are unwilling or incapable of having the conversations. But it’s ok, we can start this conversation together.
Have you ever been told?
Just get over it
You're being over dramatic
You just like the attention
You'll grow out of it
That time will heal
Well that’s bullshit, time doesn’t heal. We must heal ourselves.
What is trauma?
“Some people's lives seem to flow in a narrative; mine had many stops and starts. That's what trauma does. It interrupts the plot…It just happens, and then life goes on. No one prepares you for it.” - Jessica Stern Denial: A Memoir of Terror
Trauma is the response to a deeply distressing or disturbing event that overwhelms an individual’s ability to cope. Trauma is a fear reaction.
Other synonyms include: disturbing, shocking, distressing, disquieting, upsetting, damaging, scarring, injurious, harmful, painful, hurtful, agonizing, chilling, awful, alarming, devastating, excruciating, horrifying, terrifying.
The DSM, qhich stands for Diagnostic and Statistical Manual of Mental Disorders, they define trauma as direct personal experience of an event that involves actual or threatened death or serious injury; or when you witness this type of threat of physical integrity to someone else.
When something traumatic happens, it is often overwhelming, and it can be hard to come to terms with what has happened. It can be hard to accept the reality of it. The experience is likely to be very different from anything you have gone through before. It can make you question things that you have always thought were true. You might no longer believe that the world is a safe place, that people are generally good, or that you are in control of what happens to you or that you deserve love. When people talk about their world being turned upside down after a traumatic event, it might mean these big picture beliefs have been shattered.
History
https://newperspectivesinc.com/the-history-of-psychological-trauma/
Prolonged exposure to violence and trauma has severe effects on an individual’s psychological state. The need for a model of intervention is paramount to help the individual cope with life’s tragedies. We must first define the nature of trauma and crisis, and then view the current models of treatment. Crisis, refers to a perception of an event or situation as an intolerable difficulty that exceeds the resources and coping skills of a person. The event or situation can manifest itself in many forms, but it is the emotional reaction to the event or situation that causes the state of crisis. This crisis can be too overwhelming for the individual and may cause the individual to respond in a pathological manner. The state of crisis may cause a person to respond with ideations of suicide and homicide. The crisis itself has the potential to cause serious damage to an individual’s cognitive, affective, and behavioral states.
Individuals in crisis have suffered from a psychological trauma. Psychological trauma is an affliction of the powerless. Trauma renders a person helpless and powerless due to the overwhelming force of the event. The traumatic event causing the crisis alters the individual’s belief of a just and fair world. The event or situation destroys the individual’s sense of control, connection, and meaning. The individual’s mind responds to this trauma similar to the body responding to distress. The mind will attempt to reach a state of homeostasis. The psychological trauma represents a condition of acute distress causing a disturbance in the balanced state, thus creating psychological disequilibrium.
As a result of this response, the individual will suffer from acute distress paired with functional impairment. The degree of distress and functional impairment can fluctuate from mild to severe. Without some form of relief from the crisis, the individual may become increasingly more disturbed and their behavior may become more disruptive to normal functioning. It is clear psychological trauma will alter an individual’s mental status. Crisis intervention is used to provide “first aid” for this altered mental status that will help reduce the individual’s distress and promote adaptive behavior. There are many theories surrounding psychological trauma that attempt to provide the much-needed “first aid” for the individual in crisis.
The study of psychological trauma has its roots in the later part of the nineteenth century with the work of the French neurologist Jean Martin-Charcot. Charcot was the first person to attempt to study and define a disease known as “hysteria”. Before Charcot’s research, hysteria had been considered a disease with incoherent and incomprehensible symptoms. Charcot was able to document, in great detail, the development and characteristics of the disease. He was able to demonstrate the disease was psychological in nature. He demonstrated his theory by artificially producing the disease’s symptoms in patients by using hypnosis. Charcot was unable to produce the theory on the nature of the disease and did not offer any reasonable solutions for treatment. It was the goal of his students, including Sigmund Freud, William James, and Pierre Janet, to research the nature and possible cure for hysteria.
Both Janet and Freud deduced the symptoms of hysteria were the result of psychological trauma. They believed the symptoms were the result of an altered state of consciousness produced by the unbearable emotional reactions to the traumatic events. Janet called the reaction “dissociation: and Freud called it “double consciousness”. Janet and Freud discovered symptoms could be alleviated if the patient was able to verbalize the traumatic event stored in unconscious memory. Janet would call this treatment “psychological analysis” and Freud would eventually call it “psychoanalysis”. The work by Janet, Freud and, Freud’s counterpart Joseph Brueur (broyara) gave birth to modern psychotherapy. This method of treatment would allow a person to discuss the hysteria in a manner that would be conducive to the alleviation of the symptoms.
Psychoanalytic theory dominated the research into trauma for the later part of the nineteenth century and the early twentieth century. Psychoanalysis became “a study of the internal vicissitudes of fantasy and desire, dissociated from the realty of experience”. Freud based most of his research on the exploration of women’s sexual lives. Freud found a correlation between sexually abuse women and hysterical behavior. Freud later recanted his study of hysterics in women reporting the women were not sexually abused. He reported the patients “made up” the fantasies of sexual abuse. This recantation was the turning point away from the study of hysteria and trauma as associated with the unconscious.
After the death of Charcot and the recantation of Freud’s work, the study of psychological trauma resurfaced during World War I. Charles Myers, a British psychologist, was one of the first to examine soldiers who suffered from what he termed “shell shock”. This nervous disorder was thought to be the result of the concussive effects of exploding shells. It was later discovered that soldiers, who did not see combat, would suffer the same nervous condition, as did the soldiers in combat. The prolonged exposure to war and the aftermath produced hysterical symptoms in men similar to the symptoms reported in women by Charcot and Freud.
The diagnosis of combat neurosis was not viewed as being “honorable”. Traditionalists questioned the moral integrity of the soldier and questioned whether to treat a soldier with this disorder. Traditionalists viewed the soldier afflicted with combat neurosis as a coward and an inferior human being. Lewis Yealland, a British Psychiatrist, held on to the beliefs of the Traditionalists. Yealland used a method, which included threats, punishment, and shame. If a soldier presented with mutism due to the effects of the psychological trauma, Yealland would apply electric shocks to the soldier’s throat until the soldier spoke. Yealland would apply the shocks after tying the soldier to a chair while yelling patriotic jargon for hours.
The Traditionalist view continued its form of treatment until W.H.R Rivers, a physician, offered a more humane treatment based on psychoanalytic principles. His work with a young officer, Siegfried Sassoon, demonstrated the humane approach to treatment could help the soldier return combat without the hysterical symptoms. Rivers’ approach proved to be a success, but a few years after World War I, the interest in combat neurosis faded.
Abram Kardiner, an American psychiatrist schooled in Vienna, began his research of combat neurosis in the 1920’s. Kardiner first attempted to develop a theory from the Psychoanalytic point of view on combat neurosis. He eventually abandoned the theory and replaced it with a framework based on the research of Janet. In 1941, Kardiner published his second book, The Traumatic Neuroses of War, which eventually gave way to his development of the modern framework of traumatic syndromes.
During World War II, Kardiner joined another American Psychiatrist, Herbert Spiegel, to revise his text and begin treatment based on the wok of Rivers. Kardiner and Spiegel found soldiers to be suffering from the loss of attachment to their fighting unit. The treatment would then have to be relatively close to the battlefront and include recreation of the traumatic event through hypnosis. This formed of treatment proved effective, but Kardiner and Spiegel warned military psychiatrist the effects of treatment would not be permanent due to the lasting effects of trauma on the mind. This treatment style stayed in practice until the end of World War I when, once again, the study of trauma would fade.
The Vietnam War would be the next reappearance in the interest of combat neurosis by two American psychiatrists, Robert Lifton and Chaim Shatan. Lifton and Shatan developed “rap groups” for combat veterans suffering from the psychological trauma of war and antiwar sentiment. These “rap groups” offered the soldier a place to discuss their experiences and raise awareness about the effects of war (Herman, 1992, p. 27). By the 1970’s, the “rap groups” spread across the nation forcing the Veterans Administration to begin research into the effects of combat exposure to soldiers. It was also during this time, the feminist movement began to raise awareness about the everyday violence in the sexual and domestic lives of women. Woman suffered the same effects of combat neurosis in their civilian lives. The effects of rape, sexual abuse, and sexual violence were more prevalent in women than the trauma of war on men. Freud touched on this sexual issue before his recantation several decades prior to the feminist movement.
In 1980, the American Psychiatric Association developed the category of posttraumatic stress disorders. This category was based on the work of Kardiner. It included the traumatic symptoms suffered by all effected by trauma. This category of disorders gave rise to the challenge of treating such disorders. The theories of crisis and crisis intervention began to take form amidst the newly found appreciation for traumatic stress.
Types of trauma
Acute Trauma: a one-time event such as an accident, injury, or a violent attack, especially if it was unexpected or happened in childhood.
Chronic Trauma: Ongoing, relentless stress such as living in a crime-ridden neighborhood, battling a life-threatening illness or experiencing traumatic events that occur repeatedly, such as bullying, domestic violence, or childhood neglect.
Complex trauma: is exposure to varied and multiple traumatic events, often of an invasive, interpersonal nature (meaning between two people) involves ‘being or feeling’ trapped
We can also breakdown the type of trauma more specifically based on the 4 following identities Courtois outlined in (2014): impersonal, interpersonal, identity and community
Impersonal trauma: occurs randomly such as a natural disaster or accident
Interpersonal trauma: deliberately perpetrated on an individual by another or others as in abuse, neglect, victimization, exploitation
Identity trauma: Ongoing discrimination, devaluation and even violence based on the victim’s sense of self including gender, race, ethnicity, sexual orientation and identity
Community trauma: also known as intergenerational or historical traumaand involves ongoing discrimination, devaluation and even violence targeting certain groups (eg., ethnic, religious, political)
Types of traumatic events
Trauma is a broad term used to describe a wide range of incidents, the most common include:
Rape or sexual assault
Behaviors that are sexually abusive often involve bodily contact, such as sexual kissing, touching, fondling of genitals, and intercourse. However, behaviors may be sexually abusive even if they do not involve contact, such as of genital exposure (“flashing”), verbal pressure for sex, and sexual exploitation such as pornography.
General physical assault
Domestic or intimate-partner violence
Extreme verbal and emotional abuse
Bullying and repeated harassment of any kind
Terminal illness
School Violence & Community Violence
Medical Trauma
War time and combat experience
Traumatic Loss
Traumatic loss or grief can occur following a death of someone important to a child or adult. The death is typically sudden and unexpected.
Natural disasters
Accidents such as car crashes or fire
Parental neglect
Neglect can mean failure to provide food, clothing, shelter, medical care, mental health treatment, education, or proper supervision to a child or exposing a child to dangerous environments. Neglect is the most common form of abuse reported to child welfare authorities.
It’s important to realize that trauma is very different to other stressful events, like a relationship breakdown or the death of a loved one through natural causes. These events can affect a person’s mental health, but they are not the same as the traumatic events described above. The reality of trauma is that it can come from anywhere and manifest in a variety of physical and psychological symptoms. People who go through these types of extremely traumatic experiences often have certain symptoms and problems afterward.
Psychological symptoms of trauma
Cognitive:
Intrusive thoughts of the event that may occur out of the blue
Nightmares
Visual images of the event, also known as flashbacks
Loss of memory and concentration abilities
Disorientation and confusion
Sudden, dramatic mood changes and excessive inappropriate reactions to situations
Feeling disconnected or numb
Dissociation, feeling of unreality or being "out of one's body"
Behavioral:
Avoidance of activities or places that trigger memories of the event
Social isolation and withdrawal
Lack of interest in activities you used to love
Increased use of alcohol or drugs
Psychological:
Overwhelming fear
Obsessive and compulsive behaviors
Detachment from other people and emotions
Emotional numbing
Depression, intense and extreme sadness, crying
Guilt
Shame
Denial
Emotional shock
Disbelief
Irritability
Anger and rage
Hopelessness
Lack of self-worth
Physical:
Tremendous fatigue and exhaustion
Tachycardia (a condition that makes your heart beat more than 100 times per minute)
Edginess
Insomnia
Chronic muscle patterns
Sexual dysfunction
Changes in sleeping and eating patterns
Vague complaints of aches and pains throughout the body
Extreme alertness; always on the lookout for warnings of potential danger and easily startled
Altered sleeping or insomnia
Changes in appetite
Headaches and nausea
Worsening of an existing medical condition
Anxiety
Panic attacks
Trembling or shaking
Pounding heart
Rapid breathing
Lump in throat; feeling choked up
Stomach tightening or churning
Feeling dizzy or faint
Cold sweats
Have you experienced trauma?
Are you unsure if you’ve experienced trauma here are a few of the clinical questions you can ask yourself, do any of the following things happen twice or more a week?
Upsetting thoughts or memories about the event that have come into your mind against you will
Upsetting dreams about the vent
Acting or feeling as though the vent were happening
Feeling upset by reminders of the event
Bodily reactions such as fast heartbeat, stomach churning, sweatiness, dizziness, when you’re reminded of the event
Difficulty falling or staying asleep
Irritability or outbursts of anger
Difficulty concentrating
Heighted awareness of potential dangers to yourself and others
Being jumpy or being startled at something unexpected
These physical symptoms create what’s called hyper-arousal, a state of being continually stressed fearful, depressed, or angry, making it difficult to do daily tasks, such as sleeping, eating or concentrating. It’s natural to have some of these symptoms after a dangerous event. Sometimes people have very serious symptoms that go away after a few weeks. This is called acute stress disorder, or ASD. When the symptoms last more than a few weeks and become an ongoing problem, it might be PTSD. Some people with PTSD don’t show any symptoms for weeks or months. Experts do not know why some people experience PTSD after a traumatic event while others do not.
The truth is at some point, most of us will live through a terrifying event. So this sounds like a lot to deal with on a daily basis right? These are symptoms don’t go away with time. We cannot sit and wait for recovery, we must seek out resources that can help us, do the work that therapy and self-improvement require, and keep hope that we can one day live a more happy and harmonious life. When you do this, you are doing more than surviving. You are thriving. I do not identify as a survivor because it puts me in victim role. A role from which I cannot move forward from. I consider myself a Thriver, someone who rebloomed stronger and full of more radiant colors than before. If you’re listening to this podcast, then you’re a Thriver too.
Next Episode
In my next episode I'm going to go more in depth into the the physical and emotional responses that happen during to trauma known as the Flight, Fight, Freeze and Fawn.
Crisis resources
If you or someone you know is suffering and needs immediate help, I recommend reaching out t
Online counsellors at https://suicidepreventionlifeline.org/chat/
Calling the National Suicide Prevention Lifeline at 1-800-273-8255
Text the crisis text line by sending the word CONNECT (in all caps) to 741741
Thank you for listening. Keep thriving.