Understanding Trauma

Victims of war deal with experiences that are beyond the comprehension of most of us who have not been in combat or exposed to such atrocities; this led to the development of the diagnosis of post-traumatic stress disorder in the late 1970s, when thousands of Vietnam veterans returned to the United States with significant psychiatric illness related to the war.

So often, when we think about and try to grasp the effects of trauma, our minds and knowledge stop at post-traumatic stress disorder.

According to the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, a person must satisfy certain criteria and exhibit specific symptoms in order to be diagnosed with post-traumatic stress disorder.

Current diagnostic criteria for post-traumatic stress disorder (PTSD) require that a person be exposed to events involving or holding the danger of death, violence, or significant harm.

You either experience the traumatic incident firsthand, discover that a loved one has been through it or is in danger from it, or are regularly exposed to graphic details of catastrophic occurrences, such as through working as a first responder at an accident site. For more than a month, one or more of the following symptoms must be present, causing severe discomfort and impeding typical daily activities and duties.

One symptom is experiencing disturbing flashbacks or recollections of the traumatic incident. having nightmares about the trauma, having flashbacks that make you feel like you're reliving it, having continuing or severe emotional discomfort, or having physical symptoms.

Children under the age of six years old have distinctive PTSD symptoms. playacting the horrific incident, or parts of it, or having terrifying nightmares that may or may not include the traumatic event itself.

If we just consider individuals in the context of the experiences that fall within the parameters of a PTSD diagnosis, we may be inclined to discount someone's experience of trauma and fail to offer them with the appropriate treatment or resources they need.

It is crucial that we recognize that many people in our society have suffered trauma and need the same level of support as those who are clinically diagnosed with post-traumatic stress disorder (PTSD).

The discourse we want to initiate in this course and have you promote throughout the world is that trauma comes in many forms, and each may have lasting effects on brain development and function in both children and adults, as well as on their general health as they age.

In terms of public health, trauma is perhaps the most pressing issue we have as a country.

The health care and human services sector has focused mostly on symptom management.

This course's focus on identifying and resolving underlying sources of trauma has great promise for improving the lives of trauma survivors and the overall well-being of our society.

We'll go into the many definitions of trauma later in the course, but for now, know that it's any experience that significantly exceeds a person's coping abilities and leaves a lasting impression.

After many years of research and practice, it has become clear that there is a wide range of traumatic experiences and circumstances.

Numerous definitions of trauma have been developed by specialists.

Trauma is defined strictly by the American Psychological Association or APJ as seeing or experiencing death, significant injury, or sexual violence.

Some have argued that the AP's definition is too narrow, and that traumatic events may occur even if no one's physical safety is in danger.

The three E's definition proposed by the Substance Abuse and Mental Health Services Administration expands the original definition to include the idea that trauma occurs when a person is exposed to something that is both emotionally and physically threatening and has a negative impact on their ability to function and their physical, social, and spiritual health.

Another way to define trauma is as an experience that is so overwhelming that it interferes with a person's capacity to maintain a sense of safety, a feeling of control, and self-regulation.

Self-regulation is the ability to stop doing something when it's not helpful and to start doing something when it is.

A youngster who has suffered trauma may not have the self-regulatory mechanisms necessary to pay attention in class, and a patient who cannot contain their anger may also be exhibiting symptoms of disturbed self-regulation.

As a society, we tend to characterize people as "difficult," "oppositional," "rebellious," "unmotivated," "antisocial," and even "worse" if we don't grasp the nature of trauma and its consequences on individuals.

You may have thought to yourself, "Wow, you just get a job; they're so lazy" when you first saw a homeless person while driving by.

You know, it's something we routinely do.

However, statistically speaking, that individual is undoubtedly a victim of trauma and has lacked the means, resources, social support, and techniques to overcome their traumatic experiences.

It's important to avoid making assumptions about individuals and assigning them labels.

There are four primary types of trauma.

One might experience acute trauma from a single traumatic incident, chronic trauma from several events, or complex trauma that spans generations.

An accident, an act of violence, or a natural calamity are all possible examples.

One incident of physical or sexual assault may result in the death of a loved one.

After returning from relief work in Haiti following the devastating earthquake that leveled the capital city of Port au Prince and claimed the lives of thousands of Haitians a few years ago, I experienced acute trauma every time I came close to a wall or brick building and feared it would come crashing down on me.

Over the course of a few weeks, my fear of falling cinderblock walls subsided, and it no longer affects me. However, even a single exposure to a traumatic event can induce feelings of fear, helplessness, and terror and be so overwhelming that it can lead to other physical and mental health illnesses. In contrast, chronic trauma is the result of exposure to repeated stressful experiences over time.

Those who live in countries plagued by war, for instance, see the realities of death, damage, and the danger of violence on a daily basis.

It was after an earthquake in Kashmir, India, that I decided to visit there a few years ago.

Since 1947, Pakistan and India have been at odds about who should control this territory.

After three major conflicts, combat is still ongoing.

During his term, President Clinton acknowledged that this region is the most hazardous on the planet.

There is no end in sight for this conflict, which has claimed the lives of tens of thousands of people and left those who live there in a state of chronic anguish.

As for the third kind of trauma, Complex trauma is a subset of chronic trauma characterized by a high number of traumatic incidents, a high degree of repetition, duration, and interconnectedness, and the presence of direct damage, exploitation, abuse, neglect, and abandonment by main caregivers or responsible adults. Although complex trauma may happen at any point in a person's life, it most often affects those in their formative years, such as early infancy and adolescence.

When children don't get consistent nurturing, either physically or emotionally, they suffer emotional and psychological trauma.

Our little ones are in need of our love and compassion.

They should be comforted and assured of their safety.

There's a fourth kind of trauma that's easy to ignore and which you may not have heard of previously.

When I found out about it for the first time, I was completely awestruck.

One term for this phenomenon is "historical" or "intergenerational" trauma. Collective cultural trauma has been experienced by a variety of socioeconomic and ethnic groups, such as the Jewish experience of the Holocaust, which has been handed down from grandmother to father to kid. Slavery in the United States, the genocide of Native Americans, and the near extinction of the black population are all consequences of European colonization of the Americas.

The trauma perpetuated against the Native American population was plentiful and included violence rape murder and removal from their land.

What compounds the trauma with Native Americans is that there was a suppression and forced a simulation that led to the loss of language ceremonies spirituality in their culture at large.

Now in this present day Native American adults are at greater risk of experiencing feelings of psychological distress and more likely to have poor overall physical and mental health and unmet medical and psychological needs.

Suicide rates are off the charts for Native American adults and news alike.

They're higher than the national average with suicide being the second leading cause of death for Native Americans from 10 to 34 years of age.

We've just broken down the four categories of trauma.

Remember what they were if not here they are again acute trauma which is a one time occurrence.

Chronic trauma is the experience of multiple traumatic events often over a long period of time.

Complex trauma is a specific kind of chronic trauma that includes multiple traumatic events that begin at a very young age typically less than five years and are caused by adults who should have been caring for or protecting the child historical or intergenerational trauma is the emotional and psychological pain over a lifespan and across generations as a result of massive group trauma.

Let's now talk a little bit about the specific types of trauma that can occur such as neglect psychological abuse physical and sexual abuse community violence combat related violence accidents disaster and adverse childhood experiences.

I mentioned the adverse childhood experiences study before and the objectives.

We'll highlight it here first but get into it more deeply later on.

The study was conducted to see the effects of adverse childhood traumatic experiences on long term health.

The researchers conducted a study by using a questionnaire the questionnaire using a questionnaire five questions about experiences of trauma related to physical abuse verbal abuse sexual abuse physical neglect and emotional neglect.

The remaining five questions were related to other family members and asked if a parent was an alcoholic. If a mother was a victim of domestic violence if a family member was in jail if a family member was diagnosed with a mental illness and if the child experienced the disappearance of a parent through divorce death or abandonment.

The study did a lot but one of the things it did was open up a new realm of understanding about what trauma is.

I had a mentally ill family member in my household growing up.

I didn't realize until developing this course that this is a form of trauma that could have long term implications on my mental and physical health.

The study as you'll find out is a game changer and should change the way we deal with those who are victims of trauma.

There are wide and varied reactions to trauma.

Generally speaking interpersonal trauma or trauma that has occurred due to the purposeful deliberate actions of another tends to cause more severe reactions in the victim than does the result of a random event such as a natural disaster for example a hurricane or tsunami during or after traumatic events occur there can be different types of reactions or symptoms such as alterations in a victim's state of consciousness amnesia hyper amnesia which is remembering more and more details as time goes on.

A traumatic experience can lead to disassociation which means the victim emotionally detaching themselves from the negative experience depersonalization and derealization can occur to during and after a traumatic event.

This is a feeling that you're outside of your body and observing yourself where there is a sense that the world around you isn't real and that you're in a dream like state.

People also experience flashbacks and nightmares of the event.

Children who are traumatized can start having problems at school.

They may have difficulty paying attention.

Become numb listless and check out orientation with time and space can become an issue as a traumatic event disrupts their sensory and motor functions.

Trauma can cause a child to become out of touch with their feelings and they may have no idea what they're feeling or have any language or words to describe what is happening on the inside.

It's important to note that the experience of trauma isn't the same for everyone.

A similar horrible event may be experienced as for one person and not another traumatic events are typically determined by the meaning someone assigns to the event.

And how much that experience disrupts them physically or psychologically if there was betrayal or humiliation involved that increases the likelihood that a person will experience it as a traumatic event.

Another factor that increases the likelihood that someone may assign trauma to an event or experience is if there is silencing silencing means that the victim was told by someone else not to share about the event or the victim themselves never shared about the event because of shame and or humiliation.

An example of a traumatic event because a betrayal could be a boyfriend and girlfriend breaking up.

Now typically this would be thought of as traumatic per se unless the one who has broken up with his humiliated or betrayed let's say for example you have two girls Susie and Jill they are best friends and Susie is dating Bob.

Susie is totally in love with Bob but one day she finds out that Jill and Bob had been secretly going out.

Suzy eventually finds out she's being cheated on and she's heartbroken ashamed about the betrayal by the two people she deeply cares for.

Now this type of scenario happens all the time.

But Suzy is extremely sensitive and she thought she would eventually marry Bob Susy's humiliation was compounded by the fact that everyone at school knew about the cheating to make things worse.

Jill and Bob spread rumors and divulge the most intimate details of Susie and Bob's former relationship.

Suzy never shares her feelings about the humiliation and shame she experienced with anyone.

She starts feeling anxious to go to school she starts feeling depressed.

Now breakups are pretty common but due to the fact that Suzy Sallust herself there was an enormous amount of embarrassment shame and humiliation and she didn't have any social support to help her.

The situation is traumatic to Susie and she goes on to experience a lifetime of anxiety depression suspicion pain and humiliation.

As you can see traumatic experiences don't have to be out of the normal cataclysmic events.

Another example of an experience that may not typically be seen as traumatic but could have lifelong ramifications because of humiliation is the case of Joe and Tim Joe and Tim are two freshman college student boys that entered the fraternity.

Typically fraternities have some kind of initiation rites.

Joe has been told by his dad growing up about fraternity Alpha Kappa Pi Delta Chi.

It's been in his family for generations going to this fraternity.

The Dadis told him about all the initiation rites and silly things that can happen.

Then we have Tim.

Tim is the first one in his family to ever go to college and joins the fraternity just to make some friends and doesn't really know about all the rituals and the silliness that happens on initiation night the two boys are subjected to humiliation and ridicule by being made to sing songs in their underwear while getting eggs thrown at them.

Joe is eating this up and loving it but tim is humiliated ashamed and embarrassed.

Joe and Tim went through the exact same experience but tim is having nightmares flashbacks and starts becoming socially anxious.

The way we handle circumstances and traumatic experiences depends on a lot of factors such as the way we were raised.

Developmental stage personality temperament cultural beliefs religious beliefs social support resiliency and many other factors.

Joe's family supported the fraternity experience and thought it was great.

Joe had his father cheering them on and a long history of social support.

Whereas Tim didn't really have any prepping more support from family because he was the first one in his family to go to college with Tim.

The situation disrupts him emotionally socially and physiologically.

He can't get the images of being hazed out of his mind and he starts to withdraw and lose his appetite.

Eventually he drops out of school here too you can see that there was a situation we would typically equate as traumatic but the events disrupted Tim and his capacity to cope.

And it impacted him in such a way.

He eventually dropped out of school.

We've talked about the events and experiences of trauma so far.

So what about the effects the effects of trauma can occur immediately or over time sometimes years down the line people may not even recognize the connection between the effects and the event a person may begin feeling and suffering from a range of symptoms such as the inability to cope with the normal stresses and strains of daily living.

An individual may also become unable to trust and benefit from relationships for the trauma victim that may become more and more difficult to manage emotions memory attention thinking and behavior over time the effects of trauma can start to manifest as changes in the brain and body and start affecting overall health and well-being.

You've learned in the segment that the term trauma has historically been prescribed only events and experiences that are extraordinary cataclysmic or catastrophic in nature such as war natural disasters physical and sexual abuse.

However experiences such as loss of power household dysfunction and neglect are being recognized as common and pervasive and have been found to have lifelong adverse effects upon the victim the experience of trauma is not as cut and dry as we once thought a seemingly small thing could be traumatic to one and not another.

An event that is traumatic has certain characteristics such as there is disruption in the victim physically and psychologically.

There is also a sense of humiliation betrayal or silencing that shapes how the event was experienced.

Other factors such as the victim's cultural beliefs availability of social supports and the developmental stage of the individual have bearing on whether someone views an experience as traumatic or non-traumatic.

This newfound understanding of trauma is super important because it challenges traditionally held beliefs and assumptions that trauma and its effects should be handled solely by mental and social work services.