About Psychological Trauma
by Diane M. Gartland Psy. D.
These days one hears the word "trauma" tossed around quite liberally as meaning anything from sadness over a failed relationship to anxiety over a test in school. "Moving is 'traumatic' for me" a distressed colleague said to me a couple of months ago. Could such a seemingly mild event as a move constitute a trauma?
Historically, 'psychological trauma' has been defined as quite specific to what is perceived, and most often is, life threatening or, at the very least, so overwhelming to the senses that it endangers the very essence of sanity itself. It is no wonder though, that people are frequently quite free with the term and often misuse it since there are so many horrid events that occur in our world and there are so many people quietly and desperately affected by such events. In addition, the effects of a traumatic event for an individual and others around that person (such as relatives, friends and healers) can have far reaching consequences and envelop many other seemingly innocuous and mild events in the future. For example, in the most recent biography of the former American first lady, known and beloved world wide (Jacqueline Bourvier Kennedy Onassis: The Untold Story by Barbara Leaming, October 2014, St. Martin's Press, NY) the horror of a post traumatic life is re-visited. The publicly dignified and demure widow of John Kennedy hid her mental distress and, according to Leaming, when someone decades later asked her what might be the greatest achievement of her life, she said: "I kept my sanity". Although she largely suffered silently, her life after the assassination was likely one where trauma figured prominantly and may have been frequently revived in her mind, emotionally, behaviorally, mentally and sensationally.
The American psychiatric manual description used commonly for diagnosing trauma has limited its usage to a group of symptoms which tends to be overly confined. Therefore the manual may not be very credible to people who have themselves experienced or know someone who has experienced an overwhelming life event or series of events. To add to the confusion, there are circumstances that, in the present, seem quite ordinary but draw reactions that are felt to be extreme such as a feeling of hatred or rage toward someone for no logical reason or an experience of terror toward someone we hardly know. Considering how the extreme experiences of parents and grandparents can have an effect on their children and how often these experiences are kept secret from those that may be hurt by them 'second hand', it is not so surprising. Once recalled and spoken about, it makes much sense.
Over more than a century, many people have wrestled with the notion of psychological or "psychic" trauma, attempting to describe it, examine it, define it, explain it, or modify its effects. There have been studies examining hostage taking, combat, war time captivity, genocide and holocausts, natural disaster, technological (human made) disaster, criminal victimization, family violence and child abuse, second generation and vicarious trauma and first responder distress . . . all of which have developed their own literature addressing the specific type of horrific event. Less formally researched but as influential may be the effects of medical trauma, extreme poverty, racism, cultural dislocation, child abandonment, etc. In addition, there have been few mental health researchers, theorists or practitioners who have not at some point been involved in the study or treatment of a traumatized person, whether they knew what it was or not and whether they were able to help or not.
Most people, including therapists and counselors, are unaware that, despite many centuries of experience with traumatic effects, it was only in very recent decades that psychological trauma was given its own categorization and its own place in the examination of mental distress. The recognition of the influence of trauma in the everyday existence of the individual and of groups and nations has been little attended to until the latter half of the 20th century and still requires further study and understanding. Nonetheless, from an overview of data collections of many different types of traumatic events over a 100 year period (Gartland, DAI, 1993), it seems fair to indicate that:
1. The PTSD model introduced by the Diagnostic and Statistical Manuel in 1985 is very helpful in describing some signs and symptoms related to traumatization but does not entirely capture the essence of what psychological trauma is across experiences and events.
2. The traumatic event becomes the most important and indeed central event of the individual's life around which all other experiences afterwards are organized and understood whether realized or not. This may also come to be true for families (such as in offspring of combat veterans or Holocaust survivors), countries and people (such as in the case of mass genocide, enslavement or forced migration).
3. Signs and symptoms that the person experiences may have some similarities across types of events but the outcome may vary by event and by culture suggesting the imbuing of the event with personally significant meaning. Psychological trauma is best treated individually.
4. The traumatic event tends to alter the personality of the individual in such a way as to change their character and possibly neurological structures.
5. Relationships with others become compromised since, in a very fundamental way, the individual 'becomes' the trauma.
6. Individuals and collectives that have experienced trauma as victims in one generation may also experience trauma as a perpetrator or vehicle of traumatization in the next, often without awareness.
7. The usual symptoms associated with trauma (nightmares, startle reactions, intrusive recollections, interpersonal aversion, avoidance of anything that could arouse recollections, inability to remember important aspects of the event or of life, feelings of a shortened future, estrangement from others, absence of feelings etc.) may or may not be in evidence. Symptoms such as intense fear or phobia of people, places and things, needing to control one's environment and the people in it, substance misuse, depressions, hyperalertness, suspiciousness and mistrust, unusual responses to pain, ADHD, outbursts of anger, problems concentrating, agitation and disorganization . . .may instead cloud the real problem.
Such symptoms are often treated by themselves which cheaply and successfully suppresses them for a time (improved school or work performance) while not addressing the underlying trouble. However, such suppression does so at the cost of medication side effects and accepting an over controlled, drab and often tense/fearful personality lacking in vitality and joy.
It is my opinion after studying this issue across decades, countries/cultures and clients that traumatization may cover so many incidences and life experiences over the course of human history, it is unlikely any one individual can escape some of its effects either directly, as a victim, as an instigator, as a witness or from intergenerational transmission. Knowing how trauma has affected us as individuals either as an offspring or as an immediate recipient, can assist us in understanding ourselves and our fellows and in starting to take measures to change the course of our lives and that of our children, our country and our world.
In the therapy consulting room, an approach which allows an individual free thought and reminiscence may lead to an awareness of crucial events and circumstances within the family and the self resembling trauma. Just recollecting and saying related thoughts aloud may substantially reduce fears and anxieties people bring with them provided a well trained therapist is able to guide the process. Sifting through these experiences and understanding their meaning for the individual can be helpful to the whole of the person that goes far beyond the controlling and suppression of symptoms through medication and management techniques. Though these may lead to partial, temporary relief which can be very welcome, it is most helpful to brain and mind development as well as relationships, to tell ones story, putting the self back together again and becoming the person one wants to be.
October 2014 - Contact author 734-302-0309 for permission to cite