As mental health language continues to creep into our daily lives, the concept of trauma appears to have gone 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 subjects of news headlines, television shows, and therapy TikTok.
Prince Harry said in his docuseries with Oprah Winfrey that addressing the trauma of his mother’s death was essential for his own well-being as well as the health of his marriage. Earlier this year, Rep. Alexandria Ocasio-Cortez spoke about the way the trauma she’s lived through as a survivor of sexual assault and the Capitol riot “compounds on each other.” People of color demand greater recognition for the mental and physical toll racial trauma takes on their lives. And the COVID-19 pandemic has been a series of traumatic events.
“It is a political act to talk about trauma because for so long, so much exploitation and perpetration and victimization were hidden and not acknowledged,” said Emily Sachs, a clinical psychologist who specializes in trauma. “People who were the subject of that were blamed for their problems. And that still goes on today.”
While some people are working to raise awareness about the prevalence of trauma, others are inadvertently diluting the term, often by using it hyperbolically: “I’m traumatized by what I ate last night” or “I accidentally killed my plant, and now I’m traumatized.”
“I think it’s a double-edged sword because, by these terms coming into our everyday vernacular, it’s almost normalizing talking about these things, but at the same time, it is absolutely minimizing the true effects of these disorders,” said psychotherapist Janel Cubbage. “Talking about mental health and all of these conditions is good, but the way that we talk about it really matters.”
What is trauma?
Trauma is both what happens to a person and their reaction to it, Sachs said. It generally refers to intense and overwhelming experiences that involve profound loss, threat, or harm to a person’s physical and/or emotional well-being.
Many trauma experts define the term broadly in their work to offer patients agency in identifying the trauma in their own lives.
“There’s value in excluding some things from what trauma might be … but at the same time, I think that we can’t have an overly narrow definition where we deny the reality of a person’s experience,” said clinical psychologist Seth Gillihan. “It’s valuable to be as inclusive as we can without diluting the term so much that then it becomes meaningless.”
Cubbage sometimes said people conflate trauma with post-traumatic stress disorder (PTSD), which has its own clinical definition and outlines clusters of specific symptoms. Not everyone who experiences trauma will experience PTSD, but that doesn’t mean they do not have prolonged difficulty functioning.
Many clinicians also argue the definition for PTSD in the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) – whose criteria begins with “exposure to actual or threatened death, serious injury, or sexual violence” – is limiting. Cubbage said it fails to address specific types of relational and racial trauma.
“If you think about someone who got cheated on by their partner, that very well can be traumatic for people, but that would not meet the criteria for PTSD,” Cubbage said. “Repeatedly watching videos of someone who looks like you being murdered by police officers or experiencing hate crimes can be traumatic, but … would not meet the criteria for PTSD. So there are a lot of issues just in terms of the way that trauma has been clinically conceptualized.”
What trauma does to us
Our body’s response to trauma is normal. It’s an adaptive reaction, a feature of the system. But because of the overwhelming nature of a traumatic experience, trauma produces a bio-psycho-social response that can change how we react to things in the long-term – loud sounds, crowded trains, the opposite sex.
“Trauma writes itself on our experience, on our hearts, on our minds, on our bodies. And really, what we’re experiencing is not the actual event, but the trace that it leaves,” Gillihan said.
During a trauma, the body’s emergency response system releases chemicals to keep it safe. Still, when that is too intense or too prolonged or happens too many times, it can cause a permanent change to the way a body produces chemicals and functions.
Trauma impacts memory since memories from traumatic experience get sealed in very intensely and accessed differently. Trauma cognitively and emotionally changes our understanding of the world, about what we can expect from other people and our environments.
Different types of trauma
Sachs said anything that causes severe panic, fear, helplessness, and horror produces a similar chemical reaction in our bodies because we are wired to keep ourselves safe. But it’s also true that different types of trauma affect people differently. Interpersonal traumas, such as rape, are shown to be the most toxic in terms of the chemical response and also in terms of the way it changes our meanings and expectations about the world and our relationships.
There’s a difference between experiencing the trauma of a natural disaster and the trauma of interpersonal violence. There’s also a difference between an acute one-time traumatic event, such as a car accident, and chronic or complex trauma.
Chronic trauma is ongoing, and complex trauma usually refers to traumatic experiences in early childhood, such as abuse or neglect. Cubbage said in her practice, she has yet to meet someone who has only experienced a single traumatic event.
Why do two people experience the same trauma but react differently
There are types of events that are likely to shake anyone’s bio-psycho-social foundation, things that are intensely shocking and universally fear-producing.
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 safety again. In contrast, others will develop long-term trauma symptoms or even PTSD.
Gillihan said his close friend was violently mugged and appeared unfazed. Gillihan had a similar experience but said he had typical post-traumatic reactions, including feeling unsafe and constantly on edge.
“People are wired differently, and it’s easy to blame ourselves if we’re someone who struggles more following a trauma. But we can’t really predict who’s going to struggle and who’s not, and it doesn’t seem to be a function of who’s tough and who’s not, of who’s fearful or who’s not. There are some correlations we can identify, but, by and large, we don’t know who’s going to bounce back after a trauma and who’s going to experience it more for longer and maybe more deeply.”
Sachs said comparing two people’s reactions to trauma is also complicated because many trauma survivors experience a delayed onset of trauma symptoms. While it may appear two people are having very different reactions, it could actually be that one person is having a delayed response and will develop clinically significant trauma pathology weeks, months, or even years later.