July 6, 2017
One of the areas of work I feel particularly passionate about in my practice is facilitating recovery after a traumatic incident. Last week, I began a discussion of trauma and PTSD, or posttraumatic stress disorder, one of my areas of specialty.
We often think of veterans when we think of PTSD. In large part, much of what we do know about trauma and PTSD is a result of the experiences of Vietnam veterans. Prior to that, while trauma responses existed, there had not been a whole lot of focus on understanding traumatic reactions. Although PTSD tends to be the issue that most often comes to mind when we consider trauma, there are a number of other responses to trauma, including things such as depression, anxiety, substance abuse, and difficulties in relationships. We will address some of these elements but, in our multi-episode Looking at Trauma series, we will mostly focus on PTSD. Most of these other issues are embedded within the constellation of PTSD and will make more sense as we understand PTSD.
To begin with, it’s important to understand what exactly a trauma is…
If we think about the definition of a trauma, it’s generally defined by dictionaries as a deeply distressing or disturbing occurrence. Often, in medical contexts, it’s described as a disruption. Different experts and different fields describe trauma in different ways, which can be confusing and even intimidate if we are looking to do our research.
However, there are some common elements in thinking about what a trauma specifically is. From the lens of mental health or psychology, trauma, as described by the American Psychological Association, is typically an emotional and somatic response to a terrible, overwhelming, situation.
According to the International Society for Traumatic Stress Studies, traumatic events are shocking and emotionally overwhelming situations that may involve actual or threatened death, serious injury, or threat to physical integrity. While the World Health Organization describes trauma as more of an emergent/disaster based situation.
There are a number of different events that can be traumatic. Some examples of these situations that may immediately come to mind include a serious and potentially life-threatening accident, assault, natural disaster, or combat. Other types of experiences can be traumatic as well such as surviving or witnessing a crime or physical, verbal, emotional, and sexual abuse, as well as bullying or even a big move. Sometimes, trauma responses can follow any major change or disruption in a person’s life.
Many people are exposed to traumatic events. In the time immediately following a trauma, most people will have the experiences of PTSD that we will talk about. However, over time, for many people, those experiences naturally decrease, and they are not diagnosed with PTSD. In other words, they naturally recover from the traumatic event. There are some people who do not recover and are later diagnosed with PTSD. Based on that, it is helpful to think of PTSD as a problem in recovery. Something got in the way of you having that natural process of recovery, and the work of therapy is to determine what got in the way and to change it so that you can recover from what happened. You and your therapist will be working to get you ̳unstuck.
Let’s look at this in more depth…
Because we know that PTSD experiences are nearly universal immediately following very serious traumatic stressors and that recovery takes a few months under normal circumstances, it may be best to think about diagnosable PTSD as a disruption or stalling out of a normal recovery process, rather than the development of a unique psychopathology. A therapist needs to determine what has interfered with normal recovery. In one case, it may be that someone believes that they will be overwhelmed by the amount of emotional reactivity that will emerge if he stops avoiding and numbing himself. Perhaps s/he was taught as a child that emotions are bad, that s/he should just get over it.‖ In another case, someone may have refused to talk about what happened with anyone because s/he blames herself for ―letting‖ the event happen and she is so shamed and humiliated that s/he is convinced that others will blame her, too. In a third case, a person may have seen something so horrifying that every time s/he falls asleep and dreams about it, s/he wakes up in a cold sweat. So, in order to sleep, s/he drinks heavily. Yet another person may be so convinced that s/he will be victimized again that s/he refuses to go out anymore and has greatly restricted his/her activities and relationships. In still another case, in which other people were killed, a person may have survivor guilt and obsesses over why s/he was spared when others were killed. S/he feels unworthy and experiences guilt whenever s/he laughs or finds himself enjoying something. In all these instances, thoughts or avoidance behaviors are interfering with emotional processing and reshaping our beliefs. There are as many individual examples of things that can block a smooth recovery as there are individuals with PTSD.
There are several categories of experiences that tend to follow a traumatic event. Last week, we more closely examined each of the categories.
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