While sitting in a local café recently, I heard someone at a nearby table expressing loudly to her partner how bad the supermarket queues had been and how in fact by the time she got out she was “traumatised”. It made me realise just how much the idea of trauma has become part of our modern thinking as well as how the concept is at risk of losing its definition.
Of course, my café neighbour did not really mean she was traumatised but just that she was very stressed by the supermarket experience. These days we might wonder how we can hold on to trauma as a meaningful concept and, more importantly, when it is that stress actually does become trauma.
Probably the clearest way to think about trauma is that it is any situation which is both overwhelming and inescapable. We can think of a whole range of situations from dreadful medical procedures to car crashes or assaults and even sudden bereavements where our abilities to cope are overwhelmed while at the same time escape is experienced as impossible.
“Too much, too quick, too soon” is often the quality of sudden one-off events that overwhelm us but other situations are longer term such as chronic illnesses or prolonged periods of extreme stress. When stress overwhelms us, it becomes traumatic stress. The diagnostic manuals try valiantly to explain what kind of situation leads to PTSD, pointing to the threat of not surviving a situation as being the biggest cause. There’s a problem here though because, however bad a situation is, the trauma is not actually in the awfulness of the situation itself but rather it is in our reactions to that situation. A diagnosis of post traumatic problems can only be made when our nervous systems, our bodies and minds, are left with painful residues that we are unable to leave behind.
These residual effects present in well recognised ways: ‘hyper-arousal’ refers to the way the nervous system remains in a heightened state as though perpetually looking for the next dangerous thing to defend itself against. This manifests in heightened anxiety and hypervigilance, with difficulties relaxing or sleeping. ‘Reexperiencing’ refers to those flashes of memories that don’t feel historical but rather like being suddenly plunged back in to the original situation often with visual and other sensory impressions adding to the intensity. ‘Numbing’ gets at the insidious emotional effects of trauma, whereby our ability to feel, react and express ourselves emotionally loses its depth and quality becoming flatter and less responsive. ‘Avoidance’ sums up the way we try to find solutions by giving a wide berth to anything that seems to remind us of the trauma. It can be about avoiding people and places but equally it can be the exhausting attempt to avoid internal experiences such as memories and feelings that connect with the trauma.
Beyond PTSD, the contemporary trauma treatment field recognises a wide range of difficulties that may stem from trauma but be less easily identified. Complex PTSD for example is a term that tries to encompass the broader effects of trauma on body, mind and relationships.
When it comes to trauma treatment, leaders in the field such as Peter Levine have made it clear that including our bodily nervous system in therapy brings in a richness and depth that adds greatly to traditional talking approaches. Overwhelming situations evoke survival responses in our nervous systems. Bringing careful guided awareness to our bodily sensations and reactions can help us discover and restore thwarted reactions as well as to melt states of frozen immobility. When we work in this way, we often experience ‘higher level’ effects such as our emotional responses shifting and new meanings becoming available in our thinking. As our physical, emotional and cognitive patterns shift, we realise that trauma does not have to be a life sentence.