As a child I was a bit of a nerd. Depending on who you talk to, bit might be an understatement. As such, I enjoy a good definition. According to Merriam-Webster, the mental health definition of trauma is a disordered psychic or behavioral state resulting from severe mental or emotional stress or physical injury. While there is already a lot to unpack with that definition, I like to look a little further. Trauma is the Greek word for wound. I really appreciate that definition, because when I work with someone who has dealt with emotional trauma, it is like dealing with a wound that has not healed properly. Any time we are triggered or reminded of the wound, it feels like it has opened up again. Sometimes I am asked if people ever forget their wounds or traumas. I wish that answer were simple. I wish I could tell you that as therapists, we have magic ways to help you heal from your traumas so that they will never bother you again and you will never have a negative thought or trigger ever again. Life, however, is not that simple. To further the analogy of the wound, I like to think of the healing like scar tissue. If I have a scar from a surgery that has healed properly, I can see the scar and know that the surgery happened and it was painful, but I likely do not feel the pain anymore. That is what I hope when working with trauma and mental health. We may still see and remember, but it will be a scar, not a wound so easily reopened. With some trauma, there may appear to be surface healing, but there is still pain under the surface. With other trauma, it may still be so sensitive that any mention of the topic brings all of the pain right to the surface. Exploring what trauma is, what we can do to help it, and how we can heal is an integral part of mental health practice.
What is PTSD?
Now that we have a basic foundation of trauma, what is PTSD, or Post-Traumatic Stress Disorder? Most mental health providers agree that this is a mental health condition that occurs after a person experiences or witnesses a traumatic event. There are of course nuances within the disorder, and this definition is far too simplistic to go into all of those. One of the main distinctions that I want to point out is that there can be PTSD even if it is not a single event. If you have had chronic abuse, neglect, or mistreatment, but cannot pinpoint a single moment or traumatic event, it is still possible that you may have PTSD. If you feel like you may have PTSD, the best way to determine for certain is to seek out a professional who can give you a full diagnosis. Within the limits of this article, I want to mention that some people are surprised that PTSD is not limited to things like assault, war, natural disasters, or accidents. Prolonged exposure to abuse, domestic violence, neglect, and other things can also lead to PTSD. Symptoms of PTSD can include negative thoughts and feelings, intrusive thoughts, avoiding places or people, and being what we call hyper-aroused, or in fight, flight, or freeze mode. One of the biggest questions we have yet to fully understand or answer is why some people who are exposed to trauma develop PTSD or other disorders, while others do not. It is not a negative flaw in the person, or something to be ashamed of if you or someone you care about has developed PTSD. I have worked with families who have all been in the same accident, yet only one of the members seems to have developed PTSD symptoms. This can lead to feelings of guilt and shame, which I discuss later in this article. When working with veterans who have witnessed combat, it is not understood why some develop PTSD and others do not. Again, it is not a flaw or a weakness. Please do not hesitate to seek out help because you feel like this is something you should take care of on your own. The way trauma affects each person has so many factors, and none of them mean you do not deserve to lead a full life.
Trauma and Mental Health
There are a multitude of ways that trauma can affect our mental health. I mentioned before about the fight, flight, or freeze mode. This is an often-used psychological phenomenon when someone finds themselves in a state of fear. Because of that fear, they revert to basic instincts. These instincts may be to fight the danger in front of us or to run away (flight). The idea of freezing is feeling lost or a need to pause or stop, not really knowing how to respond. I equate it to the idea of a deer in the headlights. Recently, the idea of a fourth reaction, fawn, has been adopted in the mental health community. The idea of fawn is a response when people try to appease or calm the threat in order to make the situation better. In traumatic situations, this can be seen often with abuse and neglect, where a person may develop people-pleasing strategies as protective strategies. Which reaction a person uses may be based on personal history, current situation, family history, or other factors. Understanding how you respond to fear can help you develop coping mechanisms and begin to heal.
Trauma shows up in many different ways in our mental health. One of the biggest things we see is challenges in regulating our emotions. What this means is that the constant state of fear leaves a person in a state of confusion about their own feelings. Shifting from anger, sadness, worry, and even tiredness or happiness can happen faster than what may happen to someone who has not experienced trauma. Trauma can also cause difficulties with trust in relationships. This may show up with self-trust, trust of others, or trust of particular parts of relationships, such as intimacy. There can also be challenges and difficulties with daily function that can be confused for other disorders. Many of the things we see in PTSD appear similar to depression and anxiety. The lack of motivation, the loss of enjoyment in things that were once enjoyable, and general fear and dread. Because there is overlap, we may not realize that we have PTSD symptoms and may not seek help for a long time.
One significant challenge we see commonly in trauma is self-blame. Sexual assault victims, physical and emotional abuse victims, and accident victims can all find themselves ruminating in self-blame. This may show up as reliving events and asking themselves what they could have changed, how they could have been able to stop events or manage them more efficiently, or find any other reason that they might be at fault.
How do we treat PTSD and Trauma?
PTSD is treated in many ways. Therapy is the main way that we treat PTSD, but the type of therapy that is utilized depends on many different factors. Medication can also be used in conjunction with therapy, but it is not always indicated. One of the oldest and most utilized forms of therapy that is used is called Cognitive Behavioral Therapy, or CBT. In simple terms, CBT is a therapy that helps us connect our thoughts (cognitions), emotions, and behaviors. A therapist would help a person with PTSD recognize the thoughts and emotions surrounding their trauma, the behaviors that result from them, and if there are interventions or skills to counteract those behaviors. Another very popular therapy for trauma is called EMDR (eye-movement desensitization and reprocessing), which is a therapeutic approach that uses bilateral stimulation while processing traumatic memories to help process and reduce the emotional charge related to the memories. Other therapists may recommend prolonged exposure therapy, art therapies, or other modalities. The right therapy for you is going to depend on many factors. The best way for you to know what will work is to see someone who can guide you through the process.
For a clinician, family member, or friend, or if you have experienced trauma yourself, one of the most important things to hear is you (or they) are doing the best you can. Especially for children in abuse situations, taking on the place of being somehow the failure can be a survival skill. If the abuser wants you to believe you are a failure, then they have won and the abuse might stop for awhile. Overcoming these beliefs that have been ingrained into your mind for a long time is not a simple process. Be kind, gentle, and compassionate. You are doing the best you can. You did what you could to survive. Speaking your truth about what happened to you to a professional may help you learn to move from surviving to thriving. It is okay to find your voice again.