Trauma’s identity crisis

Last week, I discussed one of the main errors we make when responding to others in crisis—the tendency to minimize or offer “silver-lining” solutions before the grieving process has completed.

Today, I’d like to talk more about what has contributed to trauma’s “identity crisis” in the public nomenclature.  I will explore how therapists and other mental health professionals have confused the picture a bit with their own lingo.  I also talk some about the difficulty inherent in defining a deeply personal, subjective experience in clinical terms.

Let’s start with the easiest culprit that has brought about this identity crisis.

The problem of hyperbole

The term trauma has been badly confused through daily usage.  People with a fondness for hyperbole will talk about the “trauma” of everyday events.  For example, some might use the term as a convenient hyperbole to emphasize the “traumatic” awkwardness of a bad blind date.

There’s certainly no ill-intent behind this usage, but I think that it does contribute to the watered-down vernacular.

Big T and little t traumas

Setting aside hyperbole for a moment, there’s still a deeper reason that the term has an identity crisis.  Trauma has a big job.  It encompasses an impressive breadth of experiences.

This problem of nebulous definitions and conflict over degrees of impact is depicted in the way that people talk about trauma.  In the therapeutic community, people commonly talk about “big T” and “little t” traumas.  This came, I think, from an effort to parse multiple kinds of experiences into different categories, to afford a portion of the trauma pie to the many different kinds of hurt and woundedness we can sustain in a lifetime.  “Big T” traumas refer to stark, dramatic events that most people would commonly identify as traumatic:  natural disasters, seeing combat, or experiencing torture or sexual assault.

There are other kinds of trauma, no less impactful, that have a different look to them.  These describe trauma that is not typically recognized as trauma within the governing culture.  This type of trauma, often referred to as “little t” trauma, also has a profound impact on quality of life.

Don’t let the name fool you.  “Little t” does not mean the impact is less significant.

In fact, there is often a tremendous amount of collateral damage that goes along with this sort of trauma.  Because the single events themselves may seem small scale to an observing world, there is a tendency for people to minimize or dismiss these events out of hand.  “What are you talking about?” someone may comment.  “That happened to me when I was a kid and it wasn’t a big deal.”  Or, “Lots of people have it much worse.”  This minimization can do very real damage.

A layer of shame or guilt has now been added to the already unwieldy pile of feelings a person may have about being let down repeatedly by caregivers or peers in childhood.  People come into my office branded with these admonishments.  “I don’t know why I can’t move past this,” they say.  “It’s not like I was raped or something.”

These “little t” traumas typically resemble a collection of everyday-scale failures or hurts that erode over time at a person’s basic sense of safety or worth in the world.  Growing up gay in a homophobic culture is a good example of “little t” trauma.  It describes a sometimes subtle, ongoing and corrosive form of trauma that is ever-present and often inescapable.  Being frequently shamed, bullied, or excluded as a child are examples of “little t” trauma.

Unsurprisingly, there has been little education of the public to date about these “little t” traumas, and therefore, there is a tendency to minimize or diminish the experience of people who have suffered in this way.  No surprise, then, that people with a history of “little t” traumas frequently do not classify their experiences as traumatic.

Regardless of public understanding, the takeaway message from these “little t” traumas mirror the impact felt by someone captured in a large-scale disaster.  Someone subjected to repeated interpersonal trauma with peers or parents early in life tends to have deeply held beliefs like “I am shameful” or “I am not loveable” or “I cannot trust anyone.”  People experiencing “big T” traumas have beliefs like “I am weak” or “I am powerless” or “I am not safe.”

Francine Shapiro, a psychologist, developed a powerful method of working with trauma called eye movement desensitization reprocessing (EMDR).  The examples of beliefs listed above come directly from her work.  She has extensively researched the kinds of powerful false beliefs that people “take in” in the wake of a trauma.  For more information, you can refer to her body of work or go here.

Subjectivity and ambiguous trauma

Here’s another layer of complexity:  the experience of trauma is subjective.  In other words, what is experienced as traumatizing to one person may not be so for another.  While I do love to showcase my opinion here at Mending Journeys, the subjectivity of trauma isn’t a matter of opinion.  This subjectivity is reflected in the lore of the therapeutic community as well and the current diagnosis of post-traumatic stress disorder (PTSD).

According to the DSM-IV, the diagnostic manual for mental health professionals, the impact of a traumatic event and subsequent diagnosis of PTSD is not determined exclusively by the scale of the disaster or event, but also by a person’s individual, subjective, felt-sense experience of the event.  This makes sense—the vast majority of people experience at least one traumatic experience in a lifetime, but only a small percentage develop post-traumatic stress disorder, a diagnosis that encompasses a distressing constellation of symptoms that emerge after the occurrence of a traumatic event.  A person’s individual, subjective experience of the event– along with a host of other important factors– predict outcome after a trauma.

There are also stressors that may be common or a part of a cultural rubric that nonetheless have a traumatic impact for certain individuals.  Experiencing a contentious divorce or undergoing an invasive surgery could be an example of this sort of ambiguous trauma.  There is not a consensus about how to classify these experiences.  Some might classify a nasty divorce as a “big T” trauma, others might say that it is too common to be considered traumatic or not “on scale” with other forms of “big T” trauma.  These are events are no less impacting for their commonness, and yet because they are not uniformly experienced as traumatic leaves people confused about how to classify them.

People in this ambiguous trauma no-man’s land often find themselves abandoned to their pain during a time of great need.  The community does not know how to support people in these situations.  There is no ritual built around this ambiguous kind of grief.  Culture is clear about the support afforded grieving widows, but someone after a divorce is not typically afforded the same support, even though they have also lost a spouse.

No need to ration your compassion

It’s no surprise that the concept of trauma is bent out of shape, perpetually confused in its efforts to encompass so many different experiences.

I wonder why people get really upset about broadening the definition of trauma to encompass “little t” or ambiguous traumas.  I understand the dilemma of clinicians and researchers who are trying to keep a clear sense of scope for the purpose of diagnosis or research.  When it comes to helping people make sense of their experiences, I tend to think it’s best to err on the side of compassion.

If someone aches with the awfulness of something that happened to them, they can’t stop thinking about it, and it has profoundly, negatively impacted their sense of self-worth or safety in the world, I’ll call it whatever they want.  My job is about helping people make meaning of some terrible things with some strange edges and borders.

I wonder if people worry that having a “slippery slope” definition of trauma will mean there won’t be enough compassion for the “people who really need it.”  This mindset confuses me.

I don’t understand why some people treat compassion as a finite resource.  Provided we are well-taken-care-of in our efforts to heal and serve others, the more we give, the more we have to give.  Compassion is like that.  There is plenty to be had.

The topic of trauma has been on my mind quite a bit lately.  Sadly, there has been plenty of fodder in the news to keep this topic on the forefront of my mind.  I suppose because trauma recovery is a particular interest of mine, I’m also more prone to see it in the headlines than most.  I pay attention to those stories.  I worry about how people are coping with what has happened to them.

Whatever we name these experiences, it is my hope that people get the support they need, when they need it.

With that in mind, next week I’ll offer some thoughts on how we can attend with sensitivity and kindness to the pain of our loved ones.