What is Trauma?

Trauma stems from the Greek word ‘traumatikos’ which translates to wound. While this word pertains to a physical wound, more modern definitions include psychic wounds. Trauma is defined as the lasting damage occurring from a disturbing event either to an individual or as witnessed by an individual, that lingers within our system and causes emotional, somatic, and interpersonal difficulties. Trauma stems from three co-existing conditions: an event or events which exceeds the individual’s ability to cope and exhausts the body’s natural survival mechanisms of fight or flight, and the individual is not supported to integrate the event in the aftermath. 

The trauma event:

Trauma events can range from a singular to chronic and can stem from human actions and natural disasters. Some traumas involve another person, such as violence, sexual assault, living in a war zone, bullying, abuse etc. Other traumas stem from the environment, such as natural disasters like earthquakes, bushfires, and flooding, etc. Trauma can occur from a singular event, e.g., a car accident or from a chronic eroding of the individual’s resilience, e.g., consistent criticism from a caregiver. This list is not exhaustive, as trauma is a deeply personal experience and what overwhelms the system’s survival mechanisms will be different between humans. 

The survival mechanism:

Our brain stem controls our survival responses fight, flight, freeze, and fawn. Information from our environment travels up through the spine and its first step is to move through the brain stem. If the information we receive signals alarms, our body will respond with whichever survival response is the most likely to keep us safe. Think about stepping onto a street and seeing a car coming towards you. Your brain stem takes this information and decides moving out of the way has the best chance of survival. Your brain stem engages the flight response, dumping cortisol into the system, increasing our heart rate to aid blood flow to our muscles which enables them to move us out of the way of danger rapidly. This response happens within milliseconds, we move automatically, without active “thinking”.  

Now consider the brain stem and bodily response to repeated, prolonged traumas such as abuse. On average, a hit of cortisol takes 20-60 minutes to resolve itself if you are safe again, and if you know how to regulate the nervous system. If you are living in a home where you never know when a stressor may occur, how does the body know it is safe? While our survival mechanisms are brilliant for getting us out of the way of a moving car, when we are trapped in an environment that is consistently producing a stress response, the body becomes fatigued. In these situations, the body moves out of its defensive strategies, unable to fight or flee its way out of danger and moves into its protective strategies of freeze and fawn.  

Freezing is akin to “playing dead”, hoping the threat will lose interest, and fawn is akin to feeding the threat, so it does not target you. These protective strategies are considered a last resort as both require tremendous amounts of energy to withhold the fight/flight response but with the same vigilance toward the threat. You are still highly activated, but your responses are stifled. Freeze responses include strategies like dissociation and immobilization and can span from once-off responses (freezing when that car is coming at you), to a chronic management system for stressors. Dissociative Identity Disorder is on one end of that spectrum, where the person structurally splits off parts of their personality from one another, to protect themselves from overwhelming experiences. Fawn responses can be considered both a defensive and a protective strategy, as sometimes it is used actively to ward of threats and other times as a passive response to reduce the intensity of threats. 

Peter Levine and Ann Frederick (1997) explain that when we are exposed to chronic threats, our system does not complete its survival response, and these become trapped in our body. As a reference point, think about watching two dogs playing and if this is escalating into a fight, they separate and shake off before continuing the play in a more regulated way. That shaking off is a nervous system reset, the game became too heightened, and they needed to let the fight/flight energy out. Humans require the same kind of distance and completion, and yet often our world is not set up in a way that allows this. Instead, particularly for those in traumatic environments, our nervous systems don’t reset, and we become stuck in a hyper-hypo-activation cycle. Small stressors, which normally would get “shaken off” send us into the trapped survival response – we become reactive, out of a felt sense of needing protection. 

Support for integration:

Different people can react differently to the same event, and it can be helpful to consider what supports, both internally and externally, help to integrate this experience. If we consider the Black Friday bushfires across Australia, the incidents of a clinically significant PTSD diagnosis stemming from this event were mediated by social connectivity (Bryant et al., 2017). Humans are social creatures, and often we require a level of co-regulation and connectivity to shift back into homeostasis after a traumatic event. People who are connected, supported, and allowed to process the event are much less likely to develop PTSD and move through the, expected, depressive response in the aftermath of a survival response.   

PTSD and PTSs:

We know that while trauma is estimated to impact 75% of the Australian population, only a small proportion of those individuals will go on to experience Post-Traumatic Stress Disorder (PTSD). This highlights the complexity of PTSD, simply being exposed to a traumatic event does not mean you will have symptoms like re-experiencing, night terrors and difficulty sleeping, hypervigilance, and unwanted thoughts. We do know that there is some correlation between PTSD and trauma across the lifetime, meaning individuals who experience poly-victimisation – multiple, complex traumas – are more likely to develop PTSD. Another term that is gaining traction in the Military and Emergency Services research is that of Posttraumatic Stress symptoms (PTSs). This term is used to capture individuals who might not meet the threshold for PTSD, but whose lives are significantly impacted by the symptoms which stem from their traumatic experiences. Someone might not re-experience the event, but they might have reactive anger, shame, self-harming tendencies, and interpersonal difficulties that stem from the body feeling a lack of safety due to the trauma. As our mind/body works to suppress the traumatic incident, we may begin to think this is just “who we are”, not the result of trauma. 

As the powerful author Resmaa Menakem puts it, “Many times trauma in a person decontextualised over time can look like personality. Trauma in a family decontextualised over time can look like family traits. Trauma in a people decontextualised over time can look like culture, and it takes time to slow it down so you can begin to discern what’s what”. For individuals who experience trauma in their childhood, particularly those of an interpersonal nature – domestic and family violence, physical and/or sexual abuse, neglect – symptoms can become embedded into our psyche in such a way that we view it as our personality. The process of unpacking can require professional supports which facilitate an open dialogue through a non-judgemental witnessing by another.  

Trauma survivors demonstrate tremendous resilience in everyday life, and the skills and abilities involved in managing the difficulties that can stem from trauma are not to be underestimated. Trauma impacts numerous aspects of their lives, their wellbeing, health, emotions, relationships, and identity, and yet they continue with life – some battling an internal world that no one else is ever privy to. Here at Rehab Solutions Adelaide, we support through a trauma-informed framework, meaning we assume that everyone we work with has a trauma story untold and we approach people with this in mind. If you’d like to know more about what trauma-informed practice looks like, check out our blog here, or if you’d like to know how we work with trauma, click here. 

References:

Levine, P., & Frederick, A. (1997). Waking the tiger: Healing trauma. The innate capacity to transform overwhelming experiences. North Atlantic Books. 

Bryant, R. A., Gallagher, H. C., Gibbs, L., Pattison, P., MacDougall, C., Harms, L., Block, K., Baker, E., Sinnott, V., Ireton, G., Richardson, J., Forbes, D., & Lusher, D. (2017). Mental health and social networks after disaster. The American Journal of Psychiatry, 174(3), 277-285. https://doi.org/10.1176/appi.ajp.2016.15111403