What is trauma?
Over the past several years, I’ve noticed the word trauma entering our collective lexicon. In my experience, it’s being used more in casual conversation, media, and in discourse around justice, politics, and human rights. Here in Hong Kong, during a post-protest era of political crackdown and pandemic woes, we’re speaking about it as part of a growing awareness around mental health. I am fascinated by the way our use of language evolves over time, and I see it as a net positive when people have access to specific terms that help bring meaning to their experiences.
However, some argue that trauma is being overused or misapplied. I don’t doubt that, but I see it as the exception, not the rule. Perhaps this is because I’m a psychotherapist who primarily works with trauma. I know that viewing one’s own experiences as traumatic is an individual process. In my clinical experience, people are likely to hesitate before using this term, rather than overuse it. I understand the concern with a word like trauma being diluted, given that its effects are devastating. However, trauma is more common than our understanding might let on (source). I do think that its meaning can expand to include various individual and collective experiences without detracting from that of others, and as much as possible, we should use the word in an intentional, informed way.
Trauma is anything that overwhelms our capacity to cope–and it’s more common than we think.
There are many nuances to be aware of with the term trauma. An individual’s trauma has a combined subjective and objective meaning, which makes it hard for another to say whether the term is being used correctly. As a clinician, people ask me, How do I know if what I went through was traumatic? My view is that we can leave it up to individuals to make informed determinations, perhaps with the guidance of mental health professionals and/or resources, about whether to name their experience as traumatic or not. I’ll elaborate on this stance throughout the article.
This conversation does not always lead to clean, concrete answers. I can understand the desire for clean and concrete because the very nature of trauma is that it’s just the opposite. As a trauma therapist, I spend lots of time thinking, reading, and speaking about trauma, and I still come up against snags when my current understanding conflicts with the stories, clinical examples, or lived experiences I hear about. I treat my understanding of trauma as an ever-evolving framework in my mind that is constantly growing and shifting to integrate new information, which ultimately strengthens my knowledge and my clinical skills.
At this stage of our exploration into trauma, allow me to acknowledge the deeply human desire to understand life’s complexities, while also encouraging a sense of openness and gentle curiosity about the nature of things which are difficult to harness with meaning.
Let’s start with a key understanding:
Trauma is more than an event
When exploring whether something is traumatic or not, what happened is only one piece of the puzzle. It’s the objective piece, easily stated in a few words or less: we associate things like combat, sexual assault, neglect, natural disasters, or interpersonal violence with trauma (though this is an extremely limited list). What happened matters deeply, especially in the context of #metoo and #believewomen, or when we’re listening to survivors of human trafficking, or when we’re unpacking how our early family dynamics worked. It matters because when we know that something horrific or overwhelming happened to someone, we hold the possibility that it may have fundamentally shifted the way they relate to the world. It can help us make sense of ourselves and those we interact with.
What happened is an important entry point for talking about trauma, but if we stay there and think only of events as being traumatic (or not), we miss an entire realm of subjectivity that deepens and complicates our collective discussion about trauma. In addition to what happened, there’s how we experienced it, the enduring effect that it has, and the environment it happened in. Events themselves cannot possibly capture the cascade of biological, psychological, and emotional responses that occur within individuals and communities as a result of how events are experienced, nor do they capture the environmental context in which the events occurred.
For these reasons, looking at events is considered a poor predictor of what’s traumatic (source). There is no linear relationship between specific events and resulting traumatic stress. There is no set of criteria that can be used to reliably determine which events will lead to post-trauma symptoms. What was traumatizing for me may not have been traumatizing for you, because we experienced it within our own internal and external contexts.
Simply put, what happened is like the prologue in our personal trauma story. The internal experiences that occur in response to the event(s), the environment the event(s) occurred in, as well as the long-term emotional impact of these event(s) are what make up the main chapters.
When we’re traumatized, it’s like our body’s stress response “cup” is overflowing.
Trauma is a response to an event
Our body is uniquely designed to respond when something distressing or disturbing happens to us. Shaped in infancy through genetic and environmental influences, we each have a set of neurological and physiological systems that help us to get our physical, emotional, and social needs met—essentially, they’re our survival mechanisms.
It’s like each of us have a cup inside of us—made of different materials, shapes, sizes, etc.—that is designed to respond to day-to-day stresses. Stress fills the cup, and the body’s systems empty it. The cup’s capacity is different throughout our life stages. When we’re younger, the cup is smaller and it may not empty as quickly or as easily, and we need more help from others to empty it out. For example, as a child we might feel the discomfort of hunger, a stressor, and the cup becomes full. Ideally, the body’s systems that help us communicate our hunger, eat, and digest food will empty the cup, returning us to a comfortable baseline. Later on, we learn to respond to this need ourselves.
These systems work very well, but they have limits. When stressors come too fast, too soon, or too often, naturally, the cup cannot do what it is designed to do. This can happen from a single stressor or from prolonged, repeated stressors that compromise the cup’s function. If it cannot empty itself out faster than it is being filled, then eventually, it overflows and stops functioning. The effects of the stress “spill out”, effectively disorganizing us internally and impacting our ability to influence the situation at hand. When the cup overflows and it cannot empty itself out like it’s supposed to, we are experiencing something that exceeds our capacity for coping and/or survival. It’s not our fault, it’s a fact of our biological and physiological design. This is where trauma can occur.
When we experience something distressing or disturbing that overwhelms these systems, that creates the internal conditions for a response we call trauma. This can happen at any age, though as a child, we are susceptible in different ways. When we cannot cope with the event(s), or we feel deep isolation, powerlessness, betrayal, or hopelessness, or our sense of self is diminished, or we’re cut off from our ability to experience the full range of our emotions, it’s possible that we will experience post-trauma symptoms. Post-trauma symptoms can be understood as our mind and body’s way of trying to cope with the fallout of experiencing or witnessing something that overflowed our cup. Here are some changes people can experience (source):
emotional arousal (feeling big emotions) or emotional numbing
hypervigilance (always feeling prepared for something bad)
physical symptoms like aches, pains
sleep problems, nightmares
harsh or altered beliefs about oneself or the world
changes in thinking patterns
feeling fundamentally different from others or isolated
triggers or flashbacks (re-experiencing)
dissociation
behaving differently to manage emotions (ex substance use)
avoiding others, avoiding memories, avoiding responsibilities
Of course, responses to trauma vary greatly from person to person and this list is not meant to provide definitive criteria. Experiencing some of these symptoms is not necessarily the same as having post-traumatic stress disorder (PSTD) or complex PTSD. Not all trauma leads to the onset of PTSD or CPTSD (source). I will try and elaborate on this distinction further in another post. You may be curious to learn more about CPTSD here:
Most people I work with do not have a trauma diagnosis, but rather, they come in knowing that something from the past is continuing to impact the way that they view themselves or the world in a distressing way.
Determining whether something traumatized you is a deeply personal process. We might be unsure whether to name certain experiences as traumatic because of predetermined ideas about what trauma is or isn’t. Making sense of your own story might involve looking at your own experience with the event(s), the effects that the event(s) had on you, and the environment in which the event(s) occurred, perhaps alongside a trauma-trained mental health professional.
