Room for Restoration

July 18, 2022

I once heard a woman exclaim that people where I live (midwest US) do not know “real trauma”. Her argument was that because the local general populace has not experienced war conditions, they could not know true pain and suffering and therefore have no right to feelings of crisis, anxiety, depression, or suicidal ideation. As a clinical mental health counselor, I understand what she was trying to say. I can understand that, in her own way, she was trying to encourage others to be strong and resilient in their struggles. Yet, even in knowing her intent, I want to be clear that her message shows a misunderstanding of what trauma is and how people experience it. To understand what trauma is, we first must acknowledge what trauma is not.

Trauma is Not an Event

We often hear about “traumatic events” as if the event itself is innately traumatic. My experience as a mental health professional has shown me that people who experience the exact same event can all have different responses to that event. One person may respond by building resilience and using that experience as a catalyst for self-advocacy. A second person might develop flashbacks, avoidance tendencies, hypervigilance, or become more negative in their thoughts and mood. Meanwhile a third person may walk away from it as if nothing happened at all.

In a meta-analytic review of 33 research studies on the prevalence of Posttraumatic Stress Disorder (PTSD) in veterans of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) from 2007-2013, researcher Jessica Fulton and colleagues (2015)^a estimated that 23% of the OEF/OIF veterans qualified for a PTSD diagnosis. Presumably, many of these men and women had been in similar situations which could be determined as “traumatic” and yet 77% of them did not present with PTSD. If an event is innately traumatic, then everyone who experiences it should develop a trauma response. As this is clearly not the case, trauma then cannot be defined as an event or an experience. So what is trauma?

Trauma is Stress Without Forward Movement

Healthy stress moves from activation to processing to relaxing or adaptation and then finally to releasing. Activation is that trigger point, the stimulus to the stress. This may happen when a fire alarm goes off. Once the stress has been triggered, the mind and body automatically begin processing the stress, trying to understand the threat. Once a stressor has been understood, we enter a stage of either relaxing if the stress is not a threat, or adaptation if the stressor indicates a change is necessary for survival. When a fire alarm goes off, the body goes straight into survival mode and seeks to understand if there is a real threat. If you recognize that it is a simple drill, you naturally begin to relax. The smell of smoke, however, would initiate the process of adaptation as you seek to find the nearest emergency exit. Once free of the immediate danger, your body then gradually returns to a relaxed state. Once the body recognizes that the stress inducing event or experience is over, such as the building being cleared by the fire department, it lets go of the stress and returns to a balanced state. That memory has been fully processed and has a place it belongs in the past.

You might imagine healthy stress as something that moves similar to a train on a one-way track. There is a start point and an endpoint, and then you leave it behind as you exit the train and move on to your destination. Healthy stress is helpful, it allows us to complete tasks, perform well, gets us out of threatening situations, and gives us a sense of satisfaction or strength when we are able to complete the process. Healthy stress builds resilience.

Traumatic stress is cyclical. It is like a ferris wheel that just keeps moving without letting the rider off. The process of traumatic stress is activation, deactivation, and reactivation. With traumatic stress, the healthy stress process cannot be completed and instead you are stuck in this cycle where you revisit the stress response over and over again. Trauma is held within the body’s nervous system, an incomplete process of a survival response which can be activated by something like criticism as easily as it can be triggered by assault. In order for traumatic stress to complete the process, the control center, or autonomic nervous system, must be operated in such a way as to stop the ferris wheel so that the rider can exit the car.

Let's return to the example of the fire alarm going off. A 5 year old child who has not participated in a fire drill before has just started school. The child is nervous, is in a new place with people they do not know, and is already feeling a bit unsafe. Suddenly the fire alarm goes off. The bell is loud and unfamiliar, the child freezes and cannot comprehend the teacher’s instructions for getting out of the building. Eventually the child is ushered out by the teacher unharmed. The teacher later explains that someone pulled the fire alarm as a prank, and assures the students that they were not in danger. A few weeks later that child begins to have nightmares of being trapped in a fire and develops strong anxiety symptoms around the green light on their ceiling smoke detector in their bedroom. The child may refuse to go to school and show signs of panic attacks when in new spaces or at the sight of a fire alarm. Rather than processing the stress in a healthy way, the child’s body has become stuck in a traumatic stress response. The child now associates fire alarms and smoke detectors with feeling endangered rather than as tools that keep them safe.

How Counseling Can Help

Trauma, whether from a “big” event or a “small” one, needs healing rather than comparison. Trauma is not something anyone needs to be stuck with. Rather, it is something that can be reprocessed in such a way that it builds resilience and strength. Counseling can help with that.

When treating traumatic stress responses, counselors and therapists seek to help the client to engage in the healing process. Different therapists use a variety of skills and techniques based in research. Some therapists focus more on thoughts and emotions, while others work more with the client’s physical sensations or behavioral responses. Personally, I offer my clients healing through an integrative approach which addresses the client’s whole self, connecting the person’s mind, body, emotions, environment, and community. Regardless of the techniques used, the goal of every therapist is to help their client to regain control and appropriately regulate their natural survival responses.

Remember, trauma is not an event that has happened, it does not have a specific requirement of experiences that must be met. Trauma happens within the person’s perspective, not in societal understanding. My hope is that we can move away from the stigma of trauma, that we are able to stop comparing experiences, feeling guilt or shame about our natural survival responses, and instead recognize the importance of finding healing and strength in the process.

Resources:

Fulton, J. J., Calhoun, P. S., Wagner, H. R., Schry, A. R., Hair, L. P., Feeling, N., Elbogen, E., & Beckham, J. C. (2015). The prevalence of posttraumatic stress disorder in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans: A meta-analysis. Journal of Anxiety Disorders, 31, 98–107. https://doi.org/10.1016/j.janxdis.2015.02.003