What is trauma? And what is so traumatic about it that makes it unbearable? I pose these questions in an attempt to think about how to comprehend such a vast and difficult topic.

So What is so traumatic about trauma?

The word ‘trauma’ originates from the Greek word ‘wound’. As a ‘word’, trauma describes a physical injury that connotes psychic wound’ (Dass-Brailsford, 2007). I have found that defining trauma literally does not suffice the profoundness of what trauma is. I will use Robert Stolorow’s emotive definition of trauma as a working definition:

“Trauma is constituted in an intersubjective context in which severe emotional pain cannot find a relational home in which it can be held. In such a context, painful affect states become unendurable – that is traumatic” (Stolorow, 2007 pp23 -24).

Personally, in my experience, I believe that trauma can shatter a person’s very sense of being, going beyond normal logical thinking, overriding all processes and understanding. Experiencing trauma can disrupt a person’s existence and world. There are different types of experiences that can be seen as traumatic, including: physical trauma; near death experience; an accident; sexual abuse; physical abuse; emotional abuse; neglect; being a witness to physical or emotional abuse; a victim of violence, war or terrorism; traumatic grief or separation, but these are all not exclusive.   

Judith Herman astutely captures traumatic events in that they:

“Call into question basic human relationships – breaching the attachments of family, friendships, love and community. Shatter the construction of the self that formed and sustained in relation to others.” (Herman, 1997 pp51)

The Effects of trauma

Trauma can result in both physiological and psychological effects (Dass-Brailsford, 2007). Alan Schore and others highlight that how a person responds to a traumatic event depends on a number of factors including: the characteristics of the stressor and its severity; as well as factors specific to that individual [such as the personality or pre-existing conditions] (Schore, 2002; Sherin and Nemeroff, 2011; Dass-Brailsford, 2007).  I really agree with this and believe that it is important to look at the context of the individual to gain further in-depth understanding.

Judith Herman states that:

“Traumatic events are extraordinary, because they overwhelm the ordinary human adaptations to life. Generally involve threats to life or bodily integrity, or a close encounter with violence and death” (Herman, 1997 pp34).

I agree with Herman but also feel that traumatic events do not necessary have to be life threatening to have an effect on the individual as the reaction depends on ‘who’ is receiving the trauma and their ‘own’ perception.

Understanding the Neurobiology in Trauma

Initially when danger or threat happens, it is perceived by the right brain via the amygdala, which is known as the ‘emotional hub’.  The amygdala controls both Sympathetic and Parasympathetic activities. The Sympathetic Nervous System is aroused, increasing the levels of catecholamines in the body. The adrenaline levels in the body are raised resulting in increased heart rate, and respiratory rate, what this does is prepare for the person to go into a state of alert (Herman, 1997 and Schore 2002)

My understanding is that the body needs fuel and energy to go into the most important organs at a time of stress. Thus going into ‘autopilot’ mode, the autonomic nervous system – where there is no thinking only action i.e. the fight/fright/flight/freeze response, where the person during danger takes active action through fight or flight or passive action as in freezing (Ogden and Minton, 2000). What this response does is get the body ready either to flee from the perceived danger, or sometimes the body can just freeze, becoming immobile, not able to do anything. All these different responses are a way to protect the person.

Usually when the threat goes so do the protective symptoms. The adrenaline levels are then counteracted by the hormone cortisol which takes the role of redistributing the energy levels. (Schore, 2002)

Post-Traumatic Stress Disorder (PTSD)

Sherin and Nemeroff’s describe PTSD:

“When trauma happens, for the majority the reaction is limited to an acute, transient experience. But for a significant minority of the population, the psychological trauma brought about by the profound threat leads to a longer-term syndrome that has been defined as PTSD in the clinical literature.” (2011).

When it is severe or continues for a longer time, dysregulation of the normal stress response and the Autonomic Nervous System occurs. Allan Schore (2002) clearly describes PTSD as “the result of not having dealt with the trauma or not having the capacity to ‘aversive experience’”.

PTSD is characterised by signs and symptoms existing beyond one month, and usually the reaction is grouped into three main domains, quite similar to Herman’s three categories:

1)    Reminder of the exposure (these can include flashbacks, intrusive thoughts, nightmares) – “Intrusion” 

2)    Activation (the person becomes hypervigilant/hyperaroused characterized by being easily startled, lack of sleep, irritability, impulsivity or anger) –  “Hyperarousal”

 3)    Deactivation (numbing, avoidance, hypoarousal (reduced heart and breathing rate, withdrawal, confusion, depression, amnesia, ‘spaced out’) – “Constriction”

 (Adapted from Herman, 1997 pp 35; Sherin and Nemeroff, 2011)

These reactions are ways that the body learns to cope and protect itself from the trauma recurring. For instance, some people may react to the trauma by experiencing a state of amnesia, where they have no memory of what had happened to them and that might be their only way of self-protection.

Conclusion

To conclude, I believe that trauma is traumatic because it has the ability to touch the deepest and most vulnerable sides of ourselves. But despite its powerful effect, each person is very different in how trauma can affect them. I believe the essence of trauma treatment is very much dependent on the therapeutic relationship and the uniqueness of the individual person being treated. I know there is no ‘magic wand’ that will take the pain away, or erase the past. But acknowledging and validating the persons experience is a way to say “I hear you, I see you, I understand you”, and perhaps having someone with you in your deepest moments might be a therapeutic way to cleanse the soul of some of that ‘unbearable pain’..

REFERENCES

Bromberg, P. M. (2011). The Shadow of the Tsunami: And the Growth of the Relational Mind. New York – Routledge.

Dass-Brailsford, P. (2007). A Practical Approach to Trauma: Empowering Interventions. Sage Publications.

DeYoung, P. (2003) Relational Psychotherapy: A Primer. New York: Brunner-Routledge

Herman, J. L. (1992). Complex PTSD: A Syndrome in Survivors of Prolonged and Repeated Trauma. Journal of traumatic stress, 5(3), 377-391.

Herman, J. L. (1997). Trauma and Recovery: The aftermath of Violence—From Domestic Abuse to Political Terror. New York: Basic Books.

Ogden, P., & Minton, K. (2000). Sensorimotor Psychotherapy One Method for Processing Traumatic Memory. Traumatology, 6(3), 149-173.

Schore, A. N. (2002). Dysregulation of the Right Brain: A Fundamental Mechanism of Traumatic Attachment and the Psychopathogenesis of Posttraumatic Stress Disorder. Australian and New Zealand Journal of Psychiatry, 36(1), 9-30.

Sherin, J. E., & Nemeroff, C. B. (2011). Post-Traumatic Stress Disorder: the Neurobiological Impact of Psychological Trauma. Dialogues in clinical neuroscience, 13(3), 263.

Stolorow, R. D. (2007). Trauma and Human Existence. New York: Routledge.