Dr. Brent Potter
If you’re looking for a current, accurate trauma definition, this article will provide helpful information.
Trauma is defined as a deeply distressing or disturbing experience. It can be defined as a state where a previous equilibrium favoring life is irrevocably altered.If death does not occur, a compromised equilibrium is established. It is like a bone fracturing after being bent and stressed and then repairing leaving a permanent vulnerability, or a wound that will leave a scar and sensitivity.
There is no doubt that people report feeling depressed, anxious, experiencing unusual states of consciousness, etc. Mercifully, today we know the causes of these forms of distress which also contribute to a host of physical ailments.
We don’t need more research. Trauma is painful and when we dare not look at it in ourselves and therefore, we do not open to its existence in others, we are forced to look for all kinds of other reasons. If you deny pain that goes to early experience and early loss and early trauma, then the world becomes extremely complicated and you find yourself coming up with all kinds of complicated explanations.
Yet if we see that a child has certain needs and, if you meet those needs, that child will be just fine and, if you don’t, he’ll have to adapt somehow and those adaptations will become the basis of dysfunction later on. Some might call that simplistic, but it is not simplistic, it’s simple. The world is quite simple, but we make it complicated because of our denial.
We have the evidence, it’s just that the evidence is not incorporated. So, when people talk about evidence-based practice, they are looking at a specific kind of a very narrowly defined sense of evidence. If you look at the science you can see how the children’s brains develop, how the chemistry of the brain develops, and how behaviors occur as a response to either nurturing or emotionally impoverished environments. We do not need more research. (Mate, 2012)
The question naturally arises as to where distress comes from, if not from brain diseases. The answer, as succinctly put by Mate, is clear: developmental stress and trauma. The word ‘trauma’ comes from the ancient Greek τραῦμα (wound, damage), which is akin to θραύω (to break, break in pieces, shatter, smite through). As previously mentioned, trauma is inherent in life. It and its outcomes vary in degree, but not kind, from those labeled as insane.
Epstein (2013) in his The Trauma of Everyday Life, aptly points out that it is impossible to avoid trauma. No matter how well-intentioned, well-resourced, educated, or any other positive attribute one may have, he or she will invariably experience stress, loss, grief, sickness, or hardship of one kind or another.
No one is spared from experiencing trauma to a greater or lesser degree. Imagine, if you will, one such event in your life. Now imagine if the felt sense of that event was multiplied exponentially or if there were a series of such events. It is not at all difficult to imagine the sum of the impacts this would have.
For some people, stress and trauma are normative. When this happens, especially during formative developmental years, the result is often something that will likely be labeled as mental illness and/or substance abuse or dependence in adulthood.
As Mate points out, the research is clear and unambiguous on this score. Of the voluminous studies presently accessible, there are The Collaborative Longitudinal Personality Disorders Study (Gunderson et. al., 2000) and the Centers for Disease Control and Prevention & Kaiser Permanete’s (1998) Adverse Childhood Experiences (ACE) Study.
The ACE Study used a staggering 17,000+ Kaiser Permanente patients who volunteered as subjects. This is one of the largest studies of its kind and the data it yielded continues to be analyzed to this day.
So far, it demonstrates concretely the psychological and physical health vulnerabilities resulting from developmental stress and trauma. An event of adverse childhood stress or trauma was dubbed as an Adverse Childhood Experience or ACE for short.
Shockingly, almost two-thirds of participants reported at least one ACE. More than one in five reported three or more ACEs. Undoubtedly, both the short- and long-term outcomes of ACE manifest in several psychological and often physiological ailments.
Specifically, the study analyzed the ACE score in such a fashion that each ACE counts as 1. ACE scores are tallied and statistically correlated to various forms of psychological and physical pathologies.
As ACE numbers increase, so too (and often exponentially), does the risk for the following conditions in adulthood: alcoholism, chronic obstructive pulmonary disease (COPD), depression, fetal death, health-related quality of life, illicit drug abuse, ischemic heart disease (IHD), liver disease, the risk of intimate partner violence, multiple sexual partners, sexually transmitted diseases (STDs), cigarette smoking, suicide attempts, unintended pregnancies, early initiation of tobacco smoking, early initiation of sexual activity and adolescent pregnancy.
The list is more comprehensive as the data is subject to different correlational studies. I invite you to follow the link provided in the reference section to read the original study as well as the others. The outcomes of all the studies are quite startling.
The ACE Study, as already mentioned, is not comprehensive. For the sake of keeping the study manageable, it focused on ten kinds of ACE events. Five are personal and include physical abuse, verbal abuse, sexual abuse, physical neglect, and emotional neglect.
The other five pertain to other family members: an alcoholic parent, a parent who is the victims of domestic violence, an incarcerated family member, a family member diagnosed with a mental illness, and the disappearance of a parent through diverse, death, or abandonment.
Moreover, the ACE Study focused exclusively on these types of events. It is highly likely that other ACE not presently outlined in the study would increase one’s risk of chronic psychological or physical ailments. Basically, the higher the ACE score, the higher the risk of serious illness of one sort and/or another in adulthood.
An astonishing two-thirds of the 17,000+ participants in the ACE Study had an ACE score of at least one and, of these, 87% had more than one. With an ACE score of four or more, things become gravely serious. For example, the likelihood of COPD increases 390%; hepatitis, 240%; depression 460%; suicide 1,220 %.
To their credit, the researchers note, “Of course, other types of trauma exist that could contribute to an ACE score, so it is conceivable that people could have ACE scores higher than 10; however, the ACE Study measure only 10 types” (CDC & Kaiser Permanente, 1998).
It is important to note one important kind of trauma that has received little focus in the literature but is just as impactful and destructive: unremitting generalized environmental stress. The ten types of trauma accounted for in the ACE Study and other studies are the kind of traumas that are overt, obvious. However, this does not account for other kinds of objectively present trauma as well as qualitative trauma such as unremitting generalized environmental stress.
There are, for example, patterns of communication and power dynamics that are less overt. This received some attention in the literature with Gregory Bateson (1956), whose notion of the double-bind was highly informative in understanding how early stress informs psychopathological outcomes in adult life.
This notion is picked up later in the work of Laing and others. In extremely toxic homes, anything the child does in keeping with the wishes of one caretaker simultaneously upsets the other. The child finds himself or herself in a situation where there is no chance of success. The eleven families Laing and Esterson describe in Sanity, Madness, and the Family (1970) reflect these dynamics.
While this description has been criticized as essentially blaming the parent (especially the mother), it is still important to note the phenomenon of the double bind and other “no way to win” communications and relational dynamics that produce stress and trauma. It need not be literalized to blaming one or the other parent.
This is similar to the kind of environments articulated so well by such programs as Adult Children of Alcoholics (ACAs) and one does not need to be the child of an alcoholic to be raised in a household where these pathogenic dynamics are present. ACAs give voice to this confused and confusing communication network with the phrase, “Don’t trust. Don’t talk. Don’t feel.”
Obviously, it is natural for children to want to trust caregivers and others. When this trust is violated, children learn to associate trust with vulnerability and/or being hurt. This is distressing because the child is caught between the natural desire to trust and bond and the mutually conflicting fear of being vulnerable or hurt.
Keeping one’s feelings entirely sequestered, internalized means safety yet profound loneliness and disconnectedness. One sacrifices personal relatedness for safety and survival. Often others may not even pick up on how alienated the child feels. Keeping everything private can later manifest in a variety of ways, not just silence or withdrawal.
Some children learn to keep intensely private by using humor or charm to deflect or compensate. Much of Laing’s work demonstrates how the “schizoid” or “schizophrenic” individual utilizes the philosophy of “the best defense is a good offense.” Often the seemingly bizarre behaviors are used as a strategy, albeit an odd one, to throw people off course from paying attention to their true selves.
This kind of compensation, though, need not be as extreme as “schizoid” or “schizophrenic”. Some people, including children and adolescents, are quite adept at using humor, charm, etc. to keep people from paying attention to their true selves. The name of the game is invisibility, so individuals may employ several defensive maneuvers to keep others off their track.
So, this child or teen may be quite charming, gregarious, and even masterful in relationships, and yet dying emotionally. Or the child or teen may withdraw, isolate, or retreat into a private fantasy world. In both directions, the affective tone is stress and the effect is disturbing, possibly traumatic.
Aside from the unremittingly stressful home environment, one has the added pressure of maintaining a private, safe self, used to keep others at bay. The unpredictable, unstable stress-inducing home environment leads to an internal bifurcation in the child between the self that is private and protected and the self that others see.
To add another layer, the more one invests in these two selves, the more one needs to invest in them. Emotional life and relatedness with others can only be evaded for so long. Along with the shutdown of the ability to communicate one’s true self, goes emotional shutdown.
Emotional shutdown is another self-protective maneuver. A fragmenting of one’s sense of self under increasing emotional anguish occurs. However, it is impossible to simply target and eliminate the particulars that are causing pain – abandonment, loneliness, desperation, engulfment, deprivation, guilt, remorse, implosion, anxiety, shame, anger, resentment, depression, dread, petrification.
An attempt to kill the pain is an attempt to kill off all existential-psychic reality and emotional life. A useful metaphor to understand this may be the body’s use of fever as a defense mechanism for killing off infection. In some instances, the fever response is quite effective in killing off the infection, but it is not always effective at returning to baseline temperature.
The body’s natural response to a threat may, in and of itself, prove fatal to the organism in its entirety. Shutting down one emotion means shutting down the others as well. This strategy, while beneficial or even lifesaving in the short-term has long-term consequences. Learning to shut down emotional life in childhood atrophies the capacity to relate to self and others, to have a felt sense of connectedness, embodiment, and affective attunement.
There is a vapid and vacuous sense that grows as one drifts from a feeling of being continuous in time and a shared world with others. Along with emptiness, grows a frightening realization of one’s inability to connect with others, to be spontaneous and perhaps suspicious of others’ motives or a tyrannical internal critic.
Protecting the private self through voiding feeling comes at the cost of psychological and social life and growth. Later in life, one may have lost sight of shore, so to speak, unable to articulate or even remember how one shut down emotional life. Problems crop up and one is unable to differentiate or understand what one is feeling.
Or the warning signals of emotional life may not be sent at all. The logic of the fantasy seems to be feeling is the issue and feelings do not exist, then my problems do not exist. The “Don’t trust. Don’t talk. Don’t feel.” established early on, now working in tandem and effectively so.
Such patterns, though often not as objectively present as those outlined in the ACE Study, are no less devastating in the toll they take in later life. Qualitatively and quantitatively present trauma are quite destructive on their own.
When combined in varying ways, they form a juggernaut of destructive impact upon later life. The manifestations of what is known as borderline personality disorder are not only easily understood relative to these kinds of trauma but are the logical outcome.
It is as if people exposed to these kinds of trauma do not stand much of a chance at all. And, by the way, the 17,000+ participants in the study are not representative of the populations exposed to the most egregious and protracted forms of trauma – that is, non-white populations and/or those living in grinding poverty.
“The study’s participants were 17,000 mostly white, middle, and upper-middle-class college-educated San Diegans with good jobs and great health care – they all belonged to the Kaiser Permanente health maintenance organization.)” (CDC & Kaiser Permanente, 1998). One can only assume, quite reasonably, that the impact is much greater on these vulnerable populations (Gunn & Potter, 2014).
Bateson, G., Jackson, D. D., Haley, J & Weakland, J. (1956). “Toward a theory of schizophrenia.” Behavioral Science, 1, 251-264.
Centers for Disease Control & Kaiser Permanenete, (1998). The Adverse Childhood
Experiences Study. [Online] Available: http://acestudy.org/
Epstein, M. (2013). The trauma of everyday life. New York: The Penguin Press.
Gunderson, J.G., Shea, M.T., Skodol, A.E., McGlashan, T.H., Morey, L.C., Stout,
R.L. … Keller, M.B. (2000). The collaborative longitudinal personality disorders study: Development, aims, design, and sample characteristics. Journal of Personality Disorders, 14(4), 300-15.
Gunn, J & Potter, B. (2014). Borderline personality disorder: New Perspectives on a Stigmatizing & Overused Diagnosis. Westport, CT: Praeger.
Laing, R.D. & Esterson, A. (1970). Sanity, Madness, and the Family. New York: Penguin Books.
Mate, G. (2012). Gabor Mate, M.D.: Attachment = wholeness and health or disease, ADD, addiction, violence. Retrieved 2/28/14 from http://vimeo.com/55416414
Potter, B. (2015). Elements of Reparation. London: Karnac Books.
“Offering,” courtesy of Lina Trochez, unsplash.com, CC0 License “There is Always Hope”, Courtesy of Ron Smith, Unsplash.com, CC0 License; “Green Leaf”, Courtesy of Ravi Roshan, Unsplash.com, CC0 License; “The Milky Way”, Courtesy of Greg Rakozy, Unsplash.com, CC0 License