Psychological trauma

Psychological trauma is a type of damage to the psyche that occurs as a result of a traumatic event. A traumatic event involves a singular experience or enduring event or events that completely overwhelm the individual's ability to cope or integrate the ideas and emotions involved with that experience. Trauma can be caused by a wide variety of events, but there are a few common aspects. It usually involves a complete feeling of helplessness in the face of a real or subjective threat to life, bodily integrity, or sanity. There is frequently a violation of the person's familiar ideas about the world, putting the person in a state of extreme confusion and insecurity. This is often seen when people or institutions depended on for survival violate or betray the person in some unforseen way.

Psychological trauma may accompany physical trauma or exist independently of it. Typical causes of psychological trauma are abuse, violence, the threat of either, or the witnessing of either, particularly in childhood. Catastrophic events such as earthquakes and volcanic eruptions, war or other mass violence can also cause psychological trauma. Long-term exposure to situations such as extreme poverty or milder forms of abuse, such as verbal abuse, can be traumatic (though verbal abuse can also potentially be traumatic as a single event). In some cases, even a person's own actions, such as committing rape, can be traumatic for the offender as well as the victim, especially if the offender feels helpless to control the urge to commit such crimes.

However, different people will react differently to similar events. One person may perceive an event to be traumatic that another may not, and not all people who experience a traumatic event will become psychologically traumatized.

Symptoms of trauma

People who go through traumatic experiences often have certain symptoms and problems afterward. How severe these symptoms are depends on the person, the type of trauma involved, and the emotional support they receive from others. This section is a general listing of possible symptoms, and is not exhaustive. Reactions to and symptoms of trauma can be wide and varied, and differ in severity from person to person. A traumatized individual may experience one or several of them.

After a traumatic experience, a person may re-experience the trauma mentally and physically. Because this can be uncomfortable and sometimes painful, survivors tend to avoid reminders of the trauma. They may turn to alcohol and/or drugs to try and escape the feelings. Re-experiencing symptoms are a sign that the body and mind are actively struggling to cope with the traumatic experience. Triggers and cues that are reminders of the trauma can cause anxiety and other associated emotion. Often, the person can even be completely unaware of what the trigger is. Panic attacks can result from these emotional triggers.

Intense feelings of anger may surface frequently, sometimes in very inappropriate or unexpected situations, since danger seems to always be present. Upsetting memories such as images, thoughts, or flashbacks may haunt the person, and nightmares may be frequent. Insomnia may occur as lurking fears and insecurity keep the person vigilant and on the lookout for danger, both day and night.

In time, emotional exhaustion may set in, leading to distraction, and clear thinking may be difficult. Emotional detachment, also known as dissociation or "numbing out", can frequently occur. Dissociating from the painful emotion includes numbing all emotion, and the person may seem emotionally flat, preoccupied or distant. The person can become confused in ordinary situations and have memory problems.

Some traumatized people may feel permanently damaged when trauma symptoms don't go away and they don't believe their situation will improve. This can lead to feelings of despair, loss of self-esteem, and frequently depression. If important aspects of the person's self and world understanding have been violated, the person may call their own identity into question.

These symptoms can lead to stress or anxiety disorders, or even post traumatic stress disorder, where the person experiences flashbacks and re-experiences the emotion of the trauma as if it is actually happening.

Situational Trauma

Trauma is well-known in genocide, war, and crime situations. It is almost always seen in torture victims (see psychology of torture). It also occurs in natural and man-made disasters, castastrophic mishaps, and medical emergencies. Here treatment for trauma is often either not sought, or is not avaiable. It is common, but less often identified in situations of domestic violence, pedophilia, and incest. It also occurs in victims of child or elder abuse. Victims in situations of pedophilia, domestic violence, and neglect are often not identified by caregivers and are also unlikely to receive proper treatment for ongoing trauma.

Trauma is often defined as a coping response to and a consequence of overwhelming situations. However, since overwhelm is subjective the occurrence of trauma is also subjective. There is evidence to suggest that how people cope with extremely stressful situations is associated to the traumas so suffered. Those people who cope well often show few signs of trauma while those who choose to overwhelm often suffer trauma afterward.

There is evidence from disasters that shows that some people proact, some people react, and some people overwhelm to the point of doing nothing in extreme situations. Those people who proact often overcome the extreme stresses and cope well in the situation, while those people who react often cope less well. Those people who overwhelm often die in their original positions with no noticeable coping actions. These observations suggest that overwhelm (and its associated trauma) is connected to these independent coping abilities.

There is also a distinction between trauma induced by recent situations and trauma that has been buried in the unconscious from past situations such as childhood abuse. Trauma induced from recent situations is known as 'simple' trauma in the psychological literature. Trauma from long past situations is known as 'complex' trauma. However, there is nothing simple about either form of trauma and both forms can be induced by extreme situations.

Trauma in psychoanalysis

French neurologist Jean-Martin Charcot argued that psychological trauma was the origin of all instances of the mental illness known as hysteria. Charcot's "traumatic hysteria" often manifested as a paralysis that followed a physical trauma, typically years later after what Charcot described as a period of "incubation" ^[1].

Sigmund Freud, Charcot's student and the father of psychoanalysis, examined the concept of psychological trauma throughout his career. Jean Laplanche has given a general description of Freud's understanding of trauma, which varied significantly over the course of Freud's career: "An event in the subject's life, defined by its intensity, by the subject's incapacity to respond adequately to it and by the upheaval and long-lasting effects that it brings about in the psychical organisation" ^[2].

Trauma and stress disorders

In times of war, psychological trauma has been known as shell shock or combat stress reaction (CSR). Psychological trauma may cause acute stress disorder (ASD) which may lead on to posttraumatic stress disorder (PTSD). PTSD can also develop without an antecedent ASD and may come on months or years after the trauma. Both ASD and PTSD are specific disorders in which the traumatized individual may experience nightmares, avoidance of certain situations and places, depression, and symptoms of hyper-activation. PTSD emerged as the label for this condition after the Vietnam War in which many veterans returned to their respective countries demoralized, and sometimes, addicted to drugs.

Psychological trauma is treated with therapy and, if indicated, psychotropic medications. Recent studies try to show the effect of trauma on human memory. This kind of study is useful in order to verify the attendibility of eyewitnesses involved in criminal acts.

Therapies used in the treatment of psychological trauma include: Cognitive therapy (CBT), Brief therapy, Psychodynamic psychotherapy, Play therapy, Traumatic Incident Reduction (TIR), EMDR and Dialectical behavioral therapy (DBT).

Following traumatic events, persons involved are often asked to talk about the events soon after, sometimes even immediately after the event occurred in order to start a healing process. This practice may not garner the positive results needed to recover psychologically from a traumatic event. Victims of traumatic occurrences who were debriefed immediately after the event in general do fare better than others who received therapy at a later time. Yet, there is one indication that forcing immediate debriefing may even distort the natural psychological healing process ^[3].

Growth aspects of trauma

Though the idea of trauma is most frequently thought of in negative terms, it is also often seen to have positive aspects. Many people, such as Christopher Reeves and Rick Hansen, have overcome traumas and moved on to become inspirational figures. This growth, first called posttraumatic growth in 1996 by psychologists Richard Tedeschi and Lawrence Calhoun, can involve changes in how people think of themselves, their relationships with others, including all of humanity, as well as profound philosophical, spiritual, or religious changes.

According to Lawrence G. Calhoun and Richard Tedeschi, both professors at the University of North Carolina at Charlotte, trauma experiences can lead to growth, though this is not inevitable. ^[4] They have found that "reports of growth experiences in the aftermath of traumatic events far outnumber reports of psychiatric disorders." They state that these changes can include

...improved relationships, new possibilities for one's life, a greater appreciation for life, a greater sense of personal strength and spiritual development. There appears to be a basic paradox apprehended by trauma survivors who report these aspects of posttraumatic growth: Their losses have produced valuable gains ...They also may find themselves becoming more comfortable with intimacy and having a greater sense of compassion for others who experience life difficulties.

Still, they add, "posttraumatic growth does not necessarily yield less emotional distress."

...posttraumatic growth occurs in the context of suffering and significant psychological struggle, and a focus on this growth should not come at the expense of empathy for the pain and suffering of trauma survivors. For most trauma survivors, posttraumatic growth and distress will coexist, and the growth emerges from the struggle with coping, not from the trauma itself.

They point out that "there are also a significant number of people who experience little or no growth in their struggle with trauma."

References

DePrince, A.P. & Freyd, J.J. (2002). "The Harm of Trauma: Pathological fear, shattered assumptions, or betrayal?" In J. Kauffman (Ed.) Loss of the Assumptive World: a theory of traumatic loss. (pp 71-82). New York: Brunner-Routledge. [5]
Effects of Traumatic Experiences National Center for PTSD by Eve B. Carlson, Ph.D. and Josef Ruzek, Ph.D.
University of Saskatchewan: A list of trauma symptoms
Loyola College in Maryland: Trauma and Post-traumatic Stress Disorder

External links

http://www.ptgi.uncc.edu/ Posttraumatic Growth Research and Resources maintained by Lawrence Calhoun and Richard Tedeschi
Power-Under: Trauma and Nonviolent Social Change -- a book by Steven Wineman
Emotional and Psychological Trauma: Causes, Symptoms, Effects, and Treatment
Responding to Natural Disaster: Mental health resources for Parents and Families
Disaster help for parents and children
Coping with Disasters: Natural, War, Rape and Other Traumas
Assisting Children and Adolescents in Coping with Violence and Disasters

Notes

^ Laplanche, J. and Pontalis, J.B. (1967). The Language of Psycho-Analysis. W. W. Norton and Company. p. 469. ISBN 0-393-01105-4.{{cite book}}: CS1 maint: multiple names: authors list (link)
ibid p. 465
^ Richard J. McNally, Richard A. Bryant, and Anke Ehlers (2003). "Does early psychological intervention promote recovery from posttraumatic stress?". Psychological Science in the Public Interest. 4 (2): 45.{{cite journal}}: CS1 maint: multiple names: authors list (link) Abstract
^ Paul T. P. Wong, PhD. C. Psych. Pathways to posttraumatic growth, International Network of Personal Meaning.
^ Richard G. Tedeschi, Ph.D., and Lawrence Calhoun, Ph.D. "Posttraumatic Growth: A New Perspective on Psychotraumatology" Psychiatric Times, April 2004, XXI(4).