What is Trauma: Life Event, Diagnosis or Experience?

Trigger warning

The word ‘trauma’ has slipped into everyday language in ways that I think are unhelpful for many traumatised people. True, few of us are spared some contact with real trauma at some point in our lives. But it has become too easy to respond to commonplace disruptions to life by claiming ‘It was so traumatic!’ I am not trying to suggest that, for example, having your purse stolen or missing a connection is not enormously stressful, challenging and inconvenient, but these are not usually traumas in a specific sense. A consequence of sloppy use of the word is that it can minimise the real horrors of post-traumatic reactions and reduce sympathy for sufferers. Let’s not forget that PTSD has been said to be one of the most serious mental health issues of our time (Davidson, 2000).

So, what is the difference between disruptive and unexpected life events and true trauma? Firstly, these life events are not usually enduring in their effects – we may be significantly impacted by them but only for a relatively short period of time. True trauma, on the other hand, endures for a very long time, often decades. It is a chronic condition. Secondly, while we may need to make changes in response to life events, we usually find ways of adapting and moving on. Mostly we can make choices about what we need to do. On the other hand, genuine trauma tends to encompass many areas of peoples’ lives and radically alters their physiology, their brain function and structure, even. In these aspects they have virtually no control over their lives. A defining feature of real traumatic events is the sense of threat to on-going life.

One description of the massive impact of trauma that I have liked for many years comes from Judith Herman Lewis’ classic book Trauma and Recovery: ‘‘Traumatic events call into question basic human relationships. They breach attachments of family, friendship, love, and community. They shatter the construction of the self that is formed and sustained in relation to others. They undermine the belief systems that give meaning to human experience. They violate the victim’s faith in a natural or divine order and cast the victim into a state of existential crisis……Traumatic events destroy the victim’s fundamental assumptions about the safety of the world, the positive value of the self, and the meaningful order of creation.’’ With a sharper focus on the body, I have taken the liberty of it putting it into my own words, thus: ‘Traumatic events call into question our basic relationship with our bodies. They breach the attachments of skin, bone, senses, blood and organs. They shatter the construction of the body that is formed and sustained in relation to others. They undermine the belief in our physical existence that is the basis of our  human experience. They violate the victim’s faith in a natural or sacred body and cast the victim into a state of existential crisis. Traumatic events destroy the victim’s fundamental assumptions about the safety of the body, the positive value of the body, and the meaningful order in its creation. Traumatised bodies feel utterly abandoned, utterly alone, cast out of the human and divine systems of care and protection that sustain life’.

What I maintain is that a trauma reaction is not so much about the event that precipitated it, but about the impact and experience of the victim. There is no hierarchy of trauma, though it is clear from research that early childhood developmental trauma causes immense damage and takes a very long time to recover from.

Having said all this, I think there is a grey area between troublesome life events and real trauma. Situations like living in severe poverty or being diagnosed with a life-changing or limiting illness can be experienced as traumatic, most likely because the need for survival comes into play.

I happen to be a therapist who resists diagnosis, agreeing with Stolorow that ‘To attribute the affective chaos ….of patients who were abused as children to ‘fantasy’ or to ‘borderline personality organization’ is tantamount to blaming the victim and, in doing so, reproduces features of the original trauma’. To call people who are so affected ‘disordered’ as in the ‘D’ of PTSD misses completely their sense of injury and their hope for recovery. It is possible to re-frame the diagnostic criteria of the DSM into some short statements, closer to the phenomenology of the victim which can be summed up as : ‘I feel out of control’; ‘I feel unsafe’; ‘I fear I will die’.

The reach of trauma is far further than many people imagine. Let’s not isolate victims further by being careless in how we think and talk about it.

Davidson, J.R.T., 2000, New Strategies for the Treatment of Posttraumatic Stress Disorder, Journal of Clinical Psychiatry, Vol. 61, Supplement 7

Herman, J. L., 1992, Trauma and Recovery: From Domestic Abuse to Political Terror, Basic Books, London

Stolorow, R.D., 2007, Trauma and Human Existence: Autobiographical, Psychoanalytic and Philosophical Reflections, The Analytic Press, New York