The purpose of this page is to give an overview of psychological trauma, and the neurological basis for seeing this is a ‘hidden injury’ to provide a rationale for public services being trauma informed. It is best to read this page before the page on attachment, as it is easier to get a grasp of the concept of traumatic stress first, before getting a sense of what trauma might look and feel like in a developmental context. The page is intended as an initial introduction and some references are given at for anyone who wants to extend their knowledge further.
What is trauma?
” We all have the right to feel safe all the time.” (Protective Behaviours)
It has taken a long time for human societies to learn that people can suffer psychological injuries after they have experienced traumatic events. Traumatic events are ones which involve actual or threatened injury or death or where there is a threat to the physical integrity of self. It has taken even longer for societies to learn that witnessing an event where others may come to harm is also causes the same sort of psychological damage.The feelings expereinced at the time involve helplesness, powerlessness, fear and horror. Initially experiences such as natrual disasters, war, seeing someone hurt or die, accidents, rape or physical attack were recognised as being traumatic. Over time other events have come to be seen as possibley causing trauma, such as difficult births, miscarriage, and child abuse. It has also become clearer how perception plays a role; it is the person’s understanding of what happened and how they understood the situation that is important.
Most people feel safe most of the time. This is not because the world is safe; feelings are not facts. Most people enjoy feeling a bit scared some of the time, for instance on a roller coaster or when they are watching a scary movie. However at these times people may feel frightened, but they feel safe even while they feel scared (Protective Behaviours). This is because they have control and can influence events. However in a traumatic experience, the survivor could do nothing to stop the terrifying thing from happening.
Psychological trauma is rooted in physiology. When we are scared- that is, when we do not feel safe- our body gets ready to protect us by generating small amounts of stress hormones. This is in fact good for us, and helps us cope with everyday stresses and strains. However, if we are really terrified, our body goes into fight/ flight mode. In children the attachment system is activated, as children are wired to seek out adult support when hurt or frightened. Our limbic system floods the body with stress hormones. This changes the functioning of the entire brain and body. The thinking, planning and language parts of the brain are taken over by the acting, feeling parts of the brain and the language parts of the brain are turned off. Phsycially the digestive system and sexual response system shuts down as they are not needed and the heart and breathing rate changes to power the muscles. If the dose of toxic stress is high enough the body may go into ‘freeze’ mode- where the mind protects itself and the body ‘freezes’. In large doses and over time these stress hormes are toxic to the nervous system. We can be injured by our own survical response.
One part of psychological trauma is INTRUSIVE experiences. The event is persistently relived by the person; perhaps through visual ‘flashback’ or perhaps through ’emotionally reliving the moment’. Some people have recurrent and upsetting dreams about what happened. This may mean that they suddenly act as if they were back in the moment of the traumatic event. At times can be hard for the survivor to be clear about the difference between the current time and the past. Something about a situation can trigger the traumatic memory and events now and in the past can merge together, so they seem like one single horrifying experience. At other times, thoughts or images about the traumatic event might come into the person’s mind unbidden, along with the same feelings that they had when it happened. This has been talked about as the ‘past not letting go of the survivor’, rather than the suvivor not letting go of the past. It is very distressing to be back in the moment when you thought you might be hurt or die, at any time, whether you want to or not. At times there may be clear triggers that set of an flashback or led to an emotional reliving of the moment. A triggers is something that is linked to the traumatic event, for instance if a person was just setting the table when there was a earthquakge, dinner time or forks or plates or the act of setting the table could all be triggers. Unfortunately triggers can link to one another, so if someone has a fllahabck which is really overwhelming whele setting the table another time, other things in the environment can become associated with that flashback, such as the diswasher, the TV or the phone ringing. These could then become triggers in their own right. Triggers an abound. Survivors can find one part of the event troubles them, but are puzzled and distressed because they cannot remember other parts of the event.
The other part psychological trauma involves AVOIDANCE. It is emotionally very painful to cope with the thoughts, feelings and events that go along with the psychological trauma. In order to recover the brain needs the levels of stress hormones to drop. In order to do this, people need avoid things that remind them of the trauma. It is hard for the mind to pull this one off; if the person knew they were avoiding being reminded of the traumatic event, this would actually remind them of it. This is like not thinking of pink elephants!
Survivors are on high alert, so they can be irritable and jumpy and find it hard to concentrate or remember things. They may have aches and pains, stomach and digestion issues. They may also have an exaggerated startle response.
Survivors may recover spontaneously from the experience of traumatic stress, this may have to do with their previous experiences in life and the type of stressor and how long the traumatic events went on for, or whether there was just one or a series of traumatic events. Others may go on to develop post traumtic stress disorder. In this case,the process of recovery from the trauma gets stuck, either because the survivor cannot regain a sense of safety, or because the right socail supports aren’t available, so the levels of stress hormones remain at a damaing level. Psychiatrists have decided that if the survivor experiences distress and these avoidant or instrusive symptoms which are wide ranging and lead to difficulites for the person in their social life, at home or at work and that the person has experienced them for at least a month, to meet the criteria for Post Traumatic Stress Disorder. In either case, three things are necessary for recovery (Cairns, 2009):
- Safety and stability– we cannot begin to recover from trauma until we are well away from the things that threatened us. We need to feel phsysiologically safe. Physiological safety is not the same as being objectively safe. It happens when the stress hormones which are injuring the brain and changing the way it functions start to fall, so that they are not at such a toxic level. This allows the brain to start to heal.
- Secure social relationships with well-formed attachment relationships- in order to process trauma we need social support “recovery from trauma is a psychosocial process, which takes us on a journey requiring us to find both witnesses and companions who will love us enough to hold us steady as we face our terrors” (Kate Cairns, 2009 pp103)
- The ability to express what happened- we need to be able to change the fragmented impressions from the traumatic event into a form that we can grasp and which connects all the elements of the experience together. This can be verbally, through art, music dance or (for children) play.
What do public services need to do?
Survivors find it harder to recover if:
- their experience of a horrific event is not recognised or believed– for instance rape vicitms often find that the rape is not seen as an attack but that other people choose not to belive that it happened or reframe the attack as sex
- they are blamed for the traumatic event, even if they were not responsible for the situation, for instance, victims of bullying who are blamed for the actions of the bullies because they did not fit in in some way
- they have to keep on telling their story to lots of different people, when their feelings about the event are overwhelming or too distressing e.g. if a lot of helpers ask them to say what happened first the GP, then a counsellor, then the vicar, then the family..
- there are triggers for the trauma that they cannot avoid so they are constantly overwhelmed by the feelings associated with the event
- they are still in a situation where hey have little control or choicet
- they cannot find one place where they feel physiologicaly safe
It seems to me that it is hard to categorise how much harm is being experienced by looking at the number of people who are given a diagnosis of PTSD (or a related disorders). After a traumatic event everyone involved experiences some form of distress and there has been some form of harm. Some people recover spontaneously. Some people go on to hurting in ways that seem to really get in the way of them getting what they want to out of their work, social or home life. Other people may be hurting in different ways or showing their distress in ways that are harder for us to recognise.
At the moment our social structures seems to find it hard to really grasp what we can do to help people more when terrible events happen, or what to do to avoid preventable harm. Public services are often set up so that someone has to keep on telling their stories to other people and most services do nota ctively discuss what helps there service users feel safe and secure. Often services are set up so that people have to keep on telling and retelling their story over and over again, activley give service users choice and control. Often people who have been traumatised ar re-traumatised by the services that are meant to help them; so
Kinchin D. (2004). Post Traumatic Stress Disorder: The Invisible Injury.
Bessel van der Kolk (2015). The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma.