Lesson 2: An Introduction to Trauma Attention While many of us can agree upon some things that we would consider "traumatic" the actual experience of a traumatic event is very individual. How one person experiences a trauma can be very different than how someone else experiences a trauma. Consider the wide diversity of reaction to the 9/11 tragedy. We are not talking about the difference between a person who knew someone on the planes and someone who didn't. There are differences between the experiences of people who knew people who were killed compared to those who experienced the events via the media. What one person sees as traumatic will also not be what someone else sees as traumatic. One of the most dramatic applications of Psychosocial Rehabilitation philosophy is the validation that if the client feels it is traumatic, it is.
Learning Outcomes Upon completion of this lesson's material, students will be able to:
Teaching One of the most recent traumatic events in our US history includes the events in New York City and Pennsylvania on September 11, 2001. Here are stories about that day. Other types of traumatic event occur around us. Here is some information about the Station Nightclub Fire in 2003. Read about the event then read the journal article writtent about how the survivors coped with events of that night. Station Nightclub Fire https://en.wikipedia.org/wiki/The_Station_nightclub_fire Impact of Trauma article (Schneider, J., Trinh N., Selleck, E., Fregni, F., Salles, S., Ryan, C., & Stein, J. (2012). The long-term impact of physical and emotional trauma: The Station Nightclub Fire. PLoS ONE 7(10): e47339. doi:10.1371/journal.pone.0047339) ______________________________________________________________________________________________________________________ What is Trauma? The following information on trauma is from Esther Giller, President, Sidran Institute. This article originated as a workshop presentation at the Annual Conference of the Maryland Mental Hygiene Administration, “Passages to Prevention: Prevention across Life’s Spectrum,” May 1999.(Copyright 1999) from https://www.sidran.org/resources/for-survivors-and-loved-ones/what-is-psychological-trauma/ We all use the word “trauma” in every day language to mean a highly stressful event. But the key to understanding traumatic events is that it refers to extreme stress that overwhelms a person’s ability to cope. There are no clear divisions between stress, trauma, and adaptation. Although I am writing about psychological trauma, it is also important to keep in mind that stress reactions are clearly physiological as well. Different experts in the field define psychological trauma in different ways. What I want to emphasize is that it is an individual’s subjective experience that determines whether an event is or is not traumatic. Psychological trauma is the unique individual experience of an event or enduring conditions, in which:
Thus, a traumatic event or situation creates psychological trauma when it overwhelms the individual’s ability to cope, and leaves that person fearing death, annihilation, mutilation, or psychosis. The individual may feel emotionally, cognitively, and physically overwhelmed. The circumstances of the event commonly include abuse of power, betrayal of trust, entrapment, helplessness, pain, confusion, and/or loss. This definition of trauma is fairly broad. It includes responses to powerful one-time incidents like accidents, natural disasters, crimes, surgeries, deaths, and other violent events. It also includes responses to chronic or repetitive experiences such as child abuse, neglect, combat, urban violence, concentration camps, battering relationships, and enduring deprivation. This definition intentionally does not allow us to determine whether a particular event is traumatic; that is up to each survivor. This definition provides a guideline for our understanding of a survivor’s experience of the events and conditions of his/her life. Jon Allen, a psychologist at the Menninger Clinic in Houston, Texas and author of Coping with Trauma: A Guide to Self-Understanding (1995) reminds us that there are two components to a traumatic experience: the objective and the subjective: In other words, trauma is defined by the experience of the survivor. Two people could undergo the same noxious event and one person might be traumatized while the other person remained relatively unscathed. It is not possible to make blanket generalizations such that “X is traumatic for all who go through it” or “event Y was not traumatic because no one was physically injured.” In addition, the specific aspects of an event that are traumatic will be different from one individual to the next. You cannot assume that the details or meaning of an event, such as a violent assault or rape, that are most distressing for one person will be same for another person. Trauma comes in many forms, and there are vast differences among people who experience trauma. But the similarities and patterns of response cut across the variety of stressors and victims, so it is very useful to think broadly about trauma. Single Blow vs. Repeated Trauma
As traumatic as single-blow traumas are, the traumatic experiences that result in the most serious mental health problems are prolonged and repeated, sometimes extending over years of a person’s life. A chronic trauma involves events and experiences that are repeated over and over again. Natural vs. Human Made Varieties of Man-Made Violence
We must be careful about generalizations about child sexual abuse: research shows that about 1/3 of sexually abused children have no symptoms, and a large proportion that do become symptomatic, are able to recover. Fewer than 1/5 of adults who were abused in childhood show serious psychological disturbance. More disturbance is associated with more severe abuse: longer duration, forced penetration, helplessness, fear of injury or death, perpetration by a close relative or caregiver, coupled with lack of support or negative consequences from disclosure. Physical abuse often results in violence toward others, abuse of one’s own children, substance abuse, self-injurious behavior, suicide attempts, and a variety of emotional problems. Emotional/verbal abuse: Witnessing any type of abuse can traumatizing. Seeing anyone beaten is stressful; the greater your attachment to the victim, the greater the stress. Especially painful is watching violence directed towards a caregiver, leaving the child to fear losing the primary source of security in the family. Sadistic abuse – we generally think about interpersonal violence as an eruption of passions, but the severest forms are those inflicted deliberately. Calculated cruelty can be far more terrifying than impulsive violence. Coercive control is used in settings like concentration camps, prostitution and pornography rings, and in some families. One of the best-documented research findings in the field of trauma is the DOSE-RESPONSE relationship –the higher the dose of trauma, the more potentially damaging the effects; the greater the stressor, the more likely the development of PTSD. The most personally and clinically challenging clients are those who have experienced repeatedintentional violence, abuse, and neglect from childhood onward. These clients have experienced tremendous loss, the absence of control, violations of safety, and betrayal of trust. The resulting emotions are overwhelming: grief, terror, horror, rage, and anguish. Their whole experience of identity and of the world is based upon expectations of harm and abuse. When betrayal and damage is done by a loved one who says that what he or she is doing is good and is for the child’s good, the seeds of lifelong mistrust and fear are planted. Thus, the survivor of repetitive childhood abuse and neglect expects to be harmed in any helping relationship and may interact with us as though we have already harmed him or her.
Who Are Trauma Survivors? What are the Lasting Effects of Trauma?
Post Traumatic Stress Disorder (PTSD) is the only diagnostic category in the DSM (Diagnositic and Statistical Manual of Mental Disorder) that is based on etiology. In order for a person to be diagnosed with PTSD, there had to be a traumatic event. Because most diagnoses are descriptive and not explanatory, they focus on symptoms or behaviors without a context: they do not explain how or why a person may have developed those behaviors (e.g., to cope with traumatic stress). For purposes of identifying trauma and it adaptive symptoms, It is much more useful to ask “What HAPPENED to this person” rather than “what is WRONG with this person.” Symptoms as Adaptations The Use of Adaptive Coping Strategies Developmental Factors
Disruption of these tasks in childhood can result in adaptive behavior, which may be interpreted in the mental health system as “symptoms.” For example :
Physiologic Changes Cutting edge neurological research is beginning to show to what extent trauma effects us on a biological and hormonal basis as well as psychologically and behaviorally. Research suggests that in trauma, interruptions of childhood development and hypervigilance of our autonomic systems are compounded and reinforced by significant changes in the hard-wiring of the brain. This may make it even more challenging (but not impossible) for survivors of childhood trauma to learn to do things differently. But it may also hold the promise of pharmaceutical interventions to address the biological/chemical effects of child abuse. So, as scientists learn more about what trauma is, we are seeing see that it is truly a complex mixture of biological, psychological, and social phenomena. References
Additional References
Assessment Anonymous Discussion I'm going to create a discussion board in which you can post anonymously. In this section we can express our thoughts freely regarding the content of the class and our own experiences. This is not therapy but it can be a relief to be able to express strong thoughts in a forum such as this. This section is ungraded and there is no way for anyone, myself included, to know who has posted. Please refrain from comments about the class and focus on the content of the class (there are other forums for the class and those should not be anonymous). Lesson 2 Discussion (for online course only) In this discussion we are going to focus on the wide scope of this course. When we each think of trauma we think of different things or events. We might even place them in a sort of hierarchy meaning that some events are more traumatic than others. Post your own thoughts on defining trauma from the point of view of a Mental Health Worker. Lesson 2 Quiz Answer the following question in the appropriate assessment:
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