REFLECTIONS ON TRAUMA
By Mickey Skidmore, AMHSW, ACSW, MACSW
When I began providing contractual therapy services for Open Arms about a year ago, I also began to prepare myself for the potential to be working with clients who had experienced trauma. While I’m not old enough to have been around when they referred to PTSD as “shell shock”, I am old school enough that I was trained that PTSD was the result of people experiencing or witnessing catastrophic events, such as war, earthquakes, natural disasters — in other words, circumstances that are well beyond the boundaries of normal day-to-day happenstance. Working with soldiers and their families, I anticipated that I might encounter an increase in underlying PTSD conditions in addition to the adjustment challenges that many military families endure.
Around the same time, I was also noticing a linguistic and conceptual shift with increasing numbers of my clients in private practice. Some of them were suggesting that missing their bus was “traumatic.” Or that that they were traumatised when they were anticipating a bowl of cereal for breakfast only to discover that the box was empty or the milk had soured. Still others conveyed they were traumatised by stubbing their toe on a piece of furniture on the way to the bathroom in the middle of the night with the lights out. (In some ways I understand this, as physical injury is one of the oldest and broadest definitions of trauma). In short, I noted increasing numbers of people that quickly and easily coalesced around the view that nearly every unfortunate or stressful experience was “traumatic.”
For the past 25 years I have included the concept of trauma in my orientation to grief work (noting that clients who experience trauma tend to exhibit going through phases similar to a grief process). However, as I reflected on this, I found myself becoming increasingly uncomfortable with an oversimplified and cavalier conceptualisation of trauma. From a client centred perspective, I questioned: “who am I to determine what is traumatic for someone else?” And while this helped to check my own potential biases about this, I also relied on science and the neurological reactions that individuals who have been traumatised experience. The typically involuntary reactions that such individuals experience can be viewed as confirming symptoms of someone who has witness or otherwise directly experienced trauma.
There were considerable changes in our understanding and appreciation for trauma in the DSM-V. With each revision of the DSM, the definition and criteria for PTSD have changed considerably. Perhaps the most substantial conceptual change in the DSM-5 for PTSD was the removal of the disorder from the anxiety disorders category, to a new diagnostic category named “Trauma and Stressor-related Disorders”, given considerable research has demonstrated that PTSD entails multiple emotions (e.g., guilt, shame, anger) outside of the fear/anxiety spectrum.
Regardless of how definitions of shifted over time, most people recognise sexual violence as an interpersonal trauma. It is also understandable that a significant death might also be viewed by many as traumatic as well. And there are additional circumstances that many may include in their “traumatic” vernacular. For example, many recognise bullying to be a complicated and vexing issue across the developmental spectrum. However, I have reservations about characterising this dynamic as trauma, and I am not certain it its clinically useful to think of it with this frame of reference.
While there may be debate regarding this, I submit the following: not all stressful, unfortunate, or even tragic events necessarily involve trauma. Stressful events not involving an immediate threat to life or physical injury such as psychosocial stressors (e.g., divorce or job loss) are not considered trauma in the DSM-V definition. Non-immediate, non-catastrophic life-threatening illness, such as terminal cancer, no longer qualifies as trauma, regardless of how stressful or severe it is. Medical incidents involving natural causes, such as a heart attack, no longer qualify (with limited exceptions). In short, I suppose my point is simple. If people view everything through the lens of trauma, then in many respects, are we not trivialising those who endure such unfortunate and profound experiences?
1) Statistical Manual of Mental Disorders (DSM-5).