What trauma is and why chronic adversity counts as trauma too

Trauma blog post

In common parlance, ‘trauma’ is often defined by the nature of the event itself. Even in the psychiatry movement this can be seen – e.g. -the definition of trauma as “exposure to actual or threatened death, serious injury, or sexual violence” (American Psychiatric Association [APA], 2013, p. 271). Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). However, this definition stands in contrast with most, not only because it defines trauma by the type of event rather than the event’s impact, but because it takes such a limited view of the types of event that constitute ‘traumatic’.

Although trauma has been defined in numerous ways across different disciplines, most trauma experts agree that trauma is the response to certain events such that ‘Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.

This is how SAMHSA (Substance Abuse and Mental Health Services Administration) define trauma. In keeping with most definitions, this is a functional definition – i.e. trauma is defined by its function- ie its impact – rather than any innate quality of the event(s) that precede it. This impact is often described psychologically – focusing on the experiential emotional responses of fear, helplessness and loss of control Herman J.L.(1992).

Both Herman and famous psychiatrists such as Freud understand traumatic events to be those which ‘overwhelm the ordinary human adaptations to life’ Herman J.L.(1992). This notion of ‘overwhelm’ is key – in contrast with  usual human adaptations, we experience powerful bodily and psychological responses such as disassociation. Although these responses are understood by some as a  natural and adaptive response to overwhelm (disassociation for example provides reprieve from difficult feelings and memories), the key point remains – when an event or series of events overwhelms us, and we cannot draw on usual resources to cope, then a series of trauma responses will be invoked. Similarly, traumatic stress is widely seen as a maladaptation to trauma – i.e. it occurs when the normal process of experiencing traumatic events, undergoing trauma responses and then recovering, is arrested in some way.

But where does chronic stress, chronic adversity and repeated trauma fit into this narrative? The focus on Potentially Traumatic Events (PTEs) came about to make the study of resilience easier. Yes, you read that right. A classic case of changing how we perceive reality in order to make research easier to do – more on that another time! Prior to that focus (which began in the 80s) trauma was widely accepted to include emotional responses to chronic adversity or less immediately-shocking but repeated harms. Indeed the psychological definition above is clearly congruent with chronic adversity – helplessness, fear, loss of control.

To bring chronic adversity back under the umbrella of ‘trauma’ in TRIRPP feels like an important political act. It is a reminder that chronic adversity traumatises too. It is not only the extreme and one-off acts of violence and catastrophe to which we must attend but also the impact of chronic poverty, social disenfranchisement, inadequate housing, and the powerlessness and dependency which accompany these harms.

So chronic adversity is recognised by many as a form of trauma, and they share common ground not only in terms of impact but in terms of social and psychosocial context.  I would argue that arises from a failure or absence of social support and reponse, and as such a context in which the individual is unable to act from within their usual adaptive responses and so subject to overwhelm.

This acknowledgement of chronic adversity as a form of trauma is why the resilience and social justice approach is such an important one to align with. Because resilience in the context of trauma – in the context of social injustice – is about transforming the context of that adversity. That is to say, resilience lies not within the individual but within the ability of immediate social and broader societal frameworks to provide what is needed for an adaptive response, for individuals to find strength, make positive choices, tune into what is adaptive within them even when under extreme duress. I would like to see research made into the kind of enabling environment where this can happen. That is a key part of what TRIRPP is about.

https://ncsacw.samhsa.gov/userfiles/files/SAMHSA_Trauma.pdf

Herman J.L.(1992)Trauma & Recover, Harper Collins, London p.33

 

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