I keep seeing great stuff about the ACES (http://ctmirror.org/2015/01/20/the-long-reach-of-childhood-trauma/#top) .
Think about these four questions:
- Does what happened overwhelm them to the point of being unable to cope?
- Does it render them unable to make sense of what happened in the moment or as they think about it later?
- Is it something they can’t integrate into their life?
- Does it threaten their life, bodily integrity, or sanity–again when it happened or later?
If the answers are “yes,” then it’s been processed as a traumatic event. Doesn’t matter what the name of it is, it might even be something others would find exciting or exhilarating. Could be winning the lottery. Could be a miraculous healing. Could be… anything.
Back in the 1970s and 1980s, trauma was synonymous with “major physical injuries,” “abuse,” and “neglect.” I can remember how challenging it was for mental health clinicians I was working with to think about other things as traumatic. Perhaps it was that society was just beginning to think about the impact of certain things on children, and in particular, women. We could acknowledge the mangling of the body as physical trauma–but surely the only things that constituted Trauma (yes, with a capital T and sometimes bold!) were… abuse and neglect.
So it was that many of us who sought counseling for the aftermath of psychological trauma, such as the challenges of living with disabilities, or multiple deaths, or the vagaries of family crises in early childhood were encouraged to adopt histories that while they didn’t belong to us, made us make more sense to others who could only associate our problematic behaviors–symptoms–with abuse and neglect.
Even when I began to wrestle with dissociation as a phenomenon in my life in the 1990s, uncovered after a year with over a dozen significant deaths in it, the focus was then on abuse and neglect. The more abuse and neglect, the more fragmented a person became–so it was said and believed. Thus I was encouraged, from time to time, to focus on the relational trauma that occurred as I was growing up.
And why am I concerned about this? Because then, even then, when I was doing media–Montel Williams, Faith Daniels, and other talk shows–I was talking about the fact that we needed to look
further. We needed, I felt, and I still do, to look at impact over event.
I think now we are beginning to see a sea change in the field of social work and mental health where clinicians–and those training them–are far more inclined to look more broadly at events that are the “little ts” as well as the “big Ts.” More attention is being paid to the critical relationship between the very short people (infants) and those who care for them–and while some may not be able to quell the bile they feel, others are beginning refocus on the ecology around the child: what’s happening for–or to–the caregivers? Are they overwhelmed? Do they have adequate support? How are their skills? After all, parenting comes with no guarantees of caring supportive families for the new parents, adequate income, food, or support to make it possible for new parents to be fully present for their new child or for the other children to whom one more is added!
The difference between an event being unpleasant, distressing, difficult, awful and traumatic is often the response others make to the person–or the child–who experiences it. Given care, connection, comfort, and support to the ecology in which the person lives, something that might be traumatic can be difficult instead. When we help families of all sorts in all kinds of conditions develop the strong connections that are the “glue” in healthy (or healthier) relationships, we lessen the frequency with which an event is processed as “traumatic.”
And the earlier this happens for children, the better the trajectory for their lives.
Perhaps these are the four questions that should shape events:
- Does the person or people who experience it have caring, supportive others?
- Is the environment in which they live emotionally rich and hopeful?
- Do the people around them help them make sense of their experience in ways that are comforting rather than disruptive?
- If their sanity, bodily integrity or life might have been threatened, are there people around who protect and guard them with care?
In trauma-responsive systems, the focus is less on the “shame and blame game” than on sense- and meaning-making in ways that are restorative. The four reasons to think about more than names? Simple.
- Each person lives in a context that may assign different meanings to some events. For example, while “beating” in American schools is punishable by law , school discipline in refugee camps in other countries may include actions that are called “beating.” We have no idea what that means except as we understand the word in our context.
- What is unpleasant or difficult to one may be horrific and traumatic to another. Even though we have shared meaning about specific kinds of events, there are many others on which we impose a meaning that may not be shared.
- When we confine “trauma” to a specific set of acts, we require people to “own” those acts to receive our care–whether or not they are the most problematic for them.
- Limiting a mindset to names only–abuse, neglect, combat, rape, torture–limits the breadth of human experience and its’ impact. The creativity of people who inflict awful things on others is unparalleled. Our ability to comprehend that breadth should also be unparalleled.
I often ask in classes, “To whom might a hangnail be traumatic?” The ability to answer depends on thinking in terms of the impact instead of the name of an event. If you are newly diagnosed with diabetes, or a blood borne disease such as Hepatitis C, or HIV, or if you are an infant who has never experienced a tear in your flesh and there is no one to tend to you, you might–might–process a hangnail as a threat to your life, bodily integrity or sanity.
Let’s go beyond names to impact.