Without a doubt, trauma and talk of trauma abound these days. Ever since I had counseling for military-related moral injury, I’ve thought a lot about trauma and the double-edged sword of diagnostic labels like post-traumatic stress disorder (PTSD).
Such labels offer a means to understanding trauma, but they can be burdensome in themselves. When you overly focus on an identifier like I have PTSD or I suffered this trauma, you risk identifying with it to the point that it can undermine your dignity and mental balance even more than the original traumatic event, making you feel like some sort of malfunctioning machine with a broken part.
What Qualifies as Trauma?
It’s a tricky balance to get right: discerning what is and isn’t acute trauma, and what sort of trauma goes beyond the usual levels of stress that are an inevitable part of existence.
Having primarily been associated with the horrors of war—the current situation in Ukraine is a prime example of trauma that will have long-term effects—PTSD is now thought to stem from a far wider range of experiences, though working out which ones can be hard. This dilemma has been highlighted during the COVID-19 pandemic. Quarantines, curfews, lost jobs, ruined businesses, and strained or destroyed relationships can have nasty psychological impacts, including PTSD-like symptoms, depression, and insomnia. But is it actual PTSD?
There’s a sense that the world has begun to realize the scale and nuances of trauma and is now playing catchup trying to answer that question. This even applies to the realm of psychiatry.
“Psychiatry, as a subspecialty of medicine, aspires to define mental illnesses as precisely, as let’s say, cancer of the pancreas, or streptococcal infection of the lungs,” says Bessel van der Kolk in his bestselling book, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. “However, given the complexity of mind, brain, and human attachment systems, we have not come even close to achieving that sort of precision. Understanding what is ‘wrong’ with people is currently more of a question of the mindset of the practitioner (and of what insurance companies will pay for) than of veritable, objective facts.”
Better appreciation of such complexities has led to a proliferation of mental health campaigns. These often contain important, even vital messages. At the same time, the scale of public messaging about mental health could be muddying the waters.
Traumatic Event vs. Disorder
“The opacity of the language in these campaigns means that too many negative emotions and experiences are interpreted as disorders, or things that should be feared and obliterated as soon as possible,” says academic psychologist Lucy Foulkes in a recent article in the journal of the British Psychological Society. “People experiencing garden-variety difficult emotions end up being told that there’s something wrong with them, something that needs to be fixed by outside professionals.”
[Read: “The Dharma of Trauma.”]
Trauma does not automatically lead to PTSD—events such as getting divorced, losing a job, even losing a loved one typically don’t qualify. This psychological disorder is rare and usually results from extremely traumatic and sudden events, such as military combat or torture, and often in high-stakes environments. Yet there remains significant blurring around the edges of defining trauma.
“Trauma, like pain, is not an external phenomenon that can be completely objectified,” explains the US Department of Veterans Affairs’ National Center for PTSD. “Like pain, the traumatic experience is filtered through cognitive and emotional processes before it can be appraised as an extreme threat. Because of individual differences in this appraisal process, different people appear to have different trauma thresholds.” This means that if two people are exposed to similar high-stress situations, one may be more vulnerable to developing clinical symptoms than the other. That said, the center notes that “rape, torture, genocide, and severe war-zone stress are experienced as traumatic events by nearly everyone.”
Mis- and Missing Trauma Diagnoses
The subjective element, combined with more public discussion of trauma, might explain why many people are now self-diagnosing PTSD. This has psychiatrists warning of the psychological pitfalls of misdiagnosis.
“If everyone has PTSD, including people with transient, mild symptoms, then the term loses value for people who are seriously unwell,” says Foulkes. “Mental health problems lie on a spectrum. This is an inconvenient truth, because it reveals that our experiences cannot be neatly packaged and labeled as ‘healthy’ and ‘unhealthy.’ Different parts of the spectrum require different levels and types of support.”
In this sense, misdiagnosis of PTSD risks breeding skepticism about the disorder, which can then factor into missing diagnoses.
Foulkes notes that highlighting the psychiatric basis of disorders like PTSD, schizophrenia, and obsessive-compulsive disorder could help reduce what she calls the casual misuse of these terms and help increase compassion and support for people who truly suffer from them.
Beyond those exposed to the horrors of war, police, paramedics, social workers dealing with abused children, and others exposed to trauma directly or indirectly over many years are also at risk for developing PTSD. And these are people who may find it hard to seek help. Missing a diagnosis of PTSD must not be underestimated. Studies show that adults and young people with PTSD are much more likely to attempt to commit suicide than their respective peers.
Becoming a “Trauma-Conscious” Society
Leaving PTSD aside, everyone endures some form of painful trauma sooner or later, regardless of where it lies on the spectrum. And yet we hide so much, which results in a loss of sympathy and compassion needed for those enduring it. The trauma of parental loss, for example, especially when endured as a child, is too often swept under the carpet.
[Read: “What If the Survivor You Need to Believe Is ... You?”]
“We are fundamentally social creatures—our brains are wired to foster working and playing together,” van der Kolk says. “Trauma devastates the social-engagement system and interferes with cooperation, nurturing, and the ability to function as a productive member of the clan.”
Better appreciation of how, for example, someone who cuts you off in traffic may not simply be a jerk but may have experienced some form of trauma recently is a big start toward becoming what van der Kolk describes as a “trauma-conscious society.” Imagine if everyone who had experienced some form of trauma wore a badge expressing the details of that trauma—the death of a loved one, a miscarriage, a marriage breaking down—you wouldn’t likely encounter many badge-less people. Recognition of the reality of trauma—in ourselves and others—can enable action to protect “our sources of joy, creativity, meaning and connection,” in van der Kolk’s words, that too often get suffocated by the traumas of life that eventually pile up.
“For adults and children alike, being in control of ourselves requires becoming familiar with our inner world and accurately identifying what scares, upsets, or delights us,” van der Kolk says. “Emotional intelligence starts with labeling your own feelings and attuning to the emotions of the people around you.”
Want to connect and be joyful? Consider James’s recommendations for a personal pilgrimage from your own front door.