What is a traumatic event? This is the first of a series of five posts I will devote to explaining the features of Post-Traumatic Stress Disorder, or PTSD. I mentioned last time that part of PTSD—the main part—is the way your nervous system responds to a traumatic event, or a series of traumatic events, which threaten your life or profoundly threaten your sense of safety. What I neglected to mention last time was that you could also witness an event in which someone else dies or is severely injured.
The traumatic event could be related to physical violence. For example, if you are a military servicemember in combat, it could involve being in a crowded market or apartment building when a bomb explodes, or surviving a mass shooting. a bomb exploding, a mass shooting, or a sexual assault. If you are a healthcare worker or first responder, it could be a patient that you treat dying on the emergency room operating table despite your best efforts to treat them. Generally, our nervous systems have a dramatic reaction to seeing dead bodies, and you might be traumatized if you witness someone killed in a car accident when you are just a passerby on the highway, as you certainly also could be if that person is your brother, your sister, or your best friend.
As many people are well aware in this uncertain and often violent world of ours, what we social workers refer to as “trauma” could actually be a series of events that your brain semi-consciously groups together as falling into the same category, like “police violence.” During 2020 when images of George Floyd, Trevon Martin, Brianna [NAME], and others killed or injured by violent policing practices flooded the news, I noticed it was pretty common for some patients, particularly patients of color, to report to me that just watching news footage about any one of these killings activating older memories of being singled out because of the color of their skin: being followed by police officers when they were walking to school, or in stores by owners nervous they would steal, for example. This is an example of how a series of events that you experience or witness that together telegraph that you are a less than human, can over time profoundly impact your sense of safety when you leave your home.
As a clinician who treats many people who have served in military, police, and first responder roles, I am also aware that many folks’ desires to serve their communities arose because they came from families where they weren’t treated well, leading to a search for a sense of self-worth in community service. Oftentimes, PTSD treatment that starts by focusing on a suicide bombing in Iraq, or a traumatic death of a patient in the ER where you work, ends up tracing back to earlier experiences when you may have learned from caregivers some unhelpful ways of dealing with hardship. For instance, some people with abusive parents got blamed for a family member’s drinking (“You stress us out so much!”) and therefore learned to blame other things, like not saving a buddy in combat, on themselves. The treatment ends up focusing on larger thought patterns that impact much of what that individual experiences in life, so that he or she realizes that while they have control of some things, they don’t control everything.
What I’m getting at is this: What defines a traumatic event is less what happened (though I do think that some people overuse the word “trauma” when what they really mean is “stress”), and more the way it impacts you. Because of features unique to you, such as your family history, your personality, hereditary factors, and your coping responses, certain events may cause you to center your thinking on a part of your brain called the “amygdala”—the part of your brain that controls your “fight or flight” response to danger. When you are in fight-or-flight mode, you may not be thinking through your experiences as you would if you were playing a video game or having a calm conversation over lunch with a friend. Instead, your brain is taking in events in a very limited way that focuses only on what you need to do to survive. So, in that crowded Iraqi market where a bomb explodes, you may not think, “That’s a bomb going off.” You may register the noise, the force of the blast, and the panic around you, grab the child next to you, and run the two of you to safety. As a result of having a different sort of response than you would to ordinary events, you might need some help piecing together what happened when you’re in a safe environment, so that your combat experience becomes a memory rather than something that intrudes on your thoughts when you don’t want to think about it.
Now, though, I’m getting ahead of myself –We’ll talk about intrusive thoughts next time. Just know that trauma is a heavy word that conveys a real disruption in how you think about your experience. But it can mean many different things depending on the individual, their threshold for coping with stress, and how they have learned to make sense of stressful events based on earlier life experiences. And even if an event wouldn’t meet the criteria for being “traumatic” from the subjective standpoint of you or your therapist, that does not mean that you couldn’t benefit from talking about it, figuring out why it bothers you, and learning more helpful ways to manage your feelings and thoughts about what happened.
