A Discussion about Trauma and PTSD

What trauma is

Trauma occurs from events so horrific, that they cut you to your core.  The damage is deep, and that damage will always be a part of you.  Making matters worse is that emotional trauma from the past tends to come out and bother you when you are at low points.  It is like a knife held at your side, ready to stab the second you start to stumble.    When trauma is recurrent, it can even affect your memory.   Large chunks of time during childhood are lost because it is painful to look back, and it is difficult for someone with severe trauma to describe the events.  The events come out of order when retelling the account, with some episodes forgotten.  Also trauma acts like a super glue for bad ways of looking at yourself in the world.  The victimized thinks, I am broken, I am worthless, I deserve nothing; Sometimes they think it was their fault.  In reality, they were just a victim.  If you put any human in their situation, the damage would have been severe. 
 

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'The damage from trauma cuts deep, and it will always be a part of you, but with work, you can find a sense of peace.'


How to treat emotional trauma

With a lot of work and the right treatment, you can find a sense of peace.  The treatment requires therapy.  It requires the traumatized person finding a therapist they trust and have a good rapport with.   Typically sessions should be at least a couple times a month for the first six months.   Once you are doing better you will need to revisit the therapist every couple of years.  The trauma is always going to be a part of you, but you can maintain your sense of peace permanently if you don’t turn your back on it. By this, we mean, every few years another round of counseling will be necessary.  Typically the therapist will spend the first few sessions helping the person feel safe in their own skin, establishing rapport before discussing severe events of the past.


Trauma should be approached only on good days when you feel strong.

The reason is..  when you open the door and start working though the past, it will all come at you.  It is like the flood gates have broken.  When you find a good therapist and start the journey toward healing, you will spend 80% of your energy pushing back on the pain that revisiting the trauma caused, and just letting a little bit come though at a time, just enough to manage and just enough to work through to make a positive change.   If a patient currently has depression, anxiety, or any other co-morbid issues, it is generally best to treat those before trying to tackle prior traumas. 
 

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'Only open the doors to prior trauma on days you feel strong, never try to work on prior damage when you are weak.'


A note about mental health diagnoses

Generally speaking, every mental health issue besides trauma is remarkably consistent in its presentation.  Depression in one patient has strikingly similar symptoms to depression in another.  Generalized anxiety has a core set of symptoms that tend to be seen in every patient with that condition.   The mania of bipolar has the same symptom set in most humans when it occurs.  The exception to the rule is trauma.  With trauma, all bets are off, the only rule is that the symptom presentation has no rules.   It can borrow a symptom from schizophrenia, another from bipolar, and so on.   Those patients who have severe trauma are often mislabeled as bipolar, or told they have a borderline personality disorder, or worse, given a schizophrenia spectrum diagnosis.  The other unique aspect of trauma symptoms is that they tend to change over time erratically.  Whatever symptoms are on the table today will be radically different two years down the road, not necessarily better or worse, just different.  
 

Trauma or Postraumatic Stress Disorder

We occasionally label trauma as PTSD, but in reality that symptom set is a severe over-simplification.   It best applies to a single horrific event as an adult.  A concept called Complex PTSD is gaining widespread acceptance in the mental health professional community.   It better characterizes the variable severe changes that can occur in those who have experienced recurrent trauma.  

  

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'For those who have experienced recurrent trauma, any mental health issue they develop will likely have unusual symptoms, and misdiagnosis is common'


Trauma gives one gift, and it becomes useful if you understand it.

Trauma gives one gift, it’s not worth all the pain it took to get it, but still, it is a remarkable gift.   Those who have been through terrible events during childhood have a remarkable ability to read people as pertains to their own safety. 

An example of this is..

A man who experienced severe trauma as a child is led to a room with 50 other people.  One of those other people in that room is unhinged and dangerous.  The man with prior trauma would be able to spot the dangerous person in seconds, while most everyone else would be clueless. 

This ability to read people can be useful in treatment because a traumatized person can accurately decide if a therapist will be a good match for them within minutes.  Typically individuals have to try a couple different providers before they find a good match, without prior trauma it can takes several months to decide, but someone with trauma can size up the dynamic immediately. 

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'Trauma comes with one gift, They are exceptionally good at percieving emotion and safety'

 

How those with trauma react in romantic relationships

A quick note about how those with trauma react when they are in a romantic relationship.   They tend to be very hard on those they care about.  There is a second part to their ability to read people and emotion.  They always see the ‘what’, but they tend to insert a ‘why’ that is incorrect, negative and personal. 

An example of this is..

A woman with terrible trauma when growing up later marries as an adult.  Her husband comes home one afternoon, and he seems distracted and distant, but he doesn’t want to talk about it and he doesn’t mention anything.  The woman sees that something is off in the first 3 seconds and thinks, 'he must be cheating'.  In this example, she got the ‘what’ right (he is distant and withdrawn), but she then inserted a hurtful ‘why’ that was incorrect.  (he felt out-of-sorts because his boss yelled at him over something trivial). 

They quick summary is..  for those who have prior trauma, always trust your initial read of something being off, but never trust the conclusion you jump to trying to guess what is off.  You’ll think it's about you or that it hurts you, when it is not about you at all. 
 

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'For those with trauma in a relationship, alway trust your initial read of something being off, but never trust the conclusion you jump to trying to guess what is off.'

Where to learn more

Approximately two decades ago, a Harvard doctor wrote a book that changed how the mental health profession approaches trauma.  It remains the bible of trauma.  Trauma and Recovery by Judith Herman MD.  It can be purchased on amazon for about $14.  The excerpt on the cover is very accurate.  It says "one of the most important psychiatric works to be published since Freud," by the New York Times.  I have never met the book’s author, nor do I receive anything for the endorsement.  I do feel that it was the most important book I had as I trained to be a psychiatrist.  That said, don’t try to go it alone, find the right professional providers, to start a journey of healing.       

 

          -Erik Cantrell MD, Psychiatrist

 

Professional Note:     Any mental health diagnosis has atypical symptoms if the person has severe prolonged trauma in the past.  If someone with severe trauma in the past develops depression, it is often accompanied by strange and obscure symptoms.  This goes for basically any mental health issue.  They all look different in those who have experienced severe prolonged trauma,  but the research into that is in the early stages.  In the meantime, I find it best to consider trauma as having few rules and being extremely variable.  This ends up being a useful approach in my private practice because I know severe trauma has happened in a patient's past if their symptoms do not fit the ordinary patterns of typical mental health disorders.