T:  Trauma or Trend?

The reality behind the buzzword

Since the pandemic, India has seen a new shift – a shift towards the idea of mental health. More and more mental health professionals and mental health advocates have started to increase their efforts in awareness of mental health conditions. We see many people sharing these spaces, especially those who have gone through psychiatric or therapeutic treatment compared to the pre-lockdown India. 

Social media played a massive role during the lockdown in assisting the mental health space to be out there for the masses. Thousands of videos and posts across social media about different psychiatric conditions and sub-clinical issues helped people begin their healing journey. Many started to identify that things were not okay.

There enters the concept of ‘TRAUMA.’

We live in a polarized world. We all are prone to move towards extremes because that is what we see and live on social media. So when the concept of trauma was getting introduced in our collective culture and was having its much waited, deserving limelight, it soon got caught in the middle of this polarization- “from everything we experience is traumatic to deny trauma’s existence completely.” And we are talking about this at a mass level. Before it loses its essence, let us see what trauma is and is not.

What is Trauma?

‘A wound, a hurt, a defeat’ – from the Greek word ‘trauma.’ 

Trauma is an event that can overwhelm one’s existing ability to cope and integrate experiences. Healthy coping mechanisms help one survive and make the individual feel under control. Traumatic events lead to loss of this control due to its nature. It is to lose autonomy and choice to the event occurring, being controlled by the same event.  These events threaten life, violating the body’s integrity or the psychological stability of the one having gone through it. Such events can be:

• Natural disasters (earthquakes, wildfires, tsunamis, hurricanes, etc.) or Man-made (accidents, assaults, bullying and harassment, violence, tortures, cults, military combats, etc.) 
• Household or external fires.
• Medical events (amputation, surgery procedures, sudden disability, delivery, etc.)

They can be experienced at:

• Interpersonal level (family violence and domestic abuse, physical/sexual/emotional abuse within any relationship, neglect, maltreatment, etc.)
• Family level (within family physical/emotional/sexual abuse, neglect, deprivation, etc.) 
• Institutional level (workplace harassment, etc.) 
• Collective-social level (extreme poverty, marginalization, discrimination, human rights violations, etc.) 
• Inter-generational level (consequence/impact of trauma passing down from one generation to another and creating another traumatic event; example- holocaust survivors, generation after wars/slavery, etc. This can also include families with a history of violence and neglect, creating a chain of interpersonal traumatic events).

These events can be experienced directly or indirectly. The indirect instances can include witnessing someone else going through these events or hearing narratives of trauma. When experienced indirectly, this is known as secondary or vicarious trauma. It is common among people involved in emergency work, such as medical and paramedical staff, especially in emergencies, police personnel, firefighters, etc. 

The immediate response could be being unfazed by the injuries, shock, being in a dream-like state, unable to grasp the situation and silence.

Trauma can change people. It is not just the event but the subjective experience of it. How an individual perceives the event and the meaning they give to the entire experience, influences their future interactions with themselves, others, and the world. As backed up by research across the globe, these events can induce structural changes in the human body, especially the brain’s physiology. All of this has a direct impact on the physical, cognitive, socio- interpersonal, emotional, occupational and spiritual dimensions of life:

• Physical- feeling exhausted and drained, sleep problems, chronic body pains, weaker immunity system, cardiovascular problems, etc. 
• Cognitive- lack of concentration and attention, difficulty shifting attention, lapses in memory, etc.
• Social-interpersonal- difficulty trusting people, difficulty initiating and maintaining relationships, etc.
• Emotional- lower stress tolerance, increased mood fluctuations, poor emotion regulation, anger outbursts, altered perceptions of the self, the present, others around them, and the world in general.
• Occupational- decreased work performance, difficulty in daily tasks due to physical or cognitive issues.

If it remains unprocessed or unresolved, trauma can lead to a variety of symptoms such as – 

• Having intrusive memories of the event in the form of nightmares, flashbacks, and thoughts
• Substance abuse issues
• Self-harm behaviors
• Dissociation 
• Triggering physical/medical conditions related to continued stress
• Leading to poor interpersonal relationships and loss of social structure and support
• Frequent breakdowns
• Psychiatric conditions of Post-traumatic stress disorder or Complex post-traumatic stress disorder and even psychosis.

Dr. Gabor Maté describes trauma as ‘a psychic wound’ that hinders one’s ability to grow and transform in life. The individual with an experience of trauma usually remains physically in the present. Yet, the mind functions the un/processing of the event.

Treatment and Management

The aftercare requires a lot of support and understanding. The healing journeys are different for different people and usually do not follow a clear, straight path. There are a lot of evidence-based healing modalities out there to help manage the after-effects of trauma. These can include psychotherapy, pharmacotherapy, rehabilitation, etc. Medications can help with severe and debilitating symptoms. Physical modules such as Yoga, Tai-chi, etc., are effective for many people with their bodies. Psychotherapies can involve many modalities such as:

• Cognitive Processing Therapy
• Internal Family System Therapy
• Trauma-Focused Cognitive Behavior Therapy
• Eye Movement Desensitization Reprocessing 
• Dance Movement Therapy
• Art Therapy
• Body-based therapies such as Somatic Experiencing 
• Hypnotherapy 
• Exposure Therapy
• Logotherapy 
• Animal Assisted Therapy 
• Narrative Exposure Therapy

Most of the treatment protocols begin with the first stage of stabilizing immediate symptoms such as intrusive thoughts, intense anxiety, dissociation, sleeplessness, use of drugs, mood fluctuation, anger outbursts, etc. This is done via the identification of triggers and developing skills. When the individual feels safe and in control enough, the therapist begins the second stage of processing the event without re-traumatization. This involves confronting and integrating the memories and thoughts of the traumatic event. The last step involves promoting growth, developing further resilience, and meaningful relationships with the self and others.