The Therapist Nuggets: Answering Mental Health Questions

Tête-à-tête with an HOBS in-house therapist

Mrs. Simran Dalal is an RCI Licensed Clinical Psychologist based in Gurugram. Her passion for understanding the complexities of the human mind led her on this journey of studying Psychology which she believes would continue for a very long time. She aims to be a part of her client’s journey toward healing, which she keeps in mind during her session – trying to understand them for who they are and what makes them unique. She has been trained to identify, assess and diagnose primary psychiatric conditions and develop an individualized treatment plan for the same. She has experience working with adolescents and young adults for anxiety-related issues, depression, adjustment problems, dissociation, and interpersonal issues. 

Different people understand the concept of trauma differently. What is your understanding of the term ‘Trauma’?

Trauma can be understood as an emotional or a physical response of your body to an extreme threat to your safety and survival. It is an individual response to a situation that people perceive as threatening or harmful to their wellbeing. This could be a physical threat, an emotional threat, or a psychological threat. So our response of the body to that threat is trauma. A situation could be anything; our body’s individual/unique response to that situation is based on our perception. It is the helplessness and powerlessness of the lack of autonomy at the moment that makes it very traumatic for them.

I understand it in three separate processes: the event, the experience, and the effect of the experience. The event is any situation in which the individual is placed. This can be from various conditions such as war, assaults, extreme neglect, etc. For an infant or a child, it could be any situation where they might have felt incredibly overwhelmed by their emotions. Thus, an event is anything that can generate intense emotions, distinct from our existing coping adaptabilities. Then is the experience of the event. It involves the individual perception of the event and the subjective experience of it- the level of intensity, level of severity of the particular emotion/s they might have felt during the event.

At last, the effect of the experience includes the emotional, psychological, and physical aspects of it. The emotional impact can consist of mood fluctuations, irritability, anger, sadness, numbness, anxiety, etc. Body-based responses include palpitations, dizziness, fatigue, tingling sensations on the limbs, etc.  

We can say that trauma is not one situation/s but an individual’s subjective response that threatens to overwhelm the existing coping abilities leading to intense emotional experience. You mentioned a few examples of situations that could be considered traumatic earlier. Would you like to talk about these ranges of events?

These could be natural disasters like tsunamis and earthquakes and man-made like wars, chemical explosions, and displacement of people from their homes. On a one-to-one level, it could be physical or sexual assaults, domestic violence, emotional and psychological abuse, kidnapping, etc. Not being directly involved in an event but witnessing them can be traumatic. This could be witnessing domestic violence, murders, accidents, unexpected traumatic loss of loved ones, etc. These are some events that are very frequently talked about. Thus, being traumatized increases in someone who has gone through these. These events aside, there are other events also that can be traumatic for an individual. As I mentioned, it is an individual’s subjective perception of an event.

Is there a categorization of types of trauma or trauma events as well?

There are indeed! Different theorists and therapists categorize trauma differently. They organize it based on events, effects, transmission, etc. The most basic one could be – acute, chronic, or complex trauma. These are trauma situations that the individual goes through directly. I’ll add secondary and vicarious trauma here, where the experience is indirect.

Acute trauma can be understood as a single event that induces a traumatic response, such as accidents, assaults, natural disasters, etc. Chronic Trauma is the repeated exposure to a traumatic event such as domestic violence, marital rape, and war zone situation for people living near borders. Then comes the complex trauma, which can be understood as repeated exposure to different types of traumatic events- direct, indirect, or both. 

Secondary or vicarious trauma can be understood as an event that you might have witnessed, where you were a passive element in the situation. You may have been present in the situation directly or indirectly, but it was not happening to you. Police personnel, doctors, first aid or emergency responders, firefighters, and even therapists can have these.  

What, according to you, happens just after an event has passed and what makes it traumatic? What could be some of the impacts of such a situation?

Due to sudden overwhelm, the brain and the body undergo a lot. They try to protect us by having any of these primary survival responses- Fight, Flight, or Freeze. A lot could be going on then. Due to this overwhelm, there could be an initial shock, a numbed out state. Once that is passed, it begins processing based on the individual’s subjective perception of the event. The processing is often not accurate or adequate following such a stressful event. Question for personal safety, the sudden appearance of threat agent again, all of this can come up. This can lead to feelings of shame, guilt, fear, powerlessness, etc. They can start avoiding situations or places similar to the traumatic event, be on a constant alert, and scan for any other threats. A lot of memory, concentration, and attention problems can also follow. 

On the other hand, due to the nature of the vent, it is entirely possible for the brain to just take away those memories, box them up tightly and throw them at the back of the mind completely. 

One needs to understand that these effects will be based on the type of event experienced, the age of the individual, previously held beliefs about the self and the others, and the response of those around them. Understandably, the less the individual’s age, the higher the chances to develop more significant difficulties affecting relationships with others, sense of self, coping styles, etc. 

You have mentioned the relationship one has with self and the others. How is that affected after a traumatic event?

This is a good question. We see the behavioral ‘symptoms’- constant anxiety, outbursts, and bad performances at school or work, but what can get missed out by people around us is how they are happening. 

Traumatic events, as discussed, can many times be sudden and unexpected. Imagine if these are by people that you have known for a long time- a friend, a family member, a teacher, a friendly neighbor. Or imagine that you have a safe place, a home, and you think of the world as safe, and suddenly there is this disastrous earthquake. One second you are in the presence of a trusted person or a trusted situation, and the next second it turns catastrophic. You do not know what is happening and why these people are hurting you. This can shake up the entire belief system you had developed all along. I mean, who do you trust now? The ability to trust others can be affected. It can be reflected in poor interpersonal relationships and difficulty initiating and sustaining social relationships. The safe world suddenly becomes unsafe and scary that you do not want to go out, meet people, or be out there. You might start to question your judgment. I mean, this can distort your sense of self. In many people, you can see a complete before and after- living life navigating in a ‘safe and secure’ place v/s navigating life in the same place now deemed as ‘unsafe and insecure’ and understandably so.

The sense of identity and the world changes unexpectedly, as you mentioned. How do you think this affects the mental well-being of the individual? Can you comment on the relationship between trauma and mental health?

For this, we need to understand traumatizing events and being traumatized. Many people experience at least one traumatic event, an experience that can induce trauma. But not every individual who has gone through it would be traumatized or have psychiatric problems. This is based on an individual’s resilience, the support system they have, and beliefs about self. Of course, a non-traumatized person can have difficulties initially. Still, due to the above three, they are likely to bounce back and not develop highly maladaptive coping strategies. 

On the other hand, a lack of these factors and immediate response from the surrounding can push the individual towards being traumatized. Looking through life and living through the lens of a traumatized person can be challenging. There can be mood fluctuations, difficulty forming bonds with others, and their cognitive functioning can be affected. There can exist a lot of physical complaints as well as pains. When severe, they can take up the form of different psychiatric conditions – PTSD, C-PTSD, Dissociation, Mood and Anxiety Disorders, anything.

The overall level of functioning and sense of well-being gets affected in both cases with traumatized individuals. The impact is more than the presence or absence of a disorder. 

What can make a situation less traumatic for an individual?

A sound social support system can be critical here. Someone who can sit with the traumatized individual, validate their experiences and just be there can make things much more bearable. What was lost in a relationship can be developed much more easily in another connection!

Another factor could be the existing belief system of the individual. It has been seen that someone with higher self-esteem is more likely to bounce back earlier than someone with low self-esteem. 

Having different resources at disposal, such as early help- medical and psychological, and a solid affirming response after the experience can all impact and make the situation less traumatic.

What could be the role of a therapist in the life of a traumatized individual?

Psychotherapy is one medium through which an individual can start their healing process. Therapy can give insight into the individual’s intense experiences, such as flashbacks, intrusive memories, severe anxiety and panic, poor emotion management, etc., and how to address them. Due to the overwhelming experiences, a therapist can help process the traumatic event to avoid re-traumatization. Many people do not have a supportive environment or feel they might be judged. A therapist can be a new, blank slate for the individual. As I mentioned, what was lost in a relationship, can be gained in a relationship again.

Any last words you would like to say for anyone going through a tough time?

I would just like to say that I know it must be hard. Whatever you are going through right now is not on you. It is because someone chose to be at a place they were not meant to be. Intentionally or unintentionally, harm was done. And now it is you who has to suffer a lot. It can feel that there is no one to understand you. Maybe it is indeed true that you have no one. I know it will be hard to trust me, but there will be a place in the future where you will not struggle this way. You can have meaningful connections with yourself and the world. How about we go step by step, day by day, and minute by minute? Remember that once the clock strikes midnight, it is a new day, a new day with new possibilities and a new start.