Transcription
[Music] Hi, welcome to another video from the CAG clinic. My name is Dr. Mike Lloyd and I'm the director.
In this video, we're going to be looking at a question that's often posed about the nature of trauma and the size of trauma that needs to be experienced in order to bring about, let's say, a dissociative syndrome or dissociative condition, something to the degree that could be diagnosed. And I'm going to be drawing on the work of Elllet Ninhouse in 2015 in this excellent book called The Trinity of Trauma. It's a huge book. I'll give a copy of it here. And it's got some fantastic, fantastic material in it. And there's really an interesting concept in there that was so simple. I thought it really answered the question of what we're looking at. And that is, what's the nature of trauma? Because it isn't really understood in that way when we're thinking about it.
And Elllet discussed how Eulenberg in 1878 proposed the term psychic trauma. And what Eulenberg meant by this was that it's not about the event. It's that any event can take place, and we can classify events into lots of different degrees, such as, you know, the degree to which it causes threat or harm or has some sort of like physical injury. Being that trauma actually means wound or injury or shock in some respects. So when we think about trauma, we're thinking about the wound, not the thing that caused it. So let's say a hammer can cause a wound, but it's the impact that worries us. We don't blame the hammer. We just blame, we just look at the impact. We look at the wound, and then we try and take care of it. And Nenburgg thought about psychic trauma in exactly the same way. So that any event can lead to an injury or a wound, and then that wound or injury is then subjectively experienced by the individual. And the degree to which trauma takes place is that subjective experience of the wound.
So many events can take place in the world, and some of them absolutely horrendous, but not everybody becomes traumatized. And the research over and over and over demonstrates this is that a single event trauma happening to many people has many, many different impacts. So therefore, while the event is necessary, it's an important part of a person becoming traumatized, like there has to be an event, and that event generally has to have a certain degree of intensity and, you know, a nature about harm and threat and so on and so forth in order for traumatization to take place. But actually, the wound that's caused, the impact, is the thing that we're really interested in.
And I think it's really sad that some people raise the question saying, "Well, I can't be dissociative. I can't be traumatized because not really terrible enough things have happened to me." Because what they're doing is they're labeling the obvious event stuff, such as like extreme and tra, you know, terrible abuse that takes place, for example, in childhood as a result of abusive parents or or systems and circumstances. Because that really awful stuff hasn't happened, then how can they possibly be traumatized? And what they're doing is they're belittling their own experience. They're self-deprecating their experience, and they're kind of pushing away the possibility of being traumatized because they're measuring against other people. And it's a very sad thing that people are doing that. But I do understand how that process takes place. I wish it wouldn't happen like that because what we need to understand is that it, it really, the event is going to be significant in terms of the overall healing process, coming to terms with the event, but dealing with the impact and looking at a person in terms of the things that they then experience as a result of the wound caused by the event. That's the stuff that makes people feel traumatized or not.
So we have to look at the event then as being something significant. We look at the wound then as having to be something significant, and then the impact has to have a negative connotation. Because if the intent is to go into an event to look for excitement, and let's say a person gets shot as a result of a gunfight, presumably, you know, let's say they're a soldier entering in war and they get shot. If their whole life and whole experience is to go into war and go into battle, and they completely take into account that being shot is part and parcel of that, it's unlikely they're going to be traumatized by being shot. Whereas within an individual just out in the street, if some awful event happens like a robbery or, you know, you know, a terrorist attack or something like that, and the person gets shot, it's more likely that they're going to become traumatized because their intent absolutely was not to go into that environment.
So the interpersonal factors take a to a huge degree of load in terms of whether a person becomes traumatized. So we have to take in all of these interpersonal factors about sort of age, prior experience, the nature of upbringing, the type of life that a person's had, the sort of why they're in that situation in the first place, what they're hoping to experience, whether their resilience factors, their experience in managing other difficult events that have happened in life, or is this the first or the hundredth time that something really awful has happened? All of those things come into play.
And when we look at the sort of the type of impacts that can take place, we think in terms of simple contracts such as PTSD, the avoidance, the behavioral change, the nightmares, the flashbacks, the sort of the the the type of sort of impact that it has on a person's everyday functioning can be quite easily understood, and we can call that PTSD, and that's pretty well known and pretty well valued. But when we look at other event type impact, the sort of wounds that take place aren't always that immediate. So for some people, what we have is called per traumatic impact, which means that that is happening in the moment, the sort of the shock and the horror and the disbelief about the event. And for many others, it's post-traumatic, which happens sometime after. And when we think about PTSD, we're thinking in the months following a traumatizing or potentially traumatizing event that the PTSD starts sort of manifesting within three to six months of that event. And they're very discreet, clear criteria. We make the diagnosis of PTSD. But other impacts take place which aren't really that sort of time constrained, and they can actually factor in over the course of a lifetime.
And Ella gave a list of these, which I'm going to give here because it's a, it's a, it's a massive list. So I'm just going to go through these, you know, just as a list to help people understand the type of impacts that can take place from events that we might consider to be traumatizing in some way or form. And Ella listed a degree of sort of impacts or symptoms which include fear, anger, depression, shame, disgust, substance abuse, self-deprecation, sexual problems, suicidality, self-mutilation, eating problems, sleep problems, attachment disruptions, dissociative phenomena, psychosis, relational problems, academic and occupational achievement, and severe physical illness. And there will be more.
So what Ella is basically saying from the research findings from the all the different types of research that have taken place following what Yulenberg started out as with psychic trauma is that that psychic trauma becomes operational in many aspects of a person's being and functioning, and it can really cause enormous disruptions in life. And we would look upon that now in terms of what's called complex PTSD. So the complexity is both the nature of the events that have led to these impacts, these symptoms, and the complexity of the symptoms and how they all kind of bond and join together and interrelate with each other.
What we're left with then is a sense that a single event can lead to sort of single traumatization, such as PTSD, or multiple events can lead to sort of multiple symptoms of PTSD, and there we have the complexity. This is quite well understood, and I think it should help people understand that it's really not about whether the event was bad enough to lead to a dissociative condition or a traumatizing condition. It's the multiple events. It's the complexity and interplay of all the different negative events that take place and the complex negative impact in all of these symptoms, which can then start showing through over a course of years and years and years from childhood, adolescence, all the way into adulthood, middle age, and older adulthood.
What Elllette left us with was this sense that the trauma, the actual psychic wound that takes place, is a complex interplay between the event and interpersonal factors. So ultimately then, what we have is a relationship that takes place between the event or the events, between the mind, the brain, and the body as an overall phenomena of complex interrelationships and sort of like a deep systemic web that is about our personality and and the core of our identity and what it means to be the person that we are.
So the events are significant. There has to be a wound of some form. It has to have had a negative impact. And then the degree to which that negative impact then affects the nature of the person is what leads us into the concept of trauma. So when people talk about things like a traumatizing event, it's an individual subjective experience thing. It's an event that has the potential to cause trauma depending on the interpersonal factors of each and every individual that experienced or witnessed or were part of that event. That's a much more complex thing to be looking at.
So to conclude this video, really, what I want people to to hear, I suppose, from this is that we don't measure the degree of trauma by the significance or the nature or the type of the event. We look at whether that event had an impact on that individual. It's a completely unique individual process that takes place. We don't measure as clinicians, "That was, yeah, that was bad enough to be traumatizing, and that not bad enough to be traumatizing." That's not what we do, and that's certainly not what we should be doing. We should be simply saying, "Let's look at the impact of what's happened to you." If we then want to call it a traumatizing event, we can do. That's an individual subjective experience that is measured based on the work that we do with each and every individual that we see.
So I hope that's kind of answered the the general questions about how much trauma is enough because that's not really the question that we actually ask at all. The question that we ask is, "What's been the impact of the things that have happened to you?" And when we phrase it in those terms, it allows the conversations to take place which really give us this deeper and much more useful therapeutic understanding of the nature of trauma for each and every individual as a unique person.
So thanks very much for for for watching the video and getting this far. Uh, please, as always, leave the comments and things behind in the video at the end of the descriptions, and I'll leave some references to Elllet's work within this. Uh, do all the like, subscribing, and things, and so on. And do please keep an eye on our training prospectus on the website because that's giving sort of the various webinars and things and training events that we'll be doing over the next year or so, which really sort of like work into much more the detailed constructs of all of these things that I talk about within the videos on YouTube. And as always, please do take great care.