If you’ve made it this far in your life without sustaining some kind of trauma, then you are one of the lucky ones. Most of us are experiencing different kinds of trauma all along the timeline of our lives. Some of these are big traumas, some of them small. And whether they leave a lasting mark or scar is difficult to predict.
What is Trauma?
The word trauma is subjective based on experience, so I’d like to take a moment to define it before we move on. Trauma is what occurs anytime we take on injury. This could be a physical injury: a bruise, a broken bone, a cut to the skin. Or it could be an emotional or metal injury that causes damage to the psyche: feelings of inadequacy, lack of safety, or an experience of hurt or pain.
Most of the time, a traumatic event leaves both physical and emotional wounds. For example a car accident may leave you with broken bones and a head injury, along with complex emotional scars from the fear, pain or loss that occurred. Likewise, a sexual assault leaves a complex array of physical and emotional wounds.
What is PTSD?
Post Traumatic Stress is what can occur after a physical or emotional injury. “Post” simply means after, indicating that there is a stress associated in the wake of a traumatic event. Post Traumatic Stress Disorder, or PTSD, is a diagnosable condition based on set criteria outlined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
You can see the full criteria here https://www.brainline.org/article/dsm-5-criteria-ptsd, though to summarise: a person experiences distress, upsetting memories or flashbacks, becomes unsettled or hyper-vigilant and has difficulty feeling positive about themselves or the world.
In addition, the person experiences a sense of depersonalisation or derealisation: as if things are not real or are not happening to them. PTSD is longer term: being diagnosed only after six months post event, with symptoms occurring for months or even years.
Another way to look at PTSD
There is another way that we can look at PTSD that I find very helpful. It is the program that didn’t get to run, and the dream that never happened. Let’s look at these two concepts.
The dream that never happened.
Each night, as we sleep, we take our memories from the day and reprocess them into long term memory. This happens via the rapid eye movement of REM sleep (REM stands for Rapid Eye Movement, and is the deep, dreamless stage of sleep). REM takes the memories from our cortex and moves them to the limbic brain, where they reside as long term, less impactful memories.
Traumatic events do not integrate in this way. They remain closer to our minds: more impactful, as they refuse to go to the long term memory. This is what leads to the feeling of reliving the event, of life-like flashbacks, visual and auditory hallucinations or embodied experiences of the frightening memories. The events stay up close and intense, as if we are still right there with them.
The person loses the ability to see ‘that was then’ and ‘this is now’. During trauma, the cortex can’t process complex language, so the person experiencing a flashback can’t use the appropriate language to communicate what’s going on to others.
The program that didn’t get to run
As humans we create “programs” that allow us to function with whatever is happening. These programs are created and are the best available at the time. For example, a six year old who suffers an abuse creates a program that helps them to cope and feel as safe as they can inside their environment.
Many years later that program is still running to keep them safe. However the program is out of date. The adult is still using a six year old’s program to guard themselves against an environment that no longer exists. They may avoid powerful people, stay small, do what they’re told, never step out of line, even though it is no longer required of them. They are trying to stay safe and cope with life, using an outdated operating system.
They may still see themselves as “bad” because when they are six, they were unable to understand that bad things can happen to anyone. They would’ve believed that they were bad and wrong, as that is the only thing that would’ve made sense then. As an adult, the old program needs to be re-integrated, or it will continue to run as them, their inherent belief about themselves
We can think of PTSD as the program that didn’t get to run. In the case of a traumatic event, the person may have created a program of panic, of paying attention, or of doing something. Then, as the event ended, that program did not get to complete.
And example is one of my clients, Kate, who was a paramedic for 13 years. Kate created a program of being highly functional, always paying attention, judging her performance harshly, and being emotionless during times of heavy emotion.
Later, two years after resigning, Kate was still trying to hide her grief, stay alert, and be capable. Kate had adopted a negative view of the world, was having difficulty feeling optimistic and held unconscious negative beliefs about herself within the traumatic memories.
Kate was exhausted, and all she longed to do was soften, let go of judgments about her performance as a paramedic and cry all the tears she’d had to hold in over the years. Kate’s programs were out of date. She no longer needed them in her life. We had to integrate the program so she could let them go.
Case Study on EMDR
In order to integrate Kate’s outdated program we did a full day of intensive therapy called EMDR. In our next blog we will be sharing the Kate’s story in greater detail.