Dr T Ayodele Ajayi looks at the issue of trauma, its causes, and the impact trauma has on the human psyche
What is Trauma?
Trauma is a term that has forced its way into our post COVID-19 era vocabulary. Understandably so, given the hardship the global community has experienced this decade. Trauma is a Greek word which originally means to wound or pierce. This term has quickly become ubiquitous, and we run the risk of minimising the heavy import and losing the meaning of the word. In psychological terms, trauma is a past emotional wound that affects how we live in the present and how we perceive the future. It is the psychological reaction to traumatic event(s) when the experience has not been well processed.
Every one of us at some point in our lives will either experience or know someone who has experienced trauma. These traumatic events on a personal note could be bereavement, personal assault, sexual abuse or violence, bullying, domestic violence, car crash, and other personal serious injuries among others. On a collective note, they include terrorist attacks, natural disasters, hostage situations, wars or threats of war. The experience can be singular, multiple, repeated or chronic. What is also intriguing is the subjective perception of what is traumatic. What you perceive as trauma could be different from what I experience as trauma.
The hallmark is that traumatic events destabilise one’s sense of safety; overwhelm the coping mechanism; and generate a psychological response. Unlike ordinary hardships, traumatic events tend to be sudden and unpredictable, and feel beyond a person’s control.
Adverse Childhood Experiences
Another form of trauma to bear in mind is one that children experience. The term Adverse Childhood Experiences (ACEs) is commonly used. This refers to a range of negative situations — verbal, physical, emotional or sexual — a child may face or witness while growing up. These include emotional or physical neglect; parental separation or divorce; or living in a household in which domestic violence occurs. ACEs can also include living in a household with an alcohol- or substance-abuser; or with family members who suffer mental disorders; or in a household with an incarcerated family member.
ACEs can disrupt the normal course of development, and the emotional injury can last long into adulthood. Research shows that exposure to more than four ACEs increases the risk of a range of mental and chronic physical health problems later in life. These problems are emotional regulation, anxiety, depression, PTSD, poor school performance and suicide. Physical health problems associated with ACEs are a higher risk of diabetes, heart disease, cancers and immunosuppression, and up to a 20-year reduction in life expectancy.
Another form of trauma is secondary or vicarious trauma. Vicarious trauma (VT) is defined as unfavourable changes — both affective and cognitive — resulting from exposure to second-hand traumatic material (Jimenez et al., 2021b). This arises from exposure to other people’s suffering, with those in frontline caring professions, notably physicians, healthcare workers, first responders, law enforcement agents and ministers of religion particularly at risk. Symptoms can be similar to those of primary trauma.
Effect of Trauma
Traumatic events activate the amygdala, which is an almond-shaped group of nerve cells in the central part of the brain responsible for detecting threats. These cells play a central role in the processing and memory of emotions, especially fear. On activation, the amygdala sends out an alarm to multiple body systems to prepare for defence. This ultimately leads to the release of stress hormones — cortisol, adrenaline and noradrenaline — that prepare the body for a fight-flight-or-freeze response. Fear, anxiety, anger, aggression and shock are all normal responses to trauma. Such emotions, however, should dissipate as the crisis abates and the experience fades from memory. In some people, the distressing feelings can linger, interfering with day-to-day life. This is when trauma becomes pathological, resulting in a range of mental health conditions, including Post Traumatic Stress Disorder (PTSD), depression and anxiety.
Overall, there is a need for a balanced view of trauma. Survivors need to be supported by society to get help and recover. In the converse, victims can develop unhealthy views of the world as an unsafe place. This could fester a culture of victimhood that does more harm than good by ignoring people’s capacity for growth through challenges.
A resource I recently encountered that can help believers in Christ to examine trauma through the lens of the Christian faith is a book by Kobe Campbell, Why Am I Like This? How to Break Cycles, Heal from Trauma, and Restore Your Faith. Campbell herself described her book as a ‘Trauma 101’ book for Christians.
In the second part of this article, I will be looking at the evidence-based, effective interventions for trauma and self-help techniques to help manage anxiety.
Dr T Ayodele Ajayi MbchB FRCPhysch is a consultant psychiatrist, founder and convener of the Tripart Care Emotional Wellbeing Hub, and has a YouTube channel called TriPart Care