How We Are Hardwired to Respond to Trauma
Through advances in neuroscience, we are learning that memories born of trauma, that is memories involving significant fear, are dealt with differently than every day memories. The most likely reason for this is that as we evolved, learning from fear based or traumatic incidents was crucial. It was (and still is) super important to remember that touching fire is dangerous, or to remember that in particular areas, you have a fair chance of having an encounter with a bear or cougar. Remembering and having awareness of things and situations related to our safety and survival was (and is) crucial to our survival. So the brain deals with these things differently, and embeds them into our consciousness differently than, say, multiplication tables.
Trauma memories affects our bodies in the moments during the trauma, and hundreds of times in the aftermath. In fact, even thinking about traumatic situations-much less experiencing trauma- can often affect our feeling states and our emotional states,  as well as our autonomic systems. A quick experiential example may be useful.
As adults we all know to not stick forks into electricity outlets, and most of us can remember this fact without having emotional reactions or feelings that accompany the memory. But if you’ve actually witnessed, or done this act yourself, chances are good that my mention of the idea will call up a memory and that memory will be accompanied by an automatic sense of anxiety or fear, the intensity of which may vary considerably. Even most folks who haven’t had this happen and simply deeply imagine the scenario of watching a child do this can feel anxiety or fear as a result of imagining the event.
Further, your body’s autonomic systems are affected- these systems will behave differently. The almost inescapable results of experiencing, seeing, or even deeply thinking about traumatic situations are that involuntary changes in autonomic bodily systems happen. If you take a couple of minutes to sit quietly and really focus on deeply imagining the scenario above, you may be able to notice your muscles tightening around your gut, or notice changes in your breathing patterns or other changes. This is a normal human reaction to thinking about traumatic events. By the way, if you really deeply imagined the event and did not feel anxiety or notice any changes in your body, consider the possibility that you steeled yourself in advance for the experience. This is something I will come back to later in the section on treatment for trauma based symptoms.
The point is that even thinking about trauma can and does affect our bodies involuntarily. Depending on the significance of the event or memory, the autonomic responses to it can range from slight to quite significant even years after the event.
What Happens In Our Minds To Heal From Trauma
In uncomplicated recovery from trauma, complex dynamics aimed at recovery get to work almost immediately.
In the case of a car accident where the driver suffers a broken arm, the autonomic systems will be triggered to go into high gear immediately after the accident. These systems will stay in high gear until the body thinks the danger has passed, and feels assured that safety issues (such as the broken arm) will be attended to. But long before those systems are back to normal, the person starts to try to make sense of what has just happened. In the immediate aftermath, people begin to “self soothe” little by little, that is they begin to say small things to themselves like “Oh my God my arm hurts, but I’m going to be okay”, or “Wow, that was really scary, but the scary part is over”, or even “Oh my God, I think my arm is broken, but at least I’m alive… that’s good”. Self soothing and a realization of a return to safety helps people begin to regain a sense of control again.
Regaining a Sense of Power and Control
The key thing to remember about trauma in individuals is that our sense of control vanishes during the traumatic event. Not only does it vanish, but really really bad things happen when we are not in control. So telling yourself you’re safe or it’s going to be okay is the first step at getting back a sense of control.
In regards to the car accident, or any traumatic event, it’s obviously going to take more than one or two reassurances to repair a major upset of a person’s world and the damage done. Our lives are changed as a result of any traumatic event, and its accompanying sense of a loss of control. But we’ve developed a couple of mechanisms for opportunities to reassure ourselves for as many times as it takes: Repeating events in our minds in the immediate aftermath of trauma is a normal function. In uncomplicated recovery, it’s a healing function because each time we repeat the event in our minds, parts of ourselves find ways of making more sense of the event. What needs to happen is an increasing sense of regaining control over the situation (and thus our lives) by making meaning out of the event that allows us to feel things can and will go back to being okay. We need to feel safe and that we can retake control of our lives. We need to believe the future will not be terrifying.
Creating A Storyline To Frame The Event
A related recovery mechanism we instinctively need to make meaning of what happened. So what many people do in the aftermath of trauma is talk about the event to others. Each repeating of the event in the immediate or recent aftermath of the event whether from it replaying in our minds or from us talking with others about it is an opportunity to create meaning about it that furthers these feelings. We keep creating the storyline until we’ve (consciously or not consciously) solidified some beliefs about having regained safety and control. We need to have a sense of safety and some sense of having control as deeply held personal beliefs in order to function well in the world. In creating storylines with these beliefs embedded in them, we find ways to make (relative) peace with event.
Pitfalls in Recovery
In many cases of traumatic events, humans are able to navigate this road to recovery from trauma with relatively little obstruction or detour. But a lot can and does go wrong for people in recovering from trauma.
Our Bodies Tell Us The Danger Persists
In the immediate aftermath, the autonomic systems can mislead people into thinking danger is still present. In that same car accident scenario, the person could easily react with panic at his elevated heart rate, and have thoughts that make him continue to feel he is unsafe.
The person with the elevated heart rate could easily (unconsciously) focus on the negatives, such as noticing a person who appears to not be helping instead of noticing the several people who are. He could continue to create a storyline that is problematic. “That car came out of nowhere and that guy didn’t care about my well being, therefore the world is not safe.” Sounds a bit unrealistic to a logical mind, but trauma by definition causes rattled minds that then need to find ways to regain equilibrium. Logic is not its strong suit at the moment. And it is a mind that is reacting to unusually aroused autonomic systems.
Highly Maladaptive Story Lines
One of the processes that happens during this level of autonomic arousal is the mind thinks in terms of fight or flight or freeze. In a very real sense, our normal problem solving brains are just not available to us when our autonomic systems are triggered. So faulty logic based triggered by fear can end up being unconsciously accepted by us. It can be pretty easy to solidify false beliefs and assumptions about the event and how to avoid it in the future. Eventually everyone does make storylines that give them some measure of control back over their lives, but those storylines could be problematic in other ways. Our accident survivor could develop beliefs such as “The only way to stay safe is to not ride in a car again.” The person has achieved a sense of control, but at a high price that is maladaptive.
Maladaptive StoryLines That People Live With
Our storylines around trauma change and eventually settle down as time goes on. Lots of times people begin with very primitive storylines that then become a bit more reasonable as time goes on. In a few weeks maladaptive story lines could be “I’m safe enough outside of a car. It might be safe to be in a car, but it’s likely to not be.” With a storyline like that, the person is likely to have considerable anxiety when he rides in cars. However, he may be able to live with that for some time, even the rest of his life if it’s not too bad. Most people at some points in life develop least a couple of unrealistic fears. And most have known, or at least heard of people with anxieties or fears around day to day things like this. They get anxious around certain situations, and if they dug carefully, at the bottom of their anxiety would most likely be a storyline with some kinds of maladaptive beliefs which were oftentimes triggered by autonomic system changes.
Story Development Hijacked By Our Autonomous Systems
Speaking of, storylines that were adequately healthy can sometimes turn maladaptive due to taking their cues from autonomic systems kicking into gear when they get close to the event again. The first time getting back into a car soon after an accident, virtually everyone is going to feel some effects in their bodies. Our autonomic systems get activated due to the primal way people react to -any- perceived threat to themselves. Because our bodies are reacting in ways that we associate with fear, anxiety, and overwhelm, our storylines can then be swayed from increasing safety, to increasing anxiety, which then spurs the autonomic responses to keep activating. The whole thing can become a cycle that leads to maladaptive thoughts which can eventually solidify into beliefs.
Shutting Down The Story Telling
Another pitfall in recovery is to start creating a storyline, and then shut it down. Shutting down thoughts about trauma and “putting it away” before a healthy storyline has embedded itself in our psyche is a very common response. It can happen for a variety of reasons. The person may be or believe they are in extended danger so they have to focus on survival issues instead of processing the trauma. The person may be overwhelmed by the event and not feel they are able to deal with it. Others may start to come up with unhealthy storylines such as blaming themselves, or feel they are “weak” to feel bothered by the event. So they resort to a forced stoicism. In other situations, the person may grasp (realistically or not) that the situation is likely to happen again so they set to work to try to adapt to it as best as possible. This is an important dynamic for us to pay attention to in the dynamics of Cultural PTSD. In all of those cases the trauma is buried as much as possible. For the individual, trauma based symptoms may or may not come up later as a result, depending mostly on the person’s environment, and the extent of the trauma. When trauma is significant, the coping mechanisms put into play to try to bury the trauma (as a way to protect ourselves) are often significantly maladaptive. Additionally, the mind’s ability to keep trauma unresolved is often tested later in life when the possibility of similar issues arise, or triggered due to some other circumstances, including, ironically enough, a sense of real safety.
Additional pitfalls are when similar events happen again. A new storyline for the new event has to be created. Repeated traumas complicate things because this is another devastating loss of control. Because of this, the likelihood of the person sensing they really don’t have much control climbs, and as that happens, the odds of them creating storylines that are healthy will generally decrease. Again, this element is one to keep in mind as we study Cultural PTSD and how to address it.
Trying To Heal In Isolation
Additionally, people are generally not be able to create healthy storylines completely by themselves in the aftermath of trauma. We are social beings and the need for support in the aftermath of trauma is a normal human need.
Without support, the person is less likely to regain a feeling of safety or a sense that things will go back to normal. They may blame themselves for the situation or come up with other maladaptive storylines such as “Driving is completely dangerous, I’m never going to be safe again if I get into a car.” When people do not voice storylines such as these, they do not give others a chance to refute them and help the person feel safe again.
Lack of Healthy Support
Lastly, and unfortunately, sometimes the people around the survivor may not offer healthy support. Trauma not only affects the survivor, but it also affects those in the immediate vicinity, and it most certainly affects people close to the survivor. Recall that simply thinking about fictional trauma events is enough to arouse a person’s autonomic systems of fight or flight. After a traumatic event, the people around the survivor are also in fragile states. They also need to make sense of the situation. Their sense of control and safety have also been greatly affected. In many cultures blaming the victim has been customary in regards to some situations- people are thought to have angered God or have done some other bad behavior to bring trauma upon themselves. The people nearest to the trauma and most affected by it have to create a storyline that gives them back some sense of control over life. A storyline that involves blaming the victim is one way to achieve that. This is one of many examples of Cultural PTSD.
Trauma based symptoms that do not rise to the level of PTSD can include a variety of things that range in seriousness. People often function well enough to lead productive enough lives and just learn to live with the symptoms. Other people will come in to counseling because they are having difficulty in specific areas.
If a person has just one or two of these symptoms by themselves, and they come in for help, sometimes they get misdiagnosed. For example take a person functioning well enough, but comes in because “I feel sort of numb, I’m not really enjoying life.” Up until recently, most clinicians wouldn’t think about trauma immediately when diagnosing. And some still don’t. But a growing number in the helping fields are becoming aware of the wide ranging effects of trauma on people.
In addition to individual practitioners becoming better able to perceive and treat trauma based responses, many agencies in the helping fields have become aware of trauma based responses and how people coming into their agencies might be responding to the agency policies due to trauma based responses. This awareness is called Trauma Informed Care. Basically, it’s an organizational awareness about the high levels of trauma based responses their consumers might have to their services. In light of this awareness, agencies strive to make their processes and policies more helpful to those dealing with trauma based symptoms. We will delve into Trauma Informed Care on the agency level in more detail in the next chapter.
For now, let’s go back to our PTSD symptoms. Notice the entire second cluster of symptoms in the PTSD description is about avoiding reminders of the trauma. As I said earlier trauma based responses are incredibly common when dealing with people in mental health settings. It is also very common to notice trauma based responses or symptoms in people, bring the subject up, and have the person (initially) deny or minimize the impact of trauma on their current behaviors and coping skills. A good percentage of people have no inkling that their anxieties, depression, relationship issues, or other issues can be traced back to or triggered by trauma that happened -often times- many years ago. It’s not uncommon to have a person flat out say no, they did not have any major traumas as a child, only to find out later that they had lived through situations that were clearly traumatic.
This is understandable. No one likes to think about traumatic events. Even thinking about trauma can be extremely painful. If our autonomic systems can be triggered by simply imagining a fictional scene, think about how people’s systems respond when they are faced with having to think about real trauma experiences.
Often people don’t want to believe trauma events affected them in the long term. They will attribute their trauma responses to outside factors. When first dealing with people and their trauma, it’s important to assess for their sense of safety and comfort in various aspects of their lives and it is very important to assess for their sense of safety in the clinician’s room. Trust in the clinician, and the client’s sense of control are crucial to a successful outcome.
Their hyper focus on control stays intact until they realize where it came from.
 What’s the difference between feelings and emotions? There’s still debate over that. For reference, the differences as I am using them in this piece: Our autonomic systems get triggered by an event, the changes in the body produce things we perceive of as emotional states ( a sense of fright, unease, or in positive situations connectedness, etc) which then we become aware of and accept or reject based on conscious or almost conscious thoughts. “What’s that unease? Hmmm, The situation looks potentially dangerous, I think I must be afraid.” To put it another way: Emotional states are nouns, feelings are verbs.
 Autonomic functions are almost all involuntary things like sweating, pulse rates, and blood flow constricting blood vessels. When aroused, certain hormone production increases (such as adrenalin and cortisol). Other functions like digestion processes decrease. These things are involuntary, they happen without us saying “Do this!” They are also activated by very primitive parts of our brains whose main functions are to keep us safe and alive.
 This study was groundbreaking and the original findings have been replicated in numerous smaller studies since then. https://www.cdc.gov/violenceprevention/acestudy/index.html