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Life’s Traumas—Both Large and Small
My life has been filled with trauma. When there are a lot of traumas in your life, you kind of take them for granted. As far as I’m concerned, traumas are everyday occurrences. A looped tape of my life runs through my head. I can’t seem to forget the bad experiences. And there have been so many of them that I’m always anxious and worried about what might happen next.
—Kim, forty-one-year-old shop owner
I was recently speaking with a group of people about my work on trauma and post-traumatic stress disorder (PTSD) when a man in the group asked me if I was doing any research at the local veterans’ hospital. When I explained that my work focuses primarily on women in the community, he was genuinely surprised. “I thought it was only veterans who get PTSD,” he said. “How does the average woman get PTSD if she is not in the military?”
His reaction is not unusual. Many of us tend to associate trauma and PTSD with military personnel. We have read so much about these psychically wounded warriors that it’s easy to forget how many men and women without military experience struggle with trauma. Living among us are countless millions struggling to recover from events that occurred while they were going about the simple business of everyday life. I’m talking about the friendly next-door neighbor who regularly waves to us as she walks her dog, as well as our mothers, sisters, brothers, daughters, sons, and friends. Why do so many of us feel like wounded warriors, exhausted and scarred by painful past events in our lives? Why can’t we stop thinking about what happened? And what can we do to help ourselves recover from the traumatic experiences of life?
Let’s start by acknowledging the degree to which trauma is common to all of us. A recent study of nearly seventy thousand people from all around the world reports that more than 70 percent have been exposed to one or more traumas at some time in their lives.1 Moreover, those who had a history of trauma were more likely to experience additional traumas in their future. For example, persons who experienced physical violence as children were more likely to experience violence as adults, such as muggings or domestic abuse.2 And as a result, they were at greater risk for being diagnosed with post-traumatic stress disorder. In general, the scientific literature suggests that men are slightly more likely to have traumatic experiences—but far more women suffer from PTSD. In fact, women are two to three times more likely than men to be diagnosed with PTSD.3 This statistic is alarming and one of the reasons I became interested in how women specifically respond to stress and trauma. Moreover, traumatic experiences don’t just produce symptoms of PTSD; they often produce symptoms of depression and anxiety, as well as high blood pressure, insomnia, and even obesity. They also change the way we think and what we think about. I will discuss in depth all of these responses to trauma, but before doing so, we need to consider what we mean by trauma. What is it, exactly? And how is it different from stress?
STRESS VERSUS TRAUMA
I have been studying stress and trauma for several decades, and yet still find it difficult to define them and to distinguish them from each other.4 The average dictionary definitions of stress mention “pressure” or “tension” that is applied or exerted on an object. Merriam-Webster’s defines stress as “a force exerted when one body or body part presses on, pulls on, pushes against, or tends to compress or twist another body or body part.” In this case, the word body does not necessarily refer to the human body, but it can be useful to think of it in this way. We might think of psychological stress as a force exerting itself on our brains—twisting them, causing a new, different, and generally unwelcome set of responses. We know it when we feel it.
The word trauma is derived from the Greek word for wound. If you have been psychologically traumatized, you have been in this sense “wounded.” Think about your own life. Have you felt traumatized by any of the events during it? Has anything happened that caused you to feel “unsafe”? Do you have memories of experiences that left you feeling significantly less than whole? Traumatic events are typically described as experiences during which you personally and realistically felt threatened with death or serious injury or harm. But trauma can also arise when we hear about a trauma that happens to someone else, such as the unexpected death of a loved one, family member, or close friend. Traumatic events are wide-ranging and all-encompassing, from car accidents and physical abuse to violence on the streets, natural disasters, and medical conditions. It’s hard not to recognize that daily life itself has the potential to be deeply traumatizing.
There are three key differences between stress and trauma: (1) length, (2) intensity, and (3) how we feel at the time and afterward. Let’s start with length.
Stress is often categorized as short, as in acute stress, or long, as in chronic stress. An acute stressor would be something like a small fender bender, a really bad date, or an unfortunate meal you remember best for the stomachache that followed. In contrast, chronic stress goes on and on and on, day in and day out. Chronic stress can be caused by a wide range of circumstances—everything from an overly demanding job to trying to manage unpleasant living conditions or enduring extremely difficult relationships with family or romantic partners. Long-term illnesses, such as cancer, HIV, and long-haul COVID-19, are chronic stressors. Systemic racism also falls into this category, as well as discrimination on the basis of sexual orientation, gender, and age. As one of my students once told me, “In some way or another, every day is sort of a stressful day for me.”
In contrast, traumas are usually short in duration, or at least remembered that way. We tend to remember a “car crash,” “assault,” “earthquake,” or even “romantic betrayal” as one event—as an episode. Some clinicians further distinguish between simple and complex trauma. In this case, a simple trauma refers to a single event that is definable, such as a car accident. I prefer the term acute over the term simple, because there is nothing really simple about trauma, regardless of what happened. Complex trauma, as the name implies, has more to it—more episodes, more responses, more experiences—and is oftentimes interpersonal in nature, such as the trauma associated with child abuse.
Now for intensity. Traumas are generally more intense than stressors and therefore cause more harm and injury. Recall that the word trauma arises from the word wound, whereas the word stress is defined as a twisting—a remarkably accurate description for the way we feel when we are under stress. Stress twists and turns us around, making us uncomfortable and generally unhappy. But with trauma, there is a wound, and that wound, if serious enough, will be resistant to healing and may even cause irreparable damage.
Finally, for our feelings. In general, traumas elicit negative feelings, whereas stressors do not necessarily. Many stressful events in our lives feel good—graduating from high school, getting married, or landing a dream job. I heard a lecture once during which the teacher described a set of responses and feelings that he was having—heart racing, sweating, anxious thoughts, and so on. He asked us to guess what he was experiencing. We all guessed bad things. But we were wrong; he was describing how he felt when he first fell in love. When we get excited in this way, our body physically responds with similar sensations that we have when we are facing more negative experiences. Apparently the astronaut Neil Armstrong landed on the moon with his heart racing at 150 beats per minute—which was about 80 percent of his maximum. He was stressed but in an excited, good kind of way, albeit with some fear mixed in. So, we can be highly stressed without feeling traumatized. But we cannot be traumatized without also being stressed. Highly traumatic experiences take our stress responses to another level.
EVERYONE IS THE SAME AND DIFFERENT
Each person responds to significant life events a bit differently, and these so-called individual differences are important to keep in mind when trying to understand any one person’s response. Recall the car accident I described earlier, during which the husband broke the windshield while his wife sat frozen in fear. Why did the two of them respond so differently? Or take 9/11. When the Twin Towers collapsed, some who witnessed the event ended up with PTSD, while others did not. Why were some so traumatized that they moved out of New York City altogether, while others felt fine going back downtown to work? Also, one person’s memories may be different from or sharper than someone else’s. I have a girlfriend who seems to remember everything—even waiters we had in a restaurant years ago, whereas I have no recollection whatsoever. And people are similarly different when it comes to memories of trauma. While someone can remember what happened vividly, another person may shut the memory out entirely.
Individual differences are often attributed to differences in resilience. It helps to think of each person as a rope. One person might be born with a strong, thick rope, while another is born with a thin, more fragile one. Someone who ended up with PTSD after 9/11 might have been born with a more fragile rope or lived through circumstances that frayed the rope, making it more vulnerable even before that day. If you have a stronger rope or can cultivate one, it will take more stress to break it. But if you have a fragile one or if life has weakened your rope along the way, a smaller amount of stress can cause it to fray and maybe even break. We can make our ropes stronger with healthy behaviors, such as physical exercise, eating well, and sleeping well. But we should also go beyond the obvious. We should and can train our brains to learn new skills that will help us accept and live with our own thoughts and memories—more on how to do this later. Then, when stress and trauma arise, our ropes will be less likely to break.
Take Antonio, who was a standout athlete his whole life, even though he suffered with dysthymia, a mild but persistent form of depression. When he broke his leg, his life came to a dead stop.
The whole time that I was locked up in my room I was alone with my own thoughts. I had already suffered from some depression, but it started to become more noticeable. I hit the lowest point in my life, and at that point, I truly felt my life came to an end, and I didn’t care what happened. I had pushed away my friends, I wasn’t eating, and I was sleeping all the time. I was very moody and unhappy and did some things I do not wish to mention. Do I blame my injury for my depression? No, but I do believe that the injury triggered tough emotions. As much as I wish the injury never happened, I believe that if it hadn’t, my depression would have been less noticeable and who knows what the outcome could have been. Because of my trauma, I am alive today.
It is needless to say again, but I will: we are all different. What is stressful or traumatic to one person may not be so to another. Life brings to each of us differing experiences and, as a result, differing responses. But we are also very much the same. We are human beings living in a life composed of constant change and potential danger, interweaved with opportunities for new learning and the certainty of still more change.
COMMON SOURCES OF STRESS AND TRAUMA
In the course of living an average life, we are all going to experience traumatic events, some of them severe enough to cause PTSD and others not. It’s estimated, for example, that regardless of military service, one out of ten women will develop PTSD at some point in their lives.5 The risk is less for men but they are still vulnerable. So, now I am going to review some of the common stressors and traumas that people experience. This list is not meant to be exhaustive; that would be impossible. But I do want you to at least recognize some of the traumatic life events that you or someone you know might have experienced but maybe would not have considered traumatic at the time or in retrospect. All that said, I do not mean to imply that all perturbations in life are traumatic. Years ago an established figure in the trauma field told me he was concerned about the overuse of the word trauma and, in particular, the increase in diagnoses of trauma-related mental illnesses such as PTSD. I remember him telling me that someone came to him with symptoms that they said they had acquired while watching the nightly news on television. But on the other side of the spectrum are those of our fellow human beings who experience so many traumas that they can barely recall them, much less categorize them. So with those caveats in mind, let’s review some common stressors and sources of trauma.
Difficult Childhoods
Not everyone has a perfect childhood. Many people grow up in homes that don’t feel safe, with caretakers who are physically and/or emotionally terrifying. Ongoing verbal abuse from a partner or a parent takes a toll on our mental and emotional well-being and in this way can be deeply traumatic. When these experiences continue day after day, children often learn to expect still more misfortune. As adults, these individuals may approach the world as if they were expecting to be hit or verbally assaulted—ready to flinch, run for cover, or completely shut down. A difficult childhood can also include growing up with food insecurity or in neighborhoods that feel dangerous and scary or with the experience of being repeatedly bullied. Others remember parents who abused substances, such as drugs or alcohol, and whose personalities changed accordingly. A large number of people talk about being afraid of siblings who were abusive, while others were traumatized when their parents were divorced. And some childhood experiences are almost too tragic to comprehend. One of my close friends was traumatized throughout his childhood by his own father, who suffered from severe mental illness. His father once tried to run him over with his car!6
Accidents
Most people are involved in an accident of some sort in their lifetimes, and although they may not be as dramatic as the car accident described in the prologue, they nonetheless can leave us anxious and afraid, with racing hearts and sweaty palms. And there are other possible repercussions, such as self-blame and guilt even if the person is not at fault. As people age, they are more likely to fall and injure themselves, oftentimes breaking bones. These types of accidents can spiral downward into a loss of overall health and well-being.
Disease and Illness
Being diagnosed with a serious medical condition is often traumatizing. A person may spend a year or more undergoing a variety of medical procedures and receiving treatments ranging from surgery to chemotherapy. Imagine lying in bed every night thinking about what could happen. Such experiences are highly stressful and often traumatic. Many people don’t have access to health care or medical insurance and must make impossible choices about their care or the care of their loved ones. There is still so much we must learn about the long-term consequences of suffering from a serious illness even if the illness is successfully treated, as we have learned about COVID-19 during the pandemic.
Life-Threatening Events
Natural disasters such as floods, hurricanes, and tornadoes make us more vulnerable to PTSD. Someone I knew was nearly hit by a television that flew off the counter during one of the larger earthquakes in Los Angeles. Glass was everywhere, and although he was not physically injured, he said he didn’t feel safe living in an earthquake zone anymore. He moved to the East Coast, only to be caught up in the destruction of Hurricane Sandy.
First Responders, Emergency Medical Personnel, Relief Workers, and Other Health Care Workers
Police, firefighters, nurses, doctors, and other medical personnel are regularly exposed to trauma—sometimes so much so that they become traumatized themselves. It’s hard to overstate the trauma experienced by first responders called to help people who are literally gasping for air after being infected with the novel coronavirus. Reporters on the beat are also vulnerable.
Extended Periods of Caretaking
It’s difficult to appreciate the degree of stress that must come with caretaking, not to mention all the worry and concern—and the guilt. “Am I doing the right thing? Should I be doing more?” It is difficult when the care is appreciated and perhaps more so when it is not. The number of people who reach old age is increasing every year, and with that comes more and greater need for 24/7 care, either at home or in long-term care facilities. We need only remember all the people who were left alone in hospitals and nursing homes during the pandemic, isolated from those they loved and needed the most.
Death of a Loved One
People often say that losing a loved one is just part of life, but that doesn’t make it any easier when it happens. Losing your parent is traumatic enough, but how does anyone ever recover from the loss of a child? And what about the trauma of suicide, with so many questions left unanswered?
Romantic Love and Breakups
We all know people who have been traumatized by romantic breakups. I met a woman the other day who, within minutes, told me all about her recent breakup. Out of the blue, her boyfriend of eight years left her. She couldn’t eat or sleep and spent most of her days crying. She was moving across the country just to get away from the memories. Another woman told me about how she had just met the man of her dreams. They were walking out of a restaurant one night and someone came up and stabbed him to death. She then had to call his parents to let them know what had happened to their son. She was so devastated that she quit her job as a lawyer.
Violence
Think about the children and teachers present at any of the school shootings that have taken place in this country. Or those who live in neighborhoods where gun violence occurs on their street corners. Others experience sexual and physical violence, with as many as one in three women worldwide being victimized in their lifetimes.7 And the trauma of domestic violence, much of it committed in secret with no end in sight, cannot be overestimated.
Pregnancy and Childbirth
Some women are traumatized by accidental pregnancies, and others while trying to become pregnant, which is not always an easy process. And how about childbirth itself? Women tend to expect childbirth to be an idyllic experience filled with nothing but joy, but even today, it doesn’t always work out that way. Women still experience difficult labor, extreme pain, sometimes combined with fears for the baby’s well-being. Many women describe difficult circumstances—epidurals that don’t work, neglectful hospital personnel, and partners who don’t show up.
Copyright © 2021 by Dr. Tracey Jo Shors
