I recently gave an HIV positive diagnosis to a woman in a correctional facility. She looked at me in disbelief and for a long moment she was gone, staring at the ceiling, no longer listening to what I had to say. She did not respond to my questions. Watching her reaction to the diagnosis my first thought was, “I have just shattered her sense of safety in the world.” My second thought was, “How can I possibly help her to recreate this sense of safety?”
The words of Hans Selye, the well-know Canadian stress researcher came to mind, “It must be said, without hesitation, that for man the most important stressors are emotional.” (1)
What is trauma?
Trauma is often defined as the unique individual experience of an event or enduring conditions, in which the individual is unable to integrate his or her emotional experience. An individual’s capacity to cope is overwhelmed and they may experience a threat to life, bodily integrity, or sanity. (2)
Judith Herman MD, a pioneer in trauma work, writes, “Traumatic events call into question basic human relationships. They breach the attachments of family, friendship, love and community. They shatter the construction of the self that is formed and sustained in relation to others. They undermine belief systems that give meaning to human experience. They violate the victim’s faith in a natural or divine order and cast the victim into a state of existential crisis.” (3)
Types of trauma
In a Trauma Informed Practice Guide, currently in development for the mental health and substance use system of care in BC, a number of dimensions of trauma are outlined, including magnitude, complexity, frequency, duration, and whether it occurs from an interpersonal or external source. The authors describe the following types of trauma:
- Simple or single incident trauma is related to an unexpected and overwhelming event such as an accident, natural disaster, a single episode of abuse or assault, sudden loss, or witnessing violence.
- Complex or repetitive trauma is a response(s) to ongoing abuse, domestic violence, war or ongoing betrayal, and often involves being trapped emotionally and/or physically.
- Developmental trauma results from exposure to early trauma (as infants, children and youth) involving disrupted attachment, neglect, abandonment, physical abuse or assault, sexual abuse or assault, emotional abuse, witnessing violence or death, and/or coercion or betrayal.
- Historical trauma is a cumulative emotional and psychological wounding over the lifespan and across generations emanating from massive group trauma. These collective traumas are inflicted by a subjugating, dominant population. Examples of historical trauma include genocide, colonialism, slavery and war.
- Intergenerational trauma is often described as an aspect of historical trauma. It refers to the psychological or emotional effects that can be experienced by people who live with trauma survivors. This can mean that coping and adaptation patterns developed in response to trauma are passed from one generation to the next.
- Hans Selye, The Stress of Life, rev. ed. (New York: MacGraw-Hill, 1978), 4.
- Elizabeth Vermilyea, Trauma Informed Care: Trauma and its relationship to Addiction, HIV and STIs. (lecture at BC Centre for Disease Control, Vancouver, BC, 24 November 2012).
- Judith Herman, Trauma and Recovery, (Harper Collins 1992) Chapter 3, p 51.
- Trauma Informed Practice Guide, Vancouver, BC, Draft 5, 2012.
Manifestations of trauma (June 2013)