A Definition Of Trauma
When I worked at a group practice, occasionally I would conduct intakes. The main six-page form consisted of questions I would ask in the interview and write down their answers on a clipboard. One of the questions was "Do you have a history of trauma, abuse or neglect that includes verbal, physical, emotional or sexual abuse?"
Sometimes a client would say no to this question. As I became more aware of identifying signs of trauma, I noticed some of these clients who said no to this question would disclose they had experienced a trauma in their answers to other questions I asked, such as their family history. I wanted to say something about this...but how? I didn't want to put them on the defensive. They were nervous enough, usually starting therapy for the first time in their lives.
If I asked them to define trauma in their own words, what if I they didn't know and asked me? What would I say? I realized I had some research to do. I did a Google search on trauma and found three popular websites people use.
Surprisingly, the World Health Organization website had nothing on this topic.
So I went to the American Psychological Association (APA), and their definition is "...an emotional response to a terrible event like an accident, rape or natural disaster. Immediately after the event, shock and denial are typical. Longer term reactions include unpredictable emotions, flashbacks, strained relationships and even physical symptoms like headaches or nausea. While these feelings are normal, some people have difficulty moving on with their lives."
There are several things wrong with this definition. It seems to imply you'll know if you experienced it. It focuses on a single event (known as "Big T" trauma) instead of encompassing chronic trauma (known as "little t" trauma) and it lists a broad brushstroke of symptoms that leaves out many others. The last sentence leaves out the fact that "some people" will have more difficulty "moving on" if they isolate themselves after experiencing trauma. And they include the culturally-biased word normal in their definition. I've stopped using this word with clients, substituting it with natural. My hope was to find a definition that offered a way to identify what can qualify as traumatic in early or late childhood just as easily as a single event.
The closest Wikipedia comes to defining trauma is narrowing it down as psychological trauma. Wikipedia sourced the definition from the now-defunct website of the Substance Abuse and Mental Health Services Administration (associated with the U.S. Health & Human Services branch of the federal government): psychological trauma is damage to a person's mind as a result of one or more events that cause overwhelming amounts of stress that exceed the person's ability to cope or integrate the emotions involved, eventually leading to serious, long-term negative consequences.
Damage to a person's mind? This governmental doom-and-gloom explanation seems intended for someone who has experienced trauma already or was told they experienced trauma from a healthcare professional and wants to know more information online. Besides overwhelming stress, this demoralizing definition also fails to answer the question how can you tell if you experienced trauma if you do not know what qualifies as trauma?
Eventually I stumbled upon a sound definition while reading a magazine article about treating trauma with yoga: trauma is when you are forced into a[n extremely uncomfortable] situation without your consent.
While it's not a bull's eye, it definitely hits the dartboard:
It's not wordy or complicated and easy to memorize
It applies to both big t and little t trauma
Its key ingredients are the words forced and without your consent
Almost any situation in which one experiences these key ingredients will make it feel like an event
It can pertain to emotional and sexual trauma
It can be applied to variations of trauma such as neglect and abuse
Now that I had a good definition, I felt more confident during intake interviews when I asked the trauma history question. I would follow-up with the ones who I sensed had experienced trauma by asking them what they thought it meant. Almost every one of them had difficulty with this question, said they had heard of this word many times, laughed a little at their struggle and finally asked me for help.
To my surprise reciting that simple definition was like turning on a light bulb. Many times I watched a transformation in their posture, tone of voice, facial expression and affect. I continue to use this definition in my practice when it is appropriate and it continues to be an "A-Ha" moment and serve as a map to figure out what happened in a person's life.
If you are not sure whether you have experienced trauma before the age of 18, you can take the free 10-question Adverse Childhood Experiences (ACEs).