In 1684 Blankaart’s Physical Dictionary penned the first official record of the word trauma, defining it as, “a wound, or external bodily injury.” It would be another two hundred years before the advent of psychoanalysis would usher in an expanded conception of trauma as internal injury. Psychologist William James introduced this idea in the initial issue of Psychological Review, “Certain reminiscences of the shock fall into the subliminal consciousness, where they can only be discovered in ‘hypnoid’ states. If left there, they act as permanent ‘psychic traumata’, thorns in the spirit, so to speak.”
As the language of psychology increasingly pervades contemporary culture, it is not uncommon to hear academics refer to historical traumas, journalists to national traumas, psychiatrists to The Trauma of Everyday Life, and to overhear strangers lament the trauma of not enough legroom in coach. The word trauma has become ubiquitous; is this reflective of the fact that we, collectively, feel ourselves to be traumatized? Or, as awareness of our psychic scars intensifies, have we merely improved at acknowledging trauma, as well as our own capacity to move beyond it?
Recent research on resilience seems to support the latter. Dr. George Bonanno, a professor at Teachers College, Columbia University, where I attend graduate school, contributed the theory of resilience to the study of loss and trauma, demonstrating that the most common reaction post-trauma is a lack of symptoms and a healthy outcome closely resembling the individual’s state of being pre-trauma. Assessing symptoms within the construct of post-traumatic stress disorder, only 6.7% of individuals are likely to develop prolonged suffering and dysfunction after trauma.
Resilience is a term borrowed from the physical sciences that refers to an object recoiling or its potential for elasticity. Of its three definitions,
1. The action or an act of rebounding or springing back
2. The power of resuming an original shape or position after compression
3. The energy per unit volume absorbed by a material when it is subjected to strain; the value of this at the elastic limit
only the third, as represented by the field of mechanical engineering, acknowledges that strain is absorbed and retained by an object despite its appearance of returning fully to normal.
The field of psychology approaches mental disorders from the perspective that symptoms constitute the material for diagnosis. This is true in the case of every mental disorder but one—post-traumatic stress disorder. In order to warrant a diagnosis of PTSD, an individual must have suffered direct or indirect exposure to a traumatic event, or the threat of a traumatic event, such as death, serious injury, sexual violence, as well as subsequent symptoms. Trauma researchers may object to this use of the term, “traumatic event,” preferring, “potentially traumatic event,” for its implication that, though a stressor may act upon an individual, he or she may not experience said event as traumatic.
I recently conducted a clinical interview with a woman we’ll call Rebecca who suffered a sexual assault and later presented with symptoms from each diagnostic criterion necessary for a diagnosis of PTSD. However, because her symptoms reflected distress over the negative reactions of her friends and coworkers to the assault, rather than distress over the assault itself, she did not meet the requirements for a diagnosis of PTSD.
For Rebecca, it was the constellation of events after trauma that evoked symptoms, rather than the traumatic event itself. After a forced sexual assault by the boyfriend of her roommate/coworker, she experienced feelings of anger and betrayal that did not manifest intrusively or pathologically. Unprompted, the boyfriend admitted his actions to his girlfriend (Rebecca’s roommate), the couple broke up, and Rebecca ceased to even think about the event after a week. However, a month later, the couple inexplicably got back together and Rebecca’s roommate denied that a transgression had even taken place. All of a sudden Rebecca, who had initially felt that she had moved beyond the assault, began expressing symptoms, and felt the need to tell friends about the assault, despite consciously regarding some of these disclosures as inappropriate. She couldn’t help herself, as if enacting an urgent need to assert her own reality. One night after work, in the midst of an alcohol-induced bout of mutual, intimate sharing, Rebecca told another coworker-friend what had happened. This individual told Rebecca that her roommate had voiced plans to move out of their shared apartment and in with her recently reinstated boyfriend.
Concerned, the coworker approached Rebecca’s roommate the following day at work and tried to convince her not move in with him. In an effort to control the narrative now spreading at work, Rebecca’s roommate told the CEO of their company about the “rumors” Rebecca had perpetuated. Without warning, the CEO took Rebecca into her office and yelled at her, threatening to fire her if she spoke out again. Rebecca found the experience of being yelled at by an authority figure incredibly distressing, and paradoxically felt an increased need to tell non-coworkers what had happened, despite the heavy tone of its subject and the CEO’s desire to silence her. Eventually, Rebecca resorted to purposefully getting herself laid off from the company, moving across the city, and coping with symptoms of hypervigilance, intrusive thoughts, avoidance, and alienation.
During the interview I noticed Rebecca “spacing out” while communicating aspects of her story that conjured a strong affective response. She would look off over my head and become very pale, laboring over her words so that short scenes took many minutes to relate. She clearly had a distinct memory of the story, but still struggled to tell it; it was as if her mind resisted her efforts to call these memories into consciousness. Unlike the DSM-V’s dissociative specifier for PTSD, which describes depersonalization, or, the “experience of being an outside observer or of detached from oneself,” and derealization, the “experience of unreality, distance, or distortion,” Rebecca’s experience aligns more with psychologist Jane Simington’s 2013* definition of dissociation:
“A mild dissociative reaction can include a temporary ‘zoning out.’ If the dissociative reaction intensifies, the senses and body numb, the eyes look glazed and the person’s ability to see, hear, focus or respond dulls.”
Supporting Rebecca’s assertion that her roommate’s denial of her experience and her boss’ reprimand caused more distress than the assault itself, she underwent a dissociative reaction during each of these time points in the narrative.
Simington explains this type of dissociative response neurologically, describing that the amygdala and hippocampus process events and their related emotions in concert. After the amygdala has registered emotions and bodily sensations, the hippocampus is called upon to add cognitive meaning to the event. Once the hippocampus has provided this context, information can be permanently stored in the brain as explicit memory. During a trauma this may not happen. The amygdala may record the highly charged sensations but the hippocampus can become overcharged and shut down. The traumatic event is then not recorded as explicit memory but is instead only recorded as implicit memory, in the form of highly charged emotions. When the images and sensations of an experience have not been integrated by the hippocampus, they remain in implicit-only form. Implicit-only memories are unassembled neural disarray, remaining as though frozen in time and never integrating into the life narrative. While Rebecca’s resilience has enabled her to bounce back from this trauma, time has clearly not managed to shed every last thorn from her spirit, as William James had put it.
Rebecca’s experience points to the potential unfolding of a nuanced constellation of events and symptoms after trauma. Although her reaction to trauma was delayed, she did not experience the well-known après-coup, but rather maintained healthy functioning, unfazed until her support network invalidated her experience. Based on similar clinical experiences with trauma victims, twentieth century psychoanalytic theorist, Sándor Ferenczi, found that children were much less likely to recover from a traumatic experience if their parents denied its validity. He noted that these patients often drew the therapist into their “internal dramas” in order to recreate the traumatic situation, and that the therapist’s ability to identify and validate their trauma had potential for healing. Based on this premise, Ferenczi and others conceptualized therapy as a space where past trauma was often re-experienced in the presence of an affirming, empathic listener.
Rebecca’s case highlights the fact that trauma is often not an isolated experience in the life of an individual. The echoing effects of actions, reactions, and consequences during these events forged her unique, personal trajectory after trauma. Rebecca is clearly resilient, having reclaimed her identity as a high-functioning, mostly symptom-free individual, yet her life’s course has been invariably altered by these events. While Rebecca rises to the occasion, meeting each of life’s obstacles adaptively, it would oversimplify her experience to solely discuss the “rebounding,” “recoiling,” and “elastic effects” of resilience without dually acknowledging the “energy per unit volume of strain” absorbed by Rebecca, and also the expansion of her capacities and sense of self after trauma.