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What Counts as Trauma? (Part I)

Illustration of child's head silhouette inside adult's head silhouette - Oakland Therapist EMDR Therapist

Have you ever had symptoms, beliefs and behaviors that you can’t explain, and because of that, blame yourself for them? In my practice, I encounter this frequently. I will meet people who suffer from some combination of low self-esteem, depression, substance abuse, chronic relationship difficulties, emotional numbness, codependence, chronic shame, fatigue, or almost any other psychological malady, and because they can’t understand their experiences, they think of them as character flaws. I’ll often hear something along the lines of, “It doesn’t make sense why I’m like this. I’ve had a decent life and upbringing. It’s not like I have any major trauma or anything.”

Many people never receive the help that they need because they think they shouldn’t need help. This attitude almost always stems from two sources: First, a unconscious core belief that they don’t deserve to feel better, and Second, a belief that only those who have suffered extraordinarily awful life events need professional help (and a misunderstanding of what the term “trauma” includes). This combination often leads people to continue suffering silently, with inner commentary that is self-critical.

Different Forms of Trauma

I wish that we had even rudimentary mental health education in our public school system, to help combat the misunderstandings that inevitably come from mass media and pop psychology.

One major misunderstanding is that “Trauma” only refers to major, salient, acute experiences of overt and extreme physical harm, witnessing such harm, or fearing it intensely. Most people think of things like war zones, battered spouses, car accidents, and natural disasters. They think of classic PTSD symptoms such as nightmares, flashbacks and substance abuse. Observing popular culture, it’s understandable that these impressions would form.

Such examples refer to classic, “Big T” Trauma, and of course, they are real and serious. But when you compare your own past experiences to such extreme examples, you may conclude that you don’t have any trauma in your life.

There is another kind of trauma that actually captures the experience of a much wider portion of the population, and it is called complex trauma or “little t” trauma. Complex trauma usually refers to long-term, multiple-incident or constant conditions of little or no safety in the environment or with caregivers (including spouses). And I use the term safety to refer to both physical and emotional well-being.

Emotional safety is often overlooked, but our emotional lives are so conditioned by our relationships with caregivers (whom we must trust to meet our needs) that when those relationships are toxic, abusive, or inadequate, our basic sense of safety and goodness can become deeply injured. We don’t internalize (develop the capacity to provide for ourselves) the care, stability and sense of wholeness that our caregivers should provide for us.

Emotional Safety = Survival

Some people might still want to make the distinction between emotional and physical safety when it comes to trauma. After all, isn’t it worse to be at risk of physical harm than emotional harm?

I would actually suggest the opposite. Physical harm (and the fear of it) is often overwhelming, but it is psychologically relatively simple. If you get into a car accident and become injured, you may feel immense fear and pain. But the body has natural healing mechanisms that operate outside of our control, pretty reliably. The physical injuries heal, and what’s often left is the fear in the nervous system that needs to be discharged. This is actually pretty straightforward, and I would call it “simple” Trauma.

But what if you had a parent who was emotionally abusive, neglectful, or unpredictable? As children, we are dependent on our parents to meet our basic physical needs for nourishment and safety. That means we must bond to them emotionally in order to survive. And we must work to maintain that bond, or else risk being abandoned, which our hard wiring tells us is tantamount to death.

When we fear our parents or feel unloved or neglected by them, this creates a tremendous amount of (semi-conscious) anxiety and confusion, a longing for connection, and often a sense of intrinsic unworthiness. Because these relationships are long-lasting, this anxiety and confusion becomes commonplace and entrenched in our psyches and nervous systems over a long period of time; it becomes part of our development.

Even in the case of physical abuse by a caregiver, the true core of what is harmful is the emotional and relational dimension of that abuse: the fear, the betrayal, the confusion, the scrambling to prevent it happening again.

So emotional safety is linked bioevolutionarily to physical safety, but in a less obvious way. I believe that’s why so many people believe that unless they experienced physical abuse or had overt and dramatic emotional abuse, they don’t qualify as suffering from the long-term effects of trauma. In my next post, I will describe in more detail the most common effects of complex, developmental, or “little t” trauma, and provide a roadmap for how you can heal from them.

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