Clearing up our mental health conversations is important

In an age when we seem to be intently focused on emotional health (for better or worse), some mental health terminology has gained broad acceptance – and often is used somewhat loosely and inappropriately.

We talk about being “depressed” when we’re probably just sad about a loss by the Phillies or a gain on the scales, and “addicted” when we are just fond of chocolate. We toss around the words “bipolar” or “psychotic” about conditions that are nowhere near as severe.

We also perhaps too often misuse the concept of trauma and say we’re “traumatized” by an experience in highway driving or a visit from a challenging relative. However, a broader understanding and acceptance of trauma is generally considered a good thing.

It is perhaps especially important as we age, because as our length of time on the planet expands, we increase our odds of having experienced trauma, including through what is sometimes called complicated grief, where our response to the loss of someone close, including a spouse, doesn’t follow a healthy path back to emotional health.

Trauma has been recorded as far back as 1900 BC, according to researchers at Boston University. It gained much more attention in the 1970s related to veterans of the Vietnam war, who experienced what previously had been known as “shell shock,” or more politely, “battle fatigue,” as if soldiers facing the horrors of war were just a bit tired of it.

In 1980, with the publication of the mental health bible, the DSM-III, post-traumatic stress disorder was formally recognized as a mental health diagnosis. Since then, our ideas about trauma have been refined.

“Trauma is so often misunderstood. People tend to think of it as something extreme, catastrophic or rare – war, abuse, major accidents,” said psychologist Katie Elder, founder of Delaware Psychological Services in Lewes. “While those absolutely are traumatic, that definition is too narrow and misses how trauma actually works.”

Kate Gehret, a psychotherapist in Lewes, said trauma is the response to an experience. “It could be one single traumatizing event or a long period – even a lifetime – of chronic trauma,” she said, including “personal violations.” 

“It gets very nuanced,” Elder said. “Not everything that feels traumatic meets that clinical definition, and not everything that meets the definition impacts people in the same way. Trauma isn’t just about what happened. It’s about the impact it has on us.”

She noted that one person facing a traumatic experience may integrate it and move forward, while another may feel fundamentally altered about how they see themselves and others – and their world shifts. 

The two note that trauma responses can come from experiences that don’t seem overly troubling or damaging, such as feeling unseen or unsafe in relationships over time, having an unpredictable caregiver, or experiencing a loss of control. 

Experts also say that complicated grief can sometimes have the same result. Yuval Neria, an expert on trauma and PTSD at Columbia University Medical Center, said some people fail to return to normal functioning and are stuck with a degree of steady mourning and functional impairment. For these individuals, she said, “Grief becomes chronic, enduring and disabling.” 

“Grief is a natural, expected response to loss,” Elder said. “Trauma enters when the loss overwhelms our ability to process it – when it disrupts our sense of safety, predictability or meaning in a profound way.”
For some it may be deeply painful but integrated, or for others, something that shatters their internal world, she said. Some experts suggest grief can be particularly challenging when death leaves unanswered questions, guilt or anger. 

Gehret says those suffering from trauma can experience anxiety, depression, relationship issues and substance abuse.  

“Most of the traumatized clients with whom I’ve worked almost always experience a form of anxiety,” she said. “And often, when a person is living with anxiety, they may not fully participate in life, which can result in isolation, or a diminished social life and depression. Anxiety can make it more difficult to sleep or experience joy.”

“Trauma lives in the body and the nervous system,” Elder said. “It shows up in how we respond, not just what we remember. It can appear as always being on edge, or feeling unsafe and lacking trust, or always seeking perfection or control and being disconnected.” 

Sufferers need to work through trauma by becoming more connected, more self-aware, more intentional, she said. “What matters is how we make sense of what happened, what we carry forward from it and whether we have the opportunity to process, integrate and grow.”

And she notes that such growth can indeed occur: “People can become more connected, more self-aware, more intentional after trauma – not because the trauma was good, but because of how they worked through it.”

Therapy can help, experts say, including exposure therapy, cognitive behavioral therapy and eye movement desensitization and reprocessing, undertaken with a professional. Gehret said her clients have found success by developing a “trauma narrative,” where they record their experience verbally. “However, the trauma narratives are only a part of the work they will need,” she said. “The process of therapy is important and typically very effective.” 

Elder said, “Nervous system regulation is a key to treating trauma and gaining a feeling of safety in the world.”