Trauma Talk with the Doc, Episode 2: What IS Trauma, Anyway?

Welcome to another episode! This month, the doc explains what trauma is, starts to discuss how it impacts us, and defines PTSD according to the World Health Organization and the American Psychiatric Association.

As always, this video is to help broaden your knowledge and understanding. Clinicians should never practice outside of their competence, and listeners should never take this as a diagnosis, therapy, or anything other than learning. Please reach out to a professional if you need to. Videos launch every month, opposite our main podcast Holding the Line with Got Your Six, on our Youtube channel and everywhere you get your podcasts.
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Transcript

0:00

Welcome to Trauma Talk with the Doc. I'm your host, Dr. Christina Rocks, ID. I've been working in the therapy world for almost 20 years, with most of them immersed in trauma therapy. I'm EMDRIA certified in EMDR, trained in brain spotting, internal family systems. I'm DBT certified, and all of that to say I know what I'm talking about. This miniseries is designed to provide some psychoeducation on trauma, what it is, what it does, and how it fucks us up. This is not meant to provide a diagnosis, to treat, or to do anything other than educate and hopefully entertain. If you feel some type of way about what I'm sharing, please, please talk to a trauma-informed professional. Now, without further ado, let's get nerdy

Speaker 0:49

Hey everyone. Welcome back to our second episode of Trauma Talk with the Doc. I am, as I was last time and will always be, your host, Christina Rock. And today we're gonna do a very brief introduction to what is trauma? In full disclosure, this episode will be the first one where I'm using a different format. So if I fuck it all up, sorry, I'll fix it for next time, but we're gonna kinda wing it today. We're gonna talk a little bit about the history of post-traumatic stress disorder, what it was, what we thought it was, what we think it is now and the direction that we're kind of going. We'll talk about some symptoms. We'll talk about some very peripheral brain stuff because I've got some episodes coming up where we are gonna go a little deeper into it. A little more about what specific areas of the brain do what when, what neurotransmitters do what when, and all of that good stuff. So I try to keep this in 30-minute chunks but I literally could talk about this for weeks. So, let's get started. So PTSD, post-traumatic stress disorder, it's been around since the great fires of London in the 1600s. People started to notice, physicians started to notice that the earliest documented responses during the 1600 great fires of London were you know, people were more nervous, more anxious, more jittery. They were shutting down a little bit more. Just a variety of different symptoms that we kind of know now as PTSD. But nobody really understood what it was, what it did, what to call it. In, throughout war, Civil War the Civil War here in America physicians noted increased what we call arousal symptoms. So these, this is like things like hypervigilance, irritability, an exaggerated startle response. It's like when you're up here. So if we have this zone of tolerance or this window of tolerance that we're working in, right? We're looking at arousal symptoms to be up here when you're like on edge, feeling jittery, and we're looking at hypoarousal symptoms down here or shutdown symptoms when you're feeling numb, spaced out, dissociating, et cetera. German physhi- physicians, I'm gonna fuck this all the way up, don't at me, called it Schreckneurose, I think. I'll put it on the screen so you guys can see how it's spelled. And again, if you are German and I fucked it all up, I do apologize. I'm gonna forget how to pronounce it, so don't at me or tell me 'cause I'm just gonna forget. But it's another word for fright neuroses. Throughout Europe, as different wars were going on, World War I, World War II, people noticed that things like shell shock were happening, but not just to soldiers, that it was happening to the citizens. People were more afraid. They were more worried. They were more anxious. They acted out in different ways. They were more aggressive or they were more withdrawn and shut down. And so We labeled it really with soldiers first before we actually put something on the civilian population. And while I can't speak to why and nor can current researchers speak to why, what it seems like in the literature is the assumption was that if you were a bystander, which this makes no sense to me now, but if you were a bystander just chilling in your house in London and bombs started dropping all around you and you lived, like you weren't, like you're fine. But if you're out in the field stabbing people with your bayonet, like you're unwell. Again, I don't agree with that. We now know that's not the case, but it just seemed to be like we were studying it more and associating it more with soldiers. Specifically coming back from World War I, they called it shell shock. Interestingly enough, sidestepping for a hot second, Sigmund Freud, who everybody knows is the cigar's not just a cigar and you really want to fuck your mom or your dad. His, his theory goes so much deeper than that. But he also was one of the first physicians to label trauma responses in women during a time when women, which I feel like we're going back to now where women were just seen as like these hysterical creatures who just couldn't control their emotions. What Freud was discovering was that it was an underlying the symptoms had an underlying cause of traumatic experiences. So initially when the so in America, we have the Diagnostic and Statistical Manual of Mental Disorders, they're the DSM. It is based off of, bounced off of, framed from the World Health Organization's International Classification of Diseases. So throughout this, you m- you're probably gonna hear me talk about the ICD or the WHO, which is the World Health Organization. You're gonna hear me talk about the DSM. DSM is how we use, what we use to diagnose people here in America with mental health illnesses. It is, again, like I said, framed off of the ICD, International Classification of Diseases framework. But apparently America's gotta be special, so we have our own. So it was initially in the DSM, it was labeled as stress, or it was identified as stress, but it wasn't a diagnosis in the DSM I. It was more-- And the DSM I was like five pages. It was like an information pamphlet when it first came out. So, initially when it first came out, it was like, "Yeah, there's this thing," and it's probably gonna stress some people out. I'll put the definition up for you on the side screen if you feel so inclined. But it was basically like, it's a thing. People get stressed out when they experience shitty things. In the DSM II, we're in the five TR at this point, but in the DSM II it came out as transient situational disturbance, with the implication being that you are disturbed, right? You are bothered by, impacted by something shitty that happened to you, and so you have a transient or a passing issue with it, with managing yourself. DSM-III, however, was the first to actually operationally define it and list criteria. So we've gone now through two different iterations of diagnostic manuals, and finally the DSM-III was like, "You know, we should probably call-- we operationally define this," right? So an operational definition in research basically means if this is a coffee, I have to define what a coffee is so that you know whenever you see a coffee, that's what it is. That's an operational definition. Roughly. So DSM-III, the APA, the American Psychiatric Association, who publishes the DSM, decided that they were gonna operationally define the diagnosis and criteria for it, and so they did. I really like the DSM-III's definition because it was pretty broad. It was essentially it's a abnormal react-- or it's a n- it's a normal reaction to abnormal circumstances, and it's probably gonna screw you up for a while, and you're probably gonna experience these things. And it was pretty broad. And I'll talk about why I like that in just a second. DSM-IV and V, I'm sorry, the DSM-IV, the DSM-IV-TR, and then the DSM-V have sought to kind of further specify and operationally define what PTSD is and then narrow the scope of kind of what causes PTSD. I think that screws a lot of us up in the therapeutic world, in the treatment world, in the insurance world. The World Health Organization meets periodically to review all, and this is every diagnosis, medical diagnosis, mental health diagnosis, the whole bit. So they review everything from hypertension to personality disorders. And so in two thousand eighteen, the World Health Organization got together and said, "You know, I think we need to add another criteria." And so what they did is they added something called cPTSD or complex PTSD. We'll get into that in just a second. Here's why, here's why trauma is complicated Dr. Bessel van der Kolk in his, I think it was in his book, The Body Keeps the Score, which I have right here. Fantastic. Please read it. I don't know if it was in that book or in one of the many other publications that he's been a part of. He defined trauma as anything that overwhelms the brain's ability to cope, and I fucking love that Trauma is a nebulous definition. What is trauma to me is, might not be trauma to you, and vice versa. Trauma also compounds on it, on itself. So somebody who experiences one trauma based on their past experiences, their neurochemical combinations that naturally occur in their brain, their current life circumstance, how resilient they are, how capable they are, might develop PTSD, might be impacted for a short period of time and then get over it, might experience long-term debilitating consequences. And yet somebody else who experiences the same exact single incident trauma might not feel any of that stuff. I do a lot of work with peer support teams, critical incident stress management debriefs, which go watch our other podcast one of the episodes that we do with Stafford County Sheriff Deputy Sergeant Curtis, who's a g- good, a good friend of mine. He's, he's good people. That was a really funny episode. I think Brittany and I had a blast doing it. But I do a lot of that work, and so I will sit in a room with cops, dispatchers, you know, CID, clerks, whatever, and everybody's response is a little bit different. Sometimes it's more impactful, sometimes it's not. I hear a lot of like, "I don't notice any change in my routine," or, "I don't feel any different," or, "I don't feel anything at all about it." There was one CISM debrief where it was pretty, pretty brutal. Everybody in the room was stuck on this one thing, and in retrospect, looking back at it, that was-- in the moment, right, that was the most horrific part for all of them. It was just one specific thing. And in the grand scheme of things, like an outsider might look at it and be like, "That, that is what sticks-- That image is what sticks with you? This issue is what sticks with you?" And even though that was the central issue for everybody, that was like their one stuck point, their one piece of, "This was really fucked up," every single one of them had a different reaction to the incident as a whole. Some people noticed they wanted to sleep more. A couple of the guys noticed that going home was different, difficult for them. One guy noticed that he wanted to be home to be with his kids all the time. Another guy noticed that when he would go home, he just wanted to like be in his home, in his safe space. Didn't wanna have anything to do with his family because he was afraid he would put his mess, the sludge that was stuck to him from it, on his family. A dispatcher, petrified to go into the office now. Another dispatcher is dying to go into the office because she wants to get all the calls that are like this because she handled it once, she knows how to handle it again, and damn it, she's gonna make sure that everybody comes home safe next time. So I say that and I share that story because everybody has a different reaction. Regardless of what your reaction is to a traumatic event, it is a normal reaction to an abnormal experience. To those of you who know me, you know that I think normal is a stupid word. It's a setting on a washing machine. And if we think about what normal is, right, it's the norm. It's kind of like the mean. It's the middle. The average, right? So this is an average reaction to an experience that is not average. Most survivors really don't have an understanding of how complex that goes. I sit in a room across from many trauma survivors, I have for almost two decades now, and I will tell them something, and they'll be like, "Yeah, I don't understand why I'm like this." And I'm like, "Well, this is what's going on in your brain and your body when you're experiencing trauma. Do you notice this or that?" And it's, it's almost surprising how many people don't understand how deep the injury from a traumatic experience goes. Now, let's add to that the fact that there might be interpersonal trauma. Whether it's from combat, whether it's from interpersonal violence, whether it's from a car accident, whether it's from whatever, right? You have been injured, theoretically, potentially by another human being. If you're a first responder or you're a combat vet, you're choosing to traumatize yourself over and over again. That adds a whole other layer of complexity. And then when we look at first responders and veterans, the, there's almost a judgment that I have found in my work that towards them for not being able to assimilate back into normal society. Your body will react. Even when your brain says, "We're good, we're safe," you'll still notice that reaction. You'll still notice your heart rate increase. You'll still notice you jump. And kind of the biggest takeaway message from all of this is that your brain's designed to survive. Survival overrides all of your functions. So if your brain has a choice of survive or conform to society, it's gonna choose survive every single time. Every single time. So I kinda wanna get into, and I have notes here because I'm going to screw this all the way up if I don't. I want to get into the def-- actual definition of PTSD. So complex post-traumatic stress disorder and post-traumatic stress disorder are similar in a lot of ways, but a little bit different. The World Health Organization defines PTSD as exposure to an event or situation, either short or long-lasting, of an extremely threatening or horrific nature. Such events include, but are not limited to, directly experiencing natural or human-made disasters, combat, serious accidents, torture, sexual violence, terrorism, assault, or acute life-threatening illness like a heart attack, witnessing the threatened or actual injury or death of others in a sudden, unexpected, or violent manner, and learning about the sudden, unexpected, violent death of a loved one. It's a pretty broad definition of what trauma, like what makes up trauma, right? Pretty broad definition. I'm gonna switch because I wanna go over to and as much as I would love to say that I have worked with PTSD for my entire professional life, I cannot verbatim remember what the definition is word for word. So we are gonna look at a resource because that's what we gotta do sometimes All right. So post-traumatic stress disorder, according to the DSM, we have several criterion. Criterion A is the primary criterion. Y- you have to hit all of them. But in the DSM, criterion A

16:06

Is exposure to actual or threatened death, serious injury, or sexual violence in one or more of the following ways: directly wit- experiencing the traumatic events, witnessing in person the events as they occurred to others, learning that the traumatic events occurred to a close family member or close friend. In the cases of actual or threatened death of a family member or friend, the events must have been violent or accidental. Experiencing repeated or extreme exposure to aversive details of the traumatic events, like first responders collecting human remains, police officers repeatedly exposed to details of child abuse And of note, criterion A4, which is the experiencing repeated or extreme exposure, does not apply to exposure through electronic media, television, movies, or pictures unless this exposure is work-related. Here's what I don't love about this diagnosis. Thing number one is I think it narrowly defines it t-too much. If we compare the two diagnoses if we compare the two criteria, ICD 11 says, "Exposure to an event or situation, short or long-lasting, of an extremely threatening or horrific nature. Such events include but are not limited to," right? And so it goes on a whole, a whole thing. I think it's more broad. One of my biggest concerns or issues with the PTSD diagnosis is that we don't talk about neglect. We don't talk about racial disparity. We don't talk about socioeconomic status disparity. We don't talk about these really important things that are traumatic in nature, but don't directly threaten the life of another human being. That is a whole other soapbox. I will get on that later. All right, back to the ICD 11. So following the traumatic event or situation, the development of a characteristic syndrome lasting for at least several weeks consisting of all three core elements. Their three core elements are re-experiencing, deliberate avoidance, and persistent perceptions of heightened current threat. In the DSM 5 criteria, it goes on forever and ever, but you have intrusion symptoms, which similar to the ICD 11 definition. You have avoidance symptoms. You also have negative alterations in cognitions and mood, marked alterations in arousal or reactivity And then of course, the standard has to exist for longer than a month. It can't be because you were doing drugs or drinking alcohol. And it has to kind of-- it causes, this is a standard definition in a lot of our criteria. It must cause clinically significant impairment in social, occupational, or other important areas of daily functioning. So what that means is you can experience a traumatic event, right? It might give you nightmares. It might make you more cautious if you were in a car accident to get back on the road again. It might make you a little more wary to go back into workplace, into the workplace where there was a workplace shooting. It might make you anxious next time you have to walk into a hospital. Unless it impacts how you function in your daily life, we don't consider that diagnostically relevant. I will get on my soapbox at another day and time about why a lot of, and I think it's specifically veterans and first responders, really shy away from the D in PTSD, post-traumatic stress disorder. They just wanna call it post-traumatic stress. That's great. But when your behavior is altered in a way that is disordered, it's not judgment. It's not-- You're not weak, you're not stupid, you're not lame, you're not in-incapable. This is biological changes are happening. We'll get into that in other episodes. Biological changes are happening in your brain that makes it very difficult for your brain to function adaptively in an environment where you're not being re-traumatized over and over again. So that's what we mean when we talk about disorder. Your behavior, you had a normal reaction to an abnormal experience. You behaved in a way that put your survival or the survival of others, survival as a concept, ahead of everything else, which is exactly what your brain is designed to do. That is normal, that is adaptive, that is good, that is healthy. I'm gonna say that again, a little louder for the people in the back. How you behaved in your traumatic experience is adaptive, was healthy, was appropriate, was necessary Whether that means you shut down and went inward and spaced out and don't remember what happened, maybe you launched forward and attacked somebody, maybe you jumped on a grenade, maybe you ran away, maybe whatever it was, your brain said, "Oh shit, we've got to survive this," and then you did. You did the right thing. You did it the right way, period, end of story. It's what happens after, when we come home, when we're out of that environment, when that trauma is no longer ever present and crushing on us. It's like you're carrying around this, like, ball and chain of shit that's behind you. We don't want that. So trauma therapy, good trauma therapy is focused a lot on recognizing what your body's actually doing, connecting your body back to yourself, 'cause a lot of us, and I fall into this... We, we all dissociate. Everybody dissociates. It's on a spectrum. Everybody does. Also, soapbox moment, it's dissociate, not disassociate. This is my biggest fucking pet peeve. Y'all are out here talking about, "I disassociate." Disassociate what from what? Dissociate. There's no A until you get to the end. Disso- I'm gonna, hoo-hoo, I'm gonna, hmm-hmm. Anyways I will... I have one clinician who calls it disassociate, and it, like, my eye, like, involuntarily twitches. Anyways, dissociation is a natural adaptive method. It's a protection method. More, most of the time, we see this in people who are survivors of childhood abuse, in people who are survivors of sexual trauma. Because if you don't move, if you lay still, if you pretend you're dead or pretend you're asleep or you don't fight back, oftentimes the trauma's a little less brutal, horrific, whatever. However, dissociation is a normal reaction. It's something that is adaptive. It's something we all do, and it reduces brain activity to conserve energy. If you're driving down a road, you're heading to work in the morning, you leave your house, you're gonna take the same freaking turns every day. Most people do. I do have some clients who take different turns because they don't wanna be followed. I get that. This is, this is on an average day. The average human takes the same way to work every day. When you were in school, you probably had the same seat. When you I don't know, at home on your couch, probably have the same couch cushion, right? You sit in the same spot on the couch. We are creatures of habit. It is ingrained in us. It also helps reduce a lot of our brain activity. So if you're driving on your way to work in the morning and you remember leaving the house, but you don't remember most of the drive to work, your brain's dissociating. It's conserving energy. It's allocating resources to other areas and/or deciding that it just doesn't need to click in right now because this is familiar. It's a habit. It's your usual. That is normal. That is adaptive. That is healthy. Where we get into some of the let's work on grounding more and reconnecting is when that dissociation carries itself throughout... It's pervasive throughout your day, throughout your life. It's you're missing chunks of time, days of time. We'll have an episode on dissociation. I might invite my clinician on who says disassociate just, just so I can grind that word out of her. Anyways so when we talk about trauma experiences, when we talk about what trauma is, to get back on track it's very different for everybody, and it brings with it a lot of really healthy adaptive skills that you needed to survive a really not healthy, not adaptive abnormal circumstance What a good trauma therapist will do is work to pull you out of that circumstance. That good trauma therapist will work to connect what's going on up here with what's going on here, and we start by working on what's going on here. So a bottom-up therapist starts with your body. Where do you notice that in your body? What are you physically feeling right now? Nothing? You can't feel anything? Let's go back and work on that Trauma is a normal reaction to an abnormal circumstance That's what you're doing. You are experiencing something that is not in the realm of what should be happening on an average day. And you're doing that by turning off some pretty essential functions that your body needs to do, but doesn't need to do right there to survive So we'll talk a little bit more about that in our next episode. We'll talk a little bit about brain stuff. Again, if you guys have questions if you guys have thoughts, please let me know. Like I said in the beginning, we're gonna try to do a little different setup so I can, like, put some shit on the side so you can, like, read words and stuff. So if you're listening to this, please hop over to our YouTube channel so you can actually read the stuff. If you're watching this, thank you for watching. If you wanna listen, go over to Spotify or Apple Podcasts or whatever your normal podcast thing is because we're over there. And as always, please send me your questions social@yoursixcounseling.net or you can comment on this video, or you can comment on our reels that are posted, or you can just email us, call us. If you're a client watching this, come into session and be like, "Hey, you said this weird thing and I wanna know more about this." And I might add that to a pod if I feel like it's important and, you know, it has enough information and we can flesh it out enough for people to know. So thank you again everybody for listening and I will see you next month for another episode of Trauma Talk with the Doc.

Speaker 4 26:46

Thanks everyone for listening to this month's episode of Trauma Talk with the Doc. I'll be back next month with more information on all things trauma-related. Be sure to check out our other projects, Holding the Line with Got Your 6, our main podcast, which is published every other week opposite this project, and Therapy Unpacked while Holding the Line, which happens monthly opposite our main pod as well. Hopefully, today's episode made you think, helped you learn, or gave you some insight. Please hit us up on the socials or our email if you have questions or topics you'd like me to address in the next episode. See you next time.