PTSD as an "Infection" in the Wound of Trauma
"Trauma is a wound, PTSD is an infection and not all wounds get infected." (Lakeside Global Institute Deepening Trauma Awareness curriculum, adapted from Dr. Bruce Perry)
Every so often you come across a quote that shifts understanding in a profound way and this was one that did it for me. I read it in the trauma certification course I took through Lakeside Global Institute (LGI). I was 13 weeks into a 60 week process and my eyes had been opened to seeing trauma all around me - seeing how painful lived experiences, particularly those that occurred in childhood - played out in peoples' lives. And not only at UrbanPromise, where because of serving children growing up in concentrated urban poverty, stress was higher and therefore the risk of ACEs was higher. No I was seeing the impact of ACEs in tony Haddonfield, my hometown, too. And I was confused. Did everyone who experienced trauma qualify at some point for the diagnosis of PTSD? Were the terms, "trauma" and "PTSD" interchangeable? This quote answered me with a resounding no.
People are complex, and how individuals experience events that are stunning, terrifying and inescapable cannot be neatly put into a box or category. It is critical to understand that an ACE score is NOT a diagnosis! LGI taught us to think of trauma on a continuum: little "t"------------------ big "T". Perception of an event is one piece of the puzzle here: think of two people in a car hit by a deer and both are frightened. One person lives where there are lots of deer, and hears stories of this all the time - so when it happens it's annoying but their mind has context, seatbelts were on, no major injuries = small "t" trauma. The driver in the same car lives in a city, doesn't deal with or think about deer, and maybe because of the added responsibility of driving...experiences the same event as a bigger "t" trauma, with nightmares, anxiety when driving in the country...even plastic decorative deer on lawns are a little triggering! The degree of trauma is the other piece of this continuum puzzle, which is the level of impact the event has on a person's nervous system, and therefore how deeply this experience is embedded.
PTSD (post-traumatic stress disorder) has the hallmark of flashbacks, which impacted-people experience as emotional and sensory re-living of the traumatic event. It is thought that this is due to the effect of traumatic experiences on our hippocampus (responsible for creating and maintaining memory) in our brains. Our hippocampus is supposed to "time-stamp" events so we can add them to the narrative of our lives; when working well, we are able to experience an event as a memory of something that happened in the past. Toxic levels of stress interrupt the hippocampus' ability to time-stamp an event; hence the flashbacks (Dan Siegel, MD, NICABM Treating Trauma Series).
Can we prevent PTSD from occurring when someone feels safe enough with us to confide what just
happened to them? I don't have that answer. About 20% of people who experience a "harsh event" will go on to develop PTSD, and it may have something to do with their attachment style from earliest childhood (Siegel). But I do know of ways that are more helpful to respond than others, hopefully helping to limit the level of trauma on the continuum little "t"---------------big "T". I will discuss that in my next post. Until then, may it be well with your soul.