What is the international understanding of trauma?

Is there a consensus around the world about trauma? I’m not sure there is. One area there probably would be consensus about is mass trauma that occurs in the world. For example, what’s taking place between Israel and Hamas: the idea of what happens to the children on both sides of the conflict. So today, there’s 144 wars taking place in the world. What is the story for the child? That’s a trauma that we can easily find international agreement about.

Then we come to the trauma of assault. That which occurs individually. And we can think of that as an event. So when we think of things that happen physiologically or directly in front of the child, we can probably get a common acceptance of trauma. 

Then we start to get into the more nuanced understandings of trauma. Is a divorce a trauma? It could be, as the child’s structural understanding of the safety of family is gone. And as you get more nuanced, you start to have difficulties with agreement. Is a child who’s been exposed to domestic violence between a mother and a father traumatised? I would argue the answer is yes. What happens with a child who discovers that their father was killed, in war, in another part of the world. Is the profound grief and loss that comes with having lost a father in that circumstance – is that trauma? And we’re in that nuanced area where: what is the meaning of the loss to the child? And I think that’s debatable territory: as to whether it is trauma or complex grief. I would suggest that when you lose somebody in a way that you can’t quite make sense of, then you’re into ambiguous grief. And so, I think, thus trauma and grief exist on a continuum. 

The other piece that is very important is what meaning does the person give to the event? [With some people who’ve been raped] the most common experience I have seen has been associated with: this is traumatic. I’ve been violated, I’ve been raped. But I’ve also met some who’ve had significant familial and social support, who have said this was an awful event in my life, but it is not my life story, it doesn’t define me. And so they don’t frame it as trauma whereas another [person], [who had] a similar event but lacking in those support systems and those resilient skills said this was life changing, and my identity is forever that of a victim. So the other piece that comes with it is how internally has the person come to understand it? 

Let’s talk about the trauma of assault, something that occurs as an individual event

Think of a child, who has a trusted grandfather. And that grandfather has become central to how they have come to understand life. And their grandfather sexually abuses them. The child then has this central character in their life who now both changes who they are but changes how they can understand the relationship. 

How does this trauma play out in your body? What does it do to your brain, and to you physiologically? 

I’m going to do something very simple. I happened to have a little packet of something. I’m going to hand you this quickly. Did you notice how you reacted? Your brain said there’s something coming at you that you should be cautious of. You should move back. And you should also put your hand up. Your brain did a very complicated series of things and you had no conscious awareness that your brain did all of that. And the wiring in your brain said: protect yourself. That’s an example of how brain development protects us.

We’re born with way more neuronal pathways than we keep as we move on. But what if trauma is part of that neural development from the very beginning? So the brain is wired to perceive risk as dominantly occurring. If you were raised with insecurity, lack of safety, that’s what your brain builds and your brain then starts to interpret the world from that risk perspective. Now, you’ve been safe [for a while] and then you’re no longer safe and you’ve developed such a shift that your brain now wires to risk. And so your brain is now wired [for] certain signals that tell you this is not safe. So we think of a woman or a child who’s raped. And there was a particular tone of voice or a particular touch that’s now wired in the head.

Traumatic events rewire the brain. We can’t de-wire the brain. What we can do is, therapeutically, we can help people to become aware of those triggers and learn to respond differently. 

How does the fight, flight, freeze reaction work? 

If you watch children who have been traumatised, you can see how some of them get aggressive and you can see how some are trying to get away. But then you’ll watch children who just freeze. ‘Freeze’ is one of the responses to danger. And you will have seen [stories of children not fighting back]. They don’t run away. They’re frozen. This happens to adults too. Logically, the child will be able to say to you, I should have fought or run away. 

How much is the freeze response understood? Is it something that can lead to victim blaming? 

Yes, I think that can happen. Not necessarily, but it can. It’s hard for people to understand – you’re in that situation where you’re in danger and you didn’t fight back. Why didn’t you fight back? But I was so overcome with the fear, I didn’t know what to do, so I didn’t do anything. We frame this like the child is going through some kind of a conscious decision here. But it’s not conscious. 

Is there a difference between this happening with, say, a member of the family versus a stranger? How does it work?

It could be both. 

The event wires the brain. But then we also incorporate it into our understanding. But we also incorporate resilience in. So do I understand the event as something that I am capable of living with, sadly or not? Or do I incorporate it as something that “traumatises me”. Now we begin to take the approach of: how do I come to understand what has gone on to me and how do I frame it in my life? What is my story of that event? 

Can that resilience only come with external supportive assistance?

No, interestingly enough, it can also come from an internal understanding. Here’s how the internal understanding works: somehow in my life, I have come to understand from my role models, my family, my parents that bad things will happen in life, but bad things can be things can happen to everybody, and we all experience them and we learn to get over them. We learn to live with them because we can frame it as: this happens to everybody in some way or another. And everybody is capable of living with both joy and sadness simultaneously. And I’m in charge of my memory, of how I frame it, of how I experience it. So when a child learns that they can have an honest experience with something that’s negative, but also place it within the story of resilience, within the story of what I’m capable of, within the story of ‘this doesn’t define me’, then I’m less likely to engage in fight or flight or freeze. Because I now have another way to understand. 

How does trauma affect memory when you’re trying to recall the event? And how important is the first person’s reaction? 

That first person’s reaction is very important. Because it’s the signal: is it okay for me to tell the story or not? One of the huge mistakes that gets made though, is we require the child to tell the story many times. The abstract thinking of nuanced recall about something is something that happens to us around 12 or 13.

There’s an assumption that if something traumatic has happened to you that you’ve formed a memory – that you know the story exactly. And that’s not true. And so pre-adolescent children cannot give you a concrete [story]. If we invite child to begin to tell the story and just let them tell it, we’ll get the most accurate story. The prompts are, such things as: Tell me some more. And, who was there? What room were you in? 

The other challenge is that how that first person reacts determines how the rest of the story will be told. Every time the story is told, the child will incorporate, confabulate, into their story the reaction of the person they first told the story to. The more often we ask a child to tell a story, the more they will confabulate it to include what happened when they told the story before. And so, if we interview a child four times, we’re doing harm to the child, because we’re insisting the child keep bringing this back, but also the child will add to the story because that’s what the brain of the child does. 

So if a child makes a disclosure, let the child say what they have to say, and then if it has to involve a police officer, for example, wait for the police and the police should only ask the story once.

What happens if they’re not believed in the first instance? 

The reality is that the false accusation rate, depending upon where in the world you are, runs from between about 1.2 to about 8%. 

It is tiny. So you start with the expectation that given that number, there’s an exceedingly high probability this child is telling me the truth. 90% of the time it is the truth. So that being the case I’m going to listen to the story.

What are the medium- and long-term effects of trauma? You talked about the necessity of framing it right within you. But if you don’t have that support or that internal understanding, then does it affect you, academically, job-wise, relationship-wise? 

If you incorporate this into the identity: so my identity is partially or significantly impacted by the story of this event or these events, then I bring that into all of my other relationships, all of my other understandings of myself, it starts to become core. When we look at children who have experienced sexual abuse in childhood, they tend, and I use the word tend, because there’s exceptions, they tend to underperform in terms of academics, in terms of personal relation achievements. Because their expectation has been altered as a result of these events and they haven’t had the appropriate resiliency and supports to be able to create an interpretation of that, associated with the knowing that ‘I can contain this in my life and it’s not all of who I am’. That’s why those supports are so important. 

If you can’t talk about it ever, does that do more damage? 

For most people, yes. Because what begins to happen is that part of our social-emotional development, a piece of it gets stuck at the point of the trauma. And how do I work my way out of it? So my behavior in many respects can move along with my chronological development, but I can still have this one piece that doesn’t move very well. Because I’m not developing this one piece, because it’s kind of stuck in that point in time, because I can’t  explore it – my internal dialogue says I’m not allowed. It’s there, and to talk about it is shameful. And so I have no way to process it. And you’ll come across individuals who have been assaulted sexually as a child, never processed [it], and you discover they’ve never even told their spouses, 20 years on. 

Where should the support for the child come from? At the school level, at the community? 

I think support for a child has to come in a number of different ways. One of the most important supports is going to be from a trusted relative. One, who believes them. Secondly, who continues to see them for who they are, in other words, valued and strong and capable. Thirdly, who is patient, takes time to allow the child to adjust. Fourthly, when the child responds in ways that are trauma trigger responses that person recognizes that for what it is, and stays and is calm, and helps the child to pull themselves down through it.

And the second is the resumption of things in life that bring joy to the child. And this doesn’t happen in two weeks. In some respects, this may at times, take years. Your understanding of your sexual assault when you’re eight, becomes very different when you’re 14. It’s very different when you marry. We can evolve our stories over time as we mature and we become immersed in different things that we have to understand in life. These are evolving stories over time. 

Published - December 10, 2024 07:34 pm IST