What is trauma?
The English word trauma derives from the Greek word traumatikos, meaning wound. So in the broadest sense, when we discuss trauma we are simply talking about a human wound, be it physical or emotional. Whenever you get a group of professionals together to discuss issues of trauma, you will rarely hear the same definition offered twice. Yet before we can launch into the specific diagnostic considerations, it might be helpful to review some general definitions of the terminology that we will be discussing in this chapter.
Here is one definition of trauma used by the American Psychological Association:
"Trauma is an emotional response to a terrible event like an accident, rape, or natural disaster. Immediately after the event, shock and denial are typical. Longer term reactions include unpredictable emotions, flashbacks, strained relationships and even physical symptoms like headaches or nausea. While these feelings are normal, some people have difficulty moving on with their lives."
It is important to note that this definition includes not only people who directly experienced such events, but also those who may have directly witnessed such an event. For instance, directly witnessing a horrific accident can meet the criteria for trauma, while indirect experiencing or witnessing, such as watching an accident on TV, does not.
For many trauma specialists, this definition has limitations. First, trauma is not restricted to a singular event of catastrophic proportion. Trauma may also occur from exposure to a series of traumatizing experiences, such as growing up in a violent or alcoholic home where there are too many "events" to even name. Second, people respond to trauma differently, depending on a variety of factors. Therefore, trying to condense it all into a single definition seems artificial and contrived. In fact, one of the world's leading trauma scholars, Bessel van der Kolk, M.D. refrains from giving a standardized, cookie-cutter definition of trauma in the opening pages of his groundbreaking book, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma (2014). Instead, he uses more of a descriptive approach to defining trauma:
"Trauma, by definition is unbearable and intolerable. Most rape victims, combat soldiers, and children who have been molested become so upset when they think about what they experience that they try to push it out of their minds, trying to act as if nothing happened, and move on. It takes a tremendous amount of energy to keep functioning while carrying the memory of terror, and the shame of utter weakness and vulnerability" (p. 1-2).
To better understand the meaning of trauma, people may find it useful to return to the Greek origin of the word (wound). Since most of us have experienced some type of physical injury, or wound, let's use that knowledge to inform our understanding of emotional trauma.