Trauma: We Need to Use This Word Very Carefully

The term ‘trauma’ has permeated our public lexicon more deeply over the last few generations, becoming a common topic of discussion not just among health professionals but within everyday conversations. As parents, friends, nurses, counsellors, doctors, and therapists, it is crucial that we use this word with great care. Words evolve, but certain terms, particularly those as significant as trauma, must be safeguarded to ensure that when times are tough, those in need receive the right kind of help.

To understand the gravity of this word, let’s consider some blunt and crude figures to illustrate a point. Statistically, about one in three people will experience a significant form of trauma. In the UK, roughly 2,612,000 individuals suffer from Post-Traumatic Stress Disorder (PTSD) at any given time, according to PTSD UK. Thousands will get added to this number each year. Imagine a fully accredited therapist, trained in evidence-based approaches such as EMDR (Eye Movement Desensitisation and Reprocessing) or CBT (Cognitive Behavioural Therapy). Such a therapist might be able to treat approximately 30 people with PTSD annually, with the number of sessions required ranging from 6 to 20, depending on the severity and complexity of the cases.

However, considering the current number of about 7,500 accredited CBT practitioners and roughly 10,000 EMDR practitioners in the UK—many of whom are dual-trained in both, hence there is an overlap, and/or do not work exclusively in areas treating PTSD—the math presents a challenge. To meet the needs implied by these statistics, we would require around 87,067 fully trained and accredited psychotherapists specialising exclusively in PTSD to clear a year’s waitlist. Given the extensive training and experience required to reach this level of specialisation, achieving such numbers is highly unlikely. Obviously not everyone with PTSD will need EMDR or CBT from an accredited practitioner. I’m just highlighting that there aren’t enough counsellors, therapists, or professionals in the UK to provide therapy to everyone.

Therefore, the way we use the word ‘trauma’ must be approached with caution to avoid the risks of overdiagnosis and an excessive focus on pathology, rather than empowering individuals to lead valued lives. These specialised treatment options should be reserved for those who truly need them.

As a Mental Health Nurse with a modest set of qualifications, I do not claim expertise in diagnosis or medication. My perspective is grounded in professional experience and aimed at educational and discussion purposes. My enduring hope is that this blog will spark meaningful dialogue around this serious topic and encourage a thoughtful approach to mental health care, ensuring that those who require services receive them. I am committed to helping people care for their mental and physical well-being, regardless of the challenges they face.

A Very Amateur History Lesson

Historically, the term “trauma” referred exclusively to physical injuries and damage. However, as early as the 19th century, during the era of railway expansion, observers began to note psychological effects akin to physical trauma in individuals who had endured train accidents, a condition then referred to as “railway spine.” This marked an early acknowledgment of psychological trauma, setting the stage for a deeper understanding of its impacts.

During World War I, many soldiers were executed by firing squads for desertion, and countless others faced imprisonment during World War II. It is now understood that many of these individuals were likely suffering from what we now recognise as Post-Traumatic Stress Disorder (PTSD). At the time, however, such conditions were unrecognised and misinterpreted merely as cowardice or lack of moral fibre. The terminology of “shell shock” in WWI and “combat fatigue” in WWII captured some aspects of their distress but failed to grasp or address the psychological depth of their suffering.

It wasn’t until the Vietnam War that the psychological toll of warfare began to be more widely acknowledged. The Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III), published in 1980, officially introduced PTSD, providing a formal framework for diagnosing and treating the condition based on clinical criteria. This inclusion marked a significant advancement in the field of mental health, recognising the long-term impact of trauma beyond the immediate aftermath of the traumatic event.

From the 1990s onward, the discourse around trauma, PTSD, ‘repressed memories’, adverse childhood experiences, and stress reactions has evolved considerably. Influential authors such as Gabor Maté and Bessel van der Kolk have popularised the understanding that past trauma exerts a significant influence on our present and future health. Their works emphasise how unresolved psychological trauma can continue to affect individuals long after the original events have passed.

Personally, I align with the notion that understanding past trauma is crucial; however, I advocate a forward-looking approach to healing. For most individuals dealing with trauma, focusing on building a valued and rewarding life, and gently expanding one’s comfort zone, offers a constructive path forward. Yet, I acknowledge that a minority of cases involving severe past traumas may require more focused therapeutic interventions to process and heal these deep psychological wounds.

As we continue to expand our understanding of trauma and its effects on mental health, it remains crucial to balance awareness of past pain with proactive strategies for resilience and growth. This approach not only honours the complexity of human psychology but also empowers individuals to envision and work towards a future unburdened by the shadows of their past.

PTSD Vs Trauma

Trauma and Post-Traumatic Stress Disorder (PTSD) are related yet distinct concepts frequently misunderstood and used interchangeably outside of professional mental health contexts. Both terms play significant roles in psychological health but denote different aspects of the experience and response to distressing events.

Trauma is an umbrella term that refers to both the event and the immediate emotional and psychological response to incidents that are deeply distressing or disturbing. Such events could be acute, like a natural disaster or a violent attack, or chronic, such as enduring abuse or prolonged exposure to combat. Trauma affects individuals differently, triggering a spectrum of emotional, psychological, and physical reactions.

PTSD, on the other hand, is a specific psychiatric diagnosis that may develop following exposure to a traumatic event. This disorder is characterised by persistent symptoms that last longer than one month and significantly impair an individual’s ability to function in daily life. These symptoms include flashbacks, nightmares, heightened vigilance, severe anxiety, and a tendency to avoid reminders of the trauma, which can lead to uncontrollable and intrusive thoughts about the event.

For example, consider two individuals involved in a violent car crash. Both initially experience intense shock and trauma, mentally and physically. After a few months, one individual begins to recover; they manage to overcome their initial anxiety, start driving again, and while the memory of the crash remains distressing, its emotional impact gradually diminishes, allowing them to function effectively in their daily life. The other individual, however, does not experience the same recovery. They remain haunted by the event, avoid any reminders of the crash, are unable to drive, and continue to suffer from persistent symptoms. This person may be diagnosed with PTSD after a thorough assessment by a specialist and could benefit from specific evidence-based treatments, such as Cognitive Behavioural Therapy (CBT) for PTSD or Eye Movement Desensitisation and Reprocessing Therapy (EMDR).

In essence, while trauma refers to both a significant event and the natural emotional response to it, PTSD represents a clinical condition characterised by prolonged and severe psychological distress following a traumatic event. Visually, if one were to illustrate this relationship with a Venn diagram, “life experiences” would form the largest circle, within which “trauma” would be a smaller circle, encompassing those who experience lasting psychological impact from traumatic events. Nested inside the “trauma” circle would be an even smaller circle for “PTSD,” representing those whose trauma evolves into this more enduring and debilitating condition.

We All Experience Trauma

When it comes to trauma, if you took a random person off the street or even examined your own life, you would likely find it peppered with trauma. About 1 in 3 of us will experience a significant trauma in our lives. It’s a normal part of the human experience.

Trauma does not necessarily equate to a mental health problem, nor is it an accurate predictor of future difficulties. While it can lead to mental health and physical issues, for every individual with a high ACE (Adverse Childhood Experience) score and mental health challenges, there’s likely another who has overcome similar adversities to lead a robust, resilient life. The ACE framework, while valuable, often lacks nuance; for instance, a child who was lightly smacked versus one who suffered severe physical abuse would check the same box on an ACE questionnaire, despite the vastly different intensities and contexts of their experiences. Clearly, difficult childhood experiences do not automatically lead to problems later in life, and in the absence of PTSD symptoms, pathologizing or therapy may not be necessary.

In my work, I’ve met many people who are managing well despite significant past traumas. This observation highlights a frequently underestimated human quality: resilience. Adversity does not invariably weaken us; often, it fosters resilience. Instead of assuming trauma invariably leads to vulnerability, we might benefit more from exploring what enables people to thrive in spite of it.

Severe adverse experiences can undoubtedly cause profound harm, but having endured them in childhood doesn’t automatically necessitate a focus on these experiences or a hypersensitive approach to them in later life. In my view, excessively dwelling on past trauma and regarding them as a definitive cause of current problems, risks reinforcing a type of victim mentality.

Consider my own background: I lost my father to heart disease at age five, I experienced loneliness due to an often-absent mother working multiple jobs, and faced significant educational delays in primary school. However, present day, rather than viewing these hardships through a lens of victim hood, I see them as formative experiences that taught me valuable life lessons about hardship and resilience. My mother’s determination instilled in me a respect for hard work and a realistic perspective on life and death. And through loneliness, I learned independence.

I do not claim my experiences are worthy of particular praise, or that they were traumatic, nor do I believe everyone who suffers becomes a victim. Rather, I argue that trauma is a universal part of human life that does not always have negative outcomes. It can teach us about ourselves, build resilience, and demonstrate our capacity to overcome adversity. While it may leave us with quirks and emotional scars, these idiosyncrasies are part of the rich tapestry of human experience—after all, we are all a bit peculiar in our own ways.

Therapy: Know When It’s Needed

As previously mentioned, thorough and detailed assessments are crucial in cases like PTSD, where the impact on an individual’s life can be significant. Symptoms often include avoidance of memories, reexperiencing traumatic incidents, and anxiety, among a host of other issues. Traumatic experiences that do not result in PTSD can still precipitate a wide array of mental health disorders, which may also require therapy.

For instance, a trauma that results in persistent sadness and further inactivity could potentially lead to depression. In such cases, therapy could help individuals reframe their beliefs and reengage with the world. A significant health scare might lead to health anxiety disorders, while social traumas could result in social anxiety disorders. Similarly, certain experiences can underpin conditions such as OCD and panic disorders. In these instances, treatment should primarily focus on the specific disorder.

Evidence-based therapies like Cognitive Behavioural Therapy (CBT), Dialectical Behaviour Therapy (DBT), Acceptance and Commitment Therapy (ACT), Interpersonal Therapy (IPT), Family Therapy, Mindfulness Cognitive Therapy (MCT), Schema Therapy—and many others—are designed to address these disorders by helping individuals rethink their thoughts and engage in experiments that challenge and overcome disruptive patterns.

Most therapies do not necessarily delve deeply into past traumas but instead focus on managing current emotions and thoughts. This present-focused approach can be particularly effective in helping individuals cope with and recover from their conditions without the need to re-experience traumatic events. After all, you are in more control of the now than the past.

In short, sometimes we can’t fix the source of our stress, but we can fix what keeps it going in the here and now.

Are We Causing More Harm by Recklessly Using the Word ‘Trauma’?

I was at the gym the other day when someone remarked that the weights not being re-racked properly was “traumatic.” I recall joking similarly when my favourite cheese, Blacksticks Blue, wasn’t in stock at Morrisons. Obviously, these comments are made in jest. However, they illustrate a broader issue similar to saying “I’m a bit manic depressive today” when feeling out of sorts, or claiming “I’m a bit OCD” because I like my kitchen cupboard well-organised. We should probably refrain from making such comparisons.

My concern grows when there is an overemphasis on trauma in situations where PTSD or similar conditions are absent. Even with the best intentions, this focus can inadvertently cause harm. This is the problem with applying a single mental health label to complex situations that cannot be accurately explained by one diagnosis alone. When we use the word “trauma” irresponsibly, we risk attributing a person’s challenges solely to traumatic experiences, despite trauma often being just one piece of a much larger puzzle.

Consider the case of Dave, a man in his 30s who has faced significant adversity and traumatic experiences. His father was an alcoholic, his dad died, a family member went to prison, and he witnessed domestic violence and suffered at the hands of a heavy-handed, drunk stepfather. According to the Adverse Childhood Experiences (ACE) questionnaire, Dave would score highly.

Here lies the issue: the adversity and stress Dave experienced are not his primary problems; they may have contributed to some difficulties. The pressing issues for Dave are his financial instability, unsuitable accommodation, social isolation, lack of occupation, stressful work environment, inactivity, depression, poor sleep, unhealthy eating, and reliance on unhelpful coping mechanisms. Despite this, he is often told by friends, family, and social media influencers that his problems stem from his childhood trauma and that resolving and processing this past will fix everything.

Fast forward months or even years, and perhaps Dave has read a dozen self-help books on trauma and is on several therapy waiting lists. I believe that much of this time could have been used more pragmatically. I advocate for individuals like Dave to have access to the tools and support needed to live a healthy, valued life from the outset. This support should help them function, be active, and have a supportive network. If Dave then needs therapy, go for it.

What Should We Do

Save the word trauma for the real bad stuff. The type of event that impacts life and is very distressing. Think being a victim of prolonged sexual, physical, and psychological abuse and/or witness to it. Think near-death experiences and witnessing death. Think about witnessing something very out of the blue and significant. Think war. Think about fearing for your life. Remember, these traumatic events don’t immediately constitute a mental health disorder. What people often need in these circumstances is family and peer support to engage back with the world, pushing back against the boundaries of their comfort zone, to get that bit of independence back, to learn that the trauma hasn’t won, and to have people around that they can talk to while the memory is still raw.

Let’s acknowledge that trauma in the human experience is pretty normal. We should simply acknowledge that we often go through traumatic events. In most cases, they just contribute to us being us. In some cases, they actually make us more resilient, in others a little more vulnerable. They don’t necessarily need therapy or constant rumination on the past.

Trauma can mean more resilience. I have spoken to a lot of people who have been through the mill and have overcome adversity. Challenges in life can shape us and help us grow. They can give us independence and resilience. Alcoholic parents, being bullied in school—these experiences, while difficult, can also be formative.

Know when someone needs help. Someone could experience something horrendous, but after a couple of months bounce back. Maybe they don’t need anything. But for someone else, a trauma could lead to significant changes in life, mood, well-being, and mental health. They may need more hands-on help. Keep an eye on buddies who aren’t working, meeting up, whose emotions are absent or much more intense, who are hitting the bottle/drugs more than usual. They may benefit from speaking to someone about their symptoms.

We need to sweat the small stuff. When life is tough, perhaps we’ve been through something traumatic, it is often the basics that we neglect. This is because the basics are often hard to do. We need to be around others who’ve got our back, we need to be meeting our mates, we need support, a routine, we need to bask in the sun and move our bodies, we need a sleep routine, good food in our bellies, occupation—and we need all these things especially when we don’t feel like it.

Closing remarks

The term ‘trauma’ should be wielded with precision and care, reserved for those moments that truly shatter norms and cause profound distress. It’s vital to recognise that while trauma is a common thread in the tapestry of life, it does not inevitably lead to lasting psychological damage. By fostering resilience, providing appropriate support, and reserving specialised therapeutic interventions for those who truly need them, we can empower individuals to not only recover but thrive. Our approach to trauma should be nuanced and supportive, helping each person to navigate their experiences without being defined by them. In doing so, we honor the strength of the human spirit and the capacity for recovery that resides within each of us.