IN GENERAL THE ORIGIN OF TRAUMA
CAN BE DIVIDED IN 2 CATEGORIES:
ADVERSE CHILDHOOD EXPERIENCES (ACEs)
These official ACEs (adverse childhood experiences) were studied in the US as early as 1995. It is now clear that taking these ACEs seriously, in treatment and prevention, as well as Trauma Informed Care is important to be able to reverse the enormous increase in suffering. See a comprehensive report on ACE studies and TIC here.
Abuse
- Emotional – swearing, insults, humiliation, intimidation
- Physical – pushing, grabbing, hitting, throwing, injuring or leaving marks
- Sexual – by someone from 5 years older: sexual acts, sexually touching, attempting any form of sexual intercourse
Household environment
- Mother treated violently
- Household substance abuse
- Mental illness or suicide in the household
- Separation of parents or divorce
- Detained household member
Neglect
- Emotional – Absence: feeling loved and important by family; of family who look after each other and feel close to each other; of family as a source of strength
- Physical – Absence: from someone who cared for you, looked after you well and protected you; of enough to eat; of clean clothes
OTHER FORMS OF TRAUMA
In addition to the above-mentioned forms of trauma that differ not only in age, but also in manifestation in the person, there are two more forms to mention.
COMPLEX TRAUMA & CPTSD:
You’ve probably heard of this before, or of C-PTSD. These names can also cause confusion. If by C-PTSD one means that it is a stress response to event trauma, but then (also) in childhood, then that is much too simplistic. Complex trauma, the cause of a possible stress response, is a combination of different types of trauma that has not been resolved, resulting in a snowball of re-traumatisation and/or new trauma experiences.
The consequences are usually severe and prevent the person from functioning ‘normally’ on a daily basis. A heavy combination of traumas that is quite complicated to identify. But it is possible, this often requires a multidisciplinary team of care providers. These parties must cooperate very well with each other to guarantee the safety of the client.
It should also be noted that C-PTSD is often quickly given as a diagnosis within a DSM-driven system in order to be able to offer a broader treatment than that for PTSD alone. It may well be that there is mainly developmental trauma and not Complex Trauma as described above. These are ‘administrative’ considerations.
INTERGENERATIONAL TRAUMA:
Trauma that is passed down through previous generations, both in behaviour (developmental trauma) and in DNA. If there are generations of trauma, such as in people who descend from people who were made into slaves, DNA damage can be found in the ends of chromosomes (telomeres), which causes them to shorten, which then can lead to disease and aging. Practically, this means that someone’s nervous system can be ‘on’ without there having been individual trauma.
It can cause confusion and is labeled as genetic by the medical world. Which is true according to the letter. Fortunately, studies also show that these negative gene changes can be reversed with the support of the environment and the right guidance. In any case, suppressing symptoms will not be a solution to achieve a free and happy life.
What we should certainly include in this is that in addition to the trauma, also the resilience, the survival power of ancestors can be passed on. Someone who doesn’t experience anything will also be more prone to setbacks. Addressing this natural resilience is an important part of healing intergenerational trauma.
TRAUMA IS…
Officially:
An event or series of events or circumstances that are experienced as life threatening and have permanent negative consequences for behaviour and wellbeing (mentally, physically, socially, emotionally, spiritually).
Trauma Informed Care (TIC):
Traces that are left in the brain and body after traumatic experiences. Trauma is about losing the connection with yourself (mind and body) first and then with other people and your surroundings. The nervous system and neural pathways of someone with trauma are different than of someone without trauma. The nervous system is always ‘on’ and causes the survival mechanism to get active immediately and over everything.
This can manifest itself different with each person; one is always fighting with everything and everybody, the other might be pleasing all the time and a third person just makes him- or herself invisible because fighting or fleeing was not possible at the moment the trauma occurred. In all cases there is a constant feeling of fear and hyper vigilance.
TRAUMA IS NOT…
It is not the story what happened, it is the reaction of the person’s system to the story and the survival traces that stayed. In regular health care they are still convinced that overcoming trauma is about willpower and cognitively changing your thinking and behaviour. Which is absolutely proved to be not working at all because when you are in a state of fear, the neo-cortex is offline.
The Autonomic Nervous Systeml (ANS)
TRAUMA BY
BESSEL VAN DER KOLK
IN GENERAL, THE ORIGIN OF TRAUMA CAN BE DIVIDED IN 2 CATEGORIES:
Developmental trauma
Different events and experiences over a longer period of time, in primarily the first 6 years of life, and occurs between the primary caregivers and the small child. Later in life there are hardly any memories because it is not stored in the cognitive memory. This trauma influences and creates the development of the brain, the body and the mind. It will manifest itself later in life when the person forms new relationships with other people outside the parental home. The stress that stays is not PTSD, but Developmental Trauma Disorder (DTD).
Important difference with adult event trauma is that the child has not been able to attach itself safely, the nervous system becomes hyper vigilant and that will be the blueprint for the rest of life. For a child, safe attachment is a matter of life and death. But what if that attachment is not safe? It tells the child that you’d better not get attached because it could be life threatening, that is his or her truth in life.
Developmental trauma is the unsafe attachment, which can manifest itself by:
- Neglect: emotional and/or physical
- Abuse: emotional and/or physical
In most cases the trauma is not put on the child on purpose. Trauma is a system problem and very often intergenerational transmitted, we pass it on to our children and thinking this is reality. If the parent has experienced trauma too and that has never been addressed, the chance of you passing it on in behaviour and even DNA is very likely.
But what if the child experiences events, like bullying, that do not involve the primary caregivers? In these cases trauma develops when the child comes home and there is no one to give him a safe environment, acknowledgment about what happened and protection. Saying like: “Please be a man and stand up for yourself!”. Or that the child doesn’t want to ‘bother’ the parents and keeps the thing that happened to himself. Thát is the real trauma for a child.
People who have experienced Developmental trauma are more likely to also experience adult event trauma. Like domestic violence and/or sexual assault. Thanks to academic research of so called ACEs (Adverse Childhood Experiences) we now know that the more traumatic experiences children have, the bigger the negative influence it will have on the rest of their lives. See more information about ACEs below.
Adult event trauma
Occurs from a single, identifiable event, usually during adulthood. One can remember the event and it can be relived. At that moment the nervous system is triggered and there is an overwhelming feeling that you are in mortal danger. The survival mechanism is set in motion again and again: flee, fight, freeze of collapse. This is PTSD.
It’s the kind of trauma we’ve probably all heard of. We know the stories of veterans, refugees, people who experience robberies, have to experience sexual violence, etc. Violent and life-threatening situations that can turn people into a fearful wreck from one moment to the next. It affects their whole life and that of the people around them. The fear is in the body and flares up at the slightest trigger.
Fortunately, there is a lot of attention for this form of trauma and good treatment methods are available. Such as, for example, EMDR, Internal Family Systems Therapy, Sensorimotor psychotherapy and the studies for treatment with MDMA are advanced. In regular health care, unfortunately, treatment is still mainly done with various forms of therapy that focus on changing thinking and behaviour, such as Psychotherapy, CBT and Schema Therapy. Even reliving therapies are offered while modern research shows that this will make the trauma experiences worse or will even re-traumatise. The body is not involved in these methods. The idea is still that the cognitive brain determines and controls everything.
Thanks to intensive research in neurobiology with brain scans, we now know a lot about how trauma and the stress reactions affect the brain, and therefore also which treatments are effective and which are less effective. Because these scans clearly show that the prefrontal cortex (the part where memory, speech and analytical capacity is located) in particular is offline during stress, these cognitive behavioral therapies usually do not work sufficiently.
Within the Trauma Informed movement that originated in the US, led by the native Dutch Bessel van der Kolk, a lot of attention is paid to precisely this somatic (physical) approach to healing trauma. The starting point here is observing negative feelings in a safe way without overwhelming. When EMDR is done right it has this same goal; being able to process events in a safe state of being, without being overwhelmed.
ADVERSE CHILDHOOD EXPERIENCES (ACEs)
These official ACEs (adverse childhood experiences) were studied in the US as early as 1995. It is now clear that taking these ACEs seriously, in treatment and prevention, as well as Trauma Informed Care is important to be able to reverse the enormous increase in suffering. See a comprehensive report on ACE studies and TIC here.
Abuse
- Emotional – swearing, insults, humiliation, intimidation
- Physical – pushing, grabbing, hitting, throwing, injuring or leaving marks
- Sexual – by someone from 5 years older: sexual acts, sexually touching, attempting any form of sexual intercourse
Household environment
- Mother treated violently
- Household substance abuse
- Mental illness or suicide in the household
- Separation of parents or divorce
- Detained household member
Neglect
- Emotional – Absence: feeling loved and important by family; of family who look after each other and feel close to each other; of family as a source of strength
- Physical – Absence: from someone who cared for you, looked after you well and protected you; of enough to eat; of clean clothes
OTHER FORMS OF TRAUMA
n addition to the above-mentioned forms of trauma that differ not only in age, but also in manifestation in the person, there are two more forms to mention.
COMPLEX TRAUMA & CPTSD:
You’ve probably heard of this before, or of C-PTSD. These names can also cause confusion. If by C-PTSD one means that it is a stress response to event trauma, but then (also) in childhood, then that is much too simplistic. Complex trauma, the cause of a possible stress response, is a combination of different types of trauma that has not been resolved, resulting in a snowball of re-traumatisation and/or new trauma experiences.
The consequences are usually severe and prevent the person from functioning ‘normally’ on a daily basis. A heavy combination of traumas that is quite complicated to identify. But it is possible, this often requires a multidisciplinary team of care providers. These parties must cooperate very well with each other to guarantee the safety of the client.
It should also be noted that C-PTSD is often quickly given as a diagnosis within a DSM-driven system in order to be able to offer a broader treatment than that for PTSD alone. It may well be that there is mainly developmental trauma and not Complex Trauma as described above. These are ‘administrative’ considerations.
INTERGENERATIONAL TRAUMA:
Trauma that is passed down through previous generations, both in behaviour (developmental trauma) and in DNA. If there are generations of trauma, such as in people who descend from people who were made into slaves, DNA damage can be found in the ends of chromosomes (telomeres), which causes them to shorten, which then can lead to disease and aging. Practically, this means that someone’s nervous system can be ‘on’ without there having been individual trauma.
It can cause confusion and is labeled as genetic by the medical world. Which is true according to the letter. Fortunately, studies also show that these negative gene changes can be reversed with the support of the environment and the right guidance. In any case, suppressing symptoms will not be a solution to achieve a free and happy life.
What we should certainly include in this is that in addition to the trauma, also the resilience, the survival power of ancestors can be passed on. Someone who doesn’t experience anything will also be more prone to setbacks. Addressing this natural resilience is an important part of healing intergenerational trauma.
TRAUMA INFORMED CARE EXPLAINED
Trauma Informed Care is more than just providing care and guidance, it is also aimed at stimulating a change in thinking about ‘mental’ suffering and diseases. Man is not just a cognitive being, but a whole of intuition, emotion, physical sensation and cognitive analysis.
Safety
TIC is primarily focused on the relationship between client and therapist. The choice of a therapist is of decisive importance and the choice should be yours. It is important that you feel safe, if your trauma makes it difficult to feel what safety means, see if you feel comfortable and confident.
It is important that the therapist guides the client in their own environment and helps to create a safe environment in which he or she can recover. Trauma Informed Care aims to support client control, choice and autonomy. Trauma almost always has to do with a memory of lack of control. Resilience is stimulated in the client.
Trauma as a system
Furthermore, TIC aims to promote trauma awareness among the client, but also society-wide. Trauma is by definition a systemic problem and so it is important that everyone gains more knowledge about trauma, because of this we all recognise the signals earlier and draw different conclusions about the observed behaviour than generally happens now. Hopefully, this will also lead to different choices in dealing with that behaviour. The therapist can recognise symptoms of trauma and has recovery from long-term trauma as a primary goal. Re-traumatisation is always prevented as much as possible, so there is no direct re-living.
TRAUMA INFORMED CARE HALL OF FAME
Below is an overview of the most important names in the world of Trauma Informed Care. All have been working in their field for decades and have made great discoveries when it comes to the effect and healing of trauma. An impressive list, but of course they are not the only ones. For about two years now, their work suddenly seems to be catching on, still mainly in America. Corona may have had a hand in this, the world as we have arranged it turns out not to be so controllable and it has prompted many of us to find more insight and alternatives. For me it’s a goal to get the message out in Europe and especially The Netherlands and Belgium.
Bessel van der Kolk
Bessel van der Kolk, MD has spent his career studying how children and adults adapt to traumatic experiences, and has translated emerging findings from neuroscience and attachment research to develop and study a range of treatments for traumatic stress in children and adults. He has led the introduction of PTSD in the DSM and the worldwide acceptance of EMDR and yoga, among others. Author of the book The Body Keeps the Score which has been on the bestseller list for months; we are apparently now (finally) ready for a revolution in ‘mental’ health care.
Dan Siegel
dr. Dan Siegel is a clinical professor of psychiatry at UCLA School of Medicine and co-founder of the Mindful Awareness Research Center at UCLA. An award-winning educator, he is a Distinguished Fellow of the American Psychiatric Association and recipient of several honorary awards. Dr. Siegel is also the Executive Director of the Mindsight Institute, an educational organization that offers online learning and in-person seminars that focus on how to improve the mind development of individuals, families and communities through the intersection of human relationships and fundamental biological processes.
Gabor Maté
dr. Gabor Maté, a renowned speaker and bestselling author, is highly sought after for his expertise on a range of topics, including addiction, stress and child development. Rather than providing quick solutions to these complex problems, Dr. Maté’s scientific research, case histories and his own insights and experience to present a broad perspective that enlightens and empowers people to promote their own healing and that of those around them. He has a huge list of books to his name, such as In the Realm of Hungry Ghosts (addiction) and When the Body Says No (trauma and illness).
Janina Fisher
Janina Fisher, PhD is a licensed Clinical Psychologist and Instructor at the Trauma Center, an outpatient clinic and research center founded by Bessel van der Kolk. Known for her expertise as both a therapist and consultant, she is also past president of the New England Society for the Treatment of Trauma and Dissociation, an EMDR International Association Credit Provider, a faculty member of the Sensorimotor Psychotherapy Institute, and a former Instructor, Harvard Medical School. Dr. Fisher has written many books, is the developer of the Trauma-Informed Stabilization Treatment and above all she’s an incredibly powerful and kind person.
Pat Ogden
Before the diagnosis of PTSD was included in the DSM, Dr. Ogden firsthand the way many of her patients were at the mercy of reliving the past, and that current treatment methods only seemed to evoke traumatic memories. Recognizing the link between the body and psychological problems, she began to lay the groundwork for Sensorimotor Psychotherapy® by merging somatic therapy and psychotherapy into a comprehensive method of healing this mind-body disconnect. In 1981, Dr. Ogden, after co-founding the Hakomi Institute, established her own school, today known as the Sensorimotor Psychotherapy Institute (SPI).
Peter Levine
dr. Peter A. Levine received his Ph.D. in medical biophysics from the University of California at Berkeley and also holds a PhD in psychology from International University. He has worked in the field of stress and trauma for over 40 years and is the developer of the Somatic Experiencing® method, which has recently been dubbed “evidence based” thanks to a four-year study (but had proven its worth decades before that ). This endearing man fights for a physical and biological view of trauma and is a pleasure to listen to when he talks about his work. Peter Levine is the author of several books, one of the best known is The Tiger Awakes.
Richard (Dick) Schwartz
Richard Schwartz began his career as a systemic family therapist and academic. Based on systems thinking, Dr. Schwartz Internal Family Systems (IFS) in response to clients’ descriptions of various parts of themselves. He focused on the relationships between these components and noted that there were systemic patterns in the way they were organized in clients. For me, IFS is the discovery of the (last) century, it puts the client in charge, is creative and above all respectful. Several books about IFS by him and his students have been published, which can be found on the IFS website.
Stephen Porges
Stephen W. Porges, Ph.D. is a Distinguished University Scientist at Indiana University, where he is the founder of the Traumatic Stress Research Consortium. He is a professor of psychiatry at the University of North Carolina and professor emeritus at both the University of Illinois at Chicago and the University of Maryland. He developed the Polyvagal Theory (1994), a breakthrough! He proved that there are not two nervous systems, but three: the dorsal parasympathetic system (the dorsal vagus), the sympathetic system (SAM axis), and thirdly, the ventral vagal system (the “social system” = the ventral vagus). A revolution.
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