OneWhat constitutes trauma? Turns out it’s not all that simple to define. It’s a term with both popular and professional meanings — some that focus on the event, others on the response.

Here’s Merriam-Webster online: “a deeply distressing or disturbing experience.” You can’t get much broader than that. Does that mean every such experience is traumatic?

Apparently not. The American Psychological Association (APA) website describes trauma as “… an emotional response to a terrible event like an accident, rape or natural disaster.”

DSM5 is still more specific. From this article in Professional Counselor:

[Trauma involves] “…exposure to actual or threatened death, serious injury or sexual violence in one or more of four ways: (a) directly experiencing the event; (b) witnessing, in person, the event occurring to others; (c) learning that such an event happened to a close family member or friend; and (d) experiencing repeated or extreme exposure to aversive details of such events, such as with first responders. Actual or threatened death,” the article goes on to suggest, “must have occurred in a violent or accidental manner; and experiencing cannot include exposure through electronic media, television, movies or pictures, unless it is work-related.”

Pretty complicated stuff. Still, it’s clear there are definite restrictions on what qualifies as trauma.

I’ve noticed that not every clinic bothers with such distinctions. I found this in a treatment center blog: “[Trauma] ¬†means that the event was traumatic to you. It doesn’t mean that it met some third-party definition of trauma. It doesn’t mean that there was necessarily a violence of any kind attached to it. It was just shocking. It was shocking to you.” Sounds like we’re back to the dictionary version. Reminded me of the old saw about the man with the hammer, to whom everything looks like a nail.

A question: If somebody shows up in treatment with a pattern of abuse of heroin or alcohol, how important is it to identify and resolve feelings about painful experiences in the past?

After all, most addiction patients arrive with broad complaints: They’re sad, angry, confused, as well as in trouble with substances. If we define trauma broadly enough, they’ve all had traumatic experiences. But that doesn’t tell us how to address their current symptoms. We’re free to devote time and energy to the past, but in practical terms, how much help will it be?

This is a longstanding point of debate. When I arrived in the field during the ’70s, therapists worked from the assumption that you eliminated addictive behavior through insight into its “root” psychological causes. I know people who swear it worked for them, but for the vast majority, it sure looked to me like the road to frustration. That was a reason psychoanalytic approaches faded, to be replaced by more present-focused therapies.

Which doesn’t mean that therapists shouldn’t help clients understand and deal with past trauma. But it does suggest that such insights may not do much to eliminate a patient’s desire to drink or use drugs.


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