Robert Scaer - The Body Bears the Burden 3e

Jane came into my office clearly in a state of distraction and fear. She had been involved in a relatively low-speed auto accident two months before, and instead of improving, she had begun to experience worsening cognitive and emotional symptoms. She had begun to misplace things frequently, had spells of severe physical weakness, had fallen several times, and had developed a stutter. At other times she felt agitated and fearful, and was intolerant of any stimulus, including noises, bright lights, and even simple conversation with family and friends. Even brief exposure to these seemingly minor stimuli produced confusion, anxiety, and ultimately exhaustion. When I examined her, she visibly jumped, and then pulled her arms tightly around herself when I walked around the back of the exam table to examine her spine. When asked, she stated that she felt extremely anxious and uncomfortable when I stood behind her out of her field of vision, even with a female chaperone in the room. Her past social history revealed that she had experienced a physically traumatic rape at age sixteen. She acknowledged that she had always been uncomfortable when she was in a crowd with people behind her whom she could not see. In a classroom, a theater, or at a party, she usually positioned herself with her back to the wall.

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The benchmark for psychiatric diagnoses, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSMIV), defines trauma as, The person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of The critical change in this definition is the addition to the concept of trauma that involves threatened death or serious injury. In other words, this concept now implies that trauma is an event or experience that threatens the survival of the individual.

Examples of traumatic events that the DSMIV lists include military combat, violent personal assault (sexual assault, physical attack, robbery, mugging) kidnapping being taken hostage, terrorist attack, torture, POW, natural or man-made disasters, severe MVAs life-threatening illnesses When the trauma is inflicted by another person, it is especially intense, or when the traumatized person is extremely close to the trauma, the severity of the trauma and its symptoms may be especially profound.

These definitions of trauma and its causes are useful, and much more specific than earlier concepts of sources of trauma as representing stressful events outside the usual range of human experience. However, they still do not approach the basic premise that in all cases, a traumatic experience in its intrinsic sense is one that represents a threat to the very survival of the individual. In this definition, the meaning of the experience may be as important to the traumatized person as what actually physically happens to that person.

Being kidnapped, mugged, raped, involved in warfare, or in a severe MVA are all life-threatening experiences, and therefore potentially traumatizing. Photographs of survivors of tornadoes, floods, or other natural disasters clearly reflect the shock, grief, and suffering associated with shocking and life-threatening natural events. Witnessing a graphically violent event could be perceived as shocking and traumatizing, especially if the event had personal meaning or involved another human being. Childhood trauma is perhaps the easiest to understand, given the intrinsic vulnerability of the developing child to all types of experiences. Even learning second hand about a severe traumatic event involving a loved one generally is a source of shock to a person. How all of these events may represent a threat to ones survival is less clear unless one considers the concept more carefully. We can basically say that trauma is an experience that is perceived to be a threat to life in the face of helplessness. And helplessness may in fact be the defining element that generates the neurophysiology of trauma itself.