My previous article entitled "Degrees of Trauma" dealt with an obviously severe case of childhood trauma that, followed much later in life by a harsh experience of wartime trauma, resulted in a severely traumatized and emotionally crippled individual. In our study of "degrees of trauma" or why people react differently to single event traumas in their lives, I want now to look at an individual who had a distinctly more intact/healthy background of experience growing up. Comparing such an individual to a person who grew up in the middle of ongoing childhood trauma will bring us a step closer to understanding why people react so differently to traumas that occur in adult life, regardless of how similar the traumatic events are.

"David" is a married thirty-year old Yale graduate who is pursuing a successful career in the technology field. He has never been in therapy, is seemingly well-adjusted and successful in every visible way. Through a friend, I was able to interview David closely. What I found proved enlightening to our study of trauma.

Trauma is defined, not by the length of time during which the traumatic event lasts, not by the specific characteristics of the traumatic event, but by the complete inability of our cognitive processes to grasp, conceptualize, process and understand what is happening to us. Trauma, as such, is cognitively "un-digestible". A traumatic "event" thus defined can last ten minutes, or ten years.

When I asked David, "Have you ever experienced trauma,'" it was clear from our discussion that he intellectually understood the concept of trauma quite well. He answered in the affirmative. I asked him, "What have your traumas been?"

He identified three traumatic events in his life. First, his parents divorce when he was six years old; second, his experience of 9/11; and third, his mother's brain tumor.

"After my parents divorced, when I was six, my dad left New York City, where we were living, for Boston. He left suddenly, without telling me. I could not argue or discuss anything with him - one day he had just left, he was gone. It didn't seem real. I didn't understand. There were no words that made me understand what was happening or that could help me with my feelings. I can't even describe my feelings. I was numb. I withdrew. I just remember feeling that the floor had completely dropped out from under me. My mom was there, but I felt alone, abandoned and confused. My mom worked very hard after that during my childhood years to rebuild the feeling that someone was in charge, that my world was intact and safe. My mom is really, really good at that; I knew that she was truly in charge, but to know that took a very long time."

"Tell me about what happened on 9/11."

"I had arrived at Yale University three days before 9/11. It was my first time away from home; my first time ever moving out of my mom's home. That morning I woke up. My Grandfather was calling. That NEVER happened, Grandpa calling me. He left a message. Something had happened, everybody was okay, don't worry, he said. My mom, sister and stepdad lived in Lower Manhattan - next to The World Trade Center. From my Grandfather's message, even though he tried to be reassuring, I knew something very bad was happening, but I didn't know what. I went to my computer to get on CNN. CNN was down! How was that possible!? I don't know what is going on, and I can't find out! I was in a place of having no control whatsoever, and I didn't even know what it was that I had no control over. I left my dorm room and, I don't know how, I accidentally locked the door behind me. Now I was locked out; no home, no control. Left on the outside of even knowing what was going on. I remember that someone who lived next door to me somehow got a key to let me back into my room. After that, there is a lot I do not remember."

"I know that I was listening to the radio. I remember details that have no importance. I remember thinking about 1993; I was ten when the bomb went off in the parking garage underneath the World Trade Center. I remembered that I was in school two blocks away. I remember thinking back then that if the towers fell, we would be toast. Now it was almost 10 years later: 9/11. I remember what I was thinking in 1993 when I heard on the radio: one of The World Trade towers had fallen! I had a mental image of the tower collapsing, a picture in my mind from 1993, but I could not picture it falling, right now, today, on my family."

"My Grandfather called me; everybody was okay, he said. I knew he was lying. It was 4 pm. I have almost no memory from between 10 am and 4 pm. I remember 10 am. Firemen were going into the buildings to save people. Then it was 4 pm and I did not know if my family was okay. Alive? Hurt? Dead? I can feel right now the same guilt and anxiety I felt then. Now is ten years later. My family is okay, but I still feel this huge guilt. The guilt that I wasn't there, I had left three days before, and how much I wanted and needed to be there. Intellectually, I know that being there would have been worse. I do not want to die, but if my family was going to die, then I wanted to be part of it."

"The events of 9/11 hurt my first semester emotionally and academically. I was really shaken, wrenched. My family had lost their home. My mother and sister were hurt emotionally and physically. I was haunted by what happened to them, and by my own guilt and fears and by the loss of my home that I loved so much and by my family that had always been safe and together. Now my home was gone, my family was in pieces. But what saved me after 9/11 was the special environment I was in. I had roommates with strong values who were sensitive to what I was going through. They saw me suffering. They knew the magnitude of what had happened to the world and my family, and the impact it had had on me. They helped me. They talked to me. They understood, and I knew that they understood."

David stayed in school and had the courage to reach out to people for help. He chose to be helped and supported, and he chose to be helped and supported by people. He could have chosen a different path at this point: alcohol, drugs, withdrawal, numbing, escape. The choices that he made in the months after the traumatic event have much to do with his upbringing and his mother's ability to rebuild that floor that had fallen out from under him twice before: during his parents' divorce and after the Word Trade Center bombing in 1993. Unlike the alcoholic who rejects people for the more predictable bottle, David chose the help and support of the people around him. The path toward making these choices had been laid down for him well before the events of 9/11.

I continued talking with David. "Ten years after 9/11, Mom had been sick on and off for a year. I remember when Mom told me she had a brain tumor. I knew she had been sick, but no way could I have imagined that it was anything as bad as a brain tumor. Again, I had those same feelings of guilt. Really bad, terrible guilt. Once again I was not a part of my family; I was not going through what my family was going through. I was away at graduate school. I wanted to be with my family, a part of what they were going through, even though what they were going through was horrible. I felt isolated and alone. I remember feeling completely out of control; I could not help any one or do anything. This was worse than 9/11. What happened then happened in one day, and then you could rebuild. This disease was unexpected and went on day after day after day with no end in sight and no way to know what was going to happen.

"When something happens that is completely unexpected, that I could not have predicted, and I have no ability to affect the course of events, this effects me completely. It is the feeling of being totally out of control. This does not feel like trauma. This was even worse than 9/11. This was "Mom has a brain tumor". This was Mom is in danger, BIG DANGER. I wanted to run, but I couldn't run. And then I feel even guiltier than I already do, guiltier for having these feelings of wanting to run away!

"I was horrified by Mom's surgery. It took thirteen hours, it never ended, she was going to die, and she was dying in the surgery room. I hated seeing her that way. Mom is strong. She was my rock, my floor, my support. She was my strength, she made me feel strong. The operation never ended. I felt out of control. The floor was falling out from under me. Again.

"After a year, I saw Mom getting better. I saw that COGNITIVELY she was back in control, even though the brain tumor had affected her in so many ways. But she was strong, her mind was strong, and then I began to realize that the world was strong. Today, my own wife is strong for me. She loves me - like a rock. I never doubt that love, any more than I doubt my Mom's love. My friends have been strong for me. And I am strong. I feel very lucky to live in a world where I am loved and where I have love all around me."

David grew up with the feeling that the floor was solid underneath him. When traumatic events happened to him, events that he could not fathom or define as they were happening, he was deeply affected with feelings of being out of control (reality) and more ‘neurotic' feelings of guilt and total helplessness. But as opposed to John in my previous article, David had grown up with the sense of a safety net of emotional support that he was able to use in order to regain a firm footing on his life after each of these significant traumatic events occurred.

By the very act of living, you are both on the receiving end of the world around you and of traumatic events that occur, and you also "create" the world that exists around you. A trauma that happens to a person whose emotional roots have developed in an unhealthy and emotionally unsafe past can create a bad world that must often be escaped by using the comfort and escape provided by drugs, alcohol and isolation. Often, those are the only tools an individual knows. On the other hand, a trauma with roots in a healthy past can create a world of other resources: a world of people, support and love.

Trauma can be successfully treated only when we fully understand and include the individual's life history that forms the context in which current trauma occurs. As seen in the cases of John (previous articles) and David (this article), the experiences of the past have an enormous influence on how an individual feels or reacts to a present trauma. Therefore understanding a patient's past is critical to understanding how to change the patients' experience of his or her otherwise unmitigated experience of current trauma. If the response to or interpretation of a current or recent trauma can be modified, changed or understood through a different perspective, then we have a chance to emerge healthier from the seemingly overwhelming events that haunt us.

A prospective and severely traumatized person who was considering therapy recently told me that she had resigned herself to the fact that therapy couldn't be productive, because there was no way that I, as a therapist, could change the unthinkably terrible and traumatizing experiences that had happened to her throughout her childhood. I disagreed with her conclusion. I agreed that I could not change what had happened to her in her past. But I maintained that an individual's experience of past experience, and a person's feelings about their experiences in the past, can be changed. And therein lies the hope that we can emerge from past and terrible traumas freed from the shackles of anxiety and fear that would otherwise accompany us throughout our lives.
Frederick Woolverton, Ph.D., is Director of The Village Institute for Psychotherapy in Manhattan and Fayetteville, Arkansas and is the co-author of the book "Unhooked."

Written with Robert Bradberry.

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