Different Degrees of Trauma

A series of articles about trauma: (2) Lasting Effects of Early Traumas

Posted Dec 31, 2011

In my last article, I discussed the notion of being "born into trauma". Some readers expressed concern that I was overlooking the miracle of birth and the advances we have made in creating a birth experience that is kinder to both infant and mother. In praising these achievements, one reader went so far as to state that these days trauma is absent altogether from the birthing process. Though I, too, have been privy to the miracle of happy, healthy births (I am the father of 3), I disagree that birth is trauma-free. Let me explain.

"Born into trauma" is primarily a description of the enormity of the challenge that the actual psychic or emotional experience that birth presents to the newborn's brain: the bombardment of sensations and stimuli that confront the infant who is transitioning from the safety and comfort of the womb into the complexity and confusion of the external world and the powerful needs of his own independently functioning body. Remember that, while in the womb, the infant's bodily needs are completely cared for-even at the expense of the mother, if necessary. The overwhelming early sensations of life post-birth (hunger, cold, pain, etc.) can, over time, be countered by the caregiver (Mother) who identifies and quells those rampant, ever-present sensations. The infant is fed, cleaned and swaddled. Caregivers accomplish the task of creating safety (synonymous with accurately identifying and fulfilling needs) for the infant differently, succeeding to greater or lesser degrees both in the moment and throughout the infant/child's early development. The degree to which the caregiver fosters the development in the child of a sense that the world is a safe place is exactly what determines the degree of trauma that remains in the child's-and ultimately the adult's--psyche. I believe that no caregiver, no matter how in tune he or she is with the infant/child, can stop the sensation of psychic trauma that is experienced by the infant at birth: the infant's mind is unable to grasp the sensations that immediately and inexorably occur when moving from the womb to the world. Understanding this concept of early psychic trauma that is mitigated to varying degrees by the caregiver in the days, months and years after birth is crucial to the treatment of traumatized adults; it enables us to better anticipate both a person's emotional response to present-day trauma and the psychological resources and defenses that are mobilized in an effort to cope with trauma in later years, both as it is happening and after the traumatic event or period of time has ended.

The therapy of "John" will be used to illustrate how being "born into trauma" impacted the psychological response one person had to a present day trauma. John is an alcoholic, drinking a bottle of whiskey a day. He is a veteran of the Afghanistan war, is very smart, and, at the young age of 25, has given up on the possibility that there is any joy remaining in life. He has quit. And feels the hopelessness of endless despair.

From birth to age eight, John was in foster care, passed from family to family, verbally, physically and sexually abused. Until the age of 8, John's needs were rarely met. He was not soothed as an infant; he was never reassured that the world was safe. In fact, he came to believe at a very early age that the world was dangerous and that there was no place of safety in a world that was cruel and uncaring. Though he was adopted at age 8 by caring people, the (aforementioned hypothesized) psychic trauma he experienced at birth was never contained or mitigated by his caregivers; clearly, trauma continued to be heaped upon him. Nevertheless, under the care of his "new" family, John has been able to experience some success in life: he married a loving wife and had a "successful" tour in the Air Force.

My treatment of John began with a clear warning: he has absolute disdain for any "helping" profession. Though he had been in therapy many times, each therapy failed to change his perception of the world as a cruel, dangerous place filled with mean and selfish people. Indeed, his experience in therapy had only confirmed that no one could understand the depth and nature of his pain and that there was indeed no place of safety and understanding in the world. He was seeking therapy again for two simple reasons: his wife could no longer tolerate the bitterness, hopelessness, and joblessness that defined him since his return from the Afghanistan war; and his wife could no longer tolerate the extent and the effects of his drinking. Indeed John said that his own despair was fueled by his alcoholism: "To forget the pain, I drink. If I keep drinking, my wife will leave me. If my wife leaves me, I will kill myself." John presented to me as a person who had given up on life yet, cruelly, could still recognize the pain that his pain caused his loving but battle-weary wife. And that caused him yet further pain and despair

In my words, John's presentation is blunt, simple, and straight to the point: he was born into trauma, and the subsequent care he received did nothing to modulate his sense of confusion, terror, and danger. His family (from age 8 onward) helped him to develop some resources (particularly his intellect) and his wife (to his surprise) sparked a flicker in him that he was possibly lovable. Nevertheless, he was ill-prepared for the subsequent trauma he experienced during the Afghanistan war. The stage had been set very early in his life for how he was to be affected by later trauma: during the war, he fought and scraped by and survived in the face of hardship and atrocity. It was the return to civilian life when the "fight" was over when he realized that he had no idea how to deal with the pain of the war. His medicine of choice to treat this unendurable pain was alcohol.

John has many "symptoms" that if treated as the "presenting problem" could result only in treatment failure on my part, and likely suicide on John's. For example, if treated as a marital problem or a depression or even as a returning vet with PTSD (all of which are accurate, but only in part), John would feel misunderstood and consequently even more hopeless. Why? Because John knows that his problem is himself-it is deeply rooted in him and has been with him for the entirety of his life. John's diagnosis is Developmental Trauma Disorder: his current problems reside in, and further exacerbate, the trauma he experienced at birth that went unsoothed, and the subsequent ongoing trauma he experienced in early childhood. Most notably, John was rarely, if ever, nurtured, soothed or contained as an infant/child, and so developed in a psychic world of danger, conflict and despair. The trauma of the war reactivated his childhood instinct to quit. By providing John with this narrative of his lifelong trauma and its nature and origins, he felt engaged, unable to argue his way out of his diagnosis and treatment, for which he appeared grateful. John felt "found out", like I was "on to him". But this was not at all a negative experience for John, because he concomitantly felt understood in a way he had never been understood before.

Today, John has been sober for 56 days. He is exercising regularly. Using his extraordinary intellect, he has educated himself about his condition: he recognizes that his brain is different because of his early trauma, and that means that he processes present traumas-for that matter, present situations of all kinds-differently than others. He is coming to accept that he has to live with his brain and its interpretation of his personal reality. And he knows that in living with it, he must not try to change it or alter it or deaden it with alcohol or anything else. Instead, he must find ways of living with himself, not escaping from himself

Living without altering his reality is excruciatingly hard for John. In therapy, we move between brainstorming how life can be less psychically painful for him (music, exercise, writing), and delving deeper into his dangerous past. As his therapist, I have to balance what he can tolerate uncovering and understanding on the one hand with what I wish for him and his life on the other. He has so much promise, but so much trauma, wired into his brain that I constantly need to monitor his capacity to meet the challenges I bring to him-the biggest challenge being to speak his feelings rather than deny them or use them in self- or other- punitive ways - or to try to escape from them altogether in the bottle of whiskey that has been his medicine in the past.

While John's life may be an extreme example, it illustrates how being "born into trauma", and then how unsoothed and unmitigated "birth trauma", lays the groundwork for responses to trauma that occur later in life. In John's case, his early trauma was never contained; in fact, it continued throughout his early childhood. Present traumas, therefore, proved utterly debilitating. In my next article, I will examine another interesting example of a person "born into trauma", this time a person who was contained and soothed and well-cared for throughout childhood, only to experience severe trauma in later life and how he responded to later trauma very differently from John.

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."