Melbourne, May 27 (The Conversation) It’s the word of the decade. “A major signifier of our age.” “The invisible force that shapes our lives.”
But what is “trauma”? Although it occupies the cultural spotlight,
its meaning has never been hazier. Can we bring it into focus?
“Trauma” derives from the ancient Greek for wound. According to the Oxford English Dictionary, this external bodily injury meaning dates back to 1684.
Late in the 19th century, “trauma” acquired a second meaning as psychological injury. In 1894, for example, the US philosopher and psychologist William James wrote of “permanent ‘psychic traumata’”, likening them to “thorns in the spirit”.
A third, figurative meaning emerged in the 1970s. “Trauma” now referred to suffering or adverse events in general. Just as “schizophrenia” and “hysteria” originated as clinical diagnoses and later picked up new, broader senses, trauma expanded and became a metaphor.
Trauma in psychology and psychiatry
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In the mental health disciplines, the definition of trauma has followed a winding path. In 1952’s first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), it referred exclusively to physical injury.
No diagnosis corresponding to the psychological meaning of “trauma” appeared until 1980, when DSM-III introduced post-traumatic stress disorder (PTSD).
DSM-III listed an array of PTSD symptoms and a definition of the kind of traumatic events responsible for them. For a diagnosis to be made, the event would have to evoke significant distress in almost everyone and be “outside the range of usual human experience”.
Controversially, later editions of the DSM loosened this criterion. For example, events that were indirectly witnessed – rather than directly experienced – came to be included. Emphasis shifted from an event’s objective severity to the subjective distress it caused. Consequently, a wider range of experiences became traumatic.
These changing rules for diagnosing PTSD point to a fundamental ambiguity in the psychiatric meaning of “trauma”.
It can refer to a harmful event, as when a catastrophe is described as a trauma. But it can also name the event’s psychological impact, as when a person is said to suffer from trauma.
As a result, “trauma” awkwardly straddles the objective and the subjective, cause and effect.
Concept creep
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The relaxation of the DSM’s definition of a traumatic event is an example of “concept creep” – the gradual broadening of harm-related concepts. Studies have demonstrated this trend in large historical datasets.
For example, a study by my research group shows that “trauma” came to be used in a wider range of semantic contexts from 1970 to the late 2010s. That broadening is found in general text, such as news media and fiction, as well as academic articles.
“Trauma” is also increasingly used in less emotionally fraught contexts, implying that its connotations have become milder and normalised.
Interestingly, one driver of trauma’s broadening appears to be the growing cultural prominence of the concept. Books now mention it six times more often than they did half a century ago, and in psychology articles the factor is 25. The more we talk about trauma, the more it means.
The everyday uses of ‘trauma’
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The public has embraced “trauma” and run with it. As a recent review observed, “the definition of trauma is more restricted in clinical psychology and psychiatry than in common parlance”.
Studies find that people define a wider range of adversities as traumas than the DSM, stretching the concept from so-called “big-T” traumas to relatively “small-t” traumas. For example, they extend it to experiencing poor housing conditions and street harassment.
Social media is implicated in these broadened definitions. TikTok videos commonly describe minor embarrassments as traumas (for example, “I sat in chocolate and didn’t realise”) and innocuous experiences, such as mind-wandering, as signs of it.
Some of these uses are tongue-in-cheek and knowing. They poke fun at broad definitions (for example, “trauma is when you open the cookie tin to find sewing materials”). In the same spirit, participants in a recent Irish study were ambivalent about such definitions, “welcoming trauma’s de-stigmatisation but deploring its potential trivialisation”.
Benefits and costs of broad definitions
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This ambivalence points to a backlash against expansive definitions, but that backlash carries risks. Trivialising trauma may be wrong, but people can be harmed by events that are not “big-T” traumatic. Those who have experienced adversity deserve compassion whether or not their experiences meet diagnostic benchmarks.
People who question the concept creep of “trauma” are sometimes accused of lacking compassion, glossing over adversity and policing language. If someone wants to describe their experience as traumatic, who are you to invalidate them?
However, some objections to the inflation of “trauma” are legitimate and grounded in compassionate concern. Holding a broad definition may harm people.
One study found that people induced to hold such a definition experienced more distress and intrusive thoughts after viewing a confronting video clip than those induced to hold a narrow one. Another showed that people who held broader trauma concepts were more distressed by an upsetting clip.
Perceiving something to be traumatic may contribute to making it so. Attributing distress to trauma implies that the injury we have suffered is enduring, indelible, overwhelming and identity-defining.
For the writer Will Self, trauma has become: "the idea that certain species of experience have the ability to injure us in lasting ways, such that we carry the wound – and, indeed, the experience itself – forever with us, often without our even knowing."
Understanding the cause of our suffering in this way – beyond our control, permanent and profoundly impactful – is the opposite of what is likely to promote recovery. It is a pattern associated with depression and hopelessness.
Another reason to resist the expansion of “trauma” is conceptual clarity. If all adversities become trauma, and all distress is ascribed to it, the concept becomes a blunt instrument.
“Big-T” trauma is already widespread – three quarters of Australian adults have experienced such an event, such as a life-threatening car crash or the unexpected death of a loved one – without diluting it with small-t troubles.
The expansive view of trauma promotes the increasingly popular view that distress can be explained by adverse life experiences alone. The idea we should move from asking what’s wrong with people to what happened to them sounds humane, but it can lead to simplistic trauma determinism.
Life experiences matter, but they’re not all that matters. Only 4 per cent of people who experience a DSM traumatic event develop PTSD, for example. Many biological, psychological and cultural factors play a role in mental ill health, not just traumatic experiences.
Questioning the expansion of “trauma” is essential if we are to avoid diluting and misusing the concept. This expansion is driven by benevolent societal trends but it has a downside. At this cultural moment, when “trauma” is everywhere, we need to think clearly and critically about it. (The Conversation) GRS
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