Posted by Dr. Vollmer on July 17, 2015
Trauma, a word that is hard to define, in a mental health sense, and yet it appears to be at the root of many mental health issues. The problem with understanding trauma is that the environmental impact varies enormously based on the person’s biology. We return to the gene/environment interface. Genes load the gun, environment pulls the trigger, so to speak. Trauma, broadly speaking, is the upsetting experience, which the average person never has. Trauma, in other words, implies a major diversion from our basic assumptions. Losing a child is traumatic because in this day and age, we assume that parents will die before their children. A reversal of this order leads us to think that the heartbreak is enormous, and yet generations ago, losing a child was a predictable event in that many children did not survive to adulthood. So, trauma is contextual. The child who loses his mother when he is four, may experience a trauma, but at the same time, if that child is raised by a loving father, and perhaps a loving step-mother, then the child may not experience a traumatic loss, but rather a more “ordinary” sense of loss. On the other hand, if we let the patient define the trauma, then do we say that if the patient says that he had tonsillitis at age 6 and had his tonsils removed, then do we yield to him that this was the “traumatic” moment in his life, which now explains his job and marital difficulties. There are therapies which focus on “trauma” without a consistent definition of “trauma” making the therapy less rigorous, in one sense, and yet appealing, in another. The focus on trauma as an explanation for self-sabotaging behavior, lends itself to the reductionist notion that if the therapist and patient can “work through” the trauma, then the subsequent substance abuse and mood problems will resolve. Once again, I return to my thesis. If we can agree that trauma is a complex notion, shouldn’t we also agree that the treatment of trauma is also complex, and not amenable to limited duration cookbook kinds of treatment?
Clint, twenty-two, comes to mind. His mother committed suicide when he was five, on the fourth of July, “ruining my summer,” as he said with dark humor. His father re-married to a woman which Clint says “is OK”. After graduating high school, Clint has lived a life of homelessness and drug abuse. “Do you think that you would not have your current life if your mom did not kill herself?” I ask, wondering if he connects his current despairing life to the tragic death of his mom, sixteen years ago. “How would I ever know that, ” he says instantly, followed by, “probably, that is true.” He says, with tears in his eyes, and then mine too. “I never had anyone that was passionate about me and my development, and I think that really hurt,” Clint says with surprising candor. Suddenly, Clint has come to life for me. He is not the “homeless guy with a drug problem,” as he appears from the exterior, but rather, he is a little boy who really really misses his mom. Clint needs to feel valuable and important, a process which will take mentorship, and a deep therapeutic relationship. Losing his mom was traumatic, but the end result, put into the context of his life, was a deep feeling of worthlessness and hopelessness. Clint needs housing. He needs to live a sober life. Clint needs to feel loved. Short-term treatment is likely to reinforce his sense of hopelessness, as it will create another abandonment, the worst, most anti-therapeutic outcome. The theme, again, is constant. Complex problems require complex solutions. There is no way around that.