Trauma (big T and small t)
A response to events that overwhelm a person's capacity to cope. 'Big T' trauma is exposure to actual or threatened death, serious injury or sexual violence; 'small t' trauma covers repeated, less extreme harm such as humiliation, neglect or chronic criticism.
What drives it
The mind and body learn that the world, others or the self are unsafe and organise to prevent a repeat. The pattern that once protected the person often outlives the danger.
How it shows
Work
Outsized reactions to particular things (a raised voice, being criticised in public, unpredictability from a boss); over-control or over-preparation; difficulty trusting authority; going blank in certain meetings. Often highly competent elsewhere.
Relationships
Difficulty with trust or closeness, sudden withdrawal, strong reactions to tone, partners feeling they are being treated as someone from the past. Avoidance of certain places, people or topics.
Self
Reactions that feel bigger than the situation and familiar; a body that braces before the mind knows why; certain memories you steer around.
What tells it apart
Post-traumatic stress disorder (PTSD): Most people exposed to trauma do not develop PTSD; the diagnosis needs intrusions, avoidance, negative mood changes and arousal that persist and impair for over a month.
Adverse childhood experiences (ACEs): ACEs are a checklist of childhood adversities used to predict population risk; trauma refers to the actual effect on a given person, and a high ACE score does not mean a person is traumatised.
Grief (complicated, disenfranchised, anticipatory): Grief centres on longing for what was lost; trauma centres on threat and shows as alarm, avoidance and intrusive memories of what happened.
A test
Look for reactions that are specific, repeatable, out of proportion to the present and linked in time or theme to a past event; then ask, gently, when the person first remembers feeling that way.
Questions to carry
- Which reaction is out of proportion to now, and how closely does it repeat a theme from before?
- When does a reaction of mine feel older than the moment it shows up in?
How strong the research is
moderate. The effects of serious threat (Criterion A events) are well researched; the 'small t' category is a clinical heuristic with loose edges, and popular use now applies 'trauma' to almost any distressing experience.
Where it comes from
Pierre Janet, 1889; Sigmund Freud, 1890s; DSM-III, 1980; Francine Shapiro, 1995 (big T and small t)
On the family tree: Pierre Janet
Sources
- Pierre Janet, L'Automatisme psychologique (1889)
- Sigmund Freud, Beyond the Pleasure Principle (1920)
- Sándor Ferenczi, Confusion of Tongues between Adults and the Child (1933)
- Judith Lewis Herman, Trauma and Recovery (1992)
- Vincent J. Felitti, Robert F. Anda and colleagues, Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults (the ACE Study) (1998)
- Bessel van der Kolk, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma (2014)
- Gabor Maté with Daniel Maté, The Myth of Normal: Trauma, Illness and Healing in a Toxic Culture (2022)