There Really Are Not Many Exceptions

When a symptom is described in simple and precise language, it is said to be operationalized. As Joe fell to the ground after taking a bullet in the leg, he was nearly certain he was going to die. When he lifted his head to look around, ears ringing and heart thumping, he was staring at a grotesque body lying on the ground with no head. As he scrambled back to safety, he saw severed arms, legs, and other unidentifiable body parts lying around. Joe had experienced sudden and unexpected fear for his life and had felt an overwhelming moment of panic. During some of these visits, Yvonne was raped by her father when she was eleven years old. He beat her at least twice. Yvonne described them to her therapist as more confusing than anything. That was the moment when Yvonne felt the clearest moment of panic that she and her family could be killed and that her father, the man she thought had loved her, could actually be her murderer. Carl was fifteen years old when he was in the front passenger seat of his older brother’s car. His brother was driving them home from movie night at their local high school. The country roads were empty and the night seemed quiet and peaceful.

Something Got Me Started

As they rounded a sharp curve, his brother slid the car over into the lane for oncoming traffic in order to take the curve faster. Seemingly out of nowhere, the headlights of a car appeared, coming straight at them. The other car was also coming fast and had veered outside of its lane. There was just enough time to swerve so that the rear of the car took the brunt of the impact. The sound of metal screeching against metal and glass shattering triggered instantly in Carl the thought that this must be what it sounds like to die in a car crash. His head was whipped to the left and rammed into his brother, and then they were whipped back in the other direction. His body slammed against the door and his head crashed against the window. He momentarily blacked out. When he woke up, his heart was pounding in his chest, his hands were trembling, and his survival instinct kicked in, warning him to get out of the car before they got hit by another car. The common element among all three was the sudden and unexpected moments of sheer terror. There Really Are Not Many Exceptions. I frequently encounter my fellow professionals in the field who believe there are exceptions to this rule.

Hard Feelings

When I give lectures or trainings, audience members almost invariably state that they believe neglect, living with a mother who abuses drugs, and being separated from one’s parents and placed in foster care easily qualify as traumatic events, and they have examples from their work to prove it. When we walk through their examples, however, it becomes clear that they have failed to separate discrete traumatic events from the larger stressful events. Let us walk through a discussion I had with a colleague, which is typical of these encounters. The boy was distressed to watch his parents being handcuffed and led away by police officers, but there was no violence reported. Let us look at the event more closely. I ask what happened when the police showed up at the house. Did they break down the door at midnight and everyone in the house mistakenly believed they were being robbed? Did the father physically fight with the police? Was anybody hurt and bleeding? Let us say my colleague replies that indeed the boy’s father refused to cooperate with the police and a struggle ensued. The police tackled the father to the ground. The father’s nose was smashed against the ground and blood ran down his face. You’re going to kill him! The boy now believed his father’s life was in danger. Even after walking through the example, audience members were still confused and persisted in believing the separation from the parents was indeed traumatic. See? one person said.

Nobody Told Me

The separation was traumatic just like he told you. No, I would reply, the event was not traumatic until the father fought with the police. The father’s fight with the police was a separate incident. That was a fight, not a separation from parents. The person replied, But I still think the separation was traumatic. Maybe I am deficient in the skills of persuasion. Maybe some people believe what they want to believe. As a group, they had no obvious physical injuries but exhibited a strange variety of nervous reactions. These passengers became known mainly because they were pursuing legal cases against the railroad companies and wanted compensation for their injuries. The quest for monetary compensation and fighting these battles in courtrooms would become a recurring theme in the history of trauma reactions. At the time, railway spine was considered to be a neurological condition. It would not be until quite a bit later in the twentieth century that it was recognized as a psychiatric condition. But the condition became known as soldier’s heart because he based his description of the symptoms on his observations of over 300 soldiers. It was also known as Da Costa’s syndrome. Da Costa speculated at length about the possible causes, of which he focused on fevers, hard field service, wounds, rheumatism, scurvy, sunstroke, and tobacco. He focused on physical causes, and at no point did he show any strong indication that emotional fear was a cause. Eventually, as psychiatry as a profession grew, psychiatrists helped to connect the dots that trauma causes psychological problems for people. Sigmund Freud, an Austrian neurologist but basically a practicing psychiatrist, catapulted trauma into a prominent place in one of his earliest theories. As with most of the psychiatric diagnoses of that era, the definitions of the disorders were vague and could mean vastly different things from one doctor to the next. A menu of distinctly defined symptoms described each disorder.