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Complex Trauma Syndrome

The longer I work in the field of mental health the more astounded I am at how frequently clients report having experienced some kind of invalidating abuse in their lives. Chronically exposed to comments like you’re stupid, what a loser, you’ll never amount to anything, you’re ugly, what’s wrong with you, you can’t do anything right, you ruin everything, why can’t you just be like everybody else, and who cares what you think send shock waves of erosive self-negation through the body. We start to believe we’re not good enough, that our thoughts and feelings don’t matter, our interests are a waste of time, or that we shouldn’t have been born. More than that research shows neural pathways are disrupted, we become physiologically altered to escalate defensively, over-conditioned for safety, less connected with the responses of our own body, and develop mechanisms of protection that make harmonious relationship and productive functioning increasingly difficult. We may also withdraw, become hopeless, and feel like our pain will never end.

We are particularly vulnerable to such damage when we are still growing and our brains are developing. This doesn’t always involve violence or intentional cruelty. Our parents, for example, may not be emotionally available, unsupportive, inconsistent, unreliable, untrustworthy, or unpredictably explosive. This can have the same invalidating effect as more physical kinds of abuse and may be due to a family history of trauma, addiction, denial, or coping mechanisms that make people afraid to commit or act tough because kindness, trust, and vulnerability have led to pain in the past. All this feeds a cycle of trauma, not because of some frail deficiency in certain individuals but because people are complex social creatures and feeling connected is a biological human need. The resulting scars when this relational self is battered can take root at the core of our personhood. Taking this kind of damage into account can help us better understand what is happening when we become escalated for the smallest things at the most unexpected times. We may resort to coping strategies that get us in the same old trouble. Lying and embellishing can become automatic behaviour despite an intention to be honest. We can have emptiness and pain in our hearts even when there seems to be no reason for it. This framework can help us understand why maintaining relationships may be so difficult, and why we strike out at others or seem to push them away when we would like to have a stronger social support network. Much of this self-defeating behaviour happens in an attempt to confirm our significance and defend our value when, deep inside, there’s a damaged shadow of ourselves that’s been invalidated, rejected, and socially abused. We may even become bullies ourselves.

Different healing systems over the years have encouraged us to attend the damaged “little child” inside us, and research is showing the physiological reality of damage that happens to people when the value of their humanity is threatened and undermined. Appreciating the nature of this damage often provides a more useful explanation for our distress than the diagnosis of one “disorder” or another. The problem becomes not some pathology in ourselves but the understandable impact of invalidation trauma on a socially complex human organism. The problem is reframed from being something inherently wrong with who we are, something that may make us feel unworthy, broken, or crazy, to something we can make sense of in terms of a “normal” response to various kinds of intentionally inflicted and sometimes well-meaning abuse. This way of looking also helps us have compassion and loving kindness towards ourselves rather than wasting our energy with hate and blame or self-blame, making us able to shift to a place that more quietly sees how bullying and abuse often has its roots in trauma history. This doesn’t make it OK. It gives us a better way to take care of ourselves moving forward.

When the very life of a person is threatened or they experience/witness awful things, they are often diagnosed with a “disorder” called post-traumatic stress (PTSD). This is not like an illness we contract but a description of what can happen after a trauma or series of traumas. It is based on the nature of our suffering and the quality of our subsequent experience. Various treatments have been found to help people with this and theories are still being developed to better understand what is going on in the mind and body. As our understanding grows the range of treatments found to be helpful grows accordingly. When the value of a person’s humanity is threatened, especially in a chronic way over time and most poignantly when their brain is still developing, there may also be subsequent ongoing suffering. In peacetime conditions for people who do not expose themselves to danger, violence, and carnage for a living, this kind of trauma is much more common than the shock traumas that result in PTSD. The extent of suffering caused by what we might call invalidation trauma has been referred to as “probably the single most important public health challenge” facing western society.* Growing research, like the massive well-known ACE study involving thousands of participants, reveals the true extent of this problem. Other research demonstrates the physiological and brain effects associated with socially-based trauma and alerts us to the real toll of this devastating kind of experience.

Various names have been proposed for this kind of trauma, including complex PTSD, DESNOS (disorders of extreme stress not otherwise specified), and developmental trauma disorder. In my work as a crisis counsellor I look at it from the practical viewpoint of my case documentation. For example, workers are provided with working options to choose from in the description of people’s emotional distress when they come for help. These are based on categories of psychiatrically conventional “disorders.” More and more I realize that if a category existed called complex trauma syndrome, not to pathologize people but to describe a range of characteristic experiences associated with the residue of invalidation and social abuse, this would be one the most common categories to describe cases that present to crisis for urgent mental health support.

I do not always bluntly ask a person if they are having suicidal thoughts, and I do not always bluntly ask a person if they have been abused. Rather, these are areas I try to explore in the assessment of what a person is experiencing and the nature of their suffering. The “disorders” of conventional psychiatry have utility as a description of a person’s experience (anxiety and depression being the most common) but identifying the traumatic roots of that suffering often has greater personal value as an avenue to promote appropriate self-care and recovery. Diagnosis and medication has its part to play, but acknowledging the role of invalidation trauma on our bodies gives us a way to better manage our lives so we don’t simply gather dust on a waiting list. It empowers us to start noticing when trauma activation happens and when related coping mechanisms are being triggered. This already helps us feel better because we better understand what is happening. Even more importantly, it helps us respond in ways that address the damage done rather than desperately seeking relief or trying to run away from it.

This kind of trauma is often inter-generational and has as much to do with history as specific events taking place in our lives. It is healed in the same way, slowly one day at a time. We each have our important part to play in recovery. Acknowledging our vulnerability in this regard is the farthest thing from weakness and may be our greatest source of strength in building healthy families and communities as well as the self we would like to be.

*van der Kolk, B. (2005). Developmental trauma disorder: towards a rational diagnosis for children with complex trauma histories. Psychiatric Annals, 35 (5), 401-408.

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