The Ever-Expanding Definition of Trauma
In diluting the word's meaning mental health professionals are creating a generation of victims.
In his 2016 paper, “Concept creep: Psychology’s expanding concepts of harm and pathology,” psychology professor Nick Haslam addresses the ways in which psychology has become politicized through manipulations of language and terminology: “Concepts that refer to the negative aspects of human experience and behavior have expanded their meanings so that they now encompass a much broader range of phenomena than before … [producing] an ever-increasing sensitivity to harm.” Such concept creep, Haslam notes, “runs the risk of pathologizing everyday experience and encouraging a sense of virtuous but impotent victimhood.”
One of the best examples of this type of concept creep is the redefinition of the word “trauma.” Clinicians now use the word to describe almost any adversity.
This change in usage is driven by a specific political agenda. “Trauma” has become a useful term for mental health practitioners who are involved in social justice activism, because it makes some of their core concerns, such as social inequality, seem more threatening and alarming. It is both true and unfortunate that some people have more difficult lives than others. But if we tell such people that they are traumatized victims will that improve their mental health? And is it even true?
The following statement by Drexel University’s Center for Nonviolence and Social Justice justifies the overbroad use of the word that can be found in the verbiage issued by every university campus, rehab, and counselling center today:
“The word ‘trauma’ is used to describe experiences or situations that are emotionally painful and distressing, and that overwhelm people’s ability to cope, leaving them powerless. Trauma has sometimes been defined in reference to circumstances that are outside the realm of normal human experience. Unfortunately, this definition doesn’t always hold true. For some groups of people, trauma can occur frequently and become part of the common human experience … In addition to terrifying events such as violence and assault, we suggest that relatively more subtle and insidious forms of trauma—such as discrimination, racism, oppression, and poverty—are pervasive and, when experienced chronically, have a cumulative impact that can be fundamentally life-altering.”
This redefinition of the word “trauma” is motivated by politics, dressed up as medical diagnosis.
Until recently, everyone knew what trauma meant. In the latest Diagnostic and Statistical Manual of Mental Disorders (DSM-5), trauma is defined as a psychiatric disorder with unmistakable, extremely debilitating symptoms that are closer to those of psychosis than of depression. These symptoms can occur after people have been subjected to or have witnessed “actual or threatened death, serious injury or sexual violence”—things outside the realm of “normal human experience.” This does not include “more subtle and insidious” harms, such as racism or oppression (however morally wrong these may be).
We should also question the idea that “painful and distressing” situations will necessarily “overwhelm people’s ability to cope.” This assumes that most people are fragile and powerless in the face of adversity. This simply isn’t true. Most humans (including children) are extremely resilient—even when they experience genuinely traumatic events. One 2008 study , for example, surveyed the subjective well-being of German nationals over a twenty-year period before, during, and after the death of a loved one. Around 60 percent of the subjects dealt with the bereavement relatively well and recovered within a year. Another 20 percent suffered considerably during the crisis period but returned to their previous levels of subjective well-being over the following 2–3 years. The remaining 20 percent were still grieving many years later—but many of them had already reported suffering from mental health issues before the death occurred.
The authors note that humans have a propensity to “return to a set-point of well-being relatively quickly after even the most aversive or auspicious life events.” Psychologists have known this since the 1970s . So why is this fact either not known or ignored by most mental health professionals today? Perhaps because both academic and clinical psychology have been completely captured by social justice politics, which, as sociologists Bradley Campbell and Jason Manning have discussed, valorizes victimhood.
In fact, relatively few people suffer from trauma (traditionally defined), even among the most vulnerable populations. Rates of PTSD amongst addicts, for example, are lower than those of other mental health disorders. In one study, cited by the Substance Abuse and Mental Health Service Administration (SAMHSA), the largest mental health services organization in the US, researchers looked at the prevalence of psychiatric disorders among a sample of chronic crack cocaine users in a poor community. While 24 percent of the users had a diagnosis of antisocial personality disorder and 17.8 percent suffered from depression, only 11.8 percent had experienced PTSD. Interestingly, the researchers found that white drug users were more likely to suffer from mental health conditions than black drug users, which suggests that—contrary to the Drexel University statement cited above—trauma is not primarily the result of institutionalized racism.
A study of Brazilian crack cocaine users, also cited by SAMHSA, found that the extreme street violence and degradation to which they were subjected and exposed as a result of their drug use was the primarily source of their trauma. As someone who has spent a significant amount of time working with IV drug users, I find this unsurprising.
According to SAMHSA’s guidelines on trauma-informed care (last updated in 2014), trauma arises from “an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or threatening and that has lasting adverse effects on the individual’s functioning and physical, social, emotional, or spiritual well-being.”
The problem is that this defines trauma as a matter of subjective interpretation: it suggests that any experience could be traumatic if it makes the sufferer feel bad. Parental divorce and other common adversities could be defined as “trauma” if they are “experienced” as harmful. While SAMHSA’s guide follows the DSM-5 in acknowledging that trauma is only likely to occur when people are exposed “to actual or threatened death, serious injury, or sexual violence,” it dilutes the definition by arguing that psychological trauma is “not limited to such diagnostic criteria” and can be “characterized more broadly.” It is not the nature of events themselves that defines them as traumatic, but the individual’s emotional response to those events. By this definition, a toddler who refuses to go to bed on time and whose emotional resources are “overwhelmed” by bedtime to the point of nightly tantrums could be said to be experiencing “trauma.”
This broadening of the definition has naturally led to an increase in the numbers of people reporting trauma. The mental health profession has responded by offering trauma-informed care (TIC). According to SAMHSA, most of the more than 10,000 behavioral healthcare programs in the US now provide TIC of some kind.
According to the Center of Social Research at Buffalo University , trauma-informed care “assumes that an individual is more likely than not to have a history of trauma … considers the pervasive nature of trauma and promotes environments of healing and recovery rather than practices and services that may inadvertently re-traumatize.” Patients can be re-traumatized, they allege, by “being treated like a number,” “not feeling seen or heard,” experiencing a lack of “emotional safety,” and/or being a victim of “microaggressions.”
Proponents of the trauma-informed care system have even suggested that professional trauma-finders—“trauma champions”—should be employed to root out unacknowledged trauma. According to Roger Harris and Maxine Fallot , two architects of the trauma-informed care model:
“a champion understands the impact of violence and victimization on the lives of people seeking mental health or addiction services and is a front-line worker who thinks ‘trauma first.’ When trying to understand a person’s behavior, the champion will ask, ‘is this related to abuse and violence?’”
Trauma-informed care, which pathologizes normal everyday stressors, is radically changing how people define mental health and practice mental health care. This model depicts people seeking mental health and addiction services as oppressed victims and counsellors, social workers and psychologists as their saviors. This is the language of benefactors and charity cases, of gallant knights and damsels in distress.
TIC receives significant amounts of government funding and the support of many major policy bodies. SAMHSA’s 2014 Treatment Protocols state that trauma-informed care “must permeate [their own] organization from top to bottom,” since “An organizational culture of care, safety, and respect demands activities that foster the development of trauma-informed counselors.”
Perhaps the worst aspect of this supposedly compassionate approach to mental health is a phenomenon I call therapeutic absolution. It allows therapists to effortlessly absolve their patients of responsibility for their own behavior. This is extremely unhelpful. Addicts, for example, have almost always caused considerable turmoil in both their own and other people’s lives. They need help to turn their lives around. They shouldn’t be told that “it is society that must change, not you.”
In a recent article published by Edinburgh University Press, entitled “Trauma: An ideology in search of evidence,” Mark Smith, Claire Cameron and Sebastian Monteux argue that “The prominence given to trauma perspectives has potentially iatrogenic consequences for those identified or self-identifying as traumatized.” In other words, frivolous trauma diagnoses and misguided policies can leave vulnerable people worse off than they were before they encountered mental health services. The article’s authors—Professors of Social Work and Social Pedagogy and a Lecturer in Mental Health Nursing—also note that proponents of trauma-informed care “speak of kindness, compassion and even love as being all that is required to furnish social policy with a full set of improved wellbeing outcomes … the certainty and the moral rectitude with which they do so reflects ‘a system talking to itself,’ a ‘magic circle.’”
Unfortunately, this “magic circle” is currently setting the agenda in the mental healthcare profession. The redefinition of trauma has led psychologists, academics, and counsellors to pathologize everyday adversities and convince people that they are powerless in the face of such experiences. Any instance of addiction, depression, failure, or bad behavior without obvious cause can be attributed to such “trauma.”
You are unlikely to hear this kind of rhetoric at a lay-run addiction recovery program, such as Narcotics Anonymous, where peers hold each other accountable for their actions. Nor is this the kind of thing a loving parent would be likely to say to their addicted son or daughter. This expansion of the concept of trauma is what Rob Henderson calls a luxury belief: it confers no cost on the elites that hold it, but has disastrous consequences for those who need to rebuild their lives and who will never be able to do so if they are convinced that they are powerless victims by a psychological profession that is becoming more deluded and out of touch by the day.
