Could the way we process trauma be key to understanding mental health?
PTSD isn’t just for soldiers. And the study of traumatic events, especially suffered in childhood, is evolving. Examining our lives in the context of past trauma is key to coping with it, says Sam Hancock
I was raped by someone I didn’t know after a day out drinking with a friend. After being called a liar by the first person I confided in, and facing a difficult experience with the sexual assault officer on my case who was impatient, pushy and outwardly judgemental of me throughout my police interview, my mental health deteriorated to such an extent that I completely withdrew from the world. I quit my job and spent the majority of my time in bed, unable to move. I experienced panic attacks multiple times throughout the day. I felt a huge amount of anxiety, insomnia and complete exhaustion, alongside feelings of guilt and the sense that I’d somehow brought it on myself by being in that position – because I was drunk.
“I withdrew from friends and normal life, and I began unhealthily controlling my eating habits. I was depressed – I know that now. When I did manage to get out of bed, and sometimes the house, I relied heavily on alcohol which I quickly realised numbed my emotions and allowed me to put on the happy face that the people around me needed… the one that made them feel comfortable. It all spiralled and before I knew it, normal life became drinking multiple times a week and being out until 9am with a different group of people each night.
“I developed a sense that I was untouchable. I remember so clearly thinking: ‘I’m so broken, there’s nothing left to take. I’ve experienced the thing we all fear, so there’s nothing left to be scared of.' That’s when the anger started, and I began channelling my pain into shouting at my family and those close to me, accusing them of various wrongdoings. Now I realise I was trying to place my anger somewhere, anywhere, because I couldn’t put it on the person who really deserved it.
“That anger stayed with me for a long time – it was the hardest emotion to overcome when I finally began dealing with the trauma I’d gone through years earlier.”
When Amy Elgin was diagnosed with depression after being sexually assaulted, her life unravelled before her eyes. “I was offered counselling for the depression, but not for what had actually happened to me. I went [to therapy] a couple of times, but I wasn’t encouraged to do anything that actually dealt with the fact I’d been raped,” she says. “Instead, the sessions focused on how I dealt with my depression. It just seemed bizarre to be focusing on that rather than dealing with the root of the issue.”
Like so many words associated with mental health, trauma has many meanings and takes many forms. It sparks different reactions from different people who’ve experienced different things. It seems scary. It seems big, much bigger than us. It seems ugly. And because of all this, it’s something we all try to avoid – even if it’s something we have already been through. Then it becomes something we, more often than not, work hard to ignore. But what happens if understanding, and ultimately overcoming, trauma becomes the key to understanding the large majority of psychotic diagnoses and mental ill health?
A study conducted at the University of Liverpool and published in the journal Psychiatry Research earlier this year, concluded that diagnoses are “scientifically worthless as tools to identify mental health disorders”. In particular, the research sought to scrutinise five chapters within the Diagnostic and Statistical Manual (DSM) – a standard tool for doctors, which is used everyday to make official diagnoses of patients dealing with illnesses of the mind. It was the manual’s schizophrenia, bipolar disorder, depressive disorders, anxiety disorders and trauma-related disorders’ chapters that scientists closely analysed.
And it was as a result of this research that two key findings, among others, were made. The first being that almost all diagnoses tell us little about the individual patient and what treatment they need, with the second that diagnoses mask the true role of trauma and adverse events.
The study’s lead researcher Dr Kate Allsopp, who is now a research associate at Manchester’s complex trauma and resilience research unit, says she wasn’t “particularly surprised” that trauma is so overlooked in psychiatric diagnoses or in mental health services. “On the one hand the importance of traumatic experiences in the development of mental health difficulties is a completely understandable finding, it makes sense that adversity and distressing experiences contribute to distress,” she tells me. “On the other hand, these experiences hardly had a mention in my undergraduate course and early experience working in mental health services – biological factors and the ‘chemical imbalance theory’ were very much the focus.”
One in three British adults are said to have experienced a traumatic life event; in the US it’s almost double that. And yet there seems to be a lack of awareness and connection when it comes to the treatment of mental illness and identifying trauma or a distressing life event as a possible cause. “Psychosis and related difficulties have traditionally been seen as being caused by biological factors, and therefore the first treatment that clinicians reach for is medication,” Allsopp says. “Although there has been some shifts in this area, it’s mainly been in research like Filippo Varese’s work which found that preventing childhood trauma or effectively managing its psychological effects would reduce cases of psychosis by one third.”
For Amy, it was leaving her trauma to fester that resulted in her mentality imploding and her being pushed into a life of alcohol dependency and isolation. “Trying to deal with my trauma, alone, was what overhauled my mental wellbeing,” she says. It was finally accepting what had happened that became the first step towards her getting better, she tells me. “Talking about my experience and understanding the psychology behind what I was feeling in relation to sexual assault allowed me to both be able to take control of what I was experiencing, which is a huge thing for someone who has had their control forcibly taken away, and make sense of the jumble of emotions I was feeling for the first time.
Time Line Therapy is where you look at all the events in your life that have made you feel anger, sadness, fear, guilt and hurt, and take the lessons and learnings from each event
“It empowered me to really feel the feelings I had and make peace with them, which in turn improved my health further. Eventually I didn’t need to hide my emotions from myself and when I felt them, I could begin to explore what I was feeling and what was triggering it. The answer was always the same: my trauma.”
In short, it was confronting the issue that Amy had worked so hard to repress, both herself and through therapy sessions designed to skirt around the real issue, which allowed her to gain autonomy back in her life.
Sadly, though, Amy’s experience is not unique. “People often say they aren’t asked about distressing or traumatic life experiences by mental health services,” Allsopp says. “Meaning their therapy isn’t tailored towards helping to process these difficult experiences and work through the links between them and their mental health difficulties.” Perhaps then it is necessary to explore alternative therapies; therapies that allow patients to go backwards in order to go forwards.
Rebecca Lockwood says her postnatal depression was the hardest and most traumatic period of her life – one she hopes she will never have to live through again. She was diagnosed with OCD during her pregnancy, but had no idea what that meant in the long run. Before long, Rebecca found herself in “uncontrollable fits of tears” on a daily basis and even experiencing regular suicidal thoughts. “I felt so guilty. I’d just given birth to a healthy, happy baby and couldn’t have felt more desperate, alone and as though I couldn’t cope,” she says.
Unlike Amy, Rebecca was referred for psychological therapy and found it useful – it helped shake the thoughts she was having and get her back on a better thinking path. “But what really helped was when I began using a practice called Time Line Therapy, Neuro-Linguistic Programming (NLP) and Hypnosis,” she says. “Time Line Therapy is where you look at all the events in your life that have made you feel anger, sadness, fear, guilt and hurt, and take the lessons and learnings from each event and apply those learnings to other negative events in your life up until this point. It was only through this therapy that I healed completely.”
When we don’t release trauma and trapped emotions, we self-harm, literally inflicting exponential and fresh levels of anguish and stress on our bodies and minds. We are also reinforcing negative thought processes and belief systems in our neural pathways
The experience helped Rebecca so much that she is now a certified NLP Master Coach and NLP & Hypnosis Trainer. “When I took the lessons from each negative and emotionally significant event in my life, including the period after giving birth and various events that caused my OCD, I gave it a new meaning,” she tells me. “I released the emotion around it, the trauma, and saw it through new eyes. I can now only see the reasons why it happened as being personal, positive and about my future. It was as though a dark cloud had been lifted and all of a sudden I could see clearly. The transformation was almost instant.”
The phrase “A weight off your shoulders” suddenly comes to mind. Could it be that a huge number of us are carrying around a weight – a trauma – on our shoulders and letting it have an imposing effect on the rest of our lives?
Annabel Wilson, who founded the Living Ashram app, says identifying and providing the tools to enable a person to heal from past or current trauma is crucial in empowering them to achieve positive mental, emotional, physical and spiritual health. “We cannot separate one core pillar of health from the other, as they are all inextricably linked,” she says. “When we don’t release trauma and trapped emotions, we self-harm, literally inflicting exponential and fresh levels of anguish and stress on our bodies and minds. We are also reinforcing negative thought processes and belief systems in our neural pathways; essentially hardwiring a negative, fear-based mindset in our brains.”
Living Ashram uses science-based evidence to allow users to build positive wellbeing across these pillars into their daily routine. “When trauma is unresolved, we repress the emotions we did or do not have the capacity to deal with and hold it within our bodies, where it wreaks havoc creating a state of hyperarousal,” she tells me, “where our neural pathways become so highly sensitised that excessive amounts of adrenaline is generated every time an event occurs that triggers the pain from the original trauma, and often manifesting in a range of symptoms from hypervigilance, insomnia, chronic anxiety, panic attacks, overactive startle reflex and nightmares.”
Wilson stresses that there are many effective treatment paths when it comes to trauma, all of which can be explored by victims, survivors, and even healthcare services. “Simple things such as conscious breathing or meditation, and regular exercise, are excellent to support deeper trauma healing. Forgiveness and Gratitude practice can be done daily, or weekly depending on the rate and depth that an individual is willing and able to work.”
It’s a well-known debate in the conversation around mental health: should we use time looking for the cause of someone’s illness, or just concentrate on providing them with the proper tools to deal with the problem at hand?
But it is Eye Movement Desensitisation and Reprocessing, commonly referred to as EMDR, which Wilson says she highly recommends for anyone coping with deep-seated trauma – “so long as it’s worked on with an experienced therapist. It’s the most effective modality for trauma healing that I have experienced,” she tells me. “EMDR works extremely well in conjunction with Psych-K, an energy psychology therapy, facilitated by a professional facilitator, which rebalances and clears unhealthy belief systems.”
EMDR is an eight-phase psychotherapy, which uses eye movement to enable the mind to heal from psychological trauma in the same way that the body recovers from physical trauma. According to the EMDR Institute, the method works by specialists determining which patient’s memory to target first; the patient is then asked to hold different aspects of that event or thought in mind and to use their eyes to track the specialist’s hand as it moves back and forth across the patient’s field of vision. As this happens, for reasons believed by a Harvard researcher to be connected with the biological mechanisms involved in Rapid Eye Movement (REM) sleep, internal associations arise and patients begin to process the memory and disturbing feelings. In successful EMDR therapy, the meaning of painful events is transformed on an emotional level.
More than 30 controlled outcome studies have been done on EMDR therapy; some of which show that between 84 to 90 per cent of single-trauma victims no longer have post-traumatic stress disorder after only three 90-minute sessions. Its success has caused EMDR to grow in popularity around the world.
“It’s important for all therapies,” Wilson says, “to always research and do the necessary due diligence to find the best qualified and experienced therapist that is most in alignment with your needs and goals. Ultimately, if something doesn't feel right or comfortable, keep searching until it does.”
Sadly, it would be too easy to assume dealing with a trauma is the one-track solution to solving the riddle that is mental ill health. Or that everyone even has a trauma to deal with. Amy tells me: “There absolutely needs to be accessible help for those who do not have a ‘reason’ for their ill health and it is essential that we, as a society, do not sideline anyone who is experiencing mental illness in that way. When there is no related trauma, we need to treat these people with the same service level and attention.” And of course, she’s right.
Trauma: be informed
• Use the trauma informed care project website: traumainformedcareproject.org
• Redress the power imbalance that is inherent in current mental health services
• Ensure that mental health services do not retraumatise people: many practices are likely to cause retraumatisation, such as injecting a survivor of sexual abuse
• Staff training around traumatic life experiences, their links with mental health difficulties and how to ask about it and compassionately respond
• Routinely asking about distressing life experiences in mental health services, and addressing these experiences as part of treatment/therapy
• Mental health staff should believe people when they say they are a survivor of trauma
It’s a well-known debate in the conversation around mental health: should we use time looking for the cause of someone’s illness, or just concentrate on providing them with the proper tools to deal with the problem at hand? It’s not an easy question to answer, and one that has many answers. All of which, to some degree, are true and have validity in their reasoning.
“Of course, not all mental health difficulties are caused by traumatic experiences,” Allsopp says. “But I believe it’s vital for services to consider the possibility that they might be. To only look at ‘symptoms’ is to only look at one small part of the jigsaw, which increases stigma and potentially makes these ‘symptoms’ more frightening to the person experiencing them, and leads to a limited understanding and therefore limited options for how to help that person.
“When you look at so-called ‘symptoms’ in the context of distressing life experiences and broader social discourses, be it abuse, bullying, poverty, racism, oppression, they stop being unpredictable ‘symptoms’ of a ‘disorder’ and start being understandable responses and coping mechanisms.”
Wilson, from Living Ashram, says it’s crucial to remember that a person’s safety comes first when finding the right path to recover from trauma – or indeed any dealing with mental distress. “We cannot begin to do meaningful inner-work such as trauma healing when we are not physically or emotionally safe. In cases of addiction and abuse of any kind (self-harm, physical, sexual, psychological, disordered eating, etc), the first priority is to provide an individual with the environmental and emotional support that places their safety first, and enables them to reach a state of calm and reason where they can access deeper work,” she says.
Whatever the answer, it’s clear that victims of trauma aren’t always treated properly. And that trauma has in many ways been overlooked when it comes to recovering from mental illness or distress, and understanding the wider context around psychiatric diagnoses. Rebecca says she wouldn’t be where she is today without her trauma and that she’s “truly grateful for that”.
Amy’s journey is ongoing; she’s currently deciding whether or not she’ll return to therapy. “It will always be a part of me as it is one of the few events in my life that has truly changed me, the way I live my life and those around me. But does it define me? No. It was a process but I’m now a confident, outgoing and optimistic person. I have a job I absolutely love, a home, a great support system.
“What defines me more is knowing I got back up, that I grit my teeth and kept taking steps forward.”
If you have experienced any of the issues discussed in this article and want to speak to someone, call the Samaritans on 116 123 who are open 24 hours a day 365 days a year.
The Living Ashram app is available to download on all iPhones and Android mobiles. Alternatively, check out their website here.
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