Trauma can be a tricky thing to talk about. It’s a confusing topic and one that has received lots of attention in the mental health field. The definitions of what kinds of events are traumatic and the ways that we talk about trauma reactions, both acute and post-acute, have changed several times over the years. One of the best things to come out of these many discussions is the understanding that individuals are unique and that honoring and treating their distress is more important than debating whether the event that led to their distress is big enough to qualify as traumatic. The concepts of big “t” and small “t” trauma are part of this evolution.
What is Trauma?
Trauma is a distressful event that falls outside the normal everyday experiences of an individual. These events can be human-made or the result of natural causes. When people talk about trauma, they tend to talk about big events. Things like combat, physical and sexual assault, catastrophic accidents, natural disasters, and terrorist attacks often make the list.
Oftentimes, these kinds of events include a perceived or real threat to life as well as a sense of powerlessness and helplessness. These can be classified as big “t” traumatic events. If we were all in the room together hearing the story of one of these events, we would probably agree, “Oh, yes. That was traumatic.”
Small “t” traumatic events tend to be more personal and subjective, and while they may invoke a sense of helplessness and powerlessness at the moment, they are not generally life-threatening. Some folks might not describe them as traumatic at all.
These include things like divorce, legal trouble, the death of a pet, employment issues, financial problems, interpersonal conflicts, or social issues. One small “t” event might cause very little distress. It’s the accumulation of these events that can be problematic.
Not everyone who experiences a big “t” or the accumulation of several small “t” events will develop significant problems either in the immediate or further down the road. The mind-body response to a traumatic event or the accumulation of events depends on lots of factors. These include the individual’s beliefs, values, morals, past history, general resilience and levels of distress tolerance, level of social support, perceptions, and expectations.
Another important factor that determines how an individual move through and past a traumatic event is their ability and willingness to process the thoughts and feelings that arise as a result of the event. Avoidance plays a key role in the development of trauma reaction issues (Barbash, E., 2017).
When it comes to big “t” events, avoidance behaviors can be quite obvious. One big “t” event is enough to cause serious distress, and the aftermath of big “t”s can be complicated by uncomfortable reminders like paperwork, reports, and cleanup. Individuals may use extensive energy to avoid any reminders of the big “t” event. Actions like refusing to report the assault, avoiding crowds or driving, or throwing away combat-related metals are examples of the kinds of avoidance behaviors big “t” victims might engage in.
Alcohol and drug use can also be used in attempts to avoid trauma-related distress. The trouble with distress-avoidance is that it doesn’t actually make the discomfort go away. Avoidance is a bandage, not a cure. In fact, the energy used to avoid reminders of the event ultimately prolongs distress and can result in trauma reactions that last for months or years and significantly impact the individual’s level of life-functioning. Avoidance behaviors can also circumvent treatment resulting in continued suffering.
Avoidance might look different for those who’ve experienced small “t” trauma events. Individuals who’ve experienced these types of events might rationalize that the event is “something everyone goes through” and downplay the distress they feel. They might shame themselves for “being so upset” and work hard to push past or ignore their discomfort.
Outside messages from others can also be a factor. Statements like, “aren’t you over that yet?” or “you know, when that happened to me, it was no big deal” and others like them can cause a person to avoid dealing with their distress. As with big “t” trauma avoidance, individuals struggling with small “t” distress may turn to alcohol, drugs or other addictive behaviors.
Once again, a bandage is placed over the wound. When it comes to small “t” trauma, one bandaged wound might not set off a significant trauma reaction later on, but the accumulation of these bandaged wounds can cause significant impairment for some people in the long run. As with big “t” avoidance, small “t” avoidance can also prevent treatment-seeking.
It’s important to understand that trauma related distress is not a sign of weakness. First, it is absolutely normal to have a mind-body reaction to an extraordinary life event that brings up feelings of powerlessness and helplessness. All animals have some sort of response to these kinds of events, and humans do too.
We often call the initial reaction “fight, flight, freeze’ (Roddick, 2015) . It is also normal to want to avoid distress, especially when it can feel as chaotic and out of control as the initial event, when it disrupts normal waking life, or when we receive messages that we shouldn’t be feeling distressed at all.
Of equal importance is to see that Robert Frost’s quote, “the only way out is through” holds true here. The emotional and mental distress needs to be processed and experienced in order for it to move through the body and find a resolution.
Whether big or small “t” trauma is at the root of distress, admitting to the struggle and seeking help from loved ones, friends, and professionals can help prevent long-term dysfunction and begin the healing process.
Dr. Allaire received his Bachelors of Science in Biology from the University of Houston, as Valedictorian of the College of Natural Sciences and Mathematics, and his Medical Doctorate from Baylor College of Medicine, where he served as Chief Resident. He is the medical monitor for the Physician Counseling Committee of the Harris County Medical Society and the Medical Director of Serenity House Detox. Dr. Allaire specializes in medically assisted detox cases, treating patients in recovery from addiction or other mental health disorders, the medical assessment and monitoring of patients with addictive disorders, medical care related to eating disorders and the medical treatment of patients with mental health conditions.
