When my son was six years old, he realized rather abruptly that we all have to die. I had a similar realization at about his age and I remember how suddenly and deeply that panic rolled through me. This realization cornered him. I attempted to console him as best I could—given my own death phobia and the old traumatic load I was still carrying at that time. I gave him plenty of rational information about the reality of death. I explained a little about ways that spirituality helps many of us make some workable sense of death. He would not have any of it. As we were nearing bedtime, I pulled out the nuclear warhead of awful but effective parenting: “Honey, just do like the rest of us do and pretend that it isn’t real.” That worked astonishingly well. He was able to sleep soon after and did not wake.
One of the first tasks given to biblical Adam was to name things. In my attempt to calm him, I showed my little Andrew how to unname things. I showed him a distinctly human power more vanishing than death. We all do this. We do this individually and collectively. And like all coping strategies built upon a central lie (payday loans, substance use, interpersonal power, and denial), the tax we pay for survival today compounds and presents for collection on the hind end.
As a trauma therapist, I’m frequently astonished at client attempts to vanish or minimize the impact of past wounding. Sometimes we intuit that the easiest and fastest way out is to take the bypass of vanishing the wound. Trauma work is about going through the center of things. Bypasses get you around the wound for right now, but the bypass process does not bring healing. Sometimes near the beginning of traumatic memory reprocessing in EMDR a client may report: “It wasn’t really that bad… as I play the memory, I realize that a lot of people have much worse childhoods that I had.” We are remarkably talented at vanishing our wounds. Often, we do this through comparison. We also do this by casting our wounds as not awful enough to warrant attention, treatment, and healing.
Despite my continued astonishment in seeing this in others, I do understand this impulse intimately. If things aren’t problems, we don’t have to deal with them right now. I was a working trauma therapist before I could clearly identify the wounds of my own childhood and early adulthood as trauma. My Adverse Childhood Experiences scale (ACEs) score is 6/10 and covers a large swath of human to human awfulness. An ACE score that high is correlated with many horrible emotional, behavioral, and physical health outcomes in many people. I could recognize my childhood as horribly stressful and awful, but it wasn’t PTSD bad—most people I knew with trauma had it a lot worse. I was insightful enough to recognize the profound impact that my wounds had on my ability to feel and experience emotions. I was aware that I was carrying a heavy burden from past awfulness, but that burden didn’t have a name. However, doing trauma therapy with kids several years ago started to cause my own trauma to seep out in PTSD-like ways. I didn’t get my own trauma therapy until my traumatic wounds started seeping out in ways that had a name and in ways that I could not vanish. In short, I did not visualize my wounds as trauma until I had to. In many ways, my experience vanishing trauma is more typical than exceptional.
We did not have the PTSD diagnosis until we were forced to in 1980. Our loss in Vietnam and a large cohort of politically mobilized veterans demanded some level of diagnostic visibility for war trauma. This diagnosis was controversial. The flagship trauma diagnosis of PTSD remains remarkable, despite its evolutions, because of how restrictive and conservative it is. Research into adverse childhood experiences, attachment, and human development makes clear the wide-ranging impacts of trauma across all parts of the self and across all parts of the lifespan. The current PTSD diagnosis requires a Criteria A event that must be awful enough to involve “actual or threatened death, serious injury, or sexual violence.” Additionally, the trauma must seep out and express through intrusive symptoms, avoidance, negative cognitions, and reactive triggering. All of them. Compare this with Generalized Anxiety Disorder (GAD). You pretty much meet criteria for GAD if you worry about a lot of different things and meet three of six general somatic or function complaints. In short, PTSD is trauma that seeps out in very specific and restrictive ways. If your trauma seeps out in other ways—we don’t have a name for that at all.
The current edition of the DSM is 991 pages. If it were nine pages longer, it wouldn’t be any more absurdly long. The section on Trauma and Stressor Related Disorders is 26 pages long or 2.6% of the pages. The vast majority of my clients have survived astonishingly horrible life experiences and most have presentations that are only partially described in the DSM. The core of the misery for most of my clients is centered in their unprocessed experiences of awfulness, only some of which seep out in ways consistent with PTSD or other defined disorders. Most of the depression and most of the anxiety my clients report is the seeping of old wounds. Most of their lost self-esteem is containered in the mental crevices of old awfulness. How do I know this? Because fully reprocessing those memories rapidly improves mood. It brings the self into sunshine. The DSM is not trauma-focused at a time when broader culture has begun to surface horrible truths that are ubiquitous and had been—until this very moment—unspeakable (#MeToo). PTSD was conceptualized as an exceptional diagnosis, but trauma—like death—is an existential reality. The costs of vanishing that reality compound and present for collection on the hind end. For the vast majority of us, life brings us experiences that are horrible enough to damage us profoundly—whether that damage seeps out in PTSD ways or not.
If culture, the law, schools, the mental health profession, families, and close friends all conspire to vanish the burden, reality, and presence of trauma wounding, the individual self is more than willing to go along—if not attempt to lead the way.
Go With That 