The Three E’s of Trauma
On the morning of September 11, 2001, Noam’s dad dropped him off at PS 234, just blocks north of the World Trade Center. Noam and his dad were blissfully unaware this would be the last year September 11 would merely be the day that came after September 10. They had no idea that before this day was over, Noam and his first grade friends would be watching out their classroom window as planes crashed into the very tall buildings just down the street, or that later they would watch people jump from those buildings. It never occurred to them that instead of morning milk break, they’d be running with Noam’s friends, teachers, and other parents, attempting to escape the ash and smoke filling the streets of Lower Manhattan.
In his book, The Body Keeps the Score , Bessel Van der Kolk discusses Noam’s unexpected reaction to those events. Remarkably, the sounds, sights, and sensations from that morning would never manifest in Noam as a traumatic response. In fact, within weeks he would be drawing pictures of the towers surrounded by trampolines suggesting he had re-created an alternative ending to the events, one that would prevent the same tragic outcome in the future. Psychologists working with Noam would be puzzled by his response to the event, just as they had been puzzled by the reactions of countless individuals over the years, individuals who had weathered the most difficult tragedies
with the most unremarkable responses. Equally as puzzling were those who displayed intense trauma responses after experiences most would consider difficult, but certainly not tragic. In the 16 years since 9/11, much has been learned about how Noam’s seven-year-old brain interpreted, processed, and stored the events of 9/11, and why they did not, for him, result in a trauma response.
To begin understanding the various responses to stressful life events, it becomes important to agree on a definition of trauma. The Substance Abuse and Mental Health Services Association (SAMHSA) has adopted the following definition which they refer to as The Three E’s of Trauma: “Trauma is an Event or series of events that is Experienced as physically or emotionally threatening and that has lasting adverse Effects on the individual’s functioning.” Noam certainly experienced a threatening event, but not the lasting adverse effects one might have anticipated.
Let’s begin by considering normal vs. traumatic reactions to adverse events. After an adverse event, it would not be unusual for there to be anger, sorrow, anxiety, a sense of guilt, or even numbness. Difficulties sleeping, increased startle responses, hyper-vigilance, a loss of interest, nightmares, the replaying of the experience, or even an intense desire to avoid thinking about the event would not be unusual in the first days and weeks following. In fact, for the first month or so, there are few reactions that would be considered unusual. Trauma responses develop when an individual’s adverse reactions become lasting and unavoidable-intruding into the present in spite of efforts to forget or avoid, when the responses interfere with life in debilitating ways, or when life just doesn’t go on.
Aside from a plethora of protective factors – a strong, nurturing, supportive family, consistent provision of daily needs, safety, etc. – Noam experienced two other things now recognized as beneficial in avoiding trauma responses. First, he had efficacy and esteem that allowed him to see his future separate from his past. When Noam drew those trampolines, he was telling himself that “next time will be different.” Instead of moving into a life of avoiding and re-experiencing, he imagined a future over which he has influence. The second beneficial experience occurred as Noam ran through the streets toward home and will be the subject of the next article in this series.
This is the first in a series of articles designed to explain current understanding, treatment, and impact of trauma.
Substance Abuse and Mental Health Services Administration. SAMHSA’S Concept of Trauma and Guidance for a Trauma Informed Approach. Rickville: HHS Publication No. (SMA) 14-4884.
Van der Kolk, Bessel, (2014) The body keeps the score. Penguin Random House, NY.Tags: normal vs. traumatic reactions to adverse events, symptoms of trauma, trauma
ABOUT THE AUTHOR
LIcensed Independent Mental Health Practitioner
Provisional Licensed Alcohol and Drug Counselor
- Keri Brugger, LIMHP, PLADC began working at Wholeness Healing Center in October 2016. She sees clients in the Grand Island office and also takes referrals from the Boone/Nance/Greely county areas. Keri sees individuals of all ages as well as couples and families. She has experience planning and facilitating a wide variety of process and psycho-educational groups.
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