• Deric Hollings

Big T, Little t

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Photo credit, fair use


Anecdote


Entering graduate school for social work in 2012, I was required to obtain a student photo identification (ID) card. At the ID center, I stood behind a female grad student who was asked to present state-issued ID to verify her identity.


At first, she shouted loudly about how no one informed her to bring other forms of ID. When this method of posturing didn’t have any effect, she reached into the bowels of her existence and brought forth a blood-curdling scream extended to the top of her vocal ability.


Still unmoved by the theatrics, as ID center personnel calmly advised that the student would need to come back with proper ID, she performed a maneuver that put the Gravitron ride to shame by thrusting herself downward to the ground.


In toddler-esque fashion, the student then rolled around on the ground, kicking and screaming, and shouting, “This is traumatizing!” Being asked to present a photo ID card was…traumatizing.


Trauma, trauma, trauma


Over the past couple decades or so, I’ve heard a lot about trauma. Apparently, trauma relates to any and everything one can imagine.


Your preferred coffee shop is out of a particular ingredient? Trauma! You don’t score as high on an exam as you’d like? Trauma! The person in whom you’re romantically interested rejects you? Trauma! You have no state-issued ID with you? Trauma!


This matter reminds me of an episode of The Brady Bunch I once saw in which Jan Brady laments how well-regarded her sister Marcia is. In the scene, Jan says, “Well all I hear all day long at school is how great Marcia is at this or how wonderful Marcia did that. Marcia, Marcia, Marcia!”


Only, with how virtually anything is considered trauma these days, “Trauma, trauma, trauma!”


My instinct is to declare, “If everything is trauma then nothing is,” though I know that use of a false dichotomy isn’t entirely helpful. Therefore, it may be worth exploring what trauma is so that one can better understand what trauma isn’t.


Defining trauma


Regarding its psychological meaning, Merriam-Webster defines trauma as “a disordered psychic or behavioral state resulting from severe mental or emotional stress or physical injury,” though it further dilutes the term by adding that it can also refer to “an emotional upset.”


Given this definition, trauma could be related to the psychological symptoms one may experience as a sole survivor of an airplane crash. Likewise, trauma could result if one receives mayo rather than mustard in the drive-thru when mustard was specifically requested.


For a more helpful definition, I turn to the American Psychological Association. It states, “Trauma is an emotional response to a terrible event like an accident, rape, or natural disaster.”


Psychology Today maintains this definition and adds, “Unlike ordinary hardships, traumatic events tend to be sudden and unpredictable, involve a serious threat to life—like bodily injury or death—and feel beyond a person’s control. Most important, events are traumatic to the degree that they undermine a person’s sense of safety in the world and create a sense that catastrophe could strike at any time.”


By these definitions, it would seem as though trauma is more than simple upset. Let’s go a bit further to better understand what trauma is.


The Substance Abuse and Mental Health Services Administration highlights “individual trauma as an event or circumstance resulting in: physical harm, emotional harm, and/or life-threatening harm.” “Emotional harm” is subjective, so let’s press further.


The National Board for Certified Counselors (NBCC) denotes exclusive criteria:


“Trauma is now defined as exposure to actual or threatened death, serious injury or sexual violence in one or more of four ways: (a) directly experiencing the event; (b) witnessing, in person, the event occurring to others; (c) learning that such an event happened to a close family member or friend; and (d) experiencing repeated or extreme exposure to aversive details of such events, such as with first responders. Actual or threatened death must have occurred in a violent or accidental manner; and experiencing cannot include exposure through electronic media, television, movies or pictures, unless it is work-related.”


Nowhere in the reviewed psychological definitions is trauma defined as mild annoyance, slight irritation, moderate disappointment, or simplistic emotional upset. Trauma is more than mere dissatisfaction or displeasure with one’s circumstance.


PTSD


What discussion about trauma is complete without addressing posttraumatic stress disorder (PTSD)? Though I’m aware that some people reject the “disorder” qualifier of the diagnosis, I’m addressing what is and not what one thinks ought to be.


The American Psychiatric Association states of this condition:


“Posttraumatic stress disorder (PTSD) is a psychiatric disorder that may occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, or rape or who have been threatened with death, sexual violence or serious injury.”


In psychological literature, it is stated that “traumatic stress reactions are normal reactions to abnormal circumstances.” It isn’t all too abnormal to be inconvenienced at a coffee shop, fail a test, be rejected by a love interest, or neglect to carry ID, as experience with these events is not traumatic in nature.


Concerning the Diagnostic and Statistical Manual of Mental Disorders (DSM), fifth edition, text revision—the so-called “Bible” to mental health practitioners—one source states, “witnessing does not include events that are witnessed only in electronic media, television, movies, or pictures’ in criterion A.2 was removed for children 6 years and younger,” in reference to the NBCC reference above.


To view the full DSM criteria for PTSD, see this link.


Here’s my oversimplified description of PTSD. When a person is exposed to (a) traumatic event(s) and as a result is impaired by the inability to adjust on a personal, social, and/or occupational level, the term attributed to this diminished condition is PTSD.


Big T and little t


Contrary to the proposal of some people, others claim that science is never settled. I lean closer to the latter than the former.


Nonetheless, I’m aware that the concept of trauma and treatment of PTSD are ever-evolving. For this I am in part grateful, because I remain hopeful for more effective clinical interventions in the future.


That stated I currently stand in opposition to the trend I’ve observed over the last two or so decades regarding inclusion of mildly annoying, slightly irritating, moderately disappointing, or emotionally upset events as being representative of trauma.


According to one source:


“The way people experience trauma can be grouped into two types: big T and little t. A big T event is one that most people would consider traumatic, such as a plane crash or sudden and unexpected loss of a loved one. A little t event is one experienced as traumatic at a personal level, such as the loss of a pet or a relationship breakup.”


Much as I outlined the problem with conflating sexual assault with rape in a blog post entitled Green with Anger, I maintain that there’s a difference between trauma and dissatisfaction or displeasure. Others are free to believe otherwise.


While I don’t propose to tell others how they should, must, or ought to speak, I make this distinction for myself. Additionally, when treating clients I invite them to consider that there may be a difference between trauma and simply being upset.


Expanding upon what is considered little t trauma, one source lists “interpersonal conflict, infidelity, divorce, abrupt or extended relocation, legal trouble, [and] financial worries or difficulty.” Why not toss into this mix something like breaking a fingernail?


I’m not joking. I know a person who pays over $100 per manicure session twice a month, which is half what Cardi B’s nails are said to cost. In this regard, wouldn’t a broken fingernail constitute a financial worry? How traumatic!


Addressing little t trauma, one reviewed source boldly states that “there is now evidence that repeated exposure to little t trauma can cause more emotional harm than exposure to one big T traumatic event.” I suppose one could find “evidence” to suggest a great many things.


For instance, one study examines “feminist glaciology” and its impact on environmental change. What does sex or gender have to do with the climate? Read the study to find out, because the “evidence” suggests a link.


Addressing the problem with peer review, one source asserts, “Hundreds of gibberish papers still lurk in the scientific literature.” Though perhaps controversial, the grievance studies affair highlighted a relevant issue with so-called “evidence” from peer review journals.


I don’t default to the position of “evidence” says it’s so; therefore, it must be so. In some cases, there isn’t even evidence to support medical procedures used in clinical settings.


To elucidate this point, I could address how a Pfizer official stated to the European Union parliament that the organization’s COVID-19 vaccine wasn’t tested for the purpose of stopping transmission of the virus before it was deployed for public use.


All the same, how many people across the globe received a Pfizer COVID-19 vaccination based on perceived “evidence” supporting the efficacy of the clinical intervention? Yet, I digress.


Though I’m not a fan of the relatively new classification of trauma into big and little t categories, because to me it essentially minimizes trauma by diluting it with common stressors, I comprehend the insistence for the distinction. Nonetheless, I reject this distinction.


Practical considerations


Suppose I see a client who maintains that “words are violence.” Let’s call her Jan Brady. Jan complains that hearing about how wonderful her sister Marcia is relates to a violent assault on her sensibilities.


In fact, Jan describes the experience of hearing about her sister as “traumatic.” If I were interested in job protection and saw Jan as an opportunity to make money from a vulnerable person who doesn’t understand what trauma is, I could treat her for PTSD.


I could suggest that “evidence” supports the notion of little t trauma. Continuing with this disgraceful means of coddling a client for monetary gain, I could convince Jan that she is a victim and that I have precisely the remedy by nurturing her perceived victimhood.


It very well may be that I praise myself in my own mind and to others, believing that my work with Jan is morally upstanding. By creating ferocious giants out of mere windmills, I could pat myself on the back so hard I may break my spine.


I’m aware of psychotherapeutic modalities which function precisely in this manner. A client can be convinced that some issue previously understood to be “problematic” is actually traumatic.


While I won’t identify these practices by name herein, I suspect some clinicians who encounter this post know precisely of that which I speak. I’ve no interest in victim mills, as I seek to help clients get better and not simply feel better at each session.


I’ve heard of therapists who operate along a similar axiom as Lavrentiy Beria who stated, “Show me the man and I’ll show you the crime,” though in regards to trauma, “Show me the client and I’ll show you the trauma.”


It’s a good thing for Jan that I’m not that sort of clinician. I practice Rational Emotive Behavior Therapy (REBT) which uses the ABC Model to demonstrate the wisdom of Stoic philosopher Epictetus who stated, “It’s not what happens to you, but how you react to it that matters.”


Yes, dear reader, this includes trauma.


I would assist Jan with understanding that the (A)ction of hearing how wonderful Marcia apparently is doesn’t lead to the (C)onsequence of Jan being upset or angry. Rather, what Jan tells herself—what she (B)elieves about the (A)ction—is what leads to the (C)onsequence.


In this way, it doesn’t matter whether or not Jan’s experience is categorized as “traumatic.” Instead, I teach Jan to understand how she disturbs herself and more importantly how she can stop doing so.


Admittedly, I enjoyed my proverbial popcorn when undergoing official REBT training. One fellow candidate antagonized the presenters with trappings of feminist and intersectionality rhetoric related to so-called trauma “victims” and “survivors.”


The members of the Albert Ellis Institute conducted themselves with the patience of the ID center worker back in grad school. Tantrums are inherently irrational and I knew I’d chosen the proper psychotherapeutic modality when I observed how REBT trainers handled the matter.


Perhaps most important to Jan would be a focus on unconditional acceptance. Since Jan has no control over anyone other than herself, she could learn to let go of the illusion related to having more control or influence than she actually has.


Let’s say Jan has a different presenting issue. Suppose Jan attends session and says, “I was sexually assaulted by my brother, Greg.” After an appropriate amount of time to assess her, Jan’s discussed symptoms and level of impairment align with the diagnosis of PTSD.


I would treat Jan’s issue much in the same manner as her problem with Marcia. There’s no exceptionally special care necessary to treat a label in this case. Jan could benefit from REBT with either matter.


Conclusion


Though the prevalence of equating dissatisfying or displeasing circumstances with trauma hasn’t declined within the past couple decades, I reject the blending of so-called big T and little t traumatic events.


Conflating actual traumatic experiences—those in which imminent danger or loss of life is at hand—with that relating to offense or dissatisfaction may be incredibly invalidating to those who struggle with pathological symptoms of a verified category of traits which result in a clinical diagnosis.


This isn’t to imply that one person’s offense to stimuli is necessarily unworthy of treatment; quite the contrary. However, it does speak to the issue of how creating trauma out of virtually every imaginable experience and misunderstanding of mental health conditions may be unhelpful.


We don’t have to unnecessarily entertain hyperbole when considering trauma. After all, neglecting to bring an ID card is nothing more than an inconvenience.


Trauma has a specific psychological definition, as does PTSD. Nonetheless, the manner in which I treat a client’s issue isn’t necessarily dependent upon a label.


People may “feel” better when being made into a victim and then infantilized by a therapist who seemingly empathizes with them. Rather than promoting catharsis, I’m here to help people actually get better.


If you’re looking for a provider who works to help you understand how thinking impacts physical, mental, emotional, and behavioral elements of your life, I invite you to reach out today by using the contact widget on my website.


As a psychotherapist, I’m pleased to help people with an assortment of issues ranging from anger (hostility, rage, and aggression) to relational issues, adjustment matters, trauma experience, justice involvement, attention-deficit hyperactivity disorder, anxiety and depression, and other mood or personality-related matters.


At Hollings Therapy, LLC, serving all of Texas, I aim to treat clients with dignity and respect while offering a multi-lensed approach to the practice of psychotherapy and life coaching. My mission includes: Prioritizing the cognitive and emotive needs of clients, an overall reduction in client suffering, and supporting sustainable growth for the clients I serve. Rather than simply helping you to feel better, I want to help you get better!



Deric Hollings, LPC, LCSW


References:


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