Talking about Trauma

Updated: Feb 14

I talk a lot about adoption and trauma these days. As most adoptees know well, this can be extraordinarily difficult when speaking with non-adoptees. Many people are inclined to respond with resistance. Usually, the response is something to the effect "not all adoptees are traumatized." They then go on to tell me about an adoptee they know that is perfectly well-adjusted and happy. Anecdotal evidence of individual experiences do not address group differences. It's true, most adoptees, like other people who have been exposed to potentially traumatic events, don't go on to develop serious problems. But, a non-trivial proportion do have a trauma response. This we know from available morbidity and mortality statistics as well as intake records from psychiatric and behavioral health care practices. What we don't know well-enough is the extent of the problem. What types of adoptees are more or less likely to develop conditions such as PTSD and addiction, at what stages of the life course do these problems become evident and how severe are they typically when they become recognized? All of these questions must be answered in order to prevent future trauma and to intervene in any existing difficulties. But many adoptees themselves are reticent to engage in research that they believe pathologizes them for fear of stigma. I reject any stigma associated with having a prolonged natural human response to a potentially life-threatening event. Let's chuck any stigma associated with mental illness right out the window on the grounds that it's ignorant. Trauma leads to mental health problems for many, but not all adoptees, and this is nothing to feel shame about. In fact, it should be the perpetrators of the trauma that bear the shame, not the victims.


A lot of people seem to be talking about 'trauma' these days. However, they aren't typically referring to the types of experiences that would normally lead to great concern. Sometimes, the term is evoked to loosely describe an experience that was relatively innocuous and best described as disturbing or even as something that was simply unusual. "My kids will be traumatized if they cancel the school dance," as an example. Will the kids be traumatized by sitting this dance out? Probably not. They may feel disappointed, but likely not traumatized. Related to this, I also hear the very idea of trauma being mocked by a sociopolitical faction in our culture that is convinced that too many are unscrupulously identifying as victims and unfairly acquiring special treatment based on that claim. Is there such a thing as "victim mentality" that applies here? I guess so. But shit, I don't want to make the mistake of buying into a perspective that is more concerned with over-identifying childhood trauma than under-identifying it. This is myopic and dangerous thinking. There are real people who are real victims who experience real pain caused by real external forces. Let's not get distracted by tangentially related matters often presented to divert focus from the causes of real trauma and the sometimes difficult solutions. In the process let's be clear about what we mean by trauma.


Here's my challenge: saying what we really mean often requires being hyper-specific which, for whatever reasons, may comes across as snotty to some. Few people can tolerate, no less appreciate, much specificity in language and it becomes a balancing act for a writer to hone finer points while keeping the reader interested in knowing what those points are building toward. In other words, I need to write in a way that's conversational and not overly complicated as I try to make very specific points. I'll need to practice this, I admit. I was trained as a social scientist, and while I think I'm also a decent creative writer, I'm rarely satisfied with explaining the outlines of something when the details are relevant and accessible. So, I'll try to be clear without being boring as I write about trauma and other key concepts. Concepts and the words that represent them are slippery fish, that wriggle when you try to catch them. Some others are spiny and amorphous, like blow fish, with pointy definitions and bodies that expand and contract under different conditions. But they can be caught, held and apprehended. Words have meanings, even if they are fractal at the edges.


Now, what was I talking about. Oh yeah. I was promising I'll do my best not to bore you as I try to inform you. Back to business... Of course, distress exists on a continuum and so perhaps we shouldn't fault people for measuring relatively innocuous events on the same scale as more serious stressors. But we need to remain aware that we run the risk of diluting our understanding of trauma when we habituate its conjuring. I fear that casual use of the term 'trauma' serves to minimize the potentially debilitating consequences of a life-threatening event - when real people experience real suffering. We need to empathize with the suffering because it will motivate us through the difficult work of remediation. So, let's reserve the term 'traumatic' for those events that can reasonably expected to have a serious and lasting negative consequence.


Most stakeholders in our subject area agree that, on a very basic level, there are two key elements of trauma: 1) something occurs (chronic or acute event) that is perceived as threatening and 2) there are lasting negative consequences to this experience. I'm rounding off the edges with this basic definition, but it's easy to remember these elements. Although this simplification works for most purposes, the clinical and research definitions are nuanced in important ways. Here's how the American Psychological Association defines "trauma:"


trauma n.1. any disturbing experience that results in significant fear, helplessness, dissociation, confusion, or other disruptive feelings intense enough to have a long-lasting negative effect on a person’s attitudes, behavior, and other aspects of functioning. Traumatic events include those caused by human behavior (e.g., rape, war, industrial accidents) as well as by nature (e.g., earthquakes) and often challenge an individual’s view of the world as a just, safe, and predictable place. (source: https://dictionary.apa.org/trauma retrieved 1.9.21)

So, the potentially traumatic event is judged to be traumatic post-hoc by dint of the presence of lasting negative consequences. The DSM-5 (the Diagnostic and Statistical Manual of Mental Disorders 5th Edition, the gold standard for establishing psychiatric diagnoses in the US) specifies eight criteria. All eight criteria must be present to establish a case of Post Traumatic Stress Disorder (PTSD). These include 1) experiencing a stressor, 2) intrusion symptoms, 3) avoidance, 4) negative cognition and mood, 5) hyper-arousal, 6) dysfunction, 7) sustained effect and 8) not attributable to certain exclusions. In addition, there are the two specifications of dissociation and delayed onset. In other words, the definition of PTSD has eight components and this is the constellation of symptoms related to experiencing a traumatizing event with two important specifications. You can find a summary of the criteria here https://www.ptsd.va.gov/professional/treat/essentials/dsm5_ptsd.asp#one.


I won't go further into the criteria for now, but I'm planning to describe how I fit into this definition and how I have experienced these symptoms throughout the book. For me, relinquishment in infancy was my first trauma. But I, like many adoptees, experienced later, more chronic acute stressors as well. There's some evidence that early traumatic experiences make one particularly vulnerable to future events. This chronicity is much of the reason for some to argue for the importance of the Complex PTSD (CPTSD) variant. I'll get into the distinction between PTSD and CPTSD , which may particularly apply to many adoptees in a later post. I'll also review the epidemiology of PTSD and CPTSD. I plan to dig deep down into the research from the general population level to the specific case of adult transracial adoptees as a subgroup.


Well now look at that. I set out to say a few things about how it bothers me when certain words are misappropriated and I ended up promising to do a bunch of work! The thing is, I've been intended to do this literature review for some time. I feel the need to better situate myself in a larger understanding of adoptee mental health. I'm just that kind of geek, I suppose. My hunch is that what I'm about to find is a terrible lack of understanding about adoption and lifetime PTSD and other disorders. A casual look at the literature suggests that while we know some about the health and behavioral problems of young adoptees, that there's much to learn from a life course perspective. I'm going into this from the ground floor and will work my way through each room of the building. The effort will be kind of like a SWAT team clearing a building of threat. I'll question my own knowledge base and assumptions as I go. I'll keep you updated about what I find. I hope you'll be around for me to share with you.


A gentle reminder to please subscribe in the box below! You see, the book publishing world will require me to demonstrate that someone cares about these issues and counting you among my subscribers will help to allow me to continue to pursue this important work. Look out for more book excerpts in the near future too. It's probably more fun to hear me tell stories about being an adoptee than hearing me analyze them as a scholar. Hopefully, you'll find value in both though. Thanks for stopping by!


Until next time,


Michael



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