The Basics on Trauma

I want to define some terms and briefly discuss them so that you understand our approach. More important, I don’t want you to misunderstand. The research shows that most fully matured adults with addictions have experienced trauma. To use Capstone language, Big T Trauma. The word “trauma” has gone through a long process in our understanding it and our defining it. Originally, during World War 1, soldiers would often have what was called “shell shock.” Then the term describing what the soldiers went through in war became trauma, and the shell shock condition was termed PTSD, post-traumatic stress disorder. For many years, the only cause of PTSD was considered extreme violence in war. But therapists and psychiatrists like Bessel van der Kolk, MD, who worked with veterans with PTSD as well as patients who were victims of sexual abuse and domestic violence, began to see the same PTSD symptoms in these other populations.

Therapist Speaking to Client

Fast-forward history a bit, and with the advances in technology in neuroscience, we’ve learned a vast amount of information about how the brain works in response to fear and immobility – terror and helplessness. Every time I learned a little bit more about the magnificence of our human brains, I developed more awe for God and His brilliance and power in our divine design.

Other words for “trauma” include hurts, fears, betrayals, rejections, significant losses, etc. Trauma lies on a continuum but is always about a fight-flight-freeze response. When we are faced with a threat, a message is sent to the amygdala in the limbic system of the brain. The amygdala assesses the threat and sends a message to the brain stem to activate the fight-flight-freeze response. Two systems are involved in this automatic process. The first one activates the adrenal glands to release superpower chemicals into our blood stream to give our muscles maximum power to first fight to gain safety and second, if fight can’t succeed, to flight to gain safety. This system is called the sympathetic nervous system (SNS).

This is how it works: fear trigger → amygdala → brain stem → adrenaline flood → maximum power to muscles for fight or flight. The fear trigger could be a mugger pointing a gun in your face, a doctor saying you didn’t get the results that you wanted from a test, a humiliating experience in front of peers, a rejection by a girlfriend, a teacher belittling a student, a spouse committing infidelity and many more. From the list, you can see that experiences that cause our brains to go into protection/survival mode lie on a continuum. Some are life-threatening, and some are not.

Capstone categorizes trauma into three groups, Big T, Little T and Chronic T, to match the trauma to its place on the continuum. But remember, what they all have in common is the brain’s automatic process of survival. Before we look at the categories, let’s go a little deeper into the F-F-F response.

First, there is a threat. Some things are a threat to some people and not to others. As my friend and mentor Judy Crane says, “No one can tell you what your trauma is [and is not]. If a dog runs up to me, I do not experience that as a threat. For some people, a dog running towards them is experienced as a life-or-death threat, usually because of previous life trauma with a dog. When one person is asked to sing in front of people, they experience it as joy because they love singing and are good at it. If I am asked to sing in front of anyone except my grandsons, I go into survival mode because singing is something I can’t do, I won’t do, and yes, I have humiliating experiences in my younger years. Other things are a threat to everybody: possible death, bodily harm, betrayal, rape, sexual abuse, rejection, failure, etc.

The fear threat signals the amygdala to signal the brain stem (with a few other steps and functions in the process), which lights up the adrenaline system to give our muscles maximum power to fight and/or to flight in an effort to gain safety. The two parts of the brain involved in this process are the limbic system and the brain stem. The cortex, or the thinking/decision-making part of the brain, is not involved. The F-F-F response is called a low-road response of the automatic parts of the brain. A high-road response would bring in the cortex. Again, it is offline during an F-F-F response.

The first automatic response is to fight to gain safety. If a person is attacked and fight is an option, and fighting leads to safety, the person can leave the threat situation safely, go home to their family and/or inner circle, tell their story, express their emotions, be supported by their circle and, over a few days, allow their traumatic experience to finish the trauma cycle, heal and return to a normal neurobiological state. People who go through this experience usually do not need therapy because they got what they needed through their fight responses and their families.

If fight is not an option – like the impala being chased by the cheetah, or the child being seductively or forcibly abused by the adult, or the person being mugged by a man with a gun – or if fight is attempted but is not successful in gaining safety, the brain automatically shifts to flight. And flight goes through the same process that fight does. If flight is a viable option and leads to safety, then that person can do the same as the one above: go home, share their story, express their emotions, etc. But if flight is not a viable option, or it is attempted but is unsuccessful in gaining safety, the brain automatically shifts to freeze.

When fight and flight are activated but do not lead to safety, it is either because they were attempted and failed or because there was no possible chance of them being attempted: a child being abused by an adult, a soldier in an intense battle, a driver in an out-of-control vehicle about to crash. Because their cycle was incomplete, they, the Fight and Flight responses, continue “running,” like a car engine idling but not in gear. A little bit of adrenaline continues to power the body as if expecting to suddenly shift back into fight of flight gear. This causes a lot of anxiety, hypervigilance, depression, inability to read people accurately, inability to successfully navigate relationships, sleep disturbances, and many other things, depending on the severity of the experience.

When fight-flight fails to gain safety, the brain automatically shifts to the freeze response. The SNS that was providing the full load of super-powered adrenaline shifts to the parasympathetic nervous system (PNS), which leads to the brain releasing endogenous opioids to protect people from the physical and/or emotional pain that they are about to experience. Endogenous opioids are the brains natural pain relievers. This occurs at the same neurotransmitter site as taking a pain pill or a shot of morphine or heroin.

The freeze response could happen in a bloody battle in Afghanistan or in a third-grade classroom where an 8-year-old is humiliated in front of classmates. Remember, the first option in F-F-F is to fight, but if fighting back wasn’t possible or fighting back was attempted but didn’t lead to safety, the brain automatically shifts to flight. But if flight wasn’t possible, or if it was attempted but didn’t succeed in getting to safety, the next step, freeze, automatically kicks in to protect the host from physical and/or emotional pain. Different traumas? Of course! No child ever died from being humiliated in the third grade, at least at the time of humiliation. But many people have died from self-destructive behavior that was spawned from many such humiliating experiences.

Freeze responses mean that there are incomplete cycles of fight and flight that are hurting the host in ways like those mentioned above. These incomplete cycles are like a logjam in a river. In the great northwest, loggers will cut huge trees, slide them down the mountain to a river, and float them downstream to the mill to be cut up into lumber. Sometimes, in a sharp curve in the river, the logs will jam up and stop floating down with the current. A freeze response inevitably means that there is a logjam or a stuck place in the brain with that “idling engine” of fight and flight. This anxiety and distress is what underpins addictions and other emotional health problems. To heal the brain from the anxiety and distress, you must finish the trauma cycle so the engine is turned off; in other words, you must break up the logjam.

Now let’s look at the trauma continuum. There are three categories of trauma: Big T, Little T and Chronic T. Big T traumas include death of a loved one, sexual abuse, physical abuse, a loved one’s cancer diagnosis, parents’ divorce (even if it is a merited divorce), relinquishment, infidelity (to the non-offending spouse), abandonment, infertility, miscarriages and other significant losses. You might compare a Big T Trauma to a samurai sword wound, meaning if you were being attacked by a person with a samurai sword, you would definitely respect the situation because it would be life-threatening. You would also give respect to another person who experienced a Big T. In other words, none of us hears about a family member, friend or even an unknown person going through a Big T Trauma and responds with, “Oh, that’s no big deal.” We all know it was a big deal, and we respect it as such.

Little T traumas are not only subtler, they are much more common to the young men that we work with at Capstone. Little T’s are more comparable to a toothpick wound: rejection by a girlfriend, betrayal by a friend, humiliation by a coach or teacher, harsh criticism by a parent, a personal failure or error, especially in front of an audience, or a mistake that is used to label you. For instance, missing the shot in a basketball game in the final second that would have won the game. Or walking into class late with your pants unzipped so everyone sees it, and no one ever lets you forget it. I’m sure right now that you are thinking, “Yeah, of course, everybody goes through stuff like that. It’s no big deal. Get over it!” You are right that everybody goes through Little T’s, many times, but you are wrong that it is no big deal. Keep reading for a few paragraphs, and I will explain why.

The third category is Chronic T Trauma. Where Big T’s are like samurai swords and Little T’s like toothpicks, Chronic T’s are like living in smog. Chronic T’s can be the most damaging of all the traumas. While a Chronic T environment can include Big T and Little T events, a Chronic T is a 24/7 environment. Examples include after mom’s diagnosis of breast cancer and treatment that “almost got it all,” the daily fear that it will spread. Or mom and dad have an argument, and somebody throws out the word divorce, so the children begin to walk on eggshells trying not to rock the boat. Or a basketball coach who berates his players thinking that beating them down will make them stronger, so a player is facing it 24/7 – bracing for it before it happens, enduring it while it’s happening and functioning with the memory of it afterward. One woman described her childhood like this: “My dad blew up with anger about one time each year, and I spent the other 364 days wondering, is today the day?”

Here’s why knowing and understanding this brief section on trauma is important for you to be able to make good decisions in triaging your son’s situation:

  1. Over half of the young men that we’ve worked with at Capstone since 2001 have had Big T traumas, but a little less than half had none.
  2. Every young man that has ever been to Capstone since we opened in 2001 has had Little T’s, and many had Chronic T’s.
  3. Trauma of some kind – Big, Little or Chronic – perhaps neglect, abandonment, deprivation, makes up a large portion, if not the largest portion, of the Core, and remember, the Core drives the Eruptions.
  4. Trauma wires the neurobiology to be anxious, depressed, isolated, hypervigilant, in pain or numb and makes a person neurobiologically vulnerable to compulsive and addictive behaviors – alcohol/drugs, pornography, sexual acting out, video-gaming, social media and technology, excessive eating or deprivation of food, and other self-destructive behaviors.
  5. While these traumas can destroy, they can also be healed and transform. The healing process is long and difficult but transformative in a positive way.