Little “T” Trauma by Dr. Deb Hirschhorn

Dr. Deb

Little “T” Trauma

By Deb Hirschhorn, Ph.D.

Ipicked up a book that I hadn’t read in over 20 years, and I was surprised by a statement in it.

The author, Terry Real – who has made presentations in the Five Towns before COVID – is discussing the research of Catherine Steiner Adair of the Harvard Eating Disorders Center. She was researching the transition in our society for little girls who, at age 8, when asked what they want on their pizza, will clearly tell you, “extra cheese and some peppers.”

But when those same girls get to 12, they suddenly “don’t know” what they want.

And at 13 and older, they turn to the person asking and say, “What do you want?”

Real has one word for this process of how a child grows to be a woman who has lost her voice: he calls it trauma.

Terry Real is not a feminist. He’s a humanitarian. He also asserts that the way little boys in our society are trained to lose their emotions is traumatic, too.

He tells the story of his own son, Alexander, who at 3 liked to dress up in various costumes. One day, his older brother’s friends came over and Alexander appeared at the top of the stairs dressed as Barbie, in a beautiful silver dress. His brothers’ friends didn’t make fun of him; they were too well-brought up for that. But their gaping mouths “told” little Alexander that he had crossed a forbidden line. He ran up to his room, filled with shame and never wore that particular costume again.

He got the message. At 3. Without words.

So even if a person has not been abused, made fun of, neglected, or mistreated in any way, our society creates conditions to literally traumatize children, both boys and girls: boys by learning to adhere to the code of what makes a “man” (and that means never, ever acting like a girl and stuffing emotions) and girls by losing their voice, and ultimately their identity, to the will of those they are connected to.

At that time, no one recognized any of this as trauma. We all thought of trauma as airplane crashes and attacks by strangers. But the evidence started piling up that trauma exists in the everyday lives of millions of people. Now, they’re calling this “little ‘t’ trauma.”

Bessel van der Kolk started looking into the concept of trauma with a little “t.”

He initially was working with veterans who’d returned from Vietnam. Their PTSD very clearly constituted trauma, actually, big “T” trauma. However, when he moved on to study the civilian population in inpatient treatment facilities, he started seeing parallels between those people and the vets.

He went on from there to make sense of the neuroscience underlying the same phenomena that he saw in both populations.

But there were gnawing questions.

It seemed like maybe there was a relationship between the terrible “Borderline Personality Disorder” (BPD) and trauma. Maybe it affected the other personality disorders, too. Van der Kolk and colleagues studied this with a survey of personality-disordered patients. They created a questionnaire which began innocently enough and gradually explored deeper and more personal topics.

What they learned “stunned” them.

To the question, “‘Was there anybody you felt safe with growing up?’ one out of four patients we interviewed could not recall anyone they had felt safe with as a child.” (From The Body Keeps The Score: Brain, Mind, and Body in the Healing of Trauma.)

“Imagine,” van der Kolk continues, “being a child and not having a source of safety, making your way into the world unprotected and unseen.”

People went beyond the questions that were asked to open up their own stories. “Men and women reported lying awake at night listening to furniture crashing and parents screaming…. Others talked about not being picked up at elementary school or coming home to find an empty house.”

So, wait a minute: Was this trauma at all? Doesn’t this happen to almost everyone? Why, Dr. Deb, are you making mountains out of molehills?

Let’s follow van der Kolk – and others – a little more:

We “realized that the BPD group’s problems – dissociation, desperate clinging to whoever might be enlisted to help – had probably started off as ways of dealing with overwhelming emotions and inescapable brutality.” They found that “81 percent of the patients diagnosed with BPD at

Cambridge Hospital reported severe histories of child abuse and/or neglect; in the vast majority the abuse began before age seven. This finding was particularly important because it suggested that the impact of abuse depends, at least in part, on the age at which it begins…. Numerous studies have since replicated our findings.”

Interestingly, if you asked these people whether they were abused, they often would have no memory of abuse. This is part of the brain’s protective mechanism. However, they clearly acted as if they had been victims: “They have trouble staying on tasks, and they continually lash out against themselves and others. To some degree, their problems do overlap with those of combat soldiers but they are also very different in that their childhood trauma has prevented them from developing some of the mental capacities that adult soldiers possessed before their traumas occurred.”

Let’s say that one again: The “ordinary” abuse, neglect, and emotional pain suffered by the children who grew up to have BPD meant that they would not be armed with the coping skills that adult soldiers would have to prevent the effects of trauma on them in war.

Van der Kolk and other concerned colleagues took all the data they had to Robert Spitzer who was preparing the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) for publication. Spitzer referred them to the specific workgroup associated with trauma. Nineteen out of the 21 people in that group voted for an “interpersonal trauma” diagnosis to be included in that DSM.

But in May, 1994, when the DSMIV came out, it was not included. Neither was it included in the DSM-5, the most recent variation. We do not know why.

This move did not stop van der Kolk and colleagues from continuing to explore the reach of trauma into everyday lives. In 1985, Vincent Felitti, chief of Kaiser Permanente’s Department of Preventive Medicine in San Diego, was doing a study on obesity. They created a set of questions called Adverse Childhood Experiences and added them to the usual intake forms, followed by in-depth interviews.

“The ACE study revealed that traumatic life experiences during childhood and adolescence are far more common than expected. The study respondents were mostly white, middle class, middle aged, well educated, and financially secure enough to have good medical insurance, and yet only

one third of the respondents reported no adverse childhood experiences.”

Terry Real published his couples book, “How Can I Get Through To You: Closing the Intimacy Gap Between Men and Women,” in 2002, a dozen years before van der Kolk. Yet, in it, based on his own clinical observations, Real says, “When I first began looking at gender issues, I believed that violence was a by-product of boyhood socialization. But after listening more closely to men and their families, I have come to believe that violence is boyhood socialization. [Italics in original.] The way we ‘turn boys into men’ is through injury…. Disconnection is not fallout from traditional masculinity. Disconnection is masculinity.”

Then, last week, I got an email from the IFS (Internal Family Systems) Institute.

It features a film that they thought everybody should watch with a 7-day experience (which will be over by the time you read this) of interviews by Dr. Gabor Maté, an expert in trauma. The interesting title to the film is “The Wisdom of Trauma.” The point of such a title is to answer the question posed by the Italian co-directors of the film, Marurizio and Zaya Benazzo: “Why is our society experiencing an epidemic of mental illness, chronic disease, addictions? Dr. Maté traces the root back to trauma.”

So what’s wise about that?

The Benazzos laugh as they say they thought that they had had a happy childhood. They thought that trauma is caused by “really bad things like war and murder.” But, as Maté clarifies, that is, unfortunately, not the case.

Nevertheless, when children try to cope, they manage somehow to create their own ways to survive. Those coping mechanisms may not serve us

today, but they did back then, when we were children. That is why we are still here, still coping. That is trauma’s wisdom.

This seems like important stuff, but trauma with a little “t” did not make it into the DSM, not because it shouldn’t have been there.

Perhaps the ordinariness of abuse and neglect make it un-newsworthy and therefore not worth including in the DSM. Perhaps the fact that – as I mentioned some weeks ago that psychiatrist Ron Cohen said – “developmental issues and trauma aren’t affected by medication” means that there is no profit for the pharmaceutical companies (who have extra-ordinarily close ties to the psychiatrists in charge of publishing the DSM’s). I guess we can’t get away from politics.

But that really doesn’t matter. The Benazzos are on a mission to educate everyone as to what trauma really is, along with Maté, van der Kolk, Real, and so many others. It is part of the human condition, and few people escape it.

The way little boys in our society are trained to lose their emotions is traumatic, too.

Dr. Deb Hirschhorn is a Marriage and Family Therapist. If you want help with your marriage, begin by signing up to watch her Masterclass at https://drdeb. com/myw-masterclass.