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Part 1: What is trauma?



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The term “trauma” is widely used – overused, many experts say – to describe a variety of experiences, even normal stress.


Just what is trauma? Here's a little quiz. Which of these events qualify as traumatizing?


a) A drunk driver crashes into your car.


b) As a child, you witness your father hitting your mother.


c) At work, your boss makes an unwanted sexual advance to you.


The correct answer? It depends. Two people who experience the same traumatic event can respond differently. So, any or all of the above could be traumatizing.


It depends on three things, says Tim Grove, senior director of trauma-informed strategy and practice at Wellpoint Care Network.


1. Event(s)

Does the person perceive the event or series of events as a physical or emotional threat to them or someone close to them?


"The event must reach a threshold of significance or substance compared to something more trivial,” Grove says. “If everything is trauma then nothing is trauma.”


2. Reaction

How does the person react to experiencing the event or series of events?


“It's whether that overwhelms the person’s ability to cope over a period of time,” Grove says. “We don’t have to assume that just because the event happened, that the person is necessarily going to be overwhelmed.” n other words, experiencing a traumatic event does not necessarily mean you'll be traumatized.


Friends, family, even a coworker, can help.


“The example we give is: Do you have a shoulder to cry on? Do you have someone to put their arm around you and soothe you after the event? Literally, in some circumstances, when that happens, it can have a powerful mitigating effect on whether that event becomes traumatic for that person long term,” Grove says.

3. Function

Does being overwhelmed result in the person’s inability to function?


Dysfunction could take the form of isolation, depression, damaged relationships, poor job performance, substance abuse, and even suicide.


The Substance Abuse and Mental Health Services Administration (SAMHSA) provides a similar definition:


Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.


SOURCES OF TRAUMA

Trauma often stems from childhood experiences.


Health care professionals use a 10-question form to determine if, and how much, a child was exposed to trauma. The questionnaire is called Adverse Childhood Events (“ACEs”) and is shown on the next page. The questions focus on:

  • Abuse – emotional, physical, sexual

  • Neglect – emotional, physical

  • Family dysfunction – violence against mother, substance abuse, mental illness, separation or divorce, incarcerated household member

ACEs are common: 6 of 10 American adults report having had at least one ACE, nearly 4 of 10 experienced two or more, and 1 of 6 experienced four or more, according to the Centers for Disease Control and Prevention. Adverse events are more common for minorities and low-income populations.


These childhood events can cause long-term negative impacts. Studies have found a direct link between childhood trauma and chronic disease, mental illness, incarceration, employment challenges, and difficulty forming stable relationships. The higher the number of ACEs, the greater the risk for these outcomes.


ACE QUESTIONNAIRE


BEYOND ACES

The ACEs questionnaire focuses on childhood experiences. Adults experience trauma, too. And, the questionnaire only asks about some sources of trauma. Others include natural disasters, school shootings, serious accidents, terrorist acts, combat, and vicarious trauma – witnessing, or learning about, someone else’s traumatic events.


You also are more likely to be traumatized if you live in a community with certain “risk factors,”

such as high rates of:

  • Violence and crime

  • Poverty

  • Unemployment

  • Unstable housing, where residents move frequently

Dimitri Topitzes, PhD, LCSW, has studied trauma in Milwaukee neighborhoods with high rates of poverty and crime. He's a professor at University of Wisconsin-Milwaukee and co-founder and director of clinical services at the Institute for Child and Family Well-Being.


"Over 90% of the people in those communities have experienced at least one significant interpersonal experience of trauma in their lives,” Topitzes says, “and many have experienced multiple occurrences of interpersonal trauma.”


What’s interpersonal trauma?


“Being a victim of a violent crime, whether that's a physical assault, a robbery, seeing someone get assaulted or even shot and killed. Maybe, as a child, experiencing physical or sexual abuse. So, some kind of coercion or violence that takes place in the social sphere, in the relational sphere.”


He estimates 25% to 30% of residents he and colleagues screened in Milwaukee would be diagnosed with Post-Traumatic Stress Disorder (PTSD) – higher than combat veterans, who are diagnosed at a rate of 14% to 20%.


Charlesetta (“CJ”) Jackson sees that firsthand. She works at JobsWork MKE, a nonprofit that helps disadvantaged Milwaukee residents find sustainable employment.


"My nine-year-old goddaughter ... can tell me kids that she knows that have been killed..."

CJ Jackson

JobsWork MKE



POVERTY

Even without crime, living in poverty makes you at greater risk for experiencing trauma -- with its impact potentially lasting a lifetime.


“A child growing up in poverty experiences a toxic level of stress,” according to the Wisconsin Office of Children’s Mental Health. “They often have trouble managing their emotions and ability to form healthy relationships, which inhibits their ability to reach their full adult potential.”


In Milwaukee, 24% of residents live in poverty and the unpredictability and insecurities it brings.


“When you’ve been hungry, when your family struggles with food insecurity, hunger is your norm,” says Jackson. “A full belly is something that you think about, you wonder about, but it’s not something that’s for you.”


That damages self-esteem, she says.


“Poverty is not just about the economics. It’s about a lack of a lot of other things, too. The economic deficits are what’s obvious. But what poverty does to an individual on the inside, and what he or she thinks of him or herself, and how to interact in the world, is colored by those experiences.”


The result: an increased risk for anxiety, depression, poor physical health, and drug use.



RACISM

Just being a person of color can be traumatic.


“To be excluded or dehumanized in an organization, community, or society you are part of results in prolonged, uncontrollable stress,” says Bruce D. Perry, MD, PhD, child psychiatrist, neuroscientist and noted trauma expert, in the book "What Happened to You?" which he co-authored with Oprah Winfrey. “Marginalization is a fundamental trauma.”


Mark Fossie, MS, MBA, agrees. He's a therapist at WestCare Wisconsin who works with many trauma survivors of color.



"Blatant racism is anticipated, expected..."

Mark Fossie

WestCare Wisconsin



That’s true, says Jackson of JobsWork MKE.


“The day I was born, the trauma started, because I was born into a society, a world that didn’t want me. You know that. It’s in every fiber of your life. And then add to it the stuff that goes with being part of a historically oppressed group or marginalized group.”


Research has demonstrated racism’s effect on the brain.


Scientists at the Milwaukee Trauma Outcomes Project studied the brains of people who have experienced racial discrimination and compared them to those who have experienced trauma not related to racism.


“What we found was that race-based discrimination activates the same regions of the brain and fires the same way an individual exposed to trauma would experience,” says Terri deRoon-Cassini, MS, PhD, co-founder of the Milwaukee Trauma Outcomes Project and an associate professor in the Division of Trauma & Acute Care Surgery at the Medical College of Wisconsin.


"...race-based discrimination is another form of trauma...”

Terri deRoon-Cassini, PhD Medical College of Wisconsin


MORE THAN PTSD

The "P" of Post-Traumatic Stress Disorder -- the “Post” part – is often inaccurate for people living in neighborhoods with high rates of crime and poverty. “There’s nothing ‘post’ about their trauma,” says Grove of Wellpoint Care Network. “It’s really more continuous.”


With PTSD, people struggle with troubling memories – with events of the past.


“Imagine what it would be like to not just have those memories that are wreaking havoc, but to wake up every day and try to navigate your world that continuously re-experiences trauma,” Grove says.


“It’s not just the troublesome memories from a year or two years ago. It’s the fact that they’re keenly aware that when they wake up tomorrow, and the day after, the occurrence of additional traumatic events is very real.”


As a result, trauma survivors tend to live on “high alert.” That can damage their physical and emotional health and create barriers to finding – and keeping – a job.




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