Trauma: Psychological and Behavioral Effects on Humans

Introduction to Trauma: Definitions and Origins

Trauma is considered a form of "mental agony" — distress arising from problems internal or personal to the patient or victim, undergone during a given period. Even physical or mental distress can be considered trauma. The word itself means "injury" and derives from the Greek word for "wound." Trauma is any physical or mental shock or injury, specifically a serious wound or injury caused by some physical action, such as an automobile accident or violent assault. It also refers to psychological damage or an experience that inflicts such damage. Trauma may be physical, psychological, or both; it may refer to the injury itself or to the condition that results. Profound emotional shock, physical injury, and physical shock syndrome are all defined as forms of trauma.

Traumatic experiences shake the foundation of our beliefs about safety and shatter our assumptions of trust. These events and experiences provoke reactions that seem strange and overwhelming. Such reactions are unusual and disturbing, but they are typical and expected from trauma survivors — that is, they are normal responses to abnormal events. Trauma involves exposure to a life-threatening experience and has a significant effect both cognitively and affectively. A mental health problem is considered a disorder only when it is a clinically significant behavioral or psychological syndrome associated with a painful symptom (distress) or impairment in one or more areas of functioning. Trauma may be caused by ill health, continued suffering due to illness, family problems, or employment-related stress. It may also stem from terminal diseases, sexual harassment, unemployment, poverty, accidents, disasters, exam failure, or social stigma.

This paper delves into several facets of trauma and the behavioral changes it causes in different individuals with different backgrounds. It argues that trauma has a strong effect on human behavior both cognitively and affectively, while also examining physiological responses and the degree of social support provided. A psychic trauma is one that leaves some more or less lasting effect upon the individual and their adjustment. Emotional and psychological trauma can follow many diverse kinds of physically and psychically injurious events, and the response to any given trauma can show wide individual variation — due to inherent personality and to unconscious factors that are individual-specific.

Traumatic events can play an important role in an individual's life for months, years, or even a lifetime. From the broadest viewpoint, all emotional symptoms and illnesses can be regarded as ultimately stemming from trauma, whether that trauma is physical, psychological, or both.

Certain types of neuroses and neurotic reactions can follow traumatic events, in which they may be regarded as being caused or precipitated by those events. The prior existence of favorable psychological vulnerability has a considerable bearing upon the relative emotional impact of a given traumatic event. Trauma is a common and potent cause of shock. The shock associated with physical wounds is a combination of oligemic and neurogenic shock. Neurogenic alarm is caused by strong emotional stimuli, pain, fear, bodily injury, and by deep general or spinal anesthesia. Trauma, in a sense, is a psychological condition that leads to a disturbance of intellect, consciousness, or mental functioning.

Psychological and Physiological Effects of Trauma

The effects of acute conditions include persistent confusion, disorientation, constant restlessness, hallucinations, and delusions. Chronic conditions lead to a progressive, steady decline in memory, intellect, and behavior. In recent years, increased knowledge has heightened awareness of the relationship between trauma and psychological disorders. Disabilities following trauma are sometimes observed to be disproportionate to the accompanying physical injury — a disproportion that provides presumptive evidence of emotional factors. Emotional problems not infrequently result in more pain, suffering, and disability than physical ones (Laughlin, 1963).

Anxiety, hypochondriacal, and conversion reactions are the most frequently encountered specific emotional patterns of reaction to trauma in human life. The trauma may be physical, psychic, or a combination; it may be major or minor, and its role can vary widely in the initiation of symptoms. It can initiate, precipitate, contribute to, or aggravate a neurosis. The onset of symptoms can follow the trauma immediately or may be delayed for a considerable period. The effect of a given trauma will vary widely from person to person and is largely unpredictable. When the trauma is physical, the resulting disability is sometimes seen to be disproportionate to the physical injury. The acuity or repetition — or both — of the trauma are also factors that must be considered. Psychological trauma in early childhood can often lay the foundation for later emotional illnesses and can contribute to the vulnerability of the individual to subsequent physical or psychological traumatic events, though it may alternatively lead to the development of more effective defenses.

The neuroses following trauma may be expressed in a wide variety of symptoms that can be disabling, increase the patient's susceptibility to further trauma, and interfere with or prevent normal functioning. It has been long recognized that both physical and psychological trauma can and do have far-reaching effects on human beings. A significant group has also recognized that the disability following traumatic events frequently extends far beyond any demonstrable physical impairment. Handicaps and disabilities that are emotionally based are at least as real and as troubling to the victim as physical ones. In some ways they are even more so, since one has less control or understanding of them and is thus more helpless and less able to cope effectively (Cattell, 1963).

When one begins to study emotional problems, it quickly becomes apparent that they are apt to be more painful, more troubling, and more disturbing than physical ones. Physicians can report instances in which a patient will try — sometimes with great effort — to discover physical bases for symptoms that are essentially emotional in origin. Emotional problems are likely to be far more complex in terms of resolution than physical ones. It is indeed rare, on the other hand, for a patient with physical symptoms to seek an emotional or psychological origin for them. Knowledge about neuroses and traumatic factors in their onset is becoming increasingly widespread.

An important issue, therefore, is: who is receiving what injury, and in what setting does the injury occur? One factor in determining the reaction to injury is its relative reversibility. The setting in which an injury occurs and the motivation to return to full function have a striking influence on the person's reaction. A college football player, for example, may sustain a fracture of the collarbone or shoulder blade during a game and not be aware of it until the game is over. Individuals who sustain injuries while under the influence of alcohol are also less likely to develop a post-traumatic emotional reaction than those injured in an industrial accident. The former group would prefer to overlook the situation and minimize the effect of the injury (Shulzinger, 1956).

Trauma can precipitate disabilities that are essentially emotional and psychological — often far beyond any strictly physical handicap, which need not be present at all. The severity of these disabilities is not in direct proportion to the amount of physical impact. The intensity of the emotional reaction and associated disability can vary from mild to severe. In the latter case, the person may be completely incapacitated for some period of time. The duration of the reaction may be brief or may last for decades. Trauma may trigger the initial episode of an emotional illness, or it may cause a recurrence of an illness that had been present previously. It is important to note that the sequence of trauma followed by emotional illness or personality and behavioral change is not necessarily a simple causal sequence.

The neuroses constitute one of the two major categories of psychological response to trauma, the other being the psychoses. A neurosis is an emotional illness in which there is minimal loss of contact with reality — it is a disturbance of emotional adaptation. The symptoms of neurosis are so widespread among people that it is considered more appropriate today to speak of them in terms of degree of presence and degree of resulting disability rather than their strict presence or absence. From this modern and enlightened point of view, any prejudice toward a neurotically sick person or stigmatization on this basis is simply inappropriate. Some types of neuroses have a closer causal relationship with trauma than others.

Types of Neuroses and Their Relationship to Trauma

These include, in particular:

Anxiety reactions: Anxiety neurosis is an established and more or less chronic emotional illness. It constitutes one of the anxiety reactions — the other two major ones being the acute anxiety attack or panic and the anxiety state. It is characterized primarily by the presence of anxiety and by the more direct expressions and consequences of anxiety.

Conversion reactions: In the conversion reaction, consciously disowned impulses and conflicts are transmuted into symbolic bodily expression — that is, somatic (bodily) conversions in which the conflict finds physical form.

Hypochondriacal reactions: These include states of somatic and physiological preoccupation or over-concern with health. This is a neurosis in which there is an obsessive, persistent over-concern with some aspect of physical or emotional health.

Traumatic neurosis (neurosis following trauma): Neurotic illnesses generally might be regarded as being of traumatic origin. Such trauma may be psychic, physical, or both. Early psychic trauma, for example, may lay the foundation for later emotional illness. The effects may remain latent, contributing to the later vulnerability of the individual to either physical or psychological traumatic events. Traumatic events of a psychological nature are uncovered in the definitive psychotherapy of virtually every case of neurosis. They may be little or great, single or multiple, but they will have contributed in varying degrees to the development of the neurosis. On some occasions they may have served to precipitate an incipient or latent neurosis; in other instances they may have aggravated an existing emotional situation that was already unstable. These are not imaginary illnesses. They are terribly real and terribly troubling to the person concerned.

Indeed, from the broadest point of view, all emotional illnesses could perhaps be regarded as ultimately traumatic in origin. In later life, traumatic events — whether psychological or physical in nature — may serve important functions as (1) initiating, (2) precipitating, (3) contributing to an illness, or (4) aggravating a disability or illness already established (Dunbar, 1948). Any kind of neurosis can follow trauma. Post-traumatic stress disorder arises in response to stressful events of short or long duration. Typical features include constant recollection of the trauma in memory, nightmarish experiences, a sense of emotional numbness and detachment from people, and total indifference to surroundings. Suicidal reactions are not infrequent.

In the case of traumatic neurosis adjustment disorder, the condition is a state of emotional disturbance that usually interferes with social functioning and performance in response to a stressful life event. The stress may have affected the individual's social network — for instance, through bereavement or a sense of alienation — or may arise from a major developmental transition such as starting school, becoming a parent, failing to attain a cherished personal goal, or retirement. Individual predisposition or vulnerability plays an important role in the risk of occurrence, including depressed mood, worry, or both, as well as some degree of disability in the present situation. Conduct disorders are mostly associated with adolescents. The predominant feature may be a brief or prolonged depressive reaction or a disturbance of other emotions and conduct (Cattell, 1963).

The interrelationships of personality, behavior, and trauma are extremely complex. A quick and superficial conclusion that there is a simple causative relationship between trauma and personality or behavior change is probably erroneous. Careful investigation of all the major determining factors is essential. Therapy for trauma, to be successful, requires an actively cooperative patient who participates collaboratively in the treatment. Psychotherapy — which has gathered tremendous significance in the diagnosis and treatment of psychological conditions including trauma-related problems — is the recommended approach, and must be in the hands of a skilled physician with graduate specialist training and adequate experience in psychiatry. Psychotherapy and analysis are actually an educative process of considerable depth, more personal and meaningful than many other kinds of educational approach (Weiss; English, 1949).