46 | New Scientist | 2 April 2022
Features
Rethinking
trauma
The stressful events of the past two years have
left many people reeling, but whether their
experience qualifies as trauma is hotly debated,
as Jessica Hamzelou reports
G
IVING birth. A car accident. Racial
abuse. Many of us feel we have
experienced things we would describe
as traumatic. Look no further than the past few
years. Beyond the sickness and deaths wrought
by covid-19, many psychologists warned that
the pandemic was a mental health crisis in the
making, with cases of post-traumatic stress
disorder (PTSD) predicted to soar.
Consult the medical textbooks, however,
and you find that such experiences don’t
generally qualify as trauma. People who
suddenly lost a loved one to covid-19, and those
working in hospitals and care homes might
meet the criteria. But relentless news updates
about a mysterious deadly disease, job loss,
social isolation and living under lockdown –
none of these fits the bill. “People called the
pandemic traumatic, and it’s not,” says George
Bonanno at Columbia University in New York.
In our propensity to view things as
traumatic, we may also be overplaying the
impact, Bonanno argues. His research has
shown that, given time, most of us will recover
even from the most horrifying experiences. In
light of this, says Bonanno, the word “trauma”
has lost all meaning. But others believe the
strict medical definition should be expanded
to cover a wider set of human experiences.
This explosive debate – reignited by
the pandemic and the Black Lives Matter
movement, and continuing at a time whenwar is high on the news agenda – has big
implications. Ultimately, our understanding
of what trauma is, and which experiences
qualify, determines whether people are
being unnecessarily diagnosed and treated
for PTSD, or are living with the symptoms
unable to get the treatment they need.
The medical profession has long recognised
the importance of trauma, even if it has
struggled to define it. The first edition of the
“psychiatrist’s bible”, the US Diagnostic and
Statistical Manual of Mental Disorders, or DSM,
published in 1952, mentions a “gross stress
reaction” that can result from severe situations
such as catastrophe or combat. But it wasn’t
until 1980 that PTSD was introduced.
The symptoms of PTSD include recurrent
disturbing memories, dreams or flashbacks,
stress reactions to certain cues, avoidance
behaviours, low mood or feelings such as
guilt or shame. Importantly, however, an
experience cannot be termed traumatic unless
it fits with a list of potential traumas that are
collectively called “criterion A”. This list has
widened over the years and today includes
actual or threatened death, serious injury
and sexual violence. A person must have
experienced, witnessed or had repeated
professional exposure to one of these events,
in order to qualify for a PTSD diagnosis.
The public perception of trauma has
also changed, says epidemiologist Karestan DANIEL^ STOLLE