There's No Such Thing as Little-T Trauma

Have you ever said any of these things to yourself?

• I don’t know if my experience qualifies as “trauma,” people go through worse.
• Why is she calling that traumatic? I’ve been through it, it wasn’t so bad.
• Everything is a trauma nowadays, what happened to resilience?

Trauma can be so confusing because people use the term both very loosely and quite specifically. The medical metaphor trauma is based on—physical insult or injury that leaves a wound, that needs both time and healing intervention to recover from—doesn’t always map perfectly onto psychological trauma. In addition, unlike physical trauma, there’s no evidence of psychological trauma. No one can point to a break on an X-ray, a bruise, or a stitched-up wound to say, “There! That’s the damage! That’s what happened.” Because of the way memory works and the way psychology interfaces with our narratives, and because of the way trauma already leads to self-doubt, the metaphor doesn’t really hold up.

After more than 20 years treating post-traumatic people and a lifetime of living with PTSD, I can tell you this:

• Trauma is an experience too big for your brain to metabolize.
• It’s an experience that makes you doubt your physical or psychological ability to survive.
• It makes you feel unsafe, insecure, and hypervigilant.
• It makes you doubt your ability to understand this world and to cope, or live within it.

The details of the traumatic event don’t matter at all. They matter for recovery. They matter when we try to tell, re-tell, process and reprocess what happened—that’s when we drill down on talking about the details—but they don’t matter for diagnosis.

Sarah was at work when the call came in—there’s a bomb, hidden in this school building. Sarah and her kindergarten students were first told to shelter in place, cowering under desks in a barricaded classroom, not knowing if the bomb was located in the room with them. Sarah had to keep her students calm, as her entire body was tensed, waiting for that fatal boom. Eventually, they were escorted out of the building, to shelter in an outbuilding across the street, while a bomb squad swept the building.

It turned out the whole thing was a hoax. There never had been a bomb, just a prankster whose motivations are beyond the scope of this blog post.

Is Sarah therefore not traumatized? There never was a bomb! She could have gone on with her lesson about community helpers with her kindergarteners.

But, of course, we’d all agree that this was a traumatic event.

The details don’t matter: whether there was or was not a bomb is meaningless. Sarah’s belief in a safe, just world, her belief in her own competence, her survival, all of these were shaken. This experience couldn’t just be metabolized in some “resilient” fashion. It was too big, too much, too overwhelming.

The “Little-T” and “Big-T” trauma framework oversimplifies trauma and its complex nature. It doesn’t take into account our experience of our experience.

Michelle, a post-traumatic parent, shared this experience:

I lost my mother to cancer when I was in middle school. When I think back to that time, of course, there was so much sadness around losing my mom—but there were so many other losses. My friends started distancing themselves from me, as though cancer—or losing a mom—was contagious. My dad buried himself in his work. Partially, he had to, because the business had been neglected as my mom got sicker and sicker, and partially because it made him feel less hopeless. When I think back on those years, it’s the overwhelming loneliness, losing my friends, becoming a social pariah, that are truly traumatic. Losing my mom wasn’t really the “trauma.”

And yet, Michelle’s experience of loneliness, social rejection, and lack of faith in the social world, those things would be classified as “Little-T” trauma. I hear this over and over again from post-traumatic people—trauma just doesn’t fit into neat little boxes.

So, if it’s not the details that matter and it’s often not the “Big-T” event that creates the trauma, what are we left with?

Trauma can't be categorized - it's often about what didn't happen for you, as much as what happened to you.

watcartoon/123RF

Our experience of our experience.

This is why I resist any attempt to compare or rate trauma. Incidentally, the term “Big-T” and “Little-T” trauma comes from just that—the attempt to create a trauma rating scale, a rating scale that is still used in clinical and research practice today. For research purposes, it may be useful to categorize traumas.

For clinical purposes? It’s only useful as a jumping-off point, a way of opening a dialogue of “What happened to you? What did you learn from that? How is it still affecting you? How would you like to understand the world, or yourself, differently?” and, of course, “What do you want to do about it? Where do you want to move forward with this?”

Trauma Essential Reads

Trauma Is Not a Diagnosis

When Movie Trauma Mimics Historical Trauma

I call the game of comparative trauma analysis “trauma poker” because it quickly becomes a game of one-upmanship: “I see your surviving a fake bombing and I raise you a mom who died of cancer. I see your mom who died of cancer, and I raise you a stepdad who beat me…”

I hate this game because no one wins, and often, what was traumatic wasn’t the identifiable traumatic event—it was what happened as a result, what didn’t happen for us due to the trauma, it was how we reacted internally, and what type of survival behaviors became encoded in us.

Trauma isn’t a game. It isn’t a competitive sport. Most importantly, it doesn’t have to meet some external standard to “count.” We know, deep down, which experiences were too big for our brains to metabolize. We know what shook our sense of security in the world, what threatened our physical or psychological survival. There’s no external standard that can establish that for us, that can tell us, “Yes, this was sufficiently bad enough to count as ‘traumatic.’”

Trauma often doesn’t happen in the past—it happens in the future, and it keeps on happening until we understand how those invisible wounds continue to affect us. When we use the “Little-T” and “Big-T” framework, we’re unconsciously playing trauma poker—with ourselves. We’re unconsciously gaslighting ourselves out of our own deeply held truths.

So, let’s stop playing trauma poker. Let’s stop doubting our own experience of our experience. Because what’s important in trauma isn’t what happened so much as what happened as a result. And what happened as a result is still happening and can still be healed.