The Perception of Danger

Psychological trauma defies physical detection: You cannot see it in an X-ray or an MRI; you cannot feel it during a medical examination. You can only experience it personally, both viscerally and emotionally, or witness the outward manifestations, the troubled signs of trauma. “I can’t sleep, I am exhausted, I’m anxious all the time, and I am scared to get into a car”. Or, “I can only be in a car if I am driving, I don’t remember where I put things, I can’t stop thinking about the accident, and I don’t want to leave my house”. Yet another, “I feel so depressed, I am fighting with my kids/spouse/friends, I am usually not this irritable, and I wake up almost every night from nightmares about the accident”. There are countless variations.

Head trauma or minor brain damage intensifies trauma symptoms; partly because it vastly worsens or creates the cognitive difficulties and because it produces its own pain—the perennial headache. These symptoms seem to take the longest to subside and can be quite debilitating. Postconcussional Disorder and Mild Neurocognitive Disorder are often the psychiatric diagnoses given to head trauma victims.

Often trauma symptoms take 3-4 months before they emerge. Or, people will resist, fighting back the symptoms thinking that it will go away, or they try to manage them without success. Undeniably trauma does sometimes work itself out. However, when 6 months have rolled by and things are not getting any better, something is amok. I once had a client who took 9 months to come to therapy. Prior to the accident, he enjoyed many years of being a top salesman in his field, pulling in six figures annually. (Imagine a modern-day Don Draper of “Madmen”). Then one day, while watching in his rear-view mirror, he was rear-ended. He couldn’t remember if he had hit his head, didn’t remember the actual impact, nor could he remember exiting from his vehicle. He had blacked out. Three days later he started getting constant, severe headaches. Headaches that were so bad they eventually prevented him from sleeping, prevented him from working, and forced him to the ER for pain relief. By the time he came to trauma therapy, he had been through just about every pain treatment the doctors could think of. Nothing was working. Not being a pain specialist, I simply did what I always do with new clients: Took him through a guided imagery, breathing/relaxation exercise. Within 2 minutes he fell asleep. He slept through the rest of the session. Before he left, I instructed him to do the exercise on his own each night. When he returned the following week, he reported that upon leaving my office, he noticed, that for the first time in months, he did not have a headache. Unfortunately it only lasted for a couple of hours, but he also said that his sleeping had improved significantly. The end of the story is not so neat and compact. Due to a history of what he said were serious childhood traumas that he did not want triggered, he dropped out of treatment. He was afraid of losing control. Still, the moral of the story is: Unnecessary pain and suffering is not worth it, and is treatable.

Attorneys with whom I have consulted sometimes wonder how an ordinary car accident can cause trauma. After all, isn’t Post-traumatic Stress Disorder (PTSD) reserved for those who have fought in wars, or were tortured, or were the victim of a heinous crime? First, not all trauma is PTSD. There are varying levels—some which require longer, in-depth treatment, others that can be resolved within a few sessions. There have been many cases that needed only 4-8 sessions to get past the driving phobia that many people develop. Would that have been considered full-blown PTSD? No. But driving phobias are just as viable and worthy to treat. We certainly wouldn’t want hundreds of people driving around terrified, white-knuckled at the steering wheel, and so anxious and hyper vigilant that they practically cause that which they are trying to avoid.

Secondly, trauma cannot be measured only by the external, material event that occurred. There is an internal process at work as well. I had a client who, while driving on the freeway, was hit, which somehow caused his vehicle to change direction and head towards a huge, semi-truck. As the vehicle rapidly approached the truck, the client watched, horrified and terrified, as his car actually went under the truck. Somehow the vehicle stopped and the client was able to walk out of his car virtually unscathed, at least physically. What he presented in therapy was a man riddled with trauma symptoms: unable to sleep, daily nightmares, obsessed with the accident, obsessed with how he came out alive, depressed, unable to drive, extremely anxious, not wanting to leave his house. What he vocalized is that while he watched himself go under the truck, he truly, genuinely, absolutely thought that he was going to die. It is the perception of danger that accounts for how the mind will process or not process the traumatic event.

Trauma, and its manifestations, is really not mysterious. It is when we avoid acknowledging it because we tell ourselves, or we have been told, “Hey, you didn’t get hurt too badly”, that we really feel the pain.

“Trial Lawyer”
Winter 2010
Oregon Trial Lawyers Association
Brain Injury Issue

Beverly Schwartz, LCSW
SOMA Trauma Therapy, LLC

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