Trauma may be the most common underlying factor contributing to mental disorders. Unfortunately, trauma is often overlooked, partly because it can manifest itself in so many different ways. That said, here are some common definitions. Trauma always involves a stressful trigger that activates a trauma response. Because, like everything, trauma responses are brain-based and involve the body, symptoms affect the whole person.
Old, informal, and useful definitions include:
- A stressor outside the realm of normal human experience (but sadly, trauma is all-too-common)
- A betrayal . . . (e.g., something that should not happen)
- Occurrence of an event that’s emotionally overwhelming
Below I’ve listed the essence of the DSM-5 definition for Post-Traumatic Stress Disorder (note that the whole idea of PTSD centers on the chronic or long-lasting effects of trauma).
Exposure to a traumatic stressor that involves direct personal experience, witnessing, or learning about events involving threatened death, serious injury, or a threat to your physical integrity. The trauma response includes:
- Intrusion symptoms (recurring unwanted memories, nightmares, flashbacks, and triggered distress)
- Avoidance of trauma-related thoughts or external cues
- Negative cognitive alternations (e.g., memory gaps, no joy, etc.)
- Arousal and reactivity (e.g., irritability, risky behaviors, hypervigilance, insomnia, startle response)
Trauma and trauma responses can be big, medium, and small. Big traumas meet the DSM-5 diagnostic criteria for PTSD or acute stress disorder. Small traumas are usually disturbing and disruptive, but the body and brain adjust to them within 2-3 days. Medium size traumas have lasting effects, but don’t meet formal diagnostic criterial, and are usually referred to as subclinical.
I like to think of Trauma with an uppercase T (like in the DSM) and all other traumas that are difficult, challenging, and require adjustment as traumas with a lowercase t.
What to Say
Sometimes trauma responses or symptoms are visible and obvious. If so, it’s good to say and do some of the following:
- Listen and show compassion
- Reassure participants that physical/psychological responses are normal, take up energy & need soothing
- Note that very effective treatments are available (e.g., This American Life)
- Brainstorm on what helps
- Remember: A pill is not a skill
- Link and universalize (“It’s normal to have pleasant and unpleasant reactions to things we talk about”)
- Brainstorm on more and less healthy reactions (Using substances is a quick distraction, but not a fix)
- Share hopeful stories (what skills can be developed?)
- Self-disclosure can help. But be careful with self-disclosure and remember that it’s not about you
Trauma is a normal and natural human response. You may experience trauma just by listening to people talk about trauma, or you may have your own direct experiences. When in the business of helping others, be sure to take good care of yourself.
Three Suicide Myths
Myth #1: Suicidal thoughts are about death and dying.
Most people assume that suicidal thoughts are about death and dying. On the surface, it seems like a no-brainer: Someone has thoughts about death, therefore, the thoughts must be about death. But the truth isn’t always how it appears from the surface. The human brain is complex. Thoughts about death may not be about death itself.
Myth #2: Suicide and suicidal thinking are signs of mental illness.
Not true. Philosophers and research scientists agree: nearly everyone on the planet thinks about suicide at one time or another—even if briefly. The philosopher Friedrich Nietzsche referred to suicidal thoughts as a coping strategy, writing, “The thought of suicide is a great consolation: by means of it one gets through many a dark night.”
Myth #3: Scientific knowledge about suicide risk factors and warning signs allows for the prediction and prevention of suicide.
Believing in this myth can make surviving family members, friends, and helping professionals experience too much guilt and responsibility. In fact, even the most famous suicidologists say that it’s impossible to consistently and accurately predict suicide.
Tips for Talking about Suicide
We need to be able to talk directly about suicide with courage and calmness. But first, we should listen. Here’s what you should listen for in general
- Emotional pain
- A sense of feeling trapped or ashamed
- Not believing that anything can possibly help to reduce the pain and misery
While listening, show acceptance, empathy, and compassion. Remember: suicidal thoughts are not signs of illness or moral failing; if you judge the person, it will make it harder for the person to be open. Also remember: when people talk with you about their suicidal thoughts, that’s a good thing, because you can’t help unless they’re comfortable enough with you to speak openly about their suicidal thoughts and feelings.
Traditional warning signs in particular
Although it’s good to know these warning signs, there’s not much research supporting the idea that anything predicts suicide.
- Active suicidal thinking that includes planning and talk about wanting to die
- Preparation and rehearsal behaviors (stockpiling pills, giving away belongings, etc.)
- Hopelessness related to feeling that the excruciating distress will never end
- Recklessness, impulsivity, dramatic mood changes
- Anger, anxiety, and agitation
- Feeling trapped
- No reasons for living, no purpose in life, broken relationships
- Increased alcohol or substance abuse
- Immense shame or self-hatred
How should I ask about suicide?
The answer to this is always, “Ask directly.” But we can do even better than that. We need to de-shame suicidal thoughts and talk. Before asking, communicate that you know suicidal thoughts are a normal and natural response to emotional pain and disturbing situations. For example, you could ask it this way, “I know that it’s not unusual for people to think about suicide. Have you had any thoughts about suicide?”
What should I say if someone admits to thinking about suicide? You can say things like,
- Thanks for telling me.
- It sounds like things have been terribly hard.
- Thanks for being so honest, that takes courage.
- I know I can’t instantly make everything better, but I want you to live and I want to help.
- How can I best support you right now?
- What can we do together that would help?
- When you want to give up, tell yourself to hold off for one more day, hour, minute—whatever you can.
- Or . . . use your good listening skills and reflect back the feelings and thoughts that the person shared.
Resources for Help
- National Suicide Prevention Lifeline: Call 800-273-TALK (800-273-8255)
- Crisis Text Line: Text HOME to 741741
- Bozeman Help Center – 24-Hour Crisis Line: (406) 586-3333
What is Motivational Interviewing?
Motivational interviewing (MI) is an evidence-based approach to treating substance problems, health concerns, and other mental health issues. MI is “person-centered” and based on the foundational principle that clients should be the ones who make the case for change in their lives. MI:
- Focuses on the common problem of ambivalence about change.
- Relies on four central listening skills (OARS): open questions, affirming, reflecting, and summarizing.
- Helps clients transition from less healthy to more healthy behaviors
Four overlapping components combine to create the spirit of MI:
- Collaboration (partnership; dancing, not wrestling)
- Acceptance (UPR, accurate empathy, autonomy, affirmation)
- Compassion (honoring the client’s best interest)
- Evocation (tapping the client’s well of wisdom)
MI is a specific treatment approach that requires professional training. However, operating on a few basic MI principles can improve nearly anyone’s approach to helping others. For more information, see the book: Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change. New York, NY: Guilford Press.
This handout is from a mentor workshop for the Big Sky Youth Empowerment Program. These ideas are based on research and collected from professionals who have experience working with people who are feeling suicidal. These guidelines should not be considered medical advice and are no substitute for getting an appointment with a licensed health or mental health professional. See: johnsommersflanagan.com for more information.