Integrated Counseling

“Trauma” is Greek for wound. Us humans are resilient; and we are also soft, sensitive, and deeply socially connected creatures. We sustain physical, mental, emotional, and spiritual trauma over the course of our lives, simply from living on Earth. When we experience trauma, no matter the type, it can be integrated into our systems or remain fragmented. PTSD can be seen as unintegrated trauma, and such fragmentation is a natural effect of our bodies’ protection in the moment.

While trauma has always existed, “PTSD” only came into our vocabulary in 1980. As Gwin wrote earlier this month in the St. Louis Wellness Center newsletter, Vietnam War veterans, feminists, and their allies lobbied to have it recognized in the DSM (American book of mental disorders). Their goals were to reduce stigma, help people make sense of their experiences, and improve access to resources. This process of taking a normal human experience (in this case, traumatic stress responses) and turning it into a medical diagnosis with specific treatment options is called medicalization. 

Seeing adaptive reactions and normal processes as disordered and requiring treatment has rapidly increased in recent decades. In addition to medicalizing traumatic stress responses into PTSD, many other aspects of life have seen this trend. Examples include all stages of women’s reproductive health, being gay, and every single diagnosis in the DSM.

The DSM is written by groups of members of the American Psychological Association (APA). Every few years they meet to discuss and revise the book. Earlier this year, an important study revealed that roughly 60% of the APA members who wrote the latest version directly received money from the pharmaceutical industry. More than $14.2 million was handed from big pharma to these authors as they made crucial decisions about how we see and treat mental health. It’s important to recognize the relationships between these three entities; the medicalization of mental health is not only an attempt to help people, its development is also politically and financially motivated. 

We can easily see that medicalization leads to more diagnoses given, more spending on medications and treatments, and greater profits for those who create them. What else has medicalization done for us?

1. It becomes an identity. I hear my clients say, “I am depressed”, or “I’m so ADHD”. This becomes self-fulfilling and limiting. Not to mention, people are building identities around concepts that are not even that sound to begin with.

2. It’s pathologizing. It makes people think something’s wrong with them. While most people don’t develop PTSD, traumatic stress responses are a normal reaction, not an unhealthy one. Shame makes people less likely to seek treatment and find hope.

3. We lose the bigger picture. Instead of working to fix the sources of trauma – war, poverty, stress – we focus on helping people adjust and adapt to these circumstances. 

The last couple of decades have seen an increase in medicalization with no decrease in mental illness. PTSD rates have risen. People are as unwell as ever, especially young people. How else could we treat trauma?

See trauma as a spectrum. Rather than seeing trauma as one clearly defined experience we could view it as a spectrum that everyone experiences. Some have differentiated the severity of trauma by using the terms “little t” and “big T”, with “little t” referring to the less intense end of the spectrum.

Center trauma in the treatment of all “disorders”. This study of the DSM found that almost all diagnoses “mask the role of trauma and adverse events”. We need to ask everyone about their trauma and center it in the treatment of all disorders – mental or physical.

Respect individual differences. In response to trauma being claimed more widely, I have heard many say: “Not everything is trauma! You are overreacting.” Remember, what is traumatic to one may not be for another, and not everyone develops PTSD after trauma. There are vast individual differences to consider and no one-size-fits-all approach. See Jen’s article for more.

Heal the bodymind / mindbody. As Bessel van der Kolk said, “The Body Keeps the Score”. Our approaches cannot solely focus on the mind. Our body / mind systems are so interconnected that we may as well call it a “bodymind” or “mindbody” instead. Check out Kimberly’s article, too.

Hold power accountable. Finally, we must recognize that the sources of trauma can be political and economic – like war, genocide, incarceration and poverty. If we want to fully heal our society’s trauma, we have to address this pain as well. 

Trauma is something that we all experience, in one way or another. We must tend to our wounds effectively to thrive together.

Meredith Rose is an IFS-informed psychotherapist working with adults and adolescents at the St. Louis Wellness Center. Learn more about her at wholenessandchoice.com or call 314-827-4833 to book a session.