This article is an excerpt from the Shortform book guide to "What Happened to You?" by Bruce Perry and Oprah Winfrey. Shortform has the world's best summaries and analyses of books you should be reading.
Like this article? Sign up for a free trial here .
What is emotional trauma? How does trauma differ from distress?
According to Oprah Winfrey and renowned psychiatrist Bruce D. Perry in their book What Happened to You?, there’s a difference between trauma and distress. The authors explain that trauma is made up of two factors: the stress response and the lasting impact.
Continue reading for a discussion on emotional trauma and how it affects the brain.
What Is Trauma?
What is emotional trauma? In their book What Happened to You?, Perry and Winfrey note that our society uses the term “trauma” very broadly. We sometimes refer to misfortunes as “traumatic,” such as failing an exam or receiving a negative review at work. We also might use the word to refer to an uncomfortable situation, such as watching violent news footage. The authors acknowledge that these types of events can cause distress and can even be traumatic for some people. But they urge us to use the word “trauma” carefully.
Perry explains that in psychology, trauma is difficult to define. This is because people can experience and react to the same event in different ways. For example, an earthquake might destroy one child’s home, causing severe trauma. But in a different part of the city, another child might experience only a slight shaking, which causes alarm but not lasting trauma.
Because of these difficulties, Perry and Winfrey stop short of defining trauma. Instead, they suggest that all trauma has two factors: a stress response, or the body’s reaction to a difficult event; and the lasting impact of that event. The extent and details of the stress response and the lasting impact vary based on the person. But Perry maintains that these two factors are crucial to understanding trauma.
|Trauma Is Difficult to Define…and Difficult to Share|
Trauma’s relative nature and unclear definition can make it difficult for survivors to share their experiences. This is particularly true in the case of “individual trauma,” or trauma that happens to just one person as opposed to a group of people. Because that person was the only one to experience the event, they can’t compare their reaction to that of anyone else. Therefore, they might think that the event was “not that bad” and feel shame that they still have trauma from it. They also might worry that others won’t understand or believe them when they discuss the trauma.
Therefore, if a trauma survivor shares their story with you, the most important thing you can do is believe them. Use phrases like, “It’s not your fault,” “I believe you,” “Thank you for telling me,” and “This shouldn’t have happened to you” to validate their experience.
Let’s take a look at each of these two factors of trauma: the stress response and the lasting impact.
Understanding Stress Responses
When you’re in a potentially dangerous or stressful situation, your body protects you by producing a stress response. According to Perry and Winfrey, this can take one of two forms:
1) Fight or flight: Perry and Winfrey explain that your fight-or-flight response prepares you to either confront the danger or run away. You become alert and ready for action: Blood rushes to your muscles, your heart rate increases, and your body produces adrenaline.
(Shortform note: Your fight-or-flight response happens instantly, often without you even realizing it. When you see something that your brain interprets as dangerous, it immediately sends a signal to your adrenal glands (which are in charge of producing adrenaline) through your sympathetic nervous system. This is why people can react to danger instinctively, like jumping out of the way of an oncoming truck. Before you have time to fully process what you see, your body has already kicked into gear.)
2) Dissociation: Perry and Winfrey note that in some dangerous situations, our brains calculate that we can’t fight or flee. In these cases, we react by dissociating. Dissociation prepares us to get hurt: The brain tells the body to start producing natural painkillers and redirects blood away from the muscles to protect the vital organs in the trunk. We sometimes feel as though time slows down or that we’re observing ourselves from afar.
|Dissociative Disorders Can Serve as Coping Mechanisms|
Dissociation can happen not only in the moment of a traumatic event but also afterward as a coping mechanism. There are four types of dissociative disorders common in trauma survivors:
Dissociative amnesia consists of memory loss, either of a specific event or time period or (more rarely) of a person’s entire life. As a coping mechanism, this allows the trauma survivor to forget negative events, preventing them from reliving their trauma.
Dissociative fugue is a type of dissociative amnesia. The main symptom is that the person frequently wanders away from home for hours, days, or even months, with no later memory of the trip. Scientists theorize that dissociative fugue allows the trauma survivor to physically escape their everyday life to avoid reliving trauma.
Dissociative identity disorder (DID) occurs when a person has two or more identities that each control their behavior at different times. These multiple identities each have their own background and personality traits. As a coping mechanism, DID allows the trauma survivor to distance themself from a traumatic memory by escaping into a different identity.
Depersonalization disorder occurs when a person suddenly feels as though they don’t belong to their body. As a coping mechanism, this allows the trauma survivor to detach themself from negative events, as though the events happened to someone else.For each of these disorders, mental health professionals can help patients address underlying trauma and develop strategies for dealing with symptoms.
Traumatic Events Create a Heightened Stress Response
Perry and Winfrey explain that a stress response by itself isn’t necessarily a bad thing: Stress responses protect us from harm. For example, if you’re hiking and come across a rattlesnake, having a fight-or-flight response is beneficial because it’ll make you more alert and prepare you to run away. Stress responses can also help you overcome challenges and develop resiliency. For example, having minor nerves before playing in a big sports game can make you perform better by sharpening your senses and your mind.
However, one of the common elements of trauma is that it creates an especially severe or prolonged stress response. This can occur due to a single moment of trauma or over the course of several events. Perry notes that there are no universal criteria for what counts as an “especially severe or prolonged stress response.” He acknowledges that this can make it difficult to classify trauma. But he also maintains that psychologists should understand stress responses on a case-by-case basis to provide better care to trauma survivors.
|Single-Incident Trauma Versus Complex Trauma|
Trauma that occurs over the course of several events is also called complex trauma. Research suggests that in general, complex trauma leads to more severe long-term effects than single-incident trauma. This is due to a number of factors.
First, complex trauma often leaves little time for the person to recover between traumatic events, leading to sustained stress that’s bad for their health. Second, complex trauma frequently occurs in private and in relationships that are supposed to be loving, such as the parent-child relationship. Experiencing trauma in this kind of relationship can be especially confusing and difficult, and it can make trauma survivors feel like it was their fault that the trauma occurred. These feelings of guilt or shame can prevent trauma survivors from seeking help, leading to more severe long-term effects.
|Visualizing the Stress Response: “The Window of Tolerance”|
“The Window of Tolerance” theory offers a useful way of visualizing Perry and Winfrey’s discussion of the stress response. Psychologist Daniel Siegel first proposed this theory in his 1999 book The Developing Mind. Since then, it’s helped inform how doctors and scientists view trauma and help survivors heal.
Like Perry and Winfrey, Siegel suggests that when we’re within a certain healthy range of stress, we’re grounded, flexible, and relate well to others. He calls this range the Window of Tolerance and notes that it can vary from person to person. However, when our stress levels become too high or low, we leave the Window of Tolerance and can no longer regulate our emotions. When stress levels rise, we can become hyper-aroused, which can cause anxiety, anger, and hypervigilance (this is what Perry and Winfrey call fight-or-flight mode). On the other hand, when stress levels decrease, we can become hypo-aroused, which causes numbness, depression, and passivity (what Perry and Winfrey call dissociation).
Similar to Perry and Winfrey, Siegel theorizes that trauma creates so much stress that it forces a person out of their Window of Tolerance. Furthermore, he suggests that trauma narrows the Window of Tolerance in the future, making trauma survivors more susceptible to small triggers. (We’ll discuss this in more detail shortly.) Siegel also maintains that we can widen our Window of Tolerance through mindfulness practices, therapy, and stress-reducing activities like exercise.
Trauma’s Lasting Impact
Perry and Winfrey explain that another common element of trauma is its lasting impact. Once again, they don’t offer a one-size-fits-all definition of what this lasting impact looks like. They explain that it depends on a range of factors, including the survivor’s genetic susceptibility to trauma, the strength of her community support network, and her body’s stress response to the original traumatic event. (A more severe stress response typically leads to more severe long-term effects.)
(Shortform note: In The Body Keeps the Score, Bessel van der Kolk agrees that genetics, community, and the stress response are all factors that can influence the severity of trauma’s long-term effects. Furthermore, he extends Perry and Winfrey’s claim by adding another influencing factor: a survivor’s actions during the traumatic event. According to van der Kolk, if the survivor lashed out in rage or didn’t fight back, they may repeatedly feel an overwhelming sense of shame or guilt that they didn’t act differently, even if they had no choice.)
However, Perry and Winfrey do list several common long-term effects of trauma, including flashbacks, memory loss, physical health problems, and mental health issues like depression and anxiety. We’ll discuss these lasting impacts in more depth later in the guide.
———End of Preview———
Like what you just read? Read the rest of the world's best book summary and analysis of Bruce Perry and Oprah Winfrey's "What Happened to You?" at Shortform .
Here's what you'll find in our full What Happened to You? summary :
- How childhood trauma can have a severe and lasting impact on the brain
- Why it’s so important to address your trauma
- How to heal from trauma and develop healthy relationships