Students can begin learning about treating patients with trauma early.
I grew up struggling to articulate what happened in my past—a past that led me around the globe and back home to my heritage in Iraqi Kurdistan, and to writing a book about my journey and living with unprocessed racial and developmental childhood trauma. Because I have few memories from my childhood, I use journaling, colors, drawings, and writing to retrieve pieces of fragmented memories and the suffering I carry within me. When I share stories of my trauma, people are bewildered by my neutral expression as I talk about the pain my family and I endured. A well-documented feature of trauma, one familiar to many, is the inability to emotionally articulate the experience. Understanding the features of trauma and learning to work with patients who have experienced traumatic events is essential for pharmacists to provide care.
In our society, the word “trauma” is often used casually. It is overutilized and inaccurately applied. To have a clear understanding of what trauma entails, the psychological community categorizes trauma by “Big T” and “Little t” events. “Big T” events can involve a single event or a series of repetitive exposures in which emotional distress dictates one’s common sense. These events can include war, natural disasters, displacement, and sexual or domestic violence. All of these can lead to a wide range of symptoms such as anxiety, depression, numbness, and shock. Those who experience such symptoms often suffer from posttraumatic stress disorder.
“Little t” experiences are more difficult to recognize, and their impact on the victim is harder to determine. In other words, “Little t” events are individualized; an event can be traumatic to one person yet normal to another. It is important to note that the “Little t” designation does not mean the emotional impact of the events are insignificant when compared with “Big T” experiences. There are many examples of “Little t” experiences, including non–life-threatening injuries, emotional abuse, death of a pet, bullying or harassment, and loss of significant relationships.
A person experiences trauma when exposed to events that are too much, too soon, and too fast for their unique nervous systems to process. The Substance Abuse and Mental Health Services Administration uses the “three Es” to define trauma: event, experience, and effect.1
“The complexities of these 3 interrelated components are what should be considered in clinical work,” says Bruce D. Perry, MD, PhD, clinical psychiatrist and coauthor of What Happened to You? Conversations on Trauma, Resilience, and Healing.2 Trauma can be induced by a variety of experiences, including toxic shaming, emotional abuse by a caregiver, or marginalization and dehumanization of minority groups.
Most people view the effect of trauma as a mental disorder or brain disease. However, trauma is a disease of the body that produces a variety of physiological changes experienced on a visceral level. Trauma is what happens inside of our body because of what we were exposed to. A person becomes scared, numb, or overwhelmed, and at times collapses. Patrick Carnes, PhD, author of The Betrayal Bond: Breaking Free of Exploitive Relationships, says those who experience trauma might react to minor triggers, freeze when frustrated, or become helpless in the face of simple challenges.3 In other words, they become out of touch with their reality, feelings, bodies, and needs, which in turn makes it extremely difficult to attend to anyone else’s reality, feelings, sensations, and needs. This intense reaction diminishes the victim’s ability to form intimate relationships and make decisions (particularly when under pressure), and often leads them to take things out of context. Their behavior can be seen as neurotic or out of control.
HOW TO BECOME TRAUMA INFORMED
To master trauma and to help patients who may have experienced trauma, we must bring ourselves to a full awareness of the present moment, to keep us calm and focused when exposed to images, thoughts, or sounds that are reminiscent of our past, and to restore a full ownership of our body, mind, and soul. Below are some recommendations on how to become trauma informed:
Interested in learning more? Check out this bonus content with more information on the trauma response.
About the Author
Helen Sairany earned her PharmD degree from Northeastern University and her MBA from the University of Maryland. She has extensive experience in executive leadership, administrative management, regulatory practice, and accreditation systems thanks to her work as a trauma-informed pharmacist; state executive and CEO for the South Carolina Pharmacy Association; director of content development and partnership at the American Pharmacists Association; director of quality assirance at the University of Duhok College of Pharmacy; and field provider for Doctors Without Borders in Iraq and Western Syria.
1. Substance Abuse and Mental Health Services Administration. SAMHSA's concept of trauma and guidance for a trauma-informed approach. October 2014. Accessed September 9, 2022. https://store.samhsa.gov/product/SAMHSA-s-Concept-of-Trauma-and-Guidance-for-a-Trauma-Informed-Approach/SMA14-4884
2. Perry BD, Winfrey O. What Happened to You? Conversations on Trauma, Resilience, and Healing. Macmillan; 2021.
3. Carnes PJ. The Betrayal Bond: Breaking Free ot Exploitive Relationships. Health Communications Inc; 1997.