The Silent Wound

characters in this article are fictional, created for the purpose of portraying therapeutic process.

"I dont have any specific trauma. I've never been in a car accident and I wasn't bullied when I was little. So then why am I suffering so much on the inside? Why do I feel like the light on the inside is dim? Why do I have a hard time trusting myself and letting others come close?"

This confusion exists in many clients who reach out and are brave enough to ask for help and begin therapy. This confusion is a representation of how many may not fully understand the concept of trauma. The world lacks vital information about what trauma is and is not. 

The word trauma often sends a shiver down peoples' spines.

What flashes through most minds are images that bring fear, confusion and darkness, leading to denial or avoidance of discussing the topic. The Diagnostic and Statistical Manual of Mental Disorders, a manual used by mental health practitioners to diagnose behavioral conditions defines trauma as exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways: directly experiencing the traumatic event(s); witnessing, in person, the traumatic event(s) as it occurred to others; learning that the traumatic event(s) occurred to a close family member or close friend or experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (DSM-V,2013).

The DSM-V has done a good job expanding its breadth of the diagnosis to include vicarious exposure, however there are some major limitations to the definition because one does not need to experience actual or threatened death, sexual violence or serious injury to perceive and experience an event as traumatic. 

That is why the term "psychological trauma" has been used in the more recent years to define any kind of experience where one has felt they were in danger, physically or emotionally, leaving lasting negative affects on the individuals' mental, physical, social or emotional wellbeing (SAMSHA, 2012). 

When discussing psychological trauma, it is important to clarify the two different kind of childhood trauma. Trauma of Acts of Commission, which leave the person feeling terrified and helpless in the face of fear.These include verbal, physical or sexual abuse that cause harm or even pose a threat to harm.

"But I've never been beaten or yelled at in a way that I felt scared" says the wise, insightful client as she references a recent article she read on trauma.  I had a beautiful home, siblings, weekends with my extended family and a good group of friends. And I was lucky enough to have a boyfriend by my side for years." And then her voice trails off into a whisper. "But something didn't feel right on the inside, I always felt like something was off. I doubted myself. My boyfriend liked me when I didn't voice my opinions as much. And for some reason I did not behave perfectly enough to get my parents to give me the attention, I'm realizing now, I really needed".

"I think I was starving inside, but no one knew. Not even me."

The wounds carried here are present with the sadness in her eyes and the felt sense of her sullen heart. She has been slowly learning about different kinds of wounds, losses, and is learning new ways to care for herself, now as an adult.

Here the client speaks of the quieter trauma, the Trauma of Omission, which refers to the lack of receiving what one needs in order to develop properly. These wounds fall under the umbrella of neglect, where the individual was not provided their basic emotional needs of warmth, care, love and nurture. This may include inadequate supervision, attention or emotional attunement from their caregivers. There may have also been inadequate food, shelter, education and lack of protection from potential harm, or exposure to dangerous environments.  

It's important to give credence to the fact that trauma is based solely on the individuals' experience

One person may visit her grandfather who has a terrible temper and feel ok afterwards, yet her good friend who came along for the visit may feel shaken up for a while. SAMSHA, which stands for Substance Abuse and Mental Health Services Administration, validates this point by stating that a particular event may be experienced as traumatic for one individual and not for another, proving that trauma is a completely subjective experience (SAMSHA, 2012).

Dr. Judith Lewis Herman explains trauma in terms of lasting symptoms that leave footprints on the survivor. Herman, a professor of Clinical Psychiatry at Harvard University Medical School and a pioneer in the study of PTSD and sexual abuse in women and children, is known for her development of the diagnosis of Complex PTSD.  She describes Complex PTSD as loss of self-integrity, disturbances in the ability to relate to and be intimate with others and emotion dysregulation (Herman 1992). 

 "My moods often feel like a scary roller coaster, I find myself doing things that are not aligned with my values when I feel pressure from others, and I haven't let anyone get close to me in many years. I get a panicky feeling on the inside when someone expresses interest in me.... Are these symptoms related to trauma? I thought that people like me don't get that." Sitting across me, she sheds a tear, breaths heavily and then looks across the room. She reminds herself of the grounding exercises we've been practicing. Slowly, she puts one hand on her chest, the other on her belly, slows her breath down as she grounds herself. It seems as though her prefrontal cortex is coming back online, as she shifts her focus, posture and paces her breath. There's a gentle yet powerful, almost fierce power that seems to have awakened within. 

"Does this mean I can get better though?" The heavy boulder that has been seated on her shoulders during this conversation seem to slowly roll off. 

 We notice the somatic shifts as her mind and body exchange thoughts, feelings and ideas. We tread on the new waters that are birthing, those that involve the process of reclaiming ones life. She had begun this powerful, life changing process of beginning to develop an emotional language, providing validation for her inner experiences.

Over the course of treatment she offered healing to parts of herself that were trapped at younger developmental ages, by form of creative expression of stuck feelings through art, music and narrative as she slowly embraced her voice, and her whole self. That was one of the steps towards inner safety, an upward shift that later allowed others in. 

A while passed and one summer day she shows up with a glisten in her eyes, "I can't believe I had enough oxygen in my body" is what she said as she sat down. This was in a session at a later phase of treatment, she had noticed that her hard work was paying off. She had strengthened her ability to regulate her breath, began to see a shift in stance, which mirrored the improved beliefs of self. A far way compared to when she first walked into therapy. 

This is an example of the healing process of clients who have experienced what I call the "silent wound". The wounds that hurt deeply but are not obvious, and the distress experienced comes with a chronic sense of aloneness. These clients often compare their lives to others who have been through horror; "well my experience wasn't so bad compared to ____". Here I look at clients with a heart that is filled with compassion, as I speak with a solidity in my voice, as this message is so necessary to be deeply understood,

"Your trauma, wound or loss is defined by how your mind, body and psyche experienced it. The specifics of the situation are irrelevant. There is no hierarchy of pain. Every traumatic experience is legitimate". 

If you've been struggling and thought that you have no "reason", please be gentle with yourself and send some gentle care to the spots inside that are needing warmth and compassion. You may be a trauma survivor. One who has valid reasons to be hurting. One who can also choose to begin to feel, heal, and empower yourself as you take necessary steps towards inner strength. You can learn to feel comfortable in your own skin. And you most definitely deserve to.

 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC

Substance Abuse and Mental Health Services Administration [SAMHSA], 2012

Herman, J. L. (1992). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. Journal of Traumatic Stress

Esther Goldstein LCSW is psychotherapist and trauma specialist with a private practice in Cedarhurst, NY. Esther specializes in treating anxiety, trauma, and dissociative Disorders. Esther provides trauma informed consultation to therapists committed to improving their trauma-informed practice and attachment focused EMDR consultation to therapist attaining hours towards EMDRIA certification. Esther's Website Is Integrativepsych.co