Extreme psychological distress is a normal response to extreme events – here’s why it’s unhelpful to medicalise distress

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My early TV viewing preferences were perhaps a clue that I’d make a career researching psychological trauma. I spent my youth watching the American war comedy drama M*A*S*H*, which followed a team of doctors and support staff stationed at the 4077th Mobile Army Surgical Hospital in Uijeongbu, South Korea, during the Korean war. In my 20s, I became a fan of the Chicago-based emergency room drama ER.

In these TV series, reflecting the eras in which they were set, “trauma” referred only to devastating physical injuries. The term has since moved into common parlance to describe the psychology of extreme events, as well as physical injury. But it retains a medical connotation that I think is unhelpful.

My research radically rethinks psychological trauma. Instead of trying to specify what is “wrong” with those adversely affected by psychological trauma, I focus on shared characteristics that place some, and not others, at risk of trauma. These shared attributes, known as social identities, are really important to recovery from trauma too.

Major life-changing events are common. And the most common response to traumatic events is psychological resilience: people bounce back. More than 90% of people who experience direct traumatic events such as war, sexual assault, road accidents and natural disasters do not have adverse psychological outcomes in the long term. For the most part, people manage these events and move forward.

But while most people show resilience, traumatic experiences can and often do still change them, creating new identities. For example, war and bereavement can create refugees, orphans and widows. But trauma can also make existing identities really important.

The continuing case of the UK subpostmasters wrongly convicted of financial mismanagement is a good example. Their response, led by the Justice for Subpostmasters’ Alliance, has been built both on their occupational identity as subpostmasters and the increased sense of social connection resulting from the injustice they endured.

Risk and resilience

A growing body of research has highlighted that there are many responses to psychological trauma beyond the negative personal consequences of trauma articulated within health and medicine. Some post-traumatic responses are more positive than negative, some are more social and political than psychological.

Psychological trauma is a complex personal, social and political phenomenon. Life circumstances are key to both the risk of traumatic experience and recovery in children and adults.

I worked as part of a team researching Nepal after major earthquakes there in 2015. Our findings showed that people’s social status – linked to the historical caste system – determined the amount of psychological trauma they experienced and also the extent of community belonging they felt in the aftermath of the quakes. Together, these attributes explained who showed symptoms of post-traumatic stress.

Clinical models of psychological trauma seek to treat people individually using medicine and therapy. This can result in the health benefits of being part of a community or social group being overlooked.

The pandemic has taught us that the ability to pull together is crucial to both physical and psychological health in difficult times. In the same way, individual resilience often depends on social cohesion during threatening times.

Even after the most difficult and life-threatening experiences, many people report experiencing “post-traumatic growth”, which is often described as a renewed appreciation and interest in life. Our research indicates that identity- and group-based connections are crucial to these more positive outcomes.

People can also show collective post-traumatic growth. In such cases, survivors build a collective understanding of how traumatic experiences are tied to their identities. This not only enables connections between those affected, as in the case of the UK subpostmasters, but also facilitates pushback against powerful systems that may have caused the problem to begin with and that continue to make a bad situation worse.

Resilience is political

The least powerful in any society – the poor, ethnic minorities, women, the disabled, the very young and old – are those disproportionately affected by psychological trauma. These groups can struggle to have their voices heard, so banding together to speak as one can allow the effective pursuit of justice and positive social change. This is often articulated by survivors as the “best medicine”.

Traumatic experiences, rather than resulting in passivity and victimhood, can consolidate a sense of collective self and collective agency – our sense of who we are and what we can achieve. Solidarity among those affected by trauma can reinforce existing social connections and prompt collective action with political consequences.

We have seen this process take shape during the #MeToo and #Blacklivesmatter campaigns. This type of identity-based solidarity is also at the heart of those now seeking to hold those in power to account for the UK Post Office scandal.

But why, then, is the use of a medical lens for psychological trauma so persistent? Certainly, there is a major health toll in terms of disability cost globally for a small but significant minority of people affected by trauma. This explains some of the reasons we continue to use a medical lens.

As a viewer watching both ER and M*A*S*H* I engaged and admired the health professionals and followed their stories week to week. The dramatic focus was rarely on the victims. Being seen to help is a winning response. But it takes our gaze away from preventing and protecting those vulnerable to trauma. This should be our focus.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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Orla Muldoon receives funding from European Research Council (agreement 884927).