Reflections on the Human Inability to Understand the Effects of Trauma

Regarding my experience assessing and counselling people who have been in motor vehicle accidents, perhaps the first thing to say is that the ones I see have not sustained "life threatening" injuries, but have been in accidents ranging from minor fender bumpers to ones serious enough to leave them unable to perform their daily activities including duties at work.

Those clients having the most difficulty are those with incessant headaches and related intellectual impairments. Sometimes a minor closed head injury and concussion to the brain is documented in reports. In other cases, however, no such injury is evident. Nevertheless the person is suffering headaches and, for instance, is unable to maintain mental focus on a task such as reading. It is not only that their pain focus leaves them unable to pay attention to other things or that they have become too anxious and depressed to concentrate, but that mental confusion and disorientation persist.

Physicians, lawyers, and insurance adjustors too readily attribute these impairments to previous psychological problems, particularly if the tests for physical injury reveal nothing. The implication is that a well functioning person without an identifiable head injury would not have these intellectual difficulties, and that therefore something must have already been mentally wrong with the client to predispose him or her to acquire these unexpected, lingering symptoms. This reasoning is not entirely fair, and is not of any therapeutic value to the person who is struggling with headaches and intellectual deficits and is therefore emotionally distraught.

What seems helpful to these unfortunate clients is the more holistic idea that the collision led to shock and trauma that has affected their selfhood deeply, that is, profoundly affected them in the physical, psychological and spiritual dimensions of their being. The result is a kind of post-traumatic stress, but the condition of these clients requires a much broader concept that goes beyond notions such as flashbacks, emotional numbness, and irritability. A way to understand these clients is to realize that the trauma of the accident can include a disturbance of self identity and personal beliefs brought on by a sudden loss of who they were and what they did. Thus what physically speaking was not diagnosed as "life-threatening" actually was.

Medical science does not have a good diagnostic category for these individuals. The closest are perhaps post-traumatic fibromyalgia and chronic fatigue syndrome. Likely the people that these categories include are diverse medical groups with similar presenting problems, some of whom can point to an identifiable trauma event/injury that precipitated their symptoms. In other words, medical diagnosis in this area of the impact of trauma on a person's life is currently not much more advanced that the eighteenth century diagnoses in which many disorders among men were called "hypochondriasis" and many ones among women were called "hysteria." What is clear is that before the traumatic event, the person was functioning reasonably well and after the accident he or she does not recover within "the usual" expected time such as six to eight weeks.

A good percentage of my psychological practice consists of people in motor vehicle accidents who are not recovering as expected. In most cases a whiplash injury occurred. Exactly what is going on physically seems to be something that few medical people are understanding, which is not surprising given current diagnostic confusion. What also is not surprising, to me at least, is that the injury does not show up on x-rays, CAT scans and MRI's. The psychophysical reaction to the motor vehicle accident instead appears as the headaches and cognitive deficits already mentioned, plus fatigue, depression, poor sleep, and chronic pain to name the most common problems. Also, there is emotional instability and the inability to regulate affect as is common with post traumatic stress in general, plus whatever corresponding dysfunction is occurring biochemically and physiologically including neurophysiologically. Prescription drugs aimed at knocking out the symptoms have their place as they can help the person function. The problem, however, is that these drugs do not promote systemic, psychophysical recovery of person, and might actually impede it.