I have a friend whose mother survived several years in a Nazi concentration camp during her youth. From time to time, I would ask him how his mother (who lived into her 90’s and died some years back) was doing. He would laugh and respond that if he asked her this question she would regularly respond, “as long as no one with a gun is chasing me to try to shoot me, I am fine”. I thought of this the other day after noticing the essay in the Journal of the American Medical Association discussing the finding that at least in the early months of the COVID 19 pandemic covered by the data, older Americans seem to have fared significantly better than younger ones in terms of their rates of anxiety, depression and trauma/stress related disorders (see: https://jamanetwork.com/journals/jama/fullarticle/2773479).
In fact, in the first several months of the pandemic, the CDC reported that rates of mental health complaints seemed to be inversely connected to age: younger people had the highest rates of problems and the frequency went down with each progressive age group and this finding appears to be consistent across high-income countries. This is true even though older adults were more severely impacted by the physical consequences of COVID19 disease. How do we account for this?
It is certainly possible that younger people have experienced greater impact on and disruption of life circumstances and expectations than those who are older, and it is possible that as a group, older people were less impacted or worried about jobs and financial ramifications of the upheaval from the pandemic. It also may be that as people progress in life, resulting from experiences-both good and bad-they develop greater perspective and resilience. The larger your “denominator” of life experiences, the smaller impact each individual “numerator” of event or experience has on your total state of being. My friend’s mother was unquestionably traumatized and scarred in many ways by her early experiences, but it also left her with an uncommonly large denominator of life experiences which put subsequent challenges into a completely different light. She was both chronically mildly anxious and hypervigilant and at the same time incredibly unperturbable and stolid.
In their essay, Vahia, Jeste and Reynolds discuss a factor they believe contributes to the resilience of older adults they call “wisdom”. They suggest wisdom is an amalgamation of “empathy, compassion, emotional regulation, ability to self-reflect, decisiveness while accepting uncertainty and diversity of perspectives, social advising, and spirituality.” These qualities seem tied to life experience and the broadening of perspective that can come with successful aging. It is interesting to note that these same qualities may underlie the unexpected finding that as a whole, older people report being happier than younger people (see: https://time.com/4464811/aging-happiness-stress-anxiety-depression/).
What’s wrong with “trauma informed” therapy?
Psychology and psychotherapy go through periodic phases and fashions. After many years of dominance by psychoanalytic thinking, with the advent of SSRI’s and the “biological revolution” along with the manualized and symptom focused approaches of CBT type talk treatments, psychology and psychiatry became increasingly ahistorical. What I mean by this is that the treatments were focused on removing symptoms and working on how people are feeling and functioning in the present rather than placing and understanding their experiences, feelings and relationships in a historical context. But as things often do, this approach went too far, and people soon realized that you cannot understand feelings and distress without some personal historical investigation and understanding. “Trauma informed” therapy appears to have emerged as a result of the realization that you cannot treat people (and especially young people) without understanding their experiences and especially the experiences that may have influenced their emotional pain. So what is the problem?
Of course, everyone’s painful experiences matter and will impact how they experience the world, relate to others, and feel. But when we use this terminology, we appear to be suggesting that our feelings and behaviors are the result of, or even driven-uniquely by our traumatic or painful experiences. But aren’t we more than the sum total of our pain-even when depressed or anxious? As we examine our painful or challenging life experiences it is essential to also explore how we adapted, how we met the challenges, what approaches worked, and which did not. We also need to examine how we’ve been supported and nourished and succeeded in the world. We risk with our “trauma focus”, communicating to people that they are the passive victim of their circumstances-which may be true to a large extent in many situations-but we also need to always be examining the strengths and resilience-building elements mentioned above. Those qualities associated with wisdom can be fostered, nurtured, and built and I would argue that this is a core element of any therapeutic effort no matter what school of thought. This core concern is likely to be lost when we focus too keenly on the trauma and its negative impact.
As a historical side note, it is worth observing that when Freud began to develop his understanding of mental illness, his first theory was that neurotic symptoms resulted from early traumatic experiences that had been repressed, but as he continued his work, he came to recognize that psychology and development were way more complex than this-and he expanded his thinking beyond the trauma lens. We have come full circle back to Freud’s early approach, but we need to be broader and more open-minded in our understanding of our patients’ and our own psychology and histories. Acknowledging and understanding trauma when it has occurred, is essential, but it is absolutely not our whole life story.
We need to help our patients (and try ourselves)-earlier in their lives-to develop the wisdom, perspective, empathy, and compassion that can come with aging and that make life easier and more fulfilling. This is at the core of the therapeutic enterprise and we should be careful not to lose it because of too narrow a focus.