Reflections on Trauma – interview with a clinical psychologist

with Rovshan Suleymanov, Clinical Psychologist. Interview by Seymur Kazimov .

What is psychological trauma, and how is it different from the concept of trauma that people use in everyday language?

In everyday conversation, the word “trauma” is often used to describe the experiencing of unpleasant events or feelings. Sometimes instead of saying, “I’m sad, I’m afraid, I feel guilty, I’m embarrassed, I’m hurt, I’m upset, I’m confused,” etc. we say “I’m traumatised”, but all these emotions are natural human experiences. By using the word “trauma”, we sometimes abnormalize healthy human experiences, and this itself can be a cause of distress.

Life is full of unpleasant experiences. But much of the stress related with such unpleasant experiences is put behind us when the experience is over. Just as we digest our food, so our brains ‘digest’ the stress of unpleasant events that we face in our daily lives, and the event remains in the past for us even if we remember it from time to time. However, some food can be difficult to digest, and there are experiences that undermine a person’s sense of security, and the body is unable to cope with or ‘digest’ the stress. Although the incident is over, the person retains the feeling that something could happen at any moment. Just as heavy food is not digested by the body, our psyche cannot digest the stress we experience as a result of a severe traumatic event. You could describe psychological trauma as the injury to our minds and bodies as a result of changes in our brains over a period of stress caused by severe traumatic events.

This phenomenon is expressed not only on the individual level but also on the societal level. Often traumas of the past get stuck in the public consciousness and influence the way in which society functions and behaves, shaping how a society builds their lives and models of interaction internally and externally. On this level we refer to this phenomenon as collective trauma.

What are the trauma reactions? How does trauma affect a person’s day to day life, their relationships, self-esteem, their perception of others and their worldview?

The primitive-survival part of our brain decides for us what is dangerous and what is safe. In psychological trauma, this part of the brain is disrupted and constantly sends false signals about persistent danger. It’s as if the fire department is constantly receiving false alarms and sending out its fire engines with lights flashing and sirens blaring at the slightest signal. Just as the fire department’s work is disrupted by constant false alarms, so the normal functioning of the individual is disrupted due to a constant feeling of danger.  It becomes a lot harder for a person to communicate, to regulate their feelings, to learn, or to look at events from a different perspective. Shock, denial, loss of self-confidence and confidence in others, fear, confusion, difficulty concentrating, isolation, sadness, anger, shame, and guilt – these are all reactions associated with psychological trauma. Such reactions may occur both at the time of the traumatic event and also after some time has passed.

What kind of events are traumatic? How does one’s outlook on such events change over time, and what factors make an event traumatic for a person?

A traumatic event is an event that poses a threat to the human body and a person’s security. But an event that is traumatic for one may not be traumatic for another and whether an incident is traumatic or not is linked to the person who experienced it. For example, for one in two people who witnessed suicide, the incident may be traumatic – and for the others, not.

So what makes an event traumatic for a particular individual ? There are many factors. One is whether a person feels a sense of helplessness at the time of the incident, i.e. a model of behaviour learned in childhood in reaction to traumatic events. For example, if a child is attacked by a dog but their parent picks them up and make them feel safe, then that unpleasant experience is over, as the child’s sense of security remains intact.

Another factor has to do with what meaning a person gives to an incident event, and how prepared a person is for different types of events. There are other factors related to ones’ past, such as how reliable the bond between a child and their primary carer was; whether they experienced other traumatic events or psychological disorders; what coping mechanisms a person has; their age and temperament (a person’s tendency towards a certain way of thinking, feeling and behaviour due to biological differences), and so on. All humans have strong coping mechanisms and trauma can often be a spur for growth and development, if the person receives the right kind of assistance, and therefore a person experiencing trauma should not be seen as weak.  

All humans have strong coping mechanisms and trauma can often be a spur for growth and development, if the person receives the right kind of assistance…  

It is not necessary to have experienced a traumatic event personally to be traumatised by it. There are some incidents that can been traumatic for most people. For example, if they witness the torture, murder, rape, or other forms of violence of a loved one. This is referred to as secondary trauma.

The term psychological trauma gained popularity after the two world wars and the Vietnam War. If traumatic events were previously considered to be outside the normal everyday life experiences, i.e. such as war, terrorism, natural disasters, etc., this changed over time. The US civil rights movement for social justice and an end to racial discrimination of the 1950s and 1960s, and the feminist movement of the 1980s altered our view of trauma. These movements showed that racial discrimination and violence against children and women were a part of daily life, and that the number of people experiencing psychological trauma was far greater than previously estimated.

The subject of psychological trauma was popularised in Azerbaijan after to the first and second Karabakh Wars. Furthermore, in peace time, the efforts of feminists in Azerbaijan to highlight domestic violence, and the sharing of information on social networks about violence against children in homes, schools, and kindergartens, have increased our sensitivity to the topic of trauma.

What is Post-Traumatic Stress Disorder, and what are the most effective treatments?

Psychological trauma is not the same as psychological disorder, but there are also psychological disorders that are associated with trauma. A severe psychological trauma strips a person of their sense of self-control and keeps them in a state of fear, forcing them to feel helpless, ashamed, weak, guilty, angry and confused. Sometimes a traumatised person becomes distanced both from themselves and their surroundings. Even their own body can feel strange to them, as well as objects around them and time itself.  

One such mental disorder associated with trauma which is often talked about is Post Traumatic Stress Disorder (PTSD). PTSD arises when a person has experienced or witnessed traumatic events such as natural disasters, serious accidents, war, terrorist attacks, rape, etc. However, most people do not develop PTSD after such events. An individual with PTSD often cannot rid themselves of negative memories and thoughts of a traumatic event they experienced. They try to avoid these thoughts and memories, as well as places, objects, and people who remind them of the event. They experience negative mood changes, and often have an unrealistic understanding of the causes and effects of a traumatic incident and blame themselves. They feel a constant sense of fear, horror, anger, guilt and shame, and are unable to take enjoyment in things they previously enjoyed, instead isolating themselves from other people. They can be easily irritated by any noise or sound and can have an extreme reaction to incidents that may seem minor to others. Trauma becomes a heavy burden.

Time passes but does not heal all the wounds. Yet what a person does with that time can determine whether their condition improves. Psychotherapy is often the best treatment for individuals with PTSD. By psychotherapy we mean talking therapies of different types. In cases of PTSD, the task of psychotherapy is to help a person turn their ‘non-digested’ past into the actual past.

One of the most effective psychotherapies in this field is Prolonged Exposure Therapy (PE). Individuals with PTSD often feel threatened even when there is no direct danger present. If someone who perceives an objectively safe situation as a threat constantly runs away from such situations (e.g. driving out thoughts and images in their minds, avoiding places, objects and people associated with the ‘threat’) then they are unable to find out if the situation actually poses a threat, and therefore their pathological fear continues. Prolonged Exposure Therapy encourages a person with PTSD to deal with this by spending some time in such situations and through this process comes to realise that the situation they fear is actually safe.

How do misconceptions and stigma about trauma affect people’s desire to seek treatment? Is quality psychological help universally available to those who experienced trauma? And what are the main challenges faced by those seeking help for trauma?

A person suffering from psychological trauma can feel powerless, and the cry for “Help!” only confirms that powerlessness and can prevent them from seeking help. Shame can also be a major barrier to seeking help, especially in cases of trauma as a result of intimate violence such as sexual assault.  

The biggest challenge in Azerbaijan is that quality psychological assistance is not available to people. A lot has been written and said about the psychological trauma of thousands of people who have lived through the trials of war. Most of them did not receive quality psychological assistance but instead sat down for a ‘chat’ with a psychologist. Working with trauma and providing psychological support is becoming a formality, something measured in numbers but not in terms of quality. But when was quality psychological support really available to the countless, nameless villagers who suffered from the war, or to the mine-victims, the bereaved, or people of different professions who supported the injured?; or to those people living far from the front-line who came under aerial bombing from our opponent  or who lived decades on the front line and on the border with Armenia?

A person suffering from psychological trauma can feel powerless, and the cry for “Help!” only confirms that powerlessness and can prevent them from seeking help.

Governmental and international organisations working in this field can have a positive impact on the lives of individuals, but the occasional press reports of high numbers of people who receive psychological assistance are clearly just to impress. Working with trauma needs different approaches, but it appears that the government is unable to provide such psychological assistance. Of course, it is near impossible to completely eliminate the consequences of the decades-long war, but there is also a shortage of qualified specialists.  The curricula and literature on offer at higher education institutions for the education of such professionals are long out of date. Instead of educating psychologists with critical thinking, university teaching is mainly about drilling ‘absolute truths’ into students’ minds. Azerbaijan has a long way to go to train quality professionals in this area, and the National Strategy for Psychiatric Health of the Republic of Azerbaijan (2011-2015) has not yet been updated which means we do not know what direction this field is developing in. For the development of this field, it is important to seek external assistance, to learn from global experience and introduce different new techniques. It is also important to provide training programs for practitioners and conduct practical work at the community level, and to learn from practices that put the emphasis on quality rather than quantity – which as experience shows, is the only way to deliver quantitative indicators.  

Rovshan Suleymanov, Clinical Psychologist, interviewed by Seymur Kazimov.

Photo: Larissa Sotieva

This interview is part of Indie Peace’s initiative on Collective Trauma, supported by the UK Government. The views expressed in the interview are the sole responsibility of Indie Peace and do not necessarily reflect the views of the UK government.