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Physical and Emotional Trauma

Jamie Marich, Ph.D., LPCC-S, LICDC-CS, RMT, edited by C. E. Zupanick, Psy.D.

What are the similarities and differences between physical and emotional trauma?

First, let's consider everything that your experiences have taught you about physical wounds and how they heal. Physical and emotional wounds share many similar characteristics:

body image1. Both large and small wounds can result in long-term, harmful consequences, particularly when left unattended.

2. The symptoms of unhealed or poorly healed wounds may be incorrectly attributed to other causes. The cause of these symptoms may not be readily recognized as resulting from a past injury or wound, making diagnosis and treatment more difficult.

3. Wounds are less likely to result in lasting harm when they are promptly addressed. However, some internal wounds may not be immediately evident and therefore prompt attention is not always possible.

4. Wounds may be quick and instantaneous but the healing process is not. In order to repair or heal wounds, some treatments may be initially painful or uncomfortable.

5. Healing and restoration may require adaptation to the injury or wound. In cases where permanent damage occurred, healing and restoration may require the use of assistive devices and/or adaptive coping techniques in order to function in an optimal manner.

6. People respond to injury differently.

7. Our bodies and minds are biologically designed for healing, adaption, and recovery. However, this process is different for each person.

Let's discuss these similarities in more detail:

Wounds come in a variety of shapes and sizes, resulting from various causes. While some wounds are more serious than others, wounds require some form of care in order to heal. A gunshot wound will necessitate a trip to the hospital. In fact, it may be fatal if proper care is not administered immediately. In contrast, a scrape may only need some basic first aid and a bandage. If a gunshot wound receives immediate treatment, followed by rehabilitation, the gunshot wound survivor may be well on the way to health. Meanwhile, failing to attend to a small scrape can result in serious and even fatal consequences. Even small wounds can quickly become infected or reinjured without adequate care. The same is true of emotional wounds. Even extreme forms of emotional trauma can be healed with proper care. Likewise, less extreme wounds can become severe when left untended and ignored.

Wounds can happen in an instant but healing is certainly not instantaneous, nor painless. Yet if conditions are right for healing, a person's health and well-being can be fully restored. This restoration may involve some adaptation to the injury. For instance, some wounds might require the use of assistive devices such as wheelchairs, or canes. Nonetheless, people with wheelchairs and canes can certainly lead full and rewarding lives. While wheelchairs and canes can provide evidence of trauma, they do not define the person using these assistive devices. The same is true of emotional wounds. Healing is not instantaneous and the therapeutic process is often a painful one before reaching peace and acceptance. Some people may need to develop some specific techniques to help them cope, and these techniques are analogous to an assistive device like a wheelchair. Some of these types of techniques will be discussed in the Treatment Section.

Some people seem to be able to heal from their wounds more easily than others. Perhaps they have access to superior medical care. Perhaps they can more easily arrange the time needed for recuperation and rehabilitation while others do not have this luxury due to the nature of their work and other responsibilities. Sometimes it may be a simple matter of genetics or constitution that enable one person heal more effectively than another. For example, there's no such thing as a 'simple scrape' for a hemophiliac. Sometimes healing is affected by someone's attitude. Consider the different approaches to recovery for someone who believes "I can't" versus someone who believes "I can." These same differences affect people's abilities to heal from emotional trauma.

Likewise, there are similarities between physical and emotional traumas in our responses to them. Many people in modern society attend work and meet their other responsibilities despite the fact they are injured. In fact, we seem to admire this stoic approach. Athletes are encouraged to 'dig deep' or 'push through' painful injuries even when to do so may end their careers. Even ordinary people say things like, "It's just a sprain, it's no big deal." Many cultures embrace this tough-it-out mentality. In cultures that value a powerful work ethic, injuries and sickness are often ignored or minimized. Moreover, it simply isn't feasible to interrupt our daily routine every time we get a bump or a bruise. While there may be some value to a strong work ethic, many of us internalize these tough-it-out scripts too deeply. We subsequently ignore the legitimate warning signs of physical or emotional injury that require our attention.

Unfortunately, some types of injuries can result in permanent damage. In these situations, complete recovery is not biologically realistic. Heather Bowser is the co-founder of Children of Vietnam Health Alliance. Heather was born in 1972 with only one leg and severe deformities in both hands. These injuries were attributed to her father's exposure to the chemical Agent Orange during his Army service in South Vietnam. While Heather's gestational injuries are permanent in the medical sense, her ability to adapt to the reality of her condition is nothing short of exemplary. A successful counselor, business owner, wife, mother, and advocate for victims of Agent Orange exposure and children of Vietnam Veterans, Heather Bowser proves that even with grave, irreversible physical injury, it is possible to live a full and healthy life. That is the power of adaptation and resilience. These same principles apply to emotional wounds. In some extreme cases, the damage to the psyche may be permanent and irreversible. Nonetheless, a person can adapt to this damage and live a rich and rewarding life.

Just as people respond to wounds differently, people also heal differently. Yet if the proper healing conditions are provided, the human body will repair itself, or adapt to changed conditions. We are resilient. This is true of our brains (part of our body). The human brain is hard-wired for healing. The quality of the healing conditions can make all of the difference with both physical and emotional wounds. If a person is given the resources needed for healing (e.g., healthcare, time, social support, validation, proper care, spiritual guidance), emotional wounds can be healed. As with a physical wound, the person may be left with an emotional scar. However, when a scar is given proper attention, the skin surrounding that scar becomes tougher. This offers us a beautiful metaphor for resilience.

As we have seen, there are there direct parallels between physical and emotional wounds, and the healing of those wounds. However, one important difference is that emotional wounds are invisible. With physical injuries, others can see the scar, the missing limb, and the wheelchair. These sorts of visible wounds typically evoke kindness, compassion, validation for the act of heroism it took to survive. However, the emotional wounds that people carry are not visible to others. They can only be known by the telling of the story. Since the story itself is so painful to tell, these wounds often remain invisible, and known only through the unusual array of symptoms that they produce.