The Mental Health Project is a Seattle Times initiative focused on covering mental and behavioral health issues. It is funded by Ballmer Group, a national organization focused on economic mobility for children and families. The Seattle Times maintains editorial control over work produced by this team.

Trauma is to the human mind and spirit what a physical wound is to the flesh. 

Over the course of the COVID-19 pandemic, 14,277 people have died in Washington due to the virus. An estimated 140,000 children in the U.S. now are coping with the loss of a parent or caregiver. 

Even outside the pandemic, events such as natural disasters, sexual assault, war and childhood abuse mean millions of people have experienced some form of trauma in their lifetimes. Though more than half of people who experience a traumatic event go on to recover naturally, the other half deal with persistent symptoms that affect their daily living. 

While emotional and psychological trauma is largely invisible to the eye, the tangible effects ripple through the physical body.  

Symptoms can include changes in sleeping and eating, flashbacks or nightmares, panic attacks, dissociation or numbness, hypervigilance and irritability. When these symptoms last more than a month, it can lead to a diagnosis of post-traumatic stress disorder. PTSD often overlaps with other illnesses, including anxiety or depression.

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“Around half — sometimes more — of our people who meet PTSD [diagnosis] will also meet a diagnosis for depression,” said Michele Bedard-Gillligan, a researcher and clinical psychologist from the University of Washington School of Medicine. 

How trauma affects a person largely depends on how they adapt and process the traumatic experience, and the social support they have. 

Trauma survivors who have healthy, positive relationships have a better chance of recovery, explained Bedard-Gillligan because it “makes it clear to them that it’s not their fault … that there are people they can trust, even though this bad thing happened.” 

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What we know about trauma

For people who experience persistent, chronic traumatic events such as growing up with an abusive parent, the trauma is considered complex, or C-PTSD.

Secondary trauma or vicarious trauma occurs among people who do not experience the trauma directly, but often support others or witness it secondarily, like social workers, first responders, nurses, and other public service roles. 

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Intergenerational trauma refers to the descendants of people who experienced trauma firsthand, like the children of Holocaust survivors or formerly enslaved people. While the field is relatively young, it’s led to a new study of epigenetics examining how traumatic events ripple out and physically alter gene expressions. 

In one oft-cited study from 2013 published in the journal Nature, researchers tested the effects of intergenerational trauma by negatively conditioning male mice to the scent of acetophenone (a sweet, almond-like scent). Researchers then found that the offspring of those mice were jumpy or nervous when exposed to that same scent — and so were the grandpups, or third-generation mice. 

To ensure this was not a learned trait shared from parent to offspring, the offspring mice were separated and raised by other, nonrelated mice. What’s more, when researchers dissected the brains of the offspring, they found more neurons or brain cells that detect the acetophenone than in the brains of control mice. 

The research has a long way to go, but on a psychological level, mental health professionals share anecdotal stories that children of people who faced trauma will often learn and carry on behaviors from their parents long after the event itself.

For example, a child’s sense of trust might be altered “because that’s what their parents say, ‘You can’t trust anybody. No one’s gonna come in to help you,’ ” explained Heidi Montoya, a clinical psychologist in Seattle who has worked with immigrant and refugee communities. “Now this child is having a hard time trusting and a hard time engaging in healthy romantic relationships or even healthy friendships.” 

Those later generations are more likely than the general population to engage in risky behavior or cope using substances like drugs and alcohol — and engaging in that behavior can expose them to future trauma, continuing a cycle. 

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Trauma then and now 

“I actually think of trauma as a relatively recent common construct or concept that’s been parsed from human suffering at large,” said Dave Walker, a psychologist in Kitsap County who is a Missouri Cherokee descendant. 

Walker, a self-described critic of mainstream psychology, points out that the field for too long identified problems of the individual as opposed to connecting it to systemic, societal failures. 

And while trauma is as old as time, the study of it in fields such as psychology, medicine, neuroscience and psychiatry is still evolving. PTSD, for example, was not added to the Diagnostic and Statistical Manual of Mental Disorders until 1980. 

It only became a formal diagnosis after much study and advocacy work from soldiers, families and researchers. 

Known as “shell shock” during WWI and then “post-Vietnam syndrome,” similar symptoms of PTSD also showed up in survivors of assault (formerly called “rape trauma syndrome”), and among children who grew up in abusive households. 

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More recently, trauma-informed care has become a rallying cry in education, mental and behavioral health care, and other fields. This is a departure from traditional care that focuses on what’s wrong with a patient, as opposed to what happened to a person. 

Mental health professionals such as Walker and Montoya also point out that even in situations where people seek out counseling, access to mental health care remains the biggest barrier. Having the proper insurance, finding a therapist with the right fit, expertise and background, and the time and resources like child care, all need to connect before some people finally get therapy. 

“When [people] have so many other things competing for their attention to survive, mental health is gonna take the back seat,” said Montoya. 

Healing and interventions 

Trauma is not permanent. 

Like a physical wound, emotional ones also will heal with time, care and the right tools. If recovery is taking longer than a couple of months or you find you need or want care, evidence-based treatments are available. 

Bedard-Gillligan’s work at the UW focuses on interventions following traumatic events. She uses cognitive behavioral therapy, which promotes solutions to negative learned patterns or core beliefs, and exposure therapy, in which individuals talk and confront difficult matters in their environment.  

For example, for someone who survived a sexual assault, “Now their house itself feels dangerous, even though it’s not actually the house,” said Bedard-Gillligan. “It’s what happened in the house.” 

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She’s also adapted culturally relevant interventions for Native American and Indigenous communities, leveraging their own storytelling tools. 

Walker encourages people who survived trauma to engage in self-expression like poetry, writing or singing, and exercise that helps them get in touch with their breath, including yoga or meditation if it feels safe. 

Traditional psychiatric medication for anxiety and depression might be useful. Psychedelics or entheogens such as MDMA or psilocybin are being explored as treatments for patients with PTSD and anxiety.

Vitally, more communities are having discussions about mental health, trauma and well-being. Stigma is still a problem, but people and communities will always have the ability to heal.   

For Bedard-Gillligan that is the light at the end of the tunnel.

“The thing that gives me hope is seeing people get better, seeing people who’ve really just lived through some of the most horrific things that any of us can imagine — they recover,” she said.