“Queer Therapy is Trauma Therapy”.

by | Nov 21, 2023 | Therapy, Queer, Mental Health, Wellness

Content Warning: This blog post discusses trauma and makes reference to experiences that may be triggering or upsetting, including oppression and threats of violence against queer people.

To live as a queer person in this world is an act of resistance. It takes courage to stand up in the face of the forces that would push us down. It takes prudence to recognize which battles are worth fighting. It takes compassion to seek out community and build coalition with others who have been excluded. It takes creativity and commitment to build identities and families. There is much to be proud of and to celebrate in our unrelenting queerness.

At the same time, even wrapped in our big queer joy, to engage in acts of resistance requires that there be something that we resist against. That ‘something’ takes its toll.

I would guess that no one who has the experience of existing as a queer person in this world needs me to name the various forms of pain that so many of us regularly face. We’ve all lived them. My goal here is to consider what our healing might look like. To understand this healing, we need to understand trauma. And to understand our processes of healing as queer people, we need to recognize the ways that we face off with trauma every day.

What is trauma?

The word ‘trauma’ has seen an explosion of use in recent years. It takes very little searching to find a dragon’s hoard of social media posts talking about what everyday behaviors may be trauma responses, what healthy self-love can look like, and how to set appropriate boundaries with those who have harmed us. The language of trauma and trauma treatment has permeated everyday discourse. Strategies for coping with the impacts of trauma are passed around in videos and memes. Much of this information is helpful, however, as with all things on the internet, the quality of what is available can vary. It can leave us wondering, where do I even start?

It can be helpful to first get clear on our language, and notice at least two different ways that the word ‘trauma’ can be used – a casual and a technical sense. Both uses are legitimate, but we risk confusing the conversation if we aren’t clear which sense we are using.

In a more casual use of the word, ‘trauma’ can refer to any difficult or painful experience that makes a lasting impression on us. Many things are traumatic in this sense. Getting into an argument with a friend can leave us upset and feeling strong emotions for a while. We may feel those emotions come up again when we run into that friend. However, just as not all strong sadness is clinical depression, not all painful and impactful experiences are clinical trauma.

In the technical sense, a psychological trauma is any experience that calibrates the danger sensors in our brain to be extra sensitive to the possibility of threat.1 The safety systems in our brain are constantly scanning for signs of safety and threat. When signs of safety are present, our safety center takes that information and puts it away in our archive, where it gets stored as long-term memories.

When the brain’s safety center detects threat, it responds differently. It doesn’t put the information about the threat aside to be filed as a long-term memory. Instead, our brain holds onto that experience while it turns on our internal alarm, which switches us into survival mode, commonly called “fight-or-flight”. Fight-or-flight mode is a collection of physiological, emotional, mental, and behavioral patterns that are geared toward surviving an immediate, active threat.  Once that threat is either resolved (“fight”) or escaped (“flight”), then our brain turns off that alarm and moved the experience that triggered fight or flight mode to the archive, where it gets stored as a long-term memory like any other.

This pattern of activation and deactivation of fight-or-flight mode happens to all of us, all day every day. If you are driving down the street and someone suddenly cuts you off, you may tense up, grip the wheel, and slam your foot on the brake. If there is no collision, all else being equal, you are able to keep driving, take a breath, and relax your muscles. Typically, any angry thoughts you have toward the other driver will pass, and you will be able to go on about your day. Fight or flight mode activated, and once the danger was over, it was deactivated and we were able to go back to our normal mode of functioning.

What makes an experience traumatic is that, for whatever reason, the last part of this sequence doesn’t happen. Our brains don’t recognize any way to resolve or avoid the threat. As a consequence, fight-or-flight mode stays on, or, at the very least, we become very sensitive to reminders of the kind of situation that activated our survival mode in the first place. Clinically, these reminders that activate our fight-or-flight response are called ‘triggers’.

How Do Our Brains Respond to Trauma?

There are five main responses to a traumatic event. While these responses can be problematic and get in the way of our ability to live and function when we are not in danger, they make a lot of sense and can be highly functional in situations where we are facing a threat.

The first is that the experience never gets put away in the brain’s archive as a long-term memory. The experience stays active. In a very literal sense, the safety center of our brain that is holding onto the traumatic event does not recognize that the original event has ended. This response can be important for survival. If we are in danger, it is important to keep ourselves physically prepared to respond to danger, and storing the experience as a long-term memory turns off that state of preparedness. As a consequence, people who have experienced trauma often report having poor or inconsistent memories of the traumatic event or the period of life where they experienced the trauma. This is because the usual process of storing the experience as a memory is disrupted.

Second, trauma can lead to re-experiencing. This response can come in many forms, including flashbacks, nightmares, or physical and emotional responsiveness to triggers. Re-experiencing occurs because the brain is keeping the original experience in an active state, and does not recognize that it has ended. A trauma memory is more of a re-living of the even than a recollection of it.

Third, people who have experienced trauma can be hypervigilant, always on guard and sensitive to signs of danger. Again, this makes sense from a survival perspective. If there is a threat nearby, being alert to it helps with survival.

Fourth, trauma leads to avoidance behavior. People who have experienced trauma will often avoid people, places, and things that are associated with the threat. Avoiding threats and dangers has clear survival value. In addition to external reminders, trauma can lead to avoidance of internal reminders of the threat. This can sometimes look like denial, numbing, or “checking-out” mentally. It can also look like engaging in behaviors that produce the numbing effect, which could include substance use or disordered eating.

Finally, trauma can lead to a significant increase in “negative” thoughts and emotions, which can including worry, fear, sadness, or anger. From a survival perspective, it is safer to mistake a safe object as dangerous than it is to mistake a dangerous object as a safe one. If I see a garden hose lying in the grass and avoid it because I mistake it for a venomous snake, there is no harm done. If I see a venomous snake in the grass and approach it because I mistake it for a garden hose, I put myself in danger. Better for my survival to see danger when it’s not there than to see safety when there is danger.

In all of these cases, the impacts of trauma are highly functional in the context of active danger, but can be problematic when we are not actually under threat.

Not Broken, Mis-calibrated

One thing it can be important to keep in mind is that, while trauma and the ways we respond to it can be painful and debilitating, it is not a sign that we are broken.

Imagine a thermostat that is set to turn on the heat in your home every day at 9am. During a season when it is cold in the morning, this setting makes sense. It is a reasonable response to predictably circumstances.

However, if your home were to be moved to a place where the temperature at 9am is already sweltering hot, turning on the heat is no longer functional. And if the thermostat is locked up so you can’t re-adjust its settings, then you have to find ways to cope with the fact that the heat is on when it is already hot.

In this situation, the problem is not that the thermostat is broken. It is doing exactly what it is supposed to be doing – turning on the heat when it is set to do so. The problem is that the settings are mis-calibrated for the current context.

Trauma is like that. The safety system in our brains have learned to “turn on the heat” in ways that make sense in the contexts where we were actually experiencing danger. But when we are no longer in those contexts, the settings are no longer helpful, and can become harmful.

Traumas Big and Small

In learning to recognize trauma, it is important to keep in mind that it can take many forms. The most common examples of trauma are the big bad events. These are specific, discrete events that we can point to and say, “That was a bad thing that happened.” Historically, soldiers experiencing the horrors of war and women’s experiences with domestic abuse and assault have been the paradigm examples of traumatic events.2 These are also the kinds of events that the different editions of the Diagnostic and Statistics Manual have used to define the criteria for Post-traumatic Stress Disorder (PTSD).

However, keep in mind that, psychologically, trauma is defined by the impact of experiences on how our brain processes memory. Any event that our brain experiences as a threat that we do not know how to resolve or escape could lead to some degree of trauma response. And the big bad events are not the only kinds of experiences that produce these impacts. Just as trauma can be a big event, it can also be a continuous experience of small bad events. I sometimes call this the ‘death by a thousand papercuts’ variety of trauma. The repeated and seemingly unavoidable pattern of small wounds build up to the same impact on how our brain detects and responds to potential threats. Much like microaggressions, it can be much harder to point at these smaller experiences and see how they have such a strong effect. This form of trauma can be more insidious because it is harder to see how the many small bad events are traumatic. However, when we pull back and look at the overall pattern that each individual small experience contributes to, we can see the cumulative impact.

In addition, just as trauma can be a bad thing that did happen, it can also be a good thing we needed that didn’t happen. Neglect is just as traumatic as abuse. For example, if parents are repeatedly invalidating or dismissive of their children’s identities or emotional experiences, this can have the cumulative effect of teaching the child’s brain to believe “expressing myself will get me punished by the people who are supposed to care for me.” And, as with the bad things that did happen, good things we needed that didn’t happen can be single major events or a pattern of smaller events.

Trauma in a Queerphobic World

So, what does all of this have to do with being queer? Hopefully by now we have a clear sense of the various ways that our experiences of living in a society defined by cisnormativity, heteronormativity, and compulsory monogamy can create an environment were those of us who do not fit these assumptions are constantly and often unavoidably exposed to potentially traumatic experiences. These experiences, ranging from constant microaggressions to out-right violence, can be overt acts that we experience directly, or they can come more indirectly in the form of the constant barrage anti-queer legislation, policy making, and media.

Social Work researchers Wendy Shaia and David Avruch provide a helpful tool for recognizing and making sense of the kind of traumas that queer people often face: socially-engineered trauma. As they describe them, “socially-engineered traumas (SET) have been defined as traumatic events rooted in the forces of oppression and inequality [. . .]. SET should be contrasted with randomly occurring traumatic events which do not unfold within political contexts such as racial and gender-based oppression and economic inequality.”

Much of the trauma experienced by queer folk is socially-engineered. It is not random individual events, but the rooted in social, political, and economic structures that are designed to hurt queer people. The social nature of queer trauma has at least two important implications for understanding trauma in the context of queer psych.

First, much of the trauma that we experience is the result of oppressive structures around us. This fact means that these traumas are not grounded in something that is wrong with us – they are about something that is wrong with our society. Some names for what is wrong: transphobia, homophobia, bi- and pan-invisibility, and oppressive forces that seek to negate important aspects of our lives and experiences. Recognizing queer trauma as socially-engineered can remind us that how we respond to an unjust world, no matter how unhelpful those responses may be, are not a sign of our brokenness, but of our strength and will to survive in a world that is not always kind.

Second, if we are truly committed to healing as queer people, then we cannot look only at ourselves as individuals, but also must do the work of healing the society that socially engineers our trauma. Indeed, in a world that would reduce us to individuals, building healthy families and communities in many wonderful, creative, and unique forms is itself an act of both resistance and healing.

Queer Therapy Needs to Include Trauma Therapy

As queer folk, many of us live in a society of regular traumatic stress. This lived experience of potentially traumatic threat has its impacts, impacts that can come forth in our mood, ways of thinking, feeling and behaving, sense of ourselves, and our identities. These effects in turn impact our abilities to love and know ourselves, form communities and relationships, foster healthy families, and live full lives of joy.

Given this social context, queer therapy needs to be tuned into trauma and its impacts in order to be its best. And this means looking beyond the therapy room and working to heal our unjust social structures. My hope is that these aspects of healing become more accessible for all of us, both as individuals and as communities. We deserve nothing less than the opportunity to live completely and openly queer.

 

References

  1. There are many great resources on the neurobiology of trauma. One accessible source for a general audience is Perry, B.D. & Winfrey, O. (2021). What happened to you? Conversations on trauma, resilience, and healing. Flatiron Books. The United States’ Substance Abuse and Mental Health Service Administration document, SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach, is a free and helpful resource aimed at service providers and administrators.
  2. The classic introduction to this history can be found in Herman, J. (1997). Trauma & recovery: The aftermath of violence – from domestic abuse to political terror. Basic Books.
  3. Avruch, D.O. & Shaia, W.E. (2022) Macro MI: Using Motivational Interviewing to Address Socially-engineered Trauma, Journal of Progressive Human Services, 33:2, 176-204. Quote is from pages 178-9, italics in the original.

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