Trauma is such an important issue to understand, – it underlies every DSM diagnosis, is a profound risk factor for all kinds of poor physical health, and is the often un-examined context for a huge range of ways people suffer and struggle.

But ‘trauma’ as we usually understand it and think about it can also mask crucial issues, which I’ve explored before in my article Trauma is not everything. A set of scales has been developed called Adverse Childhood Experiences, or ACE’s. It’s a clunky and challenging thing to try and clearly define adversity or trauma, given how contextualised and individual they are. It has limitations and issues. However, as a research tool, ACE’s have been fantastic at bypassing the limitations of the DSM. The linear model of one thing causes one disease/bad outcome keeps all information trapped in tiny silos. The vast landscape of adversity with all the complexity of our responses, adaptations, trade-offs, and suffering is so much broader than that approach.

Most research focuses on a single trauma or risk factor, or a single diagnosis or problem outcome alone. ACE’s allow research on clusters of adversity of all types, and finds they are risk factors for clusters of struggles of all types. Mental health is not like the epidemiology of infectious diseases where a single disease can be traced to a single bacteria or virus. It’s more like studying immune function, exploring why this person contracted the disease when exposed and that person didn’t. The gaps between exposure, colonisation, and infection. Why does this person have staph bacteria causing no problems in their skin, but that person has open wounds  infected with staph?

Vast research studies show important information such as – ACE’s are risks for every DSM diagnosis. Whether someone winds up with an addiction issue, anxiety, ADHD, or an eating disorder, exposure to ACE’s increases risk of struggle and suffering in a wide range of ways.

Another key finding was that adversity compounds. People exposed to multiple ACE’s face much higher risks of challenging and painful outcomes. Many of these outcomes are also risk factors themselves – for example childhood poverty increases the risk for depression in adulthood. But depression is also a risk factor for heart disease. And heart disease is a risk factor for depression, which is a risk factor for poverty. These vicious cycles abound, far outside of the sight of a model designed to explore one issue and one outcome.

This may seem like stating the obvious but that’s only because the outcomes of studies like this have gradually become part of popular culture – commonly accepted wisdom. Back in the 1980’s, it was ‘common wisdom’ that children were much more resilient to trauma than adults. Psychological support would be arranged for adult victims or witnesses of horror but children were assumed to be unaffected. The younger the child, the less the impact. Of course, the reverse is true. Early trauma impacts development in more profound ways than it does to an adult.

This brings into focus a common myth about resilience. Because young children rarely show distress in ways adults expected, they were seen to be coping. Their distress was overlooked, delayed, or misdiagnosed. This remains a common problem. People who ‘appear to be coping’ are often held up as examples of resilience, when the reverse is the case. If ‘coping’ is defined as not appearing overwhelmed or hugely affected, it’s actually associated with worse long term outcomes. Coping has an inverse relationship to resilience. I always think of a story from the incredible author Jackie French about this idea. She was talking about how trees deal with heatwaves and drought. The gums look awful immediately, shedding leaves and even whole limbs. The birch trees on the other hand seem to be coping, fairly unaffected except for a little drooping. But over time, the birch struggle more and more, unable to adapt, and by the end of the bad spell, most have died. The gums had fewer leaves and limbs to keep alive and shut down as much as possible through the bad patch. At the end of it they spring back into life, albeit scarred, and recover well. This is resilience.

In the alternative mental health sector, informed by consumer experiences, it’s been a common refrain to argue that the bio-medical model starts with the question “What’s wrong with you” with all the implied assumptions of personal disorder and brokenness that comes with that. The argument has been that we should instead be asking “What happened to you?” in an attempt to recognise the impact of the environment, the circumstances people are in, and the social determinants of health. It’s a powerful paradigm shift.

But this focus on Trauma can cast a shadow over something even more destructive and nebulous. If you define trauma for a moment as an adverse experience – the presence of something destructive such as a natural disaster, abusive parent, or sexual assault, we often struggle to see trauma when it looks like absence. We call it neglect when parents grossly ignore the physical needs of their children, and poverty when it’s an absence of money and resources, but struggle to even name the losses faced by a child without friends, or with loving parents too unwell or overwhelmed to attend to emotional needs. We don’t have a counterpoint for the words ‘widow’ or ‘orphan’ for when parents lose a child, and we’re still struggling with stigma around issues like infertility.

I am often asked what happened to me, what went wrong for me to have PTSD and DID. People assume there are Traumas that can be neatly summarised and have clear impact. And some can – I can talk about the stress of being stalked by a suicidal classmate who wanted more of the only person he felt understood by, even if that harmed me. But the chronic suffering of loneliness doesn’t fit expectations. As a story it lacks drama, there’s no beginning, middle, and end, no peak point of conflict to tell, no vicarious horror, no real narrative. By comparison to the unspeakable stories of violence and violation, it’s all too speakable but has no real words to convey the depths of pain. It is more likely to cue stigma than sympathy – culturally loneliness is costly to admit to, and within the rooms of mental health professionals it often earns diagnoses that assume you lack social skills or sabotage relationships. Loneliness is not only radically ignored as a source of harm, it’s taken as evidence of personal failure and defects, not of community failure. Many traumas of lack carry this stigma, the assumption that you should have tried harder or that in some way it’s your fault. If you admit to them, you’re more likely to be invalidated than supported.

There are many more losses like these that live in the shadows of the big stories of trauma. They are broken dreams and broken promises and crushed hopes. One reason they are so important is that there’s research suggesting they are even more crucial than ‘things traditionally understood as traumas’ in predicting risks of harm. By which I mean, a child without caring relationships, quality education, or safe predictable environments is at higher risk of harm than a child who experiences other traumas but also has good support. I recall reading a study following up the children who witnessed awful things during Hurricane Katrina. And yes, those who had more intense experiences, witnessing people die or in terrible pain, they were more impacted. But down the track the biggest predictor of resilience had littleto do with the severity of their experiences. It was whether they made friends in their new school. Those with friends were largely free of the chronic symptoms of traumatic stress. Those without friends lacked the social support to protect them and allow them to recover. They were experiencing significant symptoms and distress.

The presence of something bad is less destructive than the absence of good things.

This notion is not yet accepted wisdom. And because it is often misunderstood, it informs a great deal of our conversations about resilience, where people who have suffered major trauma but had great support are held up as examples to people who have struggled without essential resources but have no trauma to point to. A great deal of the time, resilience is simply about access to these resources. The presence of love, compassion, consistency, even among the devastation of chronic multiple traumas, has a profoundly protective impact.

Many of my family and friends are outliers. We have experienced severe trauma but are not addicted to ‘recreational’ drugs, victims of polypharmy, or dead. We are extremely unusual among our peers with similar experiences. People often point to our resilience as if it is a personal characteristic. While it’s true that personal characteristics play a role, there’s a lot of invisible resources and luck that play a larger one. It’s stumbling into a hearing voices group and having access to free social connection that normalised kindness to distressed freaks and outsiders. It’s having someone safe to call at 4am from the police station when you can’t go home. It’s finding a psychologist who works with you through all the missed appointments and panic attacks and ambivalence and stands by you as you find your strength to engage trauma therapy. It’s services that provided access to affordable food, it’s the friend who gave us money that went straight towards therapy, it’s the person who paid for the assessment to access support. It’s the meal on the doorstep and the voice on the phone.

Resilience is about community resources, family resources, friends, programs, money, housing, access. Invisible support. Not what happened to you, but what happened next.

And here lies our power. We may not be able to prevent the bad thing. But trauma comes with a hidden insidious message of powerlessness. And myths of resilience as a personal characteristic isolate and blame those most in need of connection and care. Trauma tells us we are helpless, not only those of us to whom it happens but those who love us. It reminds us we will never be unblemished again, that we cannot heal all the wounds or hide all the scars. It tells us a lie about our inability to protect ourselves and each other. But showing up for people is powerful. When what happens next is love and kindness, people do well. And when we understand the trauma of lack and loss as real and significant, we look at both trauma and resilience differently. We show up for each other differently. We understand that mental health support is access to counselling, but it’s also good housing programs, affordable food, and inclusive schooling. We start rewriting the narrative around trauma and resilience, about the personal characteristics of those who have suffered, and what we owe to each other.