Audio Update: Dr. Heather MacIntosh on ‘Big T’ vs. ‘little t’ trauma

Daily Audio Update: Dr. Heather MacIntosh on ‘Big T’ vs. ‘little t’ trauma
It’s something of a colloquialism, but the distinction between ‘Big T’ and ‘little t’ trauma is one that matters in the current context of COVID-19. Dr. Heather MacIntosh joins us to discuss that distinction.

Dr. Heather MacIntosh on ‘Big T’ vs. ‘little t’ trauma

Heather MacIntosh ‘Big T’ vs. ‘little t’ trauma

In your blog post you make the distinction between ‘Big T’ and ‘little t’. What is that distinction?

It’s a very generic term, it’s a big of a colloquialism, but the idea is that there are things that happen to us in life that are difficult, and can at the time feel traumatic. But they don’t knock us off our socks. So a ‘little t’ trauma would be something like a major life event – the loss of a partner, a big breakup.

But a ‘Big T’ trauma is something that really knocks your socks off. It’s something that causes you to have to stop in your tracks, regroup, and kind of figure out the meaning of life again. Those traumas are things like sexual abuse or sexual violence, domestic violence in the home. Things where your life is put at threat, or you’re witnessing someone else’s life at threat. Where there’s a lot of terror and helplessness.

And so the impacts of those different events are very different long term. And that’s not to say that what is a ‘Big T’ trauma to one person might not be a ‘little t’ trauma to someone else. So much is about where we come from, our own experiences growing up and how secure we feel in ourselves, and the age and stage we are at when those things happen.

Would you say that in the current situation with the added stress, the added fear, and the added anxiety, that more often what would have been a small t trauma can turn into a big t trauma?

Part of what is unique about this situation is the sense of helplessness that people have about being unable to do much about it. So there’s a global thing that’s happening. This pandemic has a very particular trajectory. On the one hand we’re being told stay home, that’s the thing you can do to help. On the other hand we’re being told that it could get out of control and everyone’s health could be at risk.

For people who are in first responder situations it’s very difficult at some level – I’m not an epidemiologist so I can’t really speak to this – there is a concern that infection rates among first responders are really high. So for the people who feel like there’s something they’re actively doing out in the world to mitigate by providing various services, those people’s lives are at risk by doing the thing they do. So that fits into one category.

Then there are the people who are staying at home and providing (like myself) mental health services. We’re watching people on the front lines as we provide services, and the CPA has come up with a list of psychologists who are willing to do some pro-bono services, I’m also on that list. We’re a little bit feeling helpless about how to be most of service. That can really feed into a sense of the heightening of the fight-flight-and-freeze response.

Some of us feel – and again this is very much about where we come from in terms of our own lives and our own traumas – being in our homes can feel very traumatizing, so something that might be a stressor like worrying about a family member being sick, having a parent in a retirement home.

In the past you might have gone to the gym, gone for a run, gone out with a friend. You might have had a number of strategies you would use that would help you manage that fight-flight-freeze response. Now we’re being asked to stay at home and so the fight-flight-freeze has nowhere to go.

Thankfully there are a lot of really amazing people putting meditations online, putting yogas online, putting various resources including psychotherapy into online spaces. And I would really encourage people to use those resources, because being able to connect with someone outside of your family unit, to be able to be as honest as you need to be about how distressed you are, may make a real difference in how people come out of this.