Large T's and Small T's (Trauma)

When people talk about trauma, we often think of the first list on my post. It's what the Diagnostic and Statistical Manual of Mental Disorders's (DSM) is focused on when it talks about PTSD. The DSM is a diagnostic tool that attempts to offer a common language for clinicians to use in the clinical world to support in understanding symptoms, mental health conditions, treatment planning, and research. In the DSM-5, the definition of PTSD trauma is "actual or threatened death, serious injury, or sexual violence" that has specific criteria of lasting adverse effects on a person's ability to function mentally, physically, relationally, emotionally and/or spiritually. .

The DSM can definitely be helpful at times especially in certain settings, but with all things created with good intentions, there are limitations and it has contributed to misunderstandings (and involves some politics which I won't get into on here). The DSM does not fully capture the complexity of the human condition. No book really can. .

We know that what one person may consider traumatic is not true for another person. We also know that "actual or threatened death, serious injury, or sexual violence" is not a requirement for a person to experience lasting debilitating (sometimes even more severe) effects on a person's ability to function mentally, physically, relationally, emotionally, and/or spiritually. .

We sometimes read or hear people refer to large T (traumas often related to the first list), and small T (traumas often related to the second list...also I ran out of space). While it can be helpful to make the distinction at times, I think that it can also minimize the sometimes traumatic experiences on the second list (swipe left) and provoke a sense of shame over how we might find ourselves reacting to these experiences. .

So since I am a big proponent of not comparing our "traumas" and the importance of making space for all parts of our story with each other, I'd like to just use trauma based on how we find ourselves reacting to our circumstances to help us make sense of some of our experiences in this series.

Hatty J. Lee, LMFT (she/her) is an Asian American licensed marriage and family therapist and brainspotting practitioner who has been practicing for 14 years in community mental health settings, schools, and private practice virtually across California and in-person in Los Angeles and Pasadena, California. As the founder and clinical director of a group practice called Oak and Stone Therapy in Los Angeles, CA, she trains clinicians and supports people to deepen their relationship with themselves and the most important people in their lives. She writes about mental health on her Instagram and is the co-author of The Indwell Guide that integrates visual storytelling, mental health education, and practical tools to support people to heal and thrive.