“The ordinary response to atrocities is to banish them from consciousness. Certain violations of the social compact are too terrible to utter out loud: this is the meaning of the word unspeakable. Trauma survivors want to forget, observers want to forget, and society as a whole wants to forget. It is too painful to do otherwise. We push trauma away and it rears up in other ways: Atrocities, however, refuse to be buried.”

We have a long history, including in the mental health field, of not wanting to acknowledge trauma. This includes Freud. He placed an emphasis on early childhood, and on sexuality, which was not always well received. But there is an additional reason why he is not liked. Judith Hermann eloquently describes how Sigmund Freud dealt with the traumatic stories of his patients. Many of his patients, most of whom were women, were referred to as “hysterics.” Freud realized that contrary to the common beliefs of his time, they were in fact not hysterical at all. They really had experienced abuse, rape, domestic violence, or other traumas. He presented this approach in a series of scholarly papers. He was harshly criticized by close colleagues. He then retracted his approach and went back to blaming the victims. As Herman says, “It is very tempting to take the side of the perpetrator. All the perpetrator asks is that the bystander do nothing. He appeals to the universal desire to see, hear, and speak no evil.”

Trauma is difficult to understand because deep in our hearts we don’t want to understand or feel it. We just want it to go away.

This is an attempt to protect ourselves. Trauma is exhausting and painful, including for those who experience it indirectly, by witnessing it or having it happen to a loved one. We don’t want it to happen to us and we don’t want to feel it. The effects of trauma are felt in different ways by different people and can be influenced by individual personal emotions, history, and experiences. So, it’s not totally predictable. Sometimes the effects are not felt until years later. It does not just “go away with time.” People cannot just “get over it” or “move on.”

So, what is trauma? When experts talk about trauma, they are including disruptions in the environment that impact whole societies such as natural or man-made disasters, violence, epidemics, large-scale transportation accidents, war, terrorism, political unrest, and genocide. They also include individual and familial traumas that can be experienced personally, to a loved one, threatened, witnessed, or heard about. Some of these traumas are loss through death or abandonment, abuse, rape, sexual or other violations, assaults, homelessness, divorce, poverty, chronic illnesses, physical disabilities, trafficking, learning disabilities, emergency worker exposure, war, spouse or partner battery, torture, and child abuse.

Trauma also can be caused by experiencing repeated or extreme exposure to aversive details of an event(s) (e.g., first responders collecting body parts, police officers repeatedly exposed to details of child abuse, physicians, soldiers, child welfare workers, emergency workers, social workers, law enforcement professionals, protective services professionals, artists, nurses, veterinarians, museum workers, firefighters, lawyers, teachers, psychologists, other mental health workers).

Trauma can cause “burnout.” Burnout can come from repeated direct exposure or victimization to trauma, being forced to participate in trauma, or from witnessing trauma. Burnout comes from strong, unpleasant, difficult emotions that go on for too long with no resolution or comfort. Burnout is often accompanied by feelings of exhaustion or disillusionment. “Burnout” is not a new concept. It’s been around for a long time and has been called various names such as: compassion fatigue, battle or combat fatigue, shell shock, feeling drained, nervous breakdown, crack up, shattered nerves, falling apart, emotional collapse, nervous exhaustion, moral injury, and PTSD (post-traumatic stress disorder). It’s been around, but that doesn’t mean that we accept or understand it. It is uncomfortable and undesirable to all. No one wants to feel these feelings.

There is nothing “wrong” with having symptoms of trauma or burnout. The trauma approach to understanding and helping survivors relies on the definition of post-traumatic stress disorder (PTSD). PTSD is defined as a normal reaction to abnormal situations which can be ongoing. Symptoms can be difficult and painful, but are to be expected. Survivors may need help coping with and overcoming them, but it is OK to have that need. However, just as reactions are to be expected and don’t necessarily mean that “something is wrong” with the trauma survivor, it also doesn’t mean that the reactions are OK and acceptable. The reactions are best talked about, or in the case of unacceptable behavior, they have to be controlled. Sometimes survivors do not know what to do about or how to handle what may be overwhelming reactions to trauma. So, sometimes they take it out on others or express it in situations to which it does not fit. So other people often wonder “Where did that come from?” particularly if behavior seems out of context or disconnected to current surroundings, events, or people, or has nothing to do with them. Or, “Why are you acting this way with me? You don’t like it when people act like this with you.” The problem lies where survivors need help, but do not seek it, turning instead to substance abuse, unacceptable behavior, giving up, accepting the “fate” of being chronically depressed or anxious, being always angry, or becoming “defensive.” Survivor behavior can make trauma even for others harder to understand, and this often feels unfair to the survivor. After all, they have already suffered enough. However, an important part of surviving trauma is controlling behavior so that it does not interfere with quality of life.

It is normal, not abnormal or pathological, to have even extreme reactions to abnormal events. These reactions can occur immediately after the trauma, or even after a long delay. Strong emotions created by trauma can be directed inward (at the survivor), as well as outward (behavior directed at others). Some inward reactions may possibly invisible to and hidden from others. This includes re-experiencing the trauma (“flashbacks”), avoidance of circumstances and people associated with the trauma, numbing of emotions, anxiety, depression, nightmares, and fears, mistrust of others, unwanted memories of the trauma, emotional detachment, unwanted thoughts, loss of interest or pleasure in activities, guilt, or loneliness, insomnia, agitation, irritability, hostility, hyper-vigilance, self-destructive behavior, social isolation, and avoidance of situations that bring back memories of the trauma. Survivors often feel guilty, as if what happened to them is their fault somehow. There may be disruptions in the ability to form attachments and stable relationships. Productivity at work or school, and general enjoyment of life might be affected. This is particularly true for children, who do not yet have a firmly developed self and have not had time to learn the skills to cope with the disruptions of trauma.

In addition to direct obvious physical injuries that can be caused by trauma, it can also cause physical symptoms such as increased heart rate, breathing, and blood pressure. A classic research study looking at this mind-body connection was conducted by pediatricians Meyer and Haggerty in 1962. The study followed 100 people in 16 families for a year. They found that susceptibility to the streptococcal virus (like strep throat) was associated with family stress. Families with the most stress had the most illness. More recently, on the topic of “The body keeps the score,” Dr. Vander Kolk states that we have many ways of remembering trauma, some of which do not even involve words. For example, a soldier who witnessed in horror a village burning, might panic when smelling something burning.

Acknowledging these realities is unpleasant and undesirable for all involved. It’s easier to try to forget or to think of survivors as delusional, malingerers, or hypochondriacs.

And note: Some traumas may be overwhelming to even the strongest best coping people among us. One of the earliest books about childhood death, including pediatric cancer, when it was a hopeless death sentence and children always died, and soon after the diagnosis, is called Beyond Endurance. Because it was.

It is often difficult to listen to survivors tell their accounts of trauma. The stories may be unbearable because of extraordinary cruelty, abuse, and horror. These are stories of that which is unspeakable. “To study psychological trauma is to come face to face both with human vulnerability in the natural world and with the capacity for evil in human nature. To study psychological trauma means bearing witness to horrible events.” Further, “Society becomes resentful about having its illusions of safety and predictability ruffled by people who remind them of how fragile security can be.” Trauma stories may be filled with details that evoke uncomfortable emotions such as disgust, humiliation, sadness, anger or rage, hopelessness, or helplessness. Sometimes traumatic stories are overwhelming to the listener. Then the listener may become shocked or disinterested or may try to find a way to blame the survivor.

Denial in others can make the survival from trauma even more painful and difficult. We often just don’t want to hear it. Survivors, of course, are then re-victimized by denial of their experiences. This is made worse by the fact that “People who have survived atrocities often tell their stories in a highly emotional, contradictory, and fragmented manner which undermines their credibility and thereby serves the twin imperatives of truth-telling and secrecy.” Further, “The psychological distress symptoms of traumatized people simultaneously call attention to the existence of an unspeakable secret and deflect attention away from it. This is most apparent in the way traumatized people alternate between feeling numb and reliving the event.” Further, “Those who attempt to describe the atrocities that they have witnessed also risk their own credibility. To speak publicly about one’s knowledge of atrocities is to invite the stigma it attaches to victims.”

Trauma survivors are often harassed, ridiculed, and disbelieved. Many psychotherapy patients report that one of the most painful parts of having been abused as a child is that no one believed them if they dared to ask for help. One said, “Everyone thought that my mother was so nice. And she was, to everyone else. It was crazy making.” Women who are raped are often described as “She asked for it.” This accusation would be ascribed to the clothes that she wore, where she was walking, the time, etc. These may have been risk factors, but they do not justify a rape.

We certainly see what can happen to industrial or political whistleblowers. People who speak out about physical or sexual assault by powerful people such as politicians, clergy, or other public figures, are often ignored, ridiculed, or retaliated against. Their sanity is questioned publicly. Sheer numbers of people reporting similar experiences with the same individuals does not immediately change public or legal perception.

Homelessness and food insecurity are other traumatic examples that we wish to deny exist. It must somehow be their fault. This is more comfortable to believe, as it does not challenge cherished assumptions such as the American dream, a positive outcome of pulling one’s self up by bootstraps, the safety of having a family, and the belief that people who work can make a comfortable life for themselves. Statistics are slow to reach public perception. In reality, millions of working people, including employees of Walmart and McDonald’s, rely on public assistance to survive. “There is no state or county where a renter working full-time at minimum wage can afford a two-bedroom apartment. Yet, research shows that increasing access to affordable housing is the most cost-effective strategy for reducing childhood poverty and increasing economic mobility in the United States.” In addition, veterans, young people aging out of foster care, and the disabled are a large proportion of SNAP recipients.

Trauma is not contagious. Kindness will not cause us to be infected and distancing ourselves will not protect us or make it disappear. We need to educate ourselves, learn compassion, and understand that we are all connected.

This is a call to action. Evolve. We can do better than this. Our collective future depends on it.

Peggy A. Rothbaum is a psychologist.