Chapter 7: Trauma, Stress, and Loss

Raskin explores how trauma, stress, bereavement, grief, and dissociation shape mental health. Through case examples like Joe, who developed PTSD after an earthquake, and Marigold, who struggles with prolonged grief after her husband’s death, the chapter illustrates the profound psychological impact of overwhelming experiences. Key definitions distinguish trauma (exposure to actual or threatened death, injury, or violence) from stress (a physiological and psychological response), bereavement (loss through death), grief (the emotional reaction to bereavement), and dissociation (detachment from reality, including depersonalization and derealization). Diagnostic systems DSM-5-TR and ICD-11 categorize trauma- and stressor-related disorders such as PTSD, acute stress disorder/reaction, adjustment disorder, prolonged grief disorder, reactive attachment disorder, and disinhibited social engagement disorder. DSM emphasizes PTSD’s broad symptom clusters, while ICD distinguishes PTSD from complex PTSD, which adds emotional dysregulation, feelings of worthlessness, and relational difficulties. Historical perspectives trace evolving understandings from “soldier’s heart” and “shell shock” to PTSD’s official inclusion in DSM-III, shaped by war veterans and rape trauma research. Biological perspectives examine neurotransmitters (serotonin, norepinephrine), SSRIs, SNRIs, prazosin, and antipsychotics, as well as the roles of the hippocampus, amygdala, medial prefrontal cortex, autonomic nervous system, and HPA axis. Genetic and evolutionary theories explain vulnerability, resilience, and the adaptive functions of grief and stress, while immune system research highlights inflammation as a biomarker. Psychological perspectives include psychodynamic therapies emphasizing unconscious conflict and attachment, cognitive-behavioral approaches like exposure therapy, cognitive processing therapy, trauma-focused CBT, stress inoculation training, mindfulness, ACT, and EMDR, as well as humanistic and constructivist therapies emphasizing meaning reconstruction and posttraumatic growth. Sociocultural perspectives highlight gender differences, race-based traumatic stress, systemic oppression, cultural adaptations of therapy, cross-cultural mourning rituals, and the importance of social support. Service user narratives examine stigma, debates over renaming PTSD to PTSI, and controversies over medicalizing grief. Systems approaches explore group therapy for trauma, family-focused grief therapy, and couples interventions such as CBCT and EFCT, including new research into MDMA-assisted sessions. The chapter closes with ethical debates over emerging possibilities of erasing or altering traumatic memories through drugs or neurobiological interventions. By integrating biological, psychological, social, cultural, and historical lenses, this chapter demonstrates that trauma, stress, and loss are not simply private afflictions but experiences deeply intertwined with relationships, culture, and meaning-making.