Book Review-Trauma and Recovery: The Aftermath of Violence – From Domestic Abuse to Political Terror

It would be easy to dismiss Trauma and Recovery: The Aftermath of Violence – From Domestic Abuse to Political Terror for a wide variety of traumas, because it is very focused on domestic abuse.  There’s a clear focus on this tragic type of trauma – but it’s not the only kind of trauma.  It would be an error to dismiss what can be learned from this book so quickly.  While the details about the traumas themselves are varied, the challenges that trauma creates are similar regardless of what the actual cause is.  After all, trauma is whatever someone says it is – if it’s trauma to them, then it’s trauma.  It’s about overwhelming their capacity to cope, and that is at the heart of the challenges it creates.

(Note: This blog post is one of the longest I’ve written.  Because of how the content is laid out, I decided against splitting it into multiple posts.)

Gaslighting

Set in a Sherlock Holmes London of the 19^th century, we hear tales of ghosts who haunt the living because their stories – their true stories – haven’t been told.  They’re prevented from leaving the mortal world completely until the truth can be known.  In this quaint picture of life back then with its gritty realities glows lanterns and lamps, which are fed by gas.  These gas lamps provided light for the night.

In the 21^st century, the term gaslighting has taken on a radically different and more than slightly sinister tone.  It originated from the 1944 film, Gaslight, in which a man manipulates his wife into believing she’s insane.  Thus, today, instead of pushing back the darkness, the gaslighting that we discuss encourages darkness and doubt.  It’s the intentional attempt to make someone believe that something didn’t happen – or it didn’t happen the way they remember it.  Gaslighting is a form of emotional abuse, and it leaves its victims questioning their grip on reality and which of their memories they can trust.

One of the common tactics in domestic abuse and control, gaslighting has reached a form of mastery with some individuals – much to the dismay of everyone who believes that it’s not fair to wage psychological warfare on those you supposedly care about.

There are some who would claim that the atrocities – the genocides that have happened didn’t really happen.  They deny that the truth is the truth until they’re forced to accept it because of overwhelming or irrefutable evidence.  This is what Thomas Gilovich explained in How We Know What Isn’t So.  We willingly take in information that agrees with us, but we only accept information that doesn’t agree with us when we have no other choice.

She Was Asking for It

An important cousin to gaslighting is the idea that the victim wanted to be victimized.  When stated in these direct terms, it becomes obvious that no one wants to be a victim.  It has been used as an excuse for intimate partner violence (IPV), rape, and countless other crimes.  Victims don’t “ask for it.”  However, perpetrators need to find a way to excuse their inexcusable behaviors, and the only way to do that is to shift the blame from themselves to the victim.

The power to justify our own behavior, to believe what cannot be true, is strong – even when it’s moving in the wrong direction.  Luckily, some progress has been made on this front – but blaming the victim is still way too common an occurrence.

Shell Shock

Hysteria was a woman’s disease.  The disassociation, problems with sleeping, and flashbacks weren’t for men, particularly not strong men who fought along the front lines of war.  That was the thinking until soldiers started coming back from the war who were physically fine but mentally scarred from their time.  It wasn’t public knowledge, but as much of 40% of British soldiers returned from the front of World War I were returning due to their mental wounds rather than their physical wounds.

It’s not something you tell the public when you’re putting on the image of the most powerful nation on the planet.  You don’t want the public to know there’s something wrong – something seriously wrong.  However, it was finally acknowledged that there was something sending boys home that wasn’t something that you could see as they walked down the street.  The term became “shell shocked.”  Something about the horrors of war had broken something inside their brain.

Eventually, it became accepted that it wasn’t because these men were inferior or because they weren’t good enough.  Ultimately, it became truth that these brave men were being afflicted by what they saw or did and their inability to integrate it into their broader views of the world.  Unquestionable bravery could be overcome by overwhelming fear.

Protective Factors

Helmets protected men from brain injuries – at least, the kind that came from projectiles.  However, there were other protective factors for shell shock.  The best protective factor seemed to be the group with whom the person was deployed and became to depend upon for everything.  Often, they’re called a band of brothers – or in World War I, it was more often fox-hole brothers.  Either way, when people faced unimaginable things with their group, they responded and recovered better.  Separated from their group, the situations weren’t as good.

Once the group disbanded – or when they became separated – there was another factor that seemed to form a protective bubble around the person.  That bubble was caring.  Even small, genuine concern for the person and their story, experiences, and life was often enough to change the trajectory of their life in a positive direction.  Simply listening and caring made a real difference.

Incest and Rape – Oh My!

The statistics are crushing.  One in three women were sexually abused as children, and one in four women have been raped.  It’s a crushing tragedy where our families, streets, and communities aren’t safe.  We violate a woman’s body so that she feels as if she has no control – not even of her own body.  What’s worse is the complicit relationship that society has and continues to have in this problem.  It’s hushed.  It’s swept under the rug.  It’s not discussed.  It’s hidden from sight.

#metoo as a movement was a way for women to finally stand up and be heard about the sexual abuse, intimidation, and exploitation that happened to them.  Far too many (one is too many) famous actresses tweeted with the tag.  So, too, did women of every station of life, echoing the challenges that society doesn’t want to acknowledge.  We cannot collectively traumatize so many of our sisters without causing injury to ourselves.

Trauma Turmoil

It’s an event that cannot be integrated into our understanding of the world.  It’s overwhelming.  It’s trauma.  Or rather, it’s the first definition of trauma.  It’s the event that creates the challenge that cannot be immediately processed.  However, as I noted in my review of Trauma-Informed Healthcare Approaches, we use the word “trauma” for both the event and the outcome.

When I try to explain post-traumatic stress disorder (PTSD) to others, I say that it’s an inability to process and integrate what someone has seen or done.  Most events in our life are integrated into our beliefs about the world in our sleep.  We find ways to connect the events of the day to the stories of our lives.  In any given day, we’ll use our dreams to make these connections – whether we remember them or not.  Trauma doesn’t rise to the level of PTSD in that our current skills are insufficient to integrate it – it’s just that it momentarily overwhelms our capacity to cope and integrate.

It’s possible – and appropriate – to compartmentalize the processing of trauma that happens to us or that we observe, so we can make it through the moment and do the best possible things.  First responders can’t address their personal sadness at what happened to a child until they’ve addressed the immediate needs of the child.  Nurses who are working in the intensive care unit can’t express their own loss through grief until they’ve completed their duties and attended to the families.

It’s not that delaying processing is bad – it’s bad to never process the event.  The problem is that we’re designed to process what happens to us.  It’s a part of the learning that keeps us alive.  When we try to compartmentalize, cover up, and ignore the traumas that we’ve experienced or seen, it will eventually escape.  It may be a trigger, like a song or smell that reopens an old wound – or it can be that the weight and unhappiness of holding back the trauma eventually drains us of our energy.

Fundamental Beliefs

We all carry with us a set of fundamental beliefs about the world.  These beliefs inform the way we work and the way we interact with others.  We hold countless numbers of these beliefs, from our belief in the general goodness or badness of others to our belief about how traffic will flow.  Some of these beliefs are exactly aligned with reality – others, less so.

As humans, we like certainty.  We like the idea that A+B=C – however, as I explain in my post Practical Complexity, things aren’t that simple.  We simplify reactions that happen 99% of the time into “always,” because the exceptions aren’t that frequent.  This leaves us with the problem of having to address what happens when our predictions are wrong.

Mindreading proposes that prediction is the fundamental purpose of consciousness.  Many others agree using different language, but the sentiment is the same: predicting others’ behavior – and the outcome of events – has been critical to our survival.  That’s why betrayal is so hard to deal with.  It’s a failure of our prediction of someone else’s behavior.  Unlike jokes, which train us for cognitive missteps, betrayal hurts.  (See Trust => Vulnerability =>Intimacy, Revisited for trust and vulnerability.  See Inside Jokes for how laughter is the reward for detecting a cognitive misstep.  Also see Play for the role of learning and safe environments.)  When we’ve been traumatized, we’ve almost certainly  got a fundamental belief about the world or ourselves that needs to be adjusted.

Sometimes, that adjustment is small.  Sometimes, we need to make a larger change; but because we’re Predictably Irrational and are subject to arbitrary coherence, we don’t adjust enough.  Arbitrary coherence means we have a tendency to adjust in smaller increments than the evidence would lead us to.

The real problem is that we have such a small number of interactions that it’s hard to develop good predictions – and make good adjustments.  To become really good at forecasting, we need practice, balance, and detachment – none of those things really apply in trauma.  (See Superforecasting for more about better forecasting.  See Peak for why repeated trauma wouldn’t qualify as practice.  Finally, see what we can do to build better predictions with limited data in How to Measure Anything.)

So, we’re left with a bent, broken, or shattered core belief.  It could just be the result of the probabilistic nature of reality, or it may mean that we’ve got a fundamental flaw in the way we see the world – but we don’t know which.  (See The Halo Effect for more about the probabilistic nature of the world.)

Divine Protection

Our views of the world fall between it being a fundamentally helpful and loving place and a dangerous place filled with people who will only cause you suffering.  It is on the fulcrum of this belief that we make decisions about who and when to trust as well as when we need to protect ourselves.  This has a subtle but ultimately profound effect on the safety we feel – and therefore how we combat stress.  Another way to think about this is that we believe in divine protection or not.  If we believe in divine protection, we believe that we are protected from the evils of the world – and when trauma strikes, it shatters this perception.

Not only do we need to address the trauma that befalls us, but we’re left confused as to how our god would have forsaken us.  Not only did something bad happen to us, but somehow this is a signal that we’re unloved, unworthy, or irredeemable.

One of the keys to integrating the trauma into our understanding of the world is building a meaning around the trauma that doesn’t include our fault, blame, guilt, unworthiness, or unlovability.  Even if the trauma was a result of things we did, that doesn’t mean we’re irredeemable.  This is important in our recovery process.

Compromised Intimacy

Because it’s so important, it’s critical that we address the impact of trauma on relationships and intimacy.  While rape in any form necessarily creates additional barriers to intimacy at a physical level, all trauma separates us from the rest of humanity – as well as a sense of God or the divine.  There are layers to this aspect of trauma.

First, we need to recognize that intimacy is the result of vulnerability, which is built on the feelings of safety that comes when we trust others.  Trauma, by causing us to question who we can trust and whether we’re safe, directly blocks our ability to be intimate with others.  To be clear, intimacy in this context is the state of complete trust, not necessarily any kind of physical relationship.  (See Trust => Vulnerability => Intimacy, Revisited to better understand this flow.)

Second, we need to address hope.  Hope, as Rick Snyder explains in The Psychology of Hope, is a cognitive framework built on willpower and waypower.  Willpower is in common understanding today, but Roy Baumeister’s book Willpower has a great deal more about it.  (Grit is also an excellent call to persist while explaining willpower.)  Waypower is simply knowing “how” something is going to happen.  Ultimately, this breaks down into those things we know how to do ourselves or that we trust can or will happen through others.  The second part, what can happen through others, is where it gets sticky.  If our fundamental belief of the world switches negative – even for a moment—we can break our fundamental sense of hope and thereby send ourselves into a depressive spiral – where we don’t feel like connecting with others or being intimate.

This is why the intervention of connections, community, and professionals to create a safe, caring space is so important.  With it, it’s possible to believe that the entire world isn’t bad – and therefore the resources necessary to survive the trauma maybe forthcoming.  These simple connections can be immensely powerful.

No Intervention

Often, the challenge isn’t just the trauma but the lack of any protection from it.  Imagine the family of Kitty (Catherine) Genovese.  She was raped and killed in Queens, New York in 1964.  The troubling aspect was that 38 neighbors did nothing during the 35 minutes of her screams before she was silenced by her killer.  (See Blink, Influence, People in Crisis, and The Lucifer Effect for more on the bystander effect, which is believed to drive the inaction.)  Imagine Kitty’s family and the trauma they faced as they learned of these details and came to grips with a world where none of her neighbors would even phone the police.

It changes the world that they live in.  Not only must they accept the tragic world where rapists and murderers could victimize Kitty, but also they have to accept that the rest of the population might not be as good as they believed.  Albert Bandura in Moral Disengagement examines how we can disconnect people from their moral moorings and set them adrift to behave in ways that defy explanation – including failing to protect members of their community.

Sometimes, the degree of anger and frustration is greater with the people who stood by and did nothing than the people who inflicted the trauma on the person.  It’s a greater pain to know that people wouldn’t help.

Competition and Overreactions

Almost everyone has the family member that they know not to share their trauma with.  It will end in one of two ways: a competition for whose trauma is the most traumatic, or an overreaction to the trauma that happened to you.  Somehow, they’ll act as if the trauma happened to them – and their trauma is more important than yours.  This is particularly complicated in the trauma from a death, because that death will impact almost everyone in the family, and some people will feel the impact more strongly.

Let’s dispatch the problem of competition first.  If someone is trying to compete with you about whose trauma is worse, they’re necessarily invalidating the degree to which you feel the trauma and, in some ways, are gaslighting you to say, “It wasn’t that bad.”  Sometimes, you can shut down the competition by simply stating, “I agree, your trauma was bad, it might even be worse, but we’re talking about my trauma right now.”  While this won’t shut down every competition, if you can have the wherewithal to respond by acknowledging their trauma and indicating that it’s not what you’re discussing right now, you may be able to get them to stop.

It’s important to realize that, if they’re trying to compete with you about the trauma you’re describing, they’re likely not a safe person (see Safe People), or they’ve not been able to fully process their trauma and feel as if no one is listening.  That’s why it’s important, when you’re able, to make an attempt to listen to their trauma.  It doesn’t need to be – and perhaps should not be – while you’re sharing your own trauma.

The other end of the spectrum is the overreactor.  It’s not that they’re competing with you about how their trauma is more important, impactful, or worthy of attention.  They’re too busy reacting to their trauma of the trauma that you faced to be present for how it impacted you.  They make your trauma about them and how it changes their life.  You call to tell your parents about your drunk driving conviction, and they begin to explain how it will impact their social relationships with their friends.

Many people have learned that there are some people – frequently family – who are not safe enough to discuss traumatic events with.

Separate

As humans, we need connections to other people.  (See The Dance of Connection for more.)  Because we need connection when we feel isolated and alone, we’re vulnerable.  It doesn’t matter whether the separation is real or not.  What matters is that you believe you’re alone.  When trauma rips through your life but doesn’t feel like it has ripped through your friends and acquaintances, you feel separate.  Consider the incest victim who tells no one and is isolated by feeling different.  The statistics say that it’s likely that others in their peer group have faced the same tragic event – but none of them feel safe enough to talk, and thus they’re all alone.

Conversely, their  psychological ego protection mechanisms may seek to elevate the person who doesn’t talk as superior to those who complain and whine about their trauma.  Yet these defenses are necessarily incomplete.  On the one hand, they feel better than others; in other ways, they feel inferior.  They oscillate between too good and too bad but always feel separate, disconnected, and alone.

Community is such a powerful force.  We see the power of community in Robert Putnam’s Bowling Alone and Our Kids.  We see the power of community in twelve-step groups.  (For more, see Why and How 12-Step Groups Work.)  We cannot expect to heal from trauma if we feel like we’re the only ones.

The Truly Evil Is Us

One of the more disturbing aspects of trying to recover from trauma is when we realize that the greatest atrocities in human history were sometimes aided by normal people.  Adolf Eichmann was an important part of the machine that committed genocide of Jews during World War II.  He was also judged to be relatively normal – not a depraved monster that everyone wanted to believe he was.  The questions arose about how normal men and women could do such vile things and remain “normal.”  It led to experiments like Stanley Milgram’s simulated shock experiments that had a majority of subjects believing that they were shocking other subjects with dangerous levels of current in the name of science.  It led to Phillip Zimbardo’s much-reported, aborted Stanford Prison Experiment (SPE).  Zimbardo reports the story of SPE himself in The Lucifer Effect, and Bandura decomposes how the processes work in Moral Disengagement.

The net of all this work is that the unspeakable things that some men have done are things that any of us could or would do given the right circumstances.  It harkens back to Lewin and his formula, which states that behavior is a function of both person and environment.  That is, we can’t predict behavior absent from an environment.  (See A Dynamic Theory of Personality for Lewin’s work.)  We see this environmental feedback in the extreme views that some groups develop.  (See Going to Extremes for more.)

Control via Threat

In Chasing the Scream and Dreamland, we discover the fear that can be created by random, capricious acts of violence.  Cartels don’t keep people compliant by a strictly regimented form of consequences.  Instead, they randomly make examples of people to instill fear that any disloyalty may be repaid with torture and death – not just of you but also of anyone you love.  As if torn from a page of the drug cartel playbook, often people are controlled with threats that make them fear for their own lives and the lives of their loved ones.

If you leave the person who is controlling and abusing you, they may find you and kill you and your children – or they may just as likely go kill your parents.  At least, that’s the story they tell.  It drives fear so deep into a person that it’s hard to shake.  The statistics aren’t much help here.  Roughly 40-50% of the murders of female adults are classified as IPV.  That is, the person who killed them was a spouse, partner, or ex-partner.

The randomness and the degree to which the partner seems to be willing to take their anger, rage, and vengeance makes it difficult for a woman to decide to break away.  Even then, there are far too many cases of the controlling partner finding – and returning or murdering – the one who tried to escape.

Disassociation and Altered Perception

It’s common for trauma patients to start to disassociate with their situation.  It helps to believe that whatever is happening is happening to someone else.  While it’s common, it’s not very adaptive post-trauma.  Teaching people to remain safe and connected to their experiences is an important part of the recovery process.  Detecting disassociation is a skill for both the person themselves – and for those who care about them.

The most common way that people report disassociation is that they begin to look upon the scene not from their vantage point but instead as if they were looking at it from above or from another place in the room.  This is often accompanied by a numbness.

However, this isn’t the only way to detect disassociation.  The trance-like state that disassociation induces also allows for things that normally cannot occur.  The first is that you can accept and believe two contradictory ideas.  It’s possible – for instance – to believe that the Sun rises in the East and also that the Sun rises in the West.  If evaluated together, one is obviously false, but the person who is disassociating never seems to find themselves at this particular crossroads.

Additionally, disassociated people tend to have a broadly based altered perception.  This can manifest itself in a variety of ways – like seeing the situation from another vantage point, as just explained, or by perceiving events radically differently than they could have been.

Consider an innocuous situation where one person feels animosity towards a second.  This person may believe that they were snubbed by the other.  They made a step forward, made eye contact and then the second person dismissed them.  However, the second party has no recollection of this.  This situation took place under a high-resolution camera during the daylight where what transpired was captured beautifully.  There was no motion towards the second person, no eye contact, and no snubbing.  Without video evidence, the first person would have held fast to their beliefs.  (This is a real situation.)

The ways that the perception can be distorted are almost limitless, some able to manifest in the moment and others rewriting memory to accomplish the distortion.  (See Mistakes Were Made (But Not by Me) for more about memory rewriting.)

Keeping Secrets from Yourself

Because traumatized people would prefer to believe that the traumatic events never happened, they’ll sometimes try to pretend that it didn’t.  White Bears and Other Unwanted Thoughts clearly demonstrates that this cannot be done in the broadest sense.  If you can pull this off in any limited sense, it may provide temporary relief – but ultimately the secrets will become exposed, and you’ll have to deal with them.  While it’s not appropriate to confront every challenge immediately, it should be recognized that permanent secrets don’t really work.

Finding Meaning – Even if It’s Wrong

To power our predictions, we must develop theories of how the world works.  We must find ways to explain what’s happening to us and build models that work with the experiences we have.  (For more on the model building, see Gary Klein’s excellent book, Sources of Power.)  As a child who experiences trauma inflicted upon you by your parents, you effectively have two basic meanings that you can take.  First, that your parents – who gave you life and have protected you up to this point – are really evil and are doing things to harm you.  Alternatively, you can believe that something that you’ve done is bad, and if you simply correct the bad thing that you’re doing, all will be well.

Too often, innocent children pick the second option, but there is a rationality to it.  In the face of evil parents, a child is defenseless.  There’s nothing they can do to stop the infliction of additional trauma.  They’re helpless.  (For more on helplessness, see The Hope Circuit.)  Conversely, if it’s the child that can change their behavior and get different results, they’re holding onto at least a little bit of power and hope.  So, while the second approach threatens their self-esteem, it also empowers them to make changes.

Obviously, the problem is uniformly with the parents as no innocent child deserves to be traumatized.  However, we see this pattern happening in other situations as well.  Rather than accepting the relatively uncharitable view of others, we inflict it upon ourselves because we can – we believe – change our behaviors.  We try to be perfect, because that will stop the trauma.  However, no one can be perfect.  (See Perfectionism for more on trying to be perfect.)

Rational Arguments Don’t Matter

Sometimes, it’s too hard to see someone else’s point of view.  If we accept Jonathan Haidt’s Rider-Elephant-Path model that says that our rationality is a tiny rider on top of a large emotional elephant, it becomes easier to understand how, when our emotions are out of whack, no amount of conversation with the rational rider is going to matter.  (See Switch and The Happiness Hypothesis for more on the model.)  This is one of the very odd effects that happens.  In Going to Extremes, the process of moving towards extreme positions is laid out – including the transition between “can I” and “must I” accept the other person’s arguments.

At the most basic levels, the way we feel is simply the way we feel – reality be damned.  That’s why so much of the best work in psychology has been about gaining perspective, making it easier to look at different perspectives, and taking the most helpful and generally most correct one.

The answer is sometimes to allow the elephant to settle down and give the rider a chance – but only if the person doesn’t have reinforcing messages continuing to drive their emotional response.

Body Containing Trauma

What happens when you can’t find a medical reason for a condition that’s facing someone?  The answer is you either keep looking or you dismiss it as not real.  However, over the past few decades, as we’ve advanced diagnostic tools, we’ve also improved our understanding of the relationship between the way we think and the way our body responds.  We see this in The Body Keeps the Score as well as Why Zebras Don’t Get Ulcers.  The degree to which we’re in stress and fear has a profound impact on the functioning of our immune system, and many of the diseases we face today are autoimmune diseases – that is, the immune system mistakenly attacking the body itself.

There are ways of better understanding stress and fear, including the ideas shared in Richard Lazarus’ Emotion & Adaptation, but whether you understand what’s happening or not doesn’t change the physiological impacts of long-term sustained stress.  In short, the body is damaged by our inability to process and resolve trauma.

Empowerment

If you had to pick a single word to combat trauma, it would probably be empowerment.  It’s restoring to the person a sense of self-agency that they lost through the trauma.  Whether it was a rape or a natural disaster, the trauma disrupts our ideal that we can protect ourselves and our bodies.  By empowering people to take back control of their bodies and their situations, we enable them to process and resolve the trauma.

In clinical settings, this is often about describing things before they’re done, getting micro consents, and offering choices.  They’re simple, small ways that people are being given back control of their lives – control they often believe they lost.

In Opening Up, James Pennebaker explains research he did shortly after the Mt. St. Helens eruption in 1980.  Two towns were selected: Yakima and Longview.  The recovery of the two towns couldn’t have been any more different.  Yakima was covered in over two inches of ash and sustained damage, but the community came together and ultimately told a story of empowerment, community, resilience – and opportunity to experience a once-in-a-lifetime event.  Longview, which received less than a half-inch of ash, kept a watchful eye on the mountain that they no longer trusted.  Ultimately, with time, the two communities returned to a similar sense of the event – but the difference may have been the ability of Yakima to see how they could make a difference and clean up the mess that the volcano had made of their town.

It’s Not Fair – and It’s Not Right

Life ain’t fair.  That’s not very helpful, particularly after a trauma.  Automobile accidents where the other person is at fault are largely random.  Very little of your driving ability comes into the picture when someone else is at fault.  Is it “fair” that you were the one in the accident?  Not by the definitions that people use for fair.  Of course, it’s equally not fair that someone wins the lottery, but you don’t hear the winner complaining.  In fairness, we believe that people should get exactly what they deserve, but when you live in a world of probabilities and chances, this just isn’t the case at an individual level.  The truth is that trauma isn’t fair.  Life isn’t fair.  There are ways to influence the odds of trauma, but even if you take every precaution, it’s still possible to be the unwilling recipient of trauma.

Trauma also isn’t right.  It “shouldn’t” have happened to someone.  Again, life doesn’t dole out trauma like some of karma.  It happens to good people, and it doesn’t make them any less good.  Trauma is sometimes the direct result of risks someone took – but mostly it’s just dumb bad luck.

Never Back to Normal

Getting back to normal after a trauma isn’t a thing.  A new normal is defined, and that is the way things will be.  Heracles said that a man never steps into a river twice – he’s not the same man, and it’s not the same river.  The idea that we’ll get back to the “normal” of even a minute ago is a fallacy.  However, never is this so obvious as after a trauma, when your foundational beliefs have been questioned.  Once you’ve redefined the way you see the world, even the same places and situations are different, because how you process it and what you bring are different.

When someone is struggling with a traumatic experience, the goal should be to define a positive new normal – rather than trying to get back to a place that no longer exists.

Defining the New You

One of the activities that everyone must do post-traumatic event is to redecide who they’re going to be.  This can be done consciously or unconsciously, but we must reevaluate who we are in the context of the new perspectives and information.  We must decide the kind of person we’re going to be in relation to the world that seems to have changed.  Are we going to let the trauma define us as a victim – or are we going to rise above the trauma and define ourselves by how we recover and continue rather than by what has happened to us?

Trauma is an inflection point.  It punctuates our life’s story with an exclamation point, and we can choose to use that energy to push us forward – or we can avoid it and hunker down.  Or we can decide to hunker down and recover before venturing on again, which is probably the wisest choice of all.

Courage

It takes courage to move past fear and into the new world.  Most people think that courageous people move forward without fear – but that’s not truth.  Courageous people move forward in fear with the hope they can make things better.  (See Find Your Courage for more.)  Courage brings with it a risk that things will get worse and a hope that it will get better.

When we confront despair, we make ourselves vulnerable to potential hopelessness – and temporary increased risk of suicide.  However, it’s only by confronting our fears and the despair they can bring that we can neutralize their power over us and move forward.

We must find ways to simultaneously acknowledge the fear and move forward anyway.

Return to Pooh Corner

There’s a song by Kenny Logins titled “Return to Pooh Corner,” which is about him remembering his childhood through his child’s eyes.  Sometimes, we move forward by moving backwards.  Sometimes, we gather deeper understanding as we move back to the starting point and repeat something we’ve done before.  Often, addicts “fall off the wagon” and are crushed that they can’t beat the alcohol once and for all.  However, what they fail to realize is that most addicts relapse.  Our journey to mental fitness isn’t a straight line any more than our physical health is a straight line.

This doesn’t, however, stop the guilt and shame.  Nor can it silence the voice that wonders if you’re one of the “incurable” ones.  Trauma has the same dynamics.  It can be that, after initial treatment, things seem to be going fine until something comes up.  Some trigger trips you up and makes it impossible to get back into a working rhythm.  In these cases, there’s no shame in returning to the place that you were helped – even if it feels as if there should be.  We all work through traumas only to have them resurface years in the future.

Going to Groups

Trauma and Recovery exposes a clearly articulated model of groups that has three stages – and a pre-stage where group work on trauma may not be appropriate.   The first type of group is open and welcoming.  It is designed to reestablish a sense of safety.  The second type of group is a remembrance and mourning group that has an established time limit; it helps people work through the experience of trauma by progressively increasing the degree to which affect (feeling) is connected to and processed for the event.  The final group type is reconnection, which focuses on rebuilding the sense of connection and community that trauma necessarily interrupts.

While the flow and definitions are solid, the more important part of the model is the recognition that there is no one kind of group that fits everyone’s needs.  There’s a lifecycle to grief.  (See Finding Meaning and The Grief Recovery Handbook for more.)  Different group forms work for different people in different places on their trauma recovery journey.

In the end, it’s important to realize that it’s not just the trauma that we should be focusing on.  We need to focus equally on Trauma and Recovery.

Book Review-Struggle Well: Thriving in the Aftermath of Trauma

Just because you’re in a prison doesn’t mean you’re a prisoner.  It’s the first highlight of a book that seeks to teach the difference between the conditions that you were – or are – in and the way that you process it, label it, and let it change you.  Everyone will face trauma in their lives.  There is no choice in this regard.  However, the question is whether you’ll use this trauma to grow or whether you’ll allow the trauma to crush you.  Struggle Well: Thriving in the Aftermath of Trauma comes from the Boulder Crest Foundation based in Virginia, and it’s based in some of the best we know about trauma and growth.

Growth

It was 2017 or 2018 when Marty Seligman introduced me to Rich Tedeschi.  I was working on our book Extinguish Burnout at the time.  We were grappling with the issue of post-traumatic stress disorder (PTSD) and how to avoid it.  When I reached out to ask about how one could know whether someone would react to trauma with growth or disorder, Seligman pointed to Rich as the expert.  I had recently read the excellent book, Antifragile, about how things could get better with struggle.  However, it didn’t quite explain how someone could learn to grow from trauma rather than be crushed by it.  In the years since then, Rich has been kind enough to share his wisdom on more than one occasion.  More recently, I read his book, Transformed by Trauma, to even better understand how trauma can help you grow.

Rich has been connected to the Boulder Crest Foundation for years and has helped them integrate the best research and practices into their programs to make it easier to find growth instead of disorder in the wake of trauma.

Five Areas

Growth, rather than disorder, seems to show up in five key areas:

• Personal Strength
• Meaningful Relationships
• Greater Appreciation
• Richer Spiritual or Religious Life
• Positive Future

Said differently, people grow into a better relationship and appreciation for life.  They realize what’s important to them, and they’re able to align their life’s course to that connection with the universe of people.

The Disorder

Hysteria is the first organized label for what we now would call PTSD.  It was designated to only affect women, and the ways that it was addressed weren’t good.  It was seen as a fault or a weakness and, as a result, was generally shunned.  This created a problem when 40% of the soldiers coming back to Britain in World War I returned because of psychological problems that would eventually be labeled “shell shock.”  Men, it seemed, were developing something that was thought to be a woman’s affliction – and it seems to come about as a result of the horrors of war.  This exposure had left them with deep psychological scars that could neither be explained nor seen.  The knowledge of this was kept secret for fear that widespread acceptance of this fact would demoralize the soldiers.

The struggle still was in accepting this as an outcome of their experiences rather than a personal defect of the individuals.  The sheer numbers of people made it hard to accept the earlier explanations.

Over time, we’d begin to understand that these disordered responses to trauma weren’t personal or moral failings but rather an inability to process something that they’d seen or done.  We learned that, as sense-making machines, we needed to make sense of these experiences, and it nearly universally required that we adjust our core beliefs – literally the ways we had built our lives.  That’s never easy, but for some, it seemed harder.

In Change or Die, we’re exposed to the idea that asteroids may wipe out all life on the planet.  Rather we’re re-exposed, because most of us have encountered the idea before.  For most, this doesn’t create any real anxiety.  We quickly ignore the thought, since it’s not something we can change.  It’s our ability to ignore this fact that allows us to get up, love, support, and educate our children, and get on with our daily lives.  If we believed the world was generally benevolent, and we based our life on this fact in subtle ways, we’d struggle when an alternative reality revealed itself in the cruelty of others.  Unlike the potential for asteroids, we couldn’t ignore it, because it’s woven into every decision we make.

If the world becomes fundamentally hostile, or even if we have to accept the possibility that some people are hostile, we must change what we do today, and many of the decisions we’ve made in the past would no longer be “right.”  The ripples created by changing a fundamental view – to accommodate new experiences – cannot be understated.

The Numbers

It’s a tragic reality in military and veteran populations that there can be more people lost to suicide than in war.  Suicide routinely accounts for more firearm deaths than murder.  We hear about the mass shootings and are appalled, but we fail to realize that, despite their tragic nature, they represent a trivial portion of the overall firearm deaths in the United States.  When you internalize these numbers, the need for growth from trauma rather than being crushed by it starts to set in.  Too many people are encountering a trauma they cannot process, and they’re choosing to end their lives to escape the pain.  (See The Suicidal Mind for more about suicide as an end to psychic pain – or psychache.)

Program Problems

It’s no secret – though also not well known – that many people who enter areas of mental health are looking for their own answers.  A friend of mine reported that the difference between the counselors and the patients on an inpatient psychiatric ward was that the counselors had keys.  In many ways, the inmates are running the asylum.  However, It’s not just the fact that the people who are supposed to be teaching need to do their own work, it’s that the models don’t work either.

“Catch and release” is the way that it’s described.  You come to a training or an institute, have a good time, listen to others, have an experience, and then you’re released back to your old environment presumably changed forever.  This conceptually denies what we know about learning and recovery.

The research on learning and how we learn is clear.  As adults, we learn differently than our children.  In The Adult Learner, Malcolm Knowles and his colleagues lay out the five things that adult learners need to be able to learn.  However, that’s just the first step.  Further work has been done to evaluate what actually changes perceptions, behaviors, and results.  One of the findings of this work is that we need spaced repetition, so that we’ll retain the information that we receive – and catch and release doesn’t do this.  (If you want to learn more about how we learn, see How We Learn, Learning in Adulthood, and Efficiency in Learning.)

Why We Do It

Given the prevalence of catch and release programs and the clear evidence that they don’t work, one might ask why we still do them.  There are a variety of unsatisfying answers.  “We’ve always done it that way” tops the list, followed by the close cousin, “That’s the way education is done.”  We’ve learned in a very similar way throughout our educational experience, so it’s got to be right – right?

The challenge is that these programs are what people expect, what they’ll fund, and what they know how to measure.  Though most people funding programs like this don’t know anything about Kirkpatrick’s Four Levels of Training Evaluation, they know they can measure how people feel about the class – their sentiment.  We know sentiment has effectively no correlation to desirable outcomes, but the people writing the checks, either for internal corporate development or from philanthropic foundations looking to make a change in the world, aren’t aware of the need to have a better way to measure effectiveness.

The Power of Listening

On the one hand, most of us have had a conversation with a trusted friend where they listened to us completely.  They didn’t judge or offer advice.  They said few words.  Afterward, it felt like a weight had been lifted off our shoulders.  Somehow, the simple act of listening was powerful.  On the other hand, we believe that listening couldn’t possibly make that big of a difference.  We often fail to pay enough attention to the other person or the listening process.

What professionals know is that the most powerful part of their jobs is to understand other people.  They recognize that humans are necessarily social beings who need each other to survive, and this drives an innate need to be heard and understood by others.  Evolution has primed us towards the idea that if we’re not understood, we’re dead.  For most of mankind’s time, if you weren’t understood, you had to face the world alone, and you weren’t equipped for that.  (For more about our need to be connected, see Loneliness.)

Self-Regulate to Avoid Self-Medicating

What is often missed in our culture of blame is the fact that addictions are solutions to other problems.  They started out as coping strategies that eventually began to control a person – rather than the other way around.  Certainly, addictions are problems that cause other problems, but at their root, they’re solving other internal hurts.  (See Dreamland, The Globalization of Addiction, and Chasing the Scream for more about addiction and how it works.)  What people who have worked with addicts have learned is that if you want to stop the addiction – in the long term – you’re going to need to help the person learn how to respond to trauma better.

The better a person is able to self-regulate, the less they need to self-medicate.  Instead of seeking out a way to numb the pain, they find ways to work through it directly.

The Model

Struggle Well proposes a model that has three factors surrounding a central core of spiritual wellness.  The model can be summarized as follows:

• Mental Wellness
  • Ability to concentrate
  • Creativity and problem solving
  • Curiosity
• Physical wellness
  • Fitness
  • Nutrition
  • Sleep
• Financial wellness
  • Where you live
  • How you live
  • Resources for short, medium, and long term
• Spiritual wellness (center)
  • Relationships
  • Service
  • Character

Guilt and Shame

Sometimes, our views are permanently affixed to the past and either our guilt about the things that we’ve done or shame about the people that we’ve become.  (See I Thought It Was Just Me (But It Isn’t) for more on the difference.)  There is no problem in accepting the reality of our past, but a constant focus on the past doesn’t allow us to look to the future.  What we’ve done doesn’t define us.  It shapes how others think of us and how we think of ourselves, but it’s not a fixed and unchangeable destiny.

Carol Dweck researched Mindset and found that more adaptive and useful ways of thinking acknowledge that we can continue to grow throughout our lives.  Being bad a math in the past doesn’t mean we’ll be bad at it in the future.  In No Two Alike and The Nurture Assumption, Judith Rich Harris explains how our subtle desires may result in differences in our abilities and dispositions – but that these remain very malleable to future change if we’re committed to making the change.  Small amounts of interest difference started the ball rolling, and more – but still not insurmountable – amounts of interest and desire can radically change our path.

Hurting People Hurt People

Healthy people help people.  The spiritually healthiest people – those Brené Brown would call “wholehearted” – are focused on how they can help others.  (See Daring Greatly for more.)  The unhealthy people in our lives will stumble around blindly and will hurt us – not necessarily out of malice but rather as a result of their own pain.  We minimize our hurt when we focus on our healing.  (See Hurtful, Hurt, Hurting for more.)

Looking Back on Normal for Them

There are two reasons why people will not look back on their history.  The first reason is because it’s perceived as too painful.  In this space, strategies of desensitization can be helpful.  (See Moral Disengagement for Albert Bandura’s work on desensitization.)  The second reason is trickier.  People don’t look back because they don’t perceive their history as having problems.  In short, the problem is that it doesn’t look bad, because it was normal to them.

The interesting bit is whether it was normal and healthy or only seemed like it because it was all that the person experienced.

One of my high school friends used to sleep in the dryer, because it was the only place in the house that was semi-quiet.  In my own world, my mother struggled financially.  I can remember toast and peanut butter for breakfast, and times when breakfast was a cereal with powdered milk.  Our neighbors received government cheese that they shared (or gave to us).  Our cups were margarine containers.  It was normal to me.  To be fair, growing up wasn’t bad or traumatic – but I’ve come to realize that it also wasn’t the “normal” that other children experienced.  One of my friends in grade school didn’t have a phone in their home – so I was clear that it could be worse, even back then.

I share this, because someone could ask me to look into my past, and I may not find anything that’s interesting – or it could be that others are blocking out aspects of their childhood that impact their lives today.

Integrated Self Image

Struggle Well describes it as, “The treasure that comes from connecting your head and your heart is ultimately a connection to your soul.”  I’ve previously talked about is as integrated self-image in my review of Why We Do What We Do and have explained the relationship between reason and emotion while discussing Jonathan Haidt’s Rider-Elephant-Path model.  (See Switch and The Happiness Hypothesis.)  The degree of peace we can feel if we begin to teach ourselves to appreciate both our logic and reason as well as our emotion and intuition cannot be overstated.

There’s no aspect of ourselves that has the one true answer.  Instead, like we discovered in No Bad Parts, we need all of the parts of who we are to be the best we can be.

Less About Others

What other people think of me is none of my business.  At first, it sounds odd.  But it’s about me.  How can it not be any of my business?  The answer comes in two pieces.  First, how can you know what other people actually think about you?  We know that people are not likely going to tell you what they really think.  They’re going to sugar coat their perspectives or outright lie to you.  (See Radical Candor for more.)

The second perspective is whether you’d change anything if you knew the truth.  If you knew that some people that you’re interacting with don’t appreciate your gifts and talents, does that mean you’d hide them?  Would you become a different person just to be more well liked by a few people?  You probably shouldn’t.  The saying goes, “Be yourself – unless you’re an asshole.  Then be someone else.”  It’s obviously tongue-in-cheek, but it expresses a fundamental truth that we’re best off being ourselves.

Struggle Well reports their motto as, “Say what you mean, mean what you say, and don’t say it mean.”

Knowing Who to Prune

If you want your plants to grow best, you’ll prune them.  You’ll remove the dead and non-productive parts of the plant, so that the other parts have more nutrients to grow.  Our relationships are like this.  We need the discernment to identify those relationships that nurture us and those that are harmful.  We then need to evaluate pruning relationships from our lives.

It’s the discernment that’s the hard part.  Every relationship has both good and bad.  Some things about the relationship feed us, while others drain us.  How do we know which relationships are positive – and which ones are not?  In addition to the daily ups and downs of the relationships, we need to know that there are also seasons.  When my friend lost his father, I poured more in than I got out.  A friend faces depression, and I carry the lion’s share of the load.  When I lost my son and I needed support, I have no doubt that I was taking more from the relationships than I was giving.

Fault Lines explains the rifts that can happen in family relationships.  In it, we learn that sometimes there are big events that make a big difference.  But there are also small things that, if adjusted, could take a toxic relationship and make it life-giving – if we’re willing to try to find that path.

Goals and Luck

Struggle Well suggests that great leaders have goals and that these goals create success.  Certainly, I concur that goals and work towards those goals are important.  (See The Four Disciplines of Execution, for instance.)  Conversely, I recognize what Jim Collins referred to in Good to Great as the Stockdale paradox.  It’s knowing when to stay the course and when to listen to feedback.  Even Bob Pozen in Extreme Productivity explains that his life wasn’t a straight line.  Goals are good, but we have to be equally willing to adjust them when the straight path isn’t an option.

Louis Pasteur said it best: “Chance favors the prepared.”  That is, we need to do the work that we can to prepare ourselves to take advantage of luck – or opportunity – when it appears.  Goals do that.  Investment in ourselves and our mental health does that.

PhD in GSD

Theodore Roosevelt once said, “It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat.”  He was talking about the people who have earned their PhD in Getting Shit Done (GSD).

The way to earn your PhD is to start by learning how to Struggle Well.

Book Review-Becoming Trauma Informed

Everyone has experienced trauma.  Some situation has exceeded our capacity to cope.  As professionals, friends, and community members, we’ve encountered others who are overwhelmed by life.  Becoming Trauma Informed focuses on helping us respond to those situations better.  Instead of pushing back, ignoring, invalidating, or dismissing the trauma the other person is feeling, we can learn to accept, explore, validate, and support people through the trauma.

Naming It

One of the myths of working with folks who are experiencing or have experienced trauma is that you have to have them name it and explain it.  The myth goes that you can’t support them if you’re not aware of what they’ve been through.  This is simply not true.  As someone who is responsive to another’s trauma, you don’t need to know the details of the rape, suicide attempt, war, or any of the other traumas that may be present in their lives.  You don’t even need to agree that it would be trauma for you.  You only need to know that, for them, it was trauma.  Just like you don’t get to tell someone else what they’re feeling, you cannot tell them what is and is not trauma.

Do you need to understand the feelings that they have as a result of the trauma and the triggers?  Yes.  But you don’t need to know – and you may not deserve to know – the actual details of the situation.  Those are the private domain of the traumatized person that they may or may not be ready to share.  When you move to the understanding that they own the trauma experience and they get to choose how and when to share it, you’re in a better position to support them.

I can tell you that some close friends have had trauma that I’ve never directly asked them to relate to me.  In some cases, they believe they’ve shared the story, because so many others have requested or demanded the full story.  They speak to me as if I know the full story – and I don’t correct them.  I don’t have any need to know the whole story to support them.

Distorted Identity

While it’s convenient to speak about trauma as a one-time thing, it rarely is.  Most of the time, trauma is a pattern that people see repeatedly in their life.  While some will blame the victim for finding abusive relationships, we thankfully rarely do this with children.  Still, the pull to blame the victim for their repeated traumatization is powerful.  The problem is that, even without blaming the victim, repeated trauma fragments a person’s identity.  They can’t integrate the thoughts of the trauma with the rest of their life.  That’s a part of post-traumatic stress disorder (PTSD) as was exposed in Transformed by Trauma.

No Bad Parts speaks of our psyche in terms of parts or fragments that are either protectors or exiles.  Some parts of our personality develop to protect other parts that we must exile.  Much of that work is about returning the exiles to our core personality.  It’s about integrating ourselves together again.

Integrating is one challenge.  Removing distortions is another.  Understanding Beliefs and How We Know What Isn’t So both address distortions of our thinking – and, to some degree, what can be done about it.  Neither, however, directly address trauma.  The Body Keeps the Score speaks about how our bodies encode trauma in ways that are not immediately apparent.  One of these ways may be a distorted identity.

Perceptual Fragments

James Pennebaker’s work Opening Up explains that PTSD may be an inability to process a traumatic event.  In my review for Transformed by Trauma, I walk through some of the work that makes up what we know on PTSD.  These disconnected fragments of memory are sometimes triggered by seemingly unrelated events in the same way that we see a stick on the ground and believe that it’s a snake.  The startle response is driven by our amygdala, and it’s recognition of a pattern that may potentially be threatening.  (See Paul Ekman’s work for more on the startle response in Nonverbal Messages and Telling Lies.)

Monitoring Motivation

Sometimes, people will say that others aren’t motivated.  That’s technically incorrect.  Everyone is motivated by something.  The commenter is really saying that the others aren’t motivated by the same things.  (See Who Am I? for Reiss’ excellent framework on motivations.)  Miller and Rollnick, in Motivational Interviewing, make the point that the question shouldn’t be “Why isn’t this person motivated?” but rather “For what is this person motivated?”  It’s similar to the way that Immunity to Change approaches the question by asking what’s preventing the change that is desired.  It can be as simple as the person’s rational aspects knows they should, but their emotions are unable to sustain the effort necessary.  (See Switch and The Happiness Hypothesis for the rational-emotional-default/Rider-Elephant-Path model.)  It’s also possible that we’ve not developed the willpower necessary to sustain the effort.  (See Willpower for more information on the limits of willpower.)

Delusional Beliefs

More than the simple cognitive bias that believe we’re better than we really are, a large percentage of the population describe delusional beliefs.  (See How We Know What Isn’t So for more on believing that we’re better than we are.)  Somewhere between 10 to 25 percent of the general population will hear voices, and up to 70 percent will describe delusional beliefs.  Hallucinations in particular are common in the following:

• Trauma
• Bereavement
• Sleep Deprivation
• Solitary Confinement
• Hostage Situations
• Sensory Deprivation
• Waking

Trust and Safety

Trust is critical for those who have been traumatized – that is, all of us.  We need to know how we’re going to be able to protect ourselves and who we can trust is a big part of that.  My Trust => Vulnerability => Intimacy, Revisited post covers how trust functions in detail.

Tools for Trauma

If we want to become trauma informed, we need to know to interact with others with trauma in ways that allows them to heal.  (See Hurt, Hurtful, Hurting for more on the need to heal oneself.)

• Maximize Choices – Always seek to maximize the choices where you can. Some things may need to be done, but in places where there is flexibility, allow it.  Collaborate with the person to allow them to define what they want.
• Listen – It seems silly, but we often get so wrapped up in our own worlds and what we have to get done that we don’t always really listen to what the other person is saying.
• Seek to Understand – The impossible goal is to fully understand the other person, but we should endeavor to do our best to understand the other person. This includes:
  • Whole Person – Who the person is as a person, not just the reason we’re interacting with them.
  • Experiences – The experience they have had from their point of view.
  • Context – Their broader context, including what else is going on in their world that we may not be aware of.
• Respect Choices – The more we can respect that the choices others make are theirs, and we can’t control those choices, the better off we’ll both be. (See Compelled to Control for more.)
• Validate Experiences – Where possible, validate that their experiences are theirs and that they do make sense – at least to some degree.
• Encourage Self-Advocacy – Encourage the person to recognize their strengths and their ability to self-advocate.

In the end, we won’t be perfect, but that isn’t our goal.  Our goal is Becoming Trauma Informed.

Book Review-Trauma-Informed Healthcare Approaches

Everyone has trauma.  Everyone has experienced something that has hurt them and from which they need to recover – and they may never recover completely.  There may always be that soft spot in their soul where they were hurt so deeply that no healing can find its way.  Trauma-Informed Healthcare Approaches seems to transform healthcare organizations in ways that minimize the retriggering of those who have been traumatized and to heal their hurts.

The Meaning of Trauma

Before we get too far, we must deal with the fact that we use the word “trauma” to apply to both the event and the outcome.  The bike accident is a trauma, and so, too, are the lacerations (cuts) that are sustained as a part of it.  This is important, because when we’re speaking of trauma-informed healthcare, we’re speaking of a system that recognizes and responds to the outcomes.  The emergency department is there to address the event, but the whole organization needs to respond to the outcome and support the healing process.

In Hurtful, Hurt, Hurting, I explained the difference between actions designed to hurt, feeling hurt, and the climb out of hurt.  Trauma is much the same way.  There’s the event, and there’s the need to recover from it.

Ruptured Relationships

One of the problems with trauma is that it ruptures relationships.  It can be that quickening of pulse as you get into the car after an accident or the sweaty hands when you see a German Shepherd.  It can also be a response to a person who traumatized you – the feeling when your ex calls on the phone.  The goal for trauma-informed care is to facilitate the healing of relationships to people, animals, and things.

Healing the relationships is sometimes desensitization, as Albert Bandura first explained.  This is done with a carefully controlled set of circumstances that makes people feel safe while moving closer to the area of their trauma.

Vicarious Traumatization

Experiencing someone else’s trauma by hearing their story has multiple names.  It’s sometimes called vicarious trauma, secondary traumatic stress, and compassion fatigue.  (See Is It Compassion Fatigue or Burnout? for comparing burnout and compassion fatigue.)  The fact is that listening to other people’s trauma all day takes its toll on you.  It’s hard to be fully open to others’ emotions and not pick up some of the residual.  That’s one of the reasons why it’s particularly important that people who are in caring professions learn how to manage their trauma effectively.  They’ll be receiving it consistently and will need to effectively process it before doing their next shift.

Revealing Traumas

Sometimes, it’s not yet time for someone to reveal a trauma.  It’s too new or too raw, or you’re not perceived as safe enough.  This places healthcare workers in the delicate position of needing to allow people to avoid discussing their trauma – and to signal care and concern that makes it safer for the person to be able to share in the future.

There’s no one answer to how to address this with patients – and people.  It’s a combination of the allowing and reaching into the discomfort enough that there’s a chance to resolve it.

Wayfinding through Trauma

The best thing that organizations can do is to make it easier for people to find their way through trauma.  This means sending clear signals that it’s okay to discuss, recognize, and work through trauma.  Simple things like allowing space for sharing and providing trauma-specific resources can go a long way to discovering many Trauma-Informed Healthcare Approaches.