More Sensitivity Needed Toward Trauma Survivors
By Angela Cerio, Psychiatric Survivor and Certified Psychiatric Rehabilitation Practitioner
Insights Gained from Trauma Informed Peer Support Training
How much do you know about trauma? What comes to mind? The Veteran, returning from combat with “Post Traumatic Stress?” The disaster survivor? The battered spouse? The abused child? Abandonment?
Trauma goes much further than that, as I recently learned in a Mental Health Empowerment Project (MHEP) sponsored training on “Trauma Informed Peer Support.” Studies show that over 90% of people with psychiatric diagnoses, and nearly 100% of incarcerated women are trauma survivors. Trauma can be defined as “extreme stress brought on by shocking or unexpected circumstances or events that overwhelm a person’s ability to cope.”
According to SAMHSA, there are three E's to a traumatic experience: 1. Events and circumstances which cause trauma; 2. The person’s Experience of these events determine if the event is traumatizing; 3. The Effects of the traumatic event on the individual, which includes adverse physical, social, emotional or spiritual consequences.
We use language every day which reinforces the violence in our society. These words in themselves can remind the survivor of the original trauma—perhaps without conscious awareness of the connection.
A list of dotted points in a presentation are referred to as “bullets.” Those things which evoke powerful negative emotions in us are called “triggers.” The professionals we deal with every day in behavioral health programs are frequently referred to as “front-line staff.”
As a peer support specialist, I learned early on to see “coping mechanisms” where clinicians see “symptoms.” One of the key elements needed to avoid “triggering” those behaviors we have developed to cope with trauma is feeling safe in the present.
When confronted with a threat whether real or perceived, the brain signals the body to respond with “Fight, Flight or Freeze.” When the threat is gone, the switch turns “off” and the body returns to “baseline.” If the switch is stuck in the “on” position, and the body remains prepared for threat—this is a “trauma response,” evoking whatever mechanisms the individual has developed to cope with the traumatic event. Instead of “think, process, act,” the individual goes immediately to “act.”
I cringe when I hear a mental health professional talk about a client “acting out.” “Fight” becomes “non-compliant” or “combative.” “Flight” becomes “treatment resistant” or “uncooperative”. “Freeze” becomes “passive” or “unmotivated.”
In the language of trauma-informed peer support, we see “Fight” as a struggle to hold onto or regain personal power. We see “Flight” as disengaging or withdrawing to feel safe. “Freeze” becomes giving in or giving up to those in power to avoid further harm.
The consequences of trauma include mistrust, loss of power and control, manipulation, silencing of one’s voice, invalidation of personal rights, helplessness and hopelessness, violation of personal boundaries and sense of safety. It leaves people feeling powerless and has a lasting effect on a person’s ability to trust others and form lasting relationships.
People are frequently unaware that their emotional challenges are related to past trauma. They may be responding to the present through the lenses of the past. Their coping mechanisms could lead to punitive reactions from others who may label their reaction as “non-compliance.” Trauma survivors have good reason to be sensitive to misuse of power and authority.
Healing from trauma requires first a sense of safety. Then the survivor may be able to develop the ability to trust themselves and reconnect with (or connect for the first time) and trust others. Healing begins when the trauma survivor regains a sense of control over their life and environment.
Trauma-informed services could change the way we receive help for our emotional challenges by creating safe, welcoming environments, by avoiding reoccurring trauma and victimization, by using our listening skills toward collaboration and mutuality, by giving people voice and choice, by focusing on “what happened to you?” rather than “what’s wrong with you?” Safety for us as people with emotional challenges means controlling our own lives. For providers, safety means maximizing control over the service environment and minimizing risks for both the client and the agency.
One last thing to remember is that people with emotional challenges are not limited to those of us who have been labeled by psychiatry. Clinicians are not immune to trauma responses and may not be aware when they are reacting to our challenges through the lens of their own past.
Note: Thanks to the Mental Health Empowerment Project, Cathy Cave, Bill Gamble and the NYC Department of Health and Mental Hygiene's Office of Consumer Affairs for making the training on trauma-informed peer support possible.