Moving Forward in Trauma Awareness PDF

1 | P a g e C h r i s C a v a l i e r e , F a c i n g F o r w a r d © , T r a u m a R e c o v e r y P r o g r a m

of people with mental illness have reported experiencing

Trauma related events in their lives. in

people will experience potentially traumatic events at least once in their lifetime.

“FACING FORWARD”© A Trauma Recovery Program, Created by Chris Cavaliere, CPST- ©2013

Individual trauma results from an event, series of events or set of circumstances that is experienced by the individual as physically or emotionally harmful or threatening and that has lasting adverse effects on the individual’s functioning and physical, social, emotional or spiritual well-being. (SAMHSA’S National Center For Trauma-Informed Care, 2012)

Through much discussion and deep thought, this definition of trauma comes from the

voices of those who have experienced trauma along with those who have researched these experiences and those who strive to assist the people who struggle to overcome the effects of trauma.


The prevalence of trauma in our world has become evident by recent statistical studies.

The National Comorbidity Study showed that within the general population of the US, 62% of men and 51% of women reported at least one traumatic event in their lifetime. (Kessler et al., 1999) The National Epidemiologic Survey on Alcohol Related Conditions showed that 71.6% witnessed trauma, 30.7% experienced related injury and 17.3% experienced psychological trauma. (El-Gabalaway, 2012)

In a recently released UNICEF worldwide study, 50% of girls will become victims of violence

and on any day at least one girl will suffer a traumatic event. In the NCTIC, 2012 report “Changing Communities, Changing Lives” it confers that current interest in trauma-informed approaches grew from, the stories and voices of survivors, research on trauma and violence, progressive new trauma treatment models as well as social and political action to prevent and respond more effectively to violence and abuse.

We are on the cusp of dramatic social change. As people become more trauma informed

we have begun steps in a social movement, where a common vision of change becomes the undying voices of many who say, “Things should and can be different “, holding the hope it will be so.

In considering these statistics, there is now a greater understanding today of what is

considered to be a traumatic event. From the experiences of war, natural disasters, violent assaults, serious accidents, continual

exposure to violent environments and personal abuse, whether physical or psychological, come the effects of trauma. Trauma also occurs from events outside expected life stages, such as a parent losing a beloved child or a young person being diagnosed with cancer. There is in addition, the potential effect of historical traumas proven by the Holocaust Survivor’s Study, experienced not only from first generation, but ongoing generations that may be influenced by this type of association.

Trauma also occurs in institutional settings, such as in jails and prisons, juvenile detention centers, within non trauma informed hospitals and through the process of forced hospitalizations. It can as well result through non trauma informed schools and community settings. Too, it can come through homelessness, poverty and destitution.

If one lives long enough, they will experience some kind of potentially traumatic event in their lives. Though two people may experience the same traumatic event, they will respond


differently. Trauma is determined by three things: the event itself, the individual’s experience and individual effects.

The event or circumstances may include the actual or extreme threat of physical or

psychological harm or the withholding of material or relational resources essential to healthy development. These events and circumstances may occur as a single occurrence or repeatedly over time.

An individual’s experience of these events or circumstances helps to determine whether it is traumatic. How the individual labels, assigns meaning to and is disrupted physically and psychologically by an event will determine if it is or is not experienced as trauma. In many situations, a sense of humiliation, betrayal, or silencing often shapes the experience of the event. How the event is experienced may be linked to other factors including the individual’s cultural beliefs, availability of social supports or the developmental stage of the individual during the time of the event.

The long lasting adverse effects on the individual are the result of the individual’s experience of the event or circumstances. These effects may occur immediately or over time. The connection of the events and the effects may not be recognizable for some time. These effects might include difficulty to trust and benefit from relationships, to manage emotions, memory, attention, thoughts, and behavior. This can make it challenging to deal with everyday stressors. There is evidence that neurophysiological alterations can occur that affect on-going health and well-being.

These effects from trauma do not come to us by choice. Rather they come to us unbidden and are often termed “Mental Illness”.

People who are faced with these challenges are adapting to extremely hurtful events and

very difficult circumstances. We are not crazy or insane, we are not sick, we are resilient! We can and do recover from all of these effects. Even with the neurophysiological

alterations that occur from experiencing trauma, through the discovery of neuroplasticity, which refers to the brains ability to change and adapt to alterations, we can and do heal. We can work with trauma informed practitioners in affective trauma specific therapies or we can


choose a different path for healing. Trauma is mostly experienced and remembered in the body through our senses, whether it was physical or psychological.

It benefits us to be trauma informed, as then we have the ability to make sense of our own experiences in relation to what we are doing, what we are experiencing, that may or may not benefit our lives. We then can take charge of our personal-responsibility to do the things we know help us while keeping our minds open to what we might learn from others, seeking supporters who believe in us and except us for who we are, nonjudgmentally and unconditionally.

Individual trauma involves more than just the individual. It involves the individual’s

surrounding community as well. One of the drawbacks of our society is that it often isolates people in their trauma instead of engaging the person as a community member who is important, who needs support. Too many do not understand and do not know how to be an effective supporter. Ask, ask, ask the person, validate their feelings, validate their efforts and offer to support them in a manner they tell you. Do not assume to know a person’s experience, though you may have a similar one and can empathize, each person is different. Offer to listen, listen carefully, quietly with acceptance. The aspects of cultural influence can either help or hinder both the person traumatized and potentially the person’s support community. Culture goes deep. It is more than one’s country or ethnic background, more than one’s religion or spiritual belief. It also entails one’s upbringing, which includes not only the parent’s cultural responses to the child, but also the child’s responses to their parents.

This cultural affect can involve society’s views as well, as with stigmatization, prejudices, and financial class distinctions. Trauma can be an effect for those with gender differences and preferences through the abusive influences of societies. Cultural traumatic affect can also come through biases in laws and stringent religious beliefs. The opposite can be said for laws and spiritual practices that honor, protect and accept individuality.

Part of healing comes directly from community. Feeling accepted and supported by the community of one’s choosing and having engagement in that community is paramount in lasting recovery. Gaining a feeling of acceptance and belonging is fundamental to personal development and growth. In understanding all of the contributors that define trauma, it is helpful to become more aware of specific things that are common results of re-traumatization, when the effects are more long lasting. For those who have experienced trauma, this knowledge can guide us in making sense of how we came to where we are and gives us hope for a new future.


z

Bringing Trauma Out of the Darkness! There is great loss in trauma.

The first loss is the loss of control.

There are many losses one experiences from traumatic events and in dealing with their after effects. Here are some of the common psychological and physical

effects that are associated with Traumatic Stress.


A scientific point to remember about traumatic stress is that the brain does not naturally hold those memories in the conscious, but holds them in the subconscious, in the body. That means it often continually holds the stress in the instinctive brain, acting as a reflex that creates a hypersensitivity to physical sensations, and leads to heightened emotional stress. This is a normal physiological response to abnormal circumstances.

Through neuroplasticity, we now know the brain has the power to heal! Remember recovery is possible! Psychological Effects

Shock/Denial

Shame/Guilt

Depression/Worthlessness

Irritability/Anger

Fear/Anxiety

Loss of Interest

Hopelessness

Feeling Disconnected

Loss of Trust

Social Withdrawal

Confusion

Emotion Overload

Altered Realities

Physical Effects

Flashbacks

Insomnia

Memory Loss

Chronic Headaches

Nightmares

Aches and Pains

Increased Heart Rate

Fatigue/Fibro Myalgia

Intestinal Disease

High Blood Pressure

Loss of Weight

Weight Gain

Muscle Tension/Arthritis


The Process of Grieving Relative to Trauma The process of grieving trauma is as personal as the individual’s experience.

When we experience traumatic events it is natural to go through a grieving

process. It will take time to move through this process. How much time depends on the individual’s age, their natural supports, their personal beliefs, the available options they may choose and the type of trauma they have experienced?

There are several stages of emotions that we move through in grieving. These

emotions come to us as we try to make sense of what has happened to us. Though the stages are set in an order, there are many variations of how we may move through them. Grief is a natural occurrence of loss and can come to us in bursts of emotion that can be difficult to manage as they can come at unexpected times.

Stages of Grieving Trauma

Avoidance Evasion Denial Anger/Fear Guilt/Shame Pain

Fear Numbing Weeping Acceptance Forgiveness Relief

It seems evident that many of the effects of trauma framed as PTSD are reflected in these stages, which further leads us to believe that all of these effects are a natural occurrence of grieving the losses of trauma.


The first loss from a trauma experience is a loss of control, where an individual’s inherent right to choose is taken away. In some sense this can become a familiar in a person’s life, following their traumatic experience.

As we find ways to adapt, we often fall into relying on things that may

temporarily relieve our stress, yet can send our lives out of control. Often it is these things that block us from moving forward with our lives. In turning to alcohol, drugs, unhealthy sex, gambling, overspending, overeating, self-inflicted violence and other unhelpful adaptations, trauma recovery is hindered. Though we may have stumbled into using these things for relief, it may be that we felt no choice or that we willingly chose to continue down that road and in doing so we may have been exposed to additional traumas. This can become the cycle of our lives.

WE DESERVE BETTER! Those unhelpful adaptations can seem to be our only choice, but it’s not. We

can ask ourselves, do we want better and what are we willing to do to have it. We can advocate for assistance that works for us, so we might be able to find alternative solutions that serve us more effectively. We can gain back control and begin to move forward in creating a satisfying life of self fulfilment.

This familiar loss of control can be perpetuated by the fear of change. Change

can be daunting when you think there is no other way, or that you are genetically defective. Genes are not shown to be the predominate factor in most mental diagnosis. It is now widely believed that environmental factors are more evident, traumatic experience being most common, in the advent of mental illness. Because for so many years the focus was on diagnosis, not on experience, the trauma effect was completely misunderstood. How easy then has it been for the system to miss recognizing the resiliency within us. It is easy to buy into failings when one’s self esteem has been continually batted down by stigmatizing, prejudices, homelessness, poverty and a care system that failed so many of us by lack of being trauma informed. So often we became labeled with confining


diagnosis, and described as “non-compliant”, when we were simply adapting to traumatic stress.

Though we never asked for the unbidden adaptations of mental illness, we still

have the power to take back control. When we continue to rely on unhelpful adaptations, we keep missing opportunities for change. Change is the only constant in this world and we have the power to make changes that can improve our lives.

The mental health system is now changing to become more trauma informed.

In the Substance Abuse and Mental Health Services Administration’s TIP 57,

“Trauma- Informed Care in Behavioral Health Services”, there is a solid foundation for the service system to evolve. This has not simply developed out of a psychology book. It has taken years of persistent consumer advocacy, going all the way back to the origins of the survivor/consumer movement. This awareness began late in the 1800’s, as Dorothea Dix spoke up for the mentally ill, and in documenting their horrible abusive treatment in the jails and poorhouses across the US was a testimony of trauma and re-traumatization.

If we can credit a book for first voicing the re-traumatization experienced in the mental health system, the need for change, and the advent of peer support, we look no further than Judi Chamberlin’s “On Our Own”. In her book, she gives testimony to the dysfunction of the mental health system’s traumatizing treatments and policies, while outlining how those who shared these experiences were able to come together, help each other to recover and begin the process of changing that system. What is truly astonishing is that her book was first published in 1978, 36 years before TIP 57 was published. If the people like her back then, had not stepped up and began this long lived dialogue that has culminated in the implementation of Trauma Informed Care, we


may not have ever had a voice to influence change. Fortunately, there are many that follow in the footsteps of our founders. Advocates, both those of lived experience and those who also seek to improve the mental health system, are working together to bring a better life to all who have been challenged through trauma and resulting mental illness.

The names are many who have voiced their stories to change hearts and minds,

who work tirelessly to bring trauma-awareness to the forefront of our nation. They all believe that the answer lies in seeing adaptations, not symptoms and resiliency, not pathology. Let us hope that this view is embraced and this knowledge quickly applied in programing, procedures and policies. These views are needed to address the lack of understanding that has been causing the re- traumatization of so many over the years. At SAMHSA’S National Institute for Trauma Informed Care, there is a team of peers and clinicians, who travel across the country spreading the message of trauma awareness to behavioral health organizations and the general public. They host webinars regularly and are an excellent source for information. Each of us as consumer/survivors will continue to have our voices heard in changing the programs, procedures and policies of behavioral health care services. We work now as a team with providers on an equal level of individual expertise. Doctors are experts on medicines, therapists are experts on therapies, and we are the experts on our own experience, including how therapies, medications, procedures, policies and programs affect us. Everyone now has a voice, as it should be.

Let your voice be heard!


Documents

Moving Forward in Trauma Awareness PDF