I was invited to present at Canada’s inaugural Conference on Post-Traumatic Stress Disorder. The conference was focused on ways that new legislation might support those with PTSD, provide pathways of healing, and inform the evolving Federal Framework on PTSD. My clinical work is mostly focused on trauma (and addiction, which is often a symptom of trauma); so I was invited to speak about my experience, in different parts of the world, working with organizations and communities on projects focused on trauma healing. I was encouraged to emphasize the interdisciplinarity of that work as well as its holistic character. My presentation slides are available via the link at the bottom of this post.
Trauma is an experience that exceeds our ability to manage stress. In clinical terms, trauma breaks containment: we lose our self-regulation, we are drawn into instinctive coping, and we are usually unaware of what’s happening. This is how trauma can happen invisibly and can go unseen. It is unusual for a person to notice that they are being traumatized while it’s happening. Consequently, one of the defining features of trauma involves the bypassing of (most of) our cognition: we just act — and we don’t notice.
Traumatic situations involve high levels of emotional and psychological stress. That stress, in turn, damages our ability to modulate our thoughts and emotions. We enter into a primordial consciousness that is focused on survival. The situation does not have to be authentically threatening to our survival — most traumas are not. But in the moment, as events unfold, as the stress of exposure increases and our coping abilities vanish, the defenses of our psychology begin to crumble and the body takes over. The body possesses millions of years of evolutionary wisdom about survival. It knows — without hesitation, without doubt, without thinking — how it will respond. The human animal has perfected distinct pathways of response (flight, freeze, orient, or fight) that are deeply interwoven with childhood development and the nervous system. They are automatic, autonomic, and highly effective — at least, effective from the point of view of the body, which simply wants to survive.
But what if the situation is not a threat to our survival? What if we’ve just entered a museum gallery and we see a whip once used in the slave trade, the crushed remains of human beings, or photographs of a mass execution? (These are actual examples from research and conversations with my colleagues in museum settings.) There is no risk to our physical safety in these situations, no threat to our survival. But as trauma clinicians know, our particular vulnerabilities to trauma are the result of our previous histories, our experiences and our cultures, our prior exposure to trauma and its sequelae: what’s happening now is the direct result of what happened then.
We respond to these moments — flight, freeze, orient, fight. We seek to escape, or we shut down, or we become anxious, or we get angry. Perhaps we start with one response and then shift to another. Or we blend them together. People are different; many things can happen. Although individual stress responses play out in a multitude of ways, they share one common feature: the responses lock. The deep coping mechanisms of the nervous system are not transient states when it comes to trauma. The patterns of behavior and emotion that accompany these states – driftiness, depression, fatigue, sleeplessness, irritability, impatience, overwhelm, and many others — persist long after the event. Sometimes they resolve in the days and weeks following exposure — people will say I felt weird after that experience, but I’m OK now — and sometimes they do not.
In my clinical practice, I often work with clients struggling to recover from traumatic situations that are decades in the past, and that often stretch back to early childhood. But all of us are vulnerable to trauma that is triggered by exposure to intense experiences. Previous trauma can be re-awakened by such intensity. We can be traumatized by exposure to others in distress. In our efforts to support others, we can be traumatized both vicariously and directly. We can also become overwhelmed with compassion fatigue, or hollowed out by empathy depletion. Trauma is one of the most common and pervasive human experiences, and we all face it in the natural course of our lives.
Trauma is a wound, yes, but it is also a great teacher if handled properly. With appropriate and consistent help (but never alone), we can learn to contain and redirect our stressful exposure, to understand and learn from our traumatic experiences. After all, this is how the trauma clinician works: by helping to contain activated clients, helping them identify locked imprints, and assisting them in learning the skills of self-regulation required to shift and unlock deeply-held patterns in the body and the nervous system. These shifts happen in therapy, and they can happen in facilitated activities in cultural and community settings.
My presentation at the National PTSD Conference was focused on cultural and community practices for trauma healing. Such approaches are becoming more popular and more available. I spoke about the work that I have done in museums, my interest in nature experience and physical activity, and my belief that counselling and therapy are evolving, as professions, to cultivate these more interdisciplinary and holistic methods.