Trauma Informed Care
Meets Pharma Informed Care

Wayne Munchel
11
177

The National Council on Trauma Informed Care asserts that “knowledge about the prevalence and impact of trauma has grown to the point that it is now universally understood that almost all of those seeking services in public mental health have trauma histories.”  A central tenet of trauma informed care is flipping the paradigm, from asking “what’s wrong with you?” to asking “what’s happened to you?”

But when traumatized people seek help at public mental health programs they often encounter a pronounced interest in identifying what’s wrong with them.  This is primarily due to the continued reliance on the psychiatric Bible (DSM 4/5) to determine who is eligible for services and who is not.  The frequent result is that the vast majority of these traumatized people receive diagnoses such as attention deficit, oppositional-defiant and conduct disorders (for children) and depression, bipolar and psychosis (for adults).  In turn, these diagnoses spur the treatment towards psychotropic medications.

How does this diagnostic system, and the associated provision of medications potentially impact traumatized people?  Setting aside the significant risks that the neuroleptics themselves can pose to many help seekers, how else can pharma focused interventions effect the treatment context?

The DSM 4/5 is largely concerned with nosology – the classification of diseases and categorization of “what’s wrong” (with the notable exception of PTSD).  Through this lens, practitioners focus on assessing the symptoms, impairments and deficits – not on the etiological (study of causes) questions of why these difficulties may be occurring.  The nosological approach of the DSM 4/5 could be characterized as the epitome of the “what’s wrong” perspective.

The emerging understanding of developmental trauma – referring to prolonged exposures to trauma and childhood maltreatment is described by Bruce Perry, M.D., of the Child Trauma Academy, as the “great imposter”.  He makes the case that a great number of the DSM 4/5 diagnostic labels actually represent adaptations to high levels of chronic stress.  Several recent studies have pointed out the relationship between psychotic disorders and trauma.  This recognition and reframing of symptoms as adaptations is foundational to trauma informed care and can help people make sense of their seemingly senseless behaviors.

When children, young people and adults with these significant traumatic exposures present at mental health clinics, their adaptations (i.e. dissociation, impulsiveness, social withdrawal) are often seen as symptoms to be medicated.  On the one hand, many people may experience great relief at being diagnosed (finally someone understands me and can help me!)  The chemical imbalance narrative can override the trauma narrative of what happened to them.  And medications can certainly provide welcome relief from distressing symptoms such as insomnia, anxiety and tension.  In addition, we live in a culture that is deeply attached to quick fixes in the shape of pills (and other substances).  The “what’s wrong” question gets a definitive answer; (you’re depressed) and a deceptively simple remedy (an anti-depressant).

On the other hand, trauma informed care can greatly expand our understanding, our compassion and the potential for healing and recovery.  Most people can extract little meaning from the biological viewpoint that their dopamine is low or serotonin is high.  Creating a sense of meaning from painful experiences, and restoring a sense of personal power are crucial goals of trauma informed care.  By supporting and teaching traumatized people about ways that they can emotionally regulate and self-soothe, they can begin to develop a sense of mastery and control.

Taking medications can become a very passive act, demanding little effort and responsibility on the part of the help seeker (and the help provider). Trauma informed care requires a collaborative, empowering approach that is predicated on the belief that the person is the expert on themselves and has the capacity to heal.  The Recovery Model states that diagnosis is not destiny.  In trauma informed care, diagnosis may not even be the correct starting point.

11 COMMENTS

  1. The platform of your message is nothing less than brilliant! Absolutely,, the message you have to share about how to shift the paradigm in mental care from its current system of failure IMO ( since I lost my 25 y/ o son to suicide 19 months ago) after ” the system” truly focused not on the sea of stressors he was dealing with but on the MH ” illness” the psych hospital rushed to label and drug him with a severe MI ” bipolar for life, meds for life” despite he tested + for a psychoactive substance( cannabis) which I learned too late really per the DSM “bible” should not have boxed him in but it did. Truly, as I looked at the Village program you are involved in Wayne, it’s the most hopeful, inspirational model for today’s youth and young adults I’ve seen. There’s a training program “TraumaCare” in Long Beach, CA on Sept 27 in my neck of the woods- looks exceptional. Wow, the positive message how to reach young people by truly helping them heal, not by labeling, brainwashing and drugging them-as the psych hospitals so quickly did like to my son whose life had always been whole and rewarding, but anyone can encounter a ” sea of stressors” almost overnight depends on bad luck mixed with circumstances. No wonder the former First Lady, Rosalyn Carter, herself a big advocate in MH recovery, has praised the program you’re involved with so highly! Thank you for such a positive direction this kind of program is taking the youth you meet. How can you get this program into ALL the schools across America? I believe you can save countless young people because your program focuses on how to heal and recover!!! Bravo!!!

  2. Bravo! I liked a few lines especially: “restoring a sense of personal power are crucial goals of trauma informed care… develop a sense of mastery and control.” And, “the person is the expert on themselves and has the capacity to heal.”

    Something inside of me always felt that, although a professional might be learned in treating ailments from a systematic perspective, there should be no one more knowledgeable on my specific condition than me. I believe that at the beginning of any healing, there should be the ailing person themselves, spearheading the effort, and always lighting the way for the professional at each turn. Such an approach seems to be so much more efficient in reaching true recovery.

    Wayne, That last paragraph brought it home, and you left on such a profound note: Indeed, diagnosis isn’t the starting point. Imagine how many years of pain and suffering we (well, you and your colleagues, I’m not a professional) are missing and skipping over, that may very well assist in finding the “real” diagnosis! It’s as if we are not human beings with unique features and experiences. What’s a diagnosis anyway without examining one’s past experiences that may have brought them here. Not a diagnosis at all, really. Again, it’s a case of treating the symptom, but not the cause. With a system like that, the symptoms WILL inevitably resurface again and again—the cause is still there, and the pill is just a temporarily soothing cover up.

    What’s worse, is that people become dependent on that treatment, and perhaps addicted, which may very well create yet another reason for “diagnosis”, and further “treatment”. A never ending cycle that hardly ever ends in real recovery.

    Thank you Wayne. Good post.

  3. Yes, I will definitely meet you at this conference, Wayne. As I continue to read more about the “Transition Age Youth” (TAY) services designed for ages 16-25 this is exactly the program my son should have been told about (and us, his family who were beside him from the night of his psychotic break (I believe now it was largely related to way his brain reacted to cannabis, a psychoactive drug, that many clinical studies assoc with psychosis). The TAY services which the TIP Model and training you are providing in this conference, TraumaCon, should absolutely been recommended do my son who using your words “should have had compassionate understanding
    for the “sea of stressors” he was faced with starting with a serious boating injury and surgery-loss of his well paying job while having to go on disability to rehab his leg which did not heal correctly- a few months prior to his wedding planned prior to his injury (and most definitely a HUGE mistake). Nope, the psych hospital and subsequent out-pt p-doc who accepted only cash (sure my son and his family were the cash cows) only cont’d the mantra “mentally ill for life, bipolar for life, meds for life” while my son was massively drugged with psychotropics which just compounded his brain while it was still effected by the THC since it is a lipophilic compound.
    Looking forward to learning more and trying to help others not follow the MH path my son, and his family, so blinded accepted as he was sucked into the MH “death” system until it was too late.
    Sadly, I believe these facilities are not eager to spread the word about the helping programs like TraumaCon because it might lessen the revenue these “victims” provide as many have revolving door re-admissions. “If only” young people in my son’s age were supported with alternative ways to truly heal and recover instead of the traditional Psychiatry model of today.

  4. It is good to read of this, as from my therapits viewpoint, I have always known it. I use a trance technique called Rewind to clear trauma and it “works” 90% of the time. and I use it somewhere or another in the majority of my clients. nd rather than waste time with diagnoses you realise that how people cope or not cope with past trauma explains so much. And that if you can clear the trauma then you are well on the way to recovery.

    Incidentally trauma needs to be defined broadly to include not just one off experiences but extended periods and so on. I can’t imagine how therapists heal mentally distressed clients without have an effective means to detraumatize. Maybe it is like a doctor not able to use antibiotics.

  5. Raw Trauma
    (without anything to numb you)

    A Cryptic
    by mjk

    A moment arrives
    with little to no notice
    Right then and there
    you need help

    411 or 911

    411 Directory Assistance
    911 Emergency Response

    Which number do you call

    Dial Zero for the Operator
    Dial Nine to get an Outside Line

    The Godfather: GE, We Bring Good Things To Life
    The Godmother: Nynex, Let Your Fingers Do The Talking

    The Godparents ~ Brother & Sister

    Electricity & Telephone 4 Power & Communication

    There is no directory
    Here is no assistance
    Here is constant emergency
    There is no response

    ohm milligram

  6. This is a great article, Thanks!
    Today is too a big day in Concord, NH for a related event, to date I have found our state may need further development in this area.
    But, I do hope to circulate this:

    When a judge too; walks a mile in their shoes…
    “Tepper, a veteran of 37 years on the bench, realized that childhood trauma experienced by the people who ended up in her courtroom was much worse than their paperwork showed.
    “When you dig down deeper, you wonder how these people get up in the morning,” she says. “I remember thinking at one point, ‘Oh boy, did we blow it all these years…”
    http://acestoohigh.com/2014/09/24/trauma-informed-judges-take-gentler-approach-administer-problem-solving-justice-to-stop-cycle-of-aces/

    Today, will be a very big day here in Concord, NH.
    With an event of the year, that statistically effects 1 in 4 of all humans, being supported and promoted by a good lot of professionals, administration & service providers- it may be of certain interest to: read the linked article and point out to the many of participants around 5:30 in downtown; just what this sitting Justice has to say beyond what the headline offers…

    For today, the NH Domestic Violence Coalition will be hosting the 15th annual, “Walk a Mile in Her Shoes” event. The sponsors’ ask men to don a pair of high heels and walk-a-mile, in return for donations that allow the program to further advocate for individuals whose lives have been affected by domestic violence. Although this is an interesting attempt to showcase what women go through, it is a far cry from the actual lived experience however, as the above article states; education and research, understanding as well as, “a peek at the pasts’ “, of the many individuals that the event may support has potential for positive relations and support. For if this event additionally helps the biggest decision makers in the halls of Justice, to offer better options, rather than further trauma related environments for those who became a victim not by change, but lived experience as well, that’s great.
    After reading the article, it may be in the NH Justice Systems ‘ best interest to: start an ACES connection here in NH too. If we took a moment to imagine the numerous communities’ benefits, from positive outcomes after such unfortunate situations, our state may only get better!
    Today offers a big day for NH and with the medical model so prevalent in many aspects of wellness, we should actively remember; the World Medical Associations’ Hippocratic Oath, Primum non nocere : First, DO NO HARM.

    Thanks again-