Life Lessons and Trauma Informed Care

Matthew Morris
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Trauma and experiences in life that challenge us are increasingly being recognized as the most important factors in understanding and helping people who are emotionally distressed.  The evidence consistently supports the view that the most important thing we can do is acknowledge what has happened to people. Arbitrarily attempting to classify and group people into pseudo-scientific categories serves only those who might gain in some way by doing so. Denying the relevance of life experiences only serves to allow us to avoid collectively addressing our society and the abuses it permits, how it labels people already discriminated against, and how it enables people to ignore poverty, ignore inequality, hypocrisy, and greed.

We hear more and more evidence from around the world that when we change our perceptions and harness the empathic skills that we all possess as human beings, we can all make a profound difference.  We can open our eyes, our ears, and our hearts.  This then has to be true for us all, all our life experiences, our reactions to them and the responses of those around us who influence who we are, how we feel, think and behave. They shape how we see the world and those around us, our beliefs, our hopes, and our fears.

My first real introduction to the world of madness and “mental illness” was when I was 21 years old and I left home to start my mental health nurse training. Reflecting on my own experiences has led me to consider how the trauma of participating in the psychiatric system can affect the way we care for others.

As part of our induction, in the first two weeks of my nurse training, we had a tour of St Audrey’s Hospital which had been created as the County asylum in 1829.  I don’t think anything I had experienced in my life up to that point could have prepared me for my first exposure to a psychiatric ward.  We were shown through the locked doors of a ward for older women who were diagnosed with dementia, and the scene that met us was, for me, shocking.  The woman’s bodies were emaciated and twisted as they were sitting in padded, high sided wheeled chairs called G chairs, all tilted backwards in reclining positions. Trays were attached to the front. I learned later that the trays and the reclined position were designed to act as restraints.

The cleaners were working on the ward and had moved all the chairs to the middle of the dining area. There had been no regard for the fact that people occupied the seats. They were randomly pushed to the centre of the linoleum so that the number one task of cleaning could be completed as per routine. Thinking back, I know that I was deeply shocked, but I had no words for that shock.

My first placement was on an acute admission ward at St. Clements Hospital in Ipswich, and halfway through the first day, I became aware that something was going on.  There was a rush of activity and concerned faces. Male nurses from other wards were called upon to come over and assist.  They arrived in the staff room and began to roll up their sleeves, unclip their ties, remove their watches and prepare for action.  They had an air of anticipation, adrenaline, and ritual that I could only liken to when I was part of a team that was about to go on the pitch for a football match.  It was a familiarly male atmosphere thick with tension, cigarette smoke, and bad taste humour. They were preparing themselves for action, I think secluding someone and giving them an injection.

Again I was shocked and frightened but coped by switching off from the feelings and the consequences of feeling that way. Perhaps if I were aware I would have to do something about it, and my young self didn’t have the wherewithal to react. I wonder now whether I was reacting to feeling trapped. Trapped by the decision I had made to be a part of this world, and not knowing what would happen if I walked away.

My traumas are of course mine, and I am very aware that having heard the stories of many other people’s lives over the years, my traumas are relatively small in comparison. I have had the good fortune not to have experienced the terrors and the horrific life challenges that so many people have had to face. However, my traumas, my experiences and personal challenges have inevitably influenced and shaped who I am and how I see the world. Many of my challenges and traumas I have experienced at work.

On that first placement on the acute inpatient unit, I made my first real connection with someone who was there for help. She was a middle-aged woman who was diagnosed as being depressed. I would often sit with her for long periods, usually in silence as she appeared to gain some comfort just from having someone close to her, sometimes she would cry, occasionally she would tell me about her life, and I would listen.

She was then prescribed modified electroconvulsive therapy (MECT).  This frightened her and was something that she didn’t want.  I had been asked about MECT in my interview, and although ignorant of its reality, I had tried to answer with an open mind. If it helped people, as I had been told, it could be a good thing, right?

Such was her fear this woman refused to have it.  I think it was fear, but in the depth of her despair, she wasn’t able to articulate her reasoning, just her refusal to have the treatment. The response to her refusal was to put her on a Section of the Mental Health Act and to force her to have treatment.

On the first day that she was due to have her treatment, we were ordered to observe her continually so that she couldn’t eat or drink.  People have to be fasted before treatment, as it involves having a general anaesthetic and a muscle relaxant before applying the electric current to the brain. Continual observation meant staying alongside someone within touching distance at all times.

This was to be a significant day in both our lives. Me as a shocked and bewildered observer, but I know now, complicit in my passivity. She as the victim of violence and oppression in the name of care and treatment.

One thing that is significant to what was happening, and informative about the culture within the services then, and probably now, was that no one considered changing the routine of administering treatment.  There was no thought of what this woman would be going through, except to stop her eating and drinking.  MECT always started at a set time and therefore she was had to be kept under observation before this time. No one said let’s change the routine. The routine or probably more significantly the Psychiatrist and the Anaesthetist routines were more important than patient comfort, and this was not to be questioned.  The feelings and fears of this terrified woman were not the number one consideration.

I remember that morning like you remember a nightmare. I think, when I look back on it, I probably did sleepwalk through most of my early psychiatric experiences.

The woman was small, slim, and wiry with long grey hair. She had large features and big eyes that sat deep in their sockets. When I took over my observation duty she did not speak, she hadn’t for the previous days but acknowledged me with a small nod of her head.  She sat on her bed in the dormitory, her legs not crossed but twisted, wringing her hands and twisting her head.  She would occasionally stand suddenly, making me jump, pace backwards and forwards, looking out of the three panels of the window that looked out onto the car park.  She would then return to her place on the bed.

After around 15 minutes, half way through my time of being with her, she did not return to the bed.  She left the dormitory and went down the dark corridor leading to the day room.  She then quickly jumped into one of the bathrooms and tried to shut the door.  I had been warned about not letting her get to the taps to drink but wasn’t alert to what she was thinking. She attempted to shut the door on me, and I tried to stop her, we were pushing on either side of the door.

I will never forget the look in her eyes; it was one of pleading desperation and anger, and I think she could see in mine that I was confused, frightened and that I did not know what I was doing.

After what seemed like a frozen moment in time where you aren’t sure whether minutes or seconds have passed, she suddenly released her pressure on the door, stood upright and came out of the bathroom.  She didn’t speak, all I could say was “thank you.”

I was unable to process what had happened, because in a way that part of me wasn’t there, the part that could make some sense of things. I know that I spent extended periods of my training disconnected from how things made me feel as I don’t believe that I had the resources to do anything else.  I was, and am now, considered to be a laid back person and to be taking things in stride.  However, this can often be a disguise for disassociation, and a is clearly part of my survival strategy.

What I am now able to reflect upon, and which is something that I have observed many many times during my career in others who are in the midst of incredible stress, and emotional turmoil, is this woman’s compassion, empathy, dignity, and respect.  At that moment, struggling with the pushing on the door, she was able to act upon what she saw in me and care for me!  She saw my distress, she responded to me, she took care of me, to the detriment of herself. Although we didn’t ever discuss that moment and I know people could want to interpret her actions differently, I know from the way that she looked at me, that she responded to how I felt, and that this was an act of enormous grace, courage, and compassion.

I went on that day to witness that woman carried into the treatment room, held down on a bed until the anaesthetic was given, and then “treated” with MECT.  It was one of the most distressing days of my whole working life because of what happened to her, my complicity in it and my failure to speak out on her behalf.

I felt guilty, but I don’t think I properly thought through why. Others told me that it was for her own good, that she was ill and that sometimes you have to act in people’s long-term best interest. I know I listened to this and could see this was an attempt at justification, but I just didn’t believe what I was being told, I didn’t argue, as I didn’t have anything else to say other than “surely what just happened can never be right.”

I am left to wonder whether, in understanding and recognising trauma and the effect that life has upon us all, in this crazy world, maybe we could all acknowledge that this also applies to the people working with individuals who have experienced or are experiencing distress.  We must ask to what extent the exposure to other people’s, and our own pain, influences the “science”, the therapy, the research and the theory that we use. To what extent does the life experiences of the worker influence what they do long before they even start their work, set out their goals, and make decisions about the paradigms they are working within?

Maybe we can begin to accept that people, life, feelings, creativity, cultures, beliefs, behaviours, minds, and souls are so complex and unique that they are out of reach for explanation by current science, research, facts, or truths. Perhaps this acceptance could enable us to be more accepting of difference and less fearful. We could even look closer to home for explanations of people’s struggles and acknowledge that poverty, inequality, discrimination, bullying and abuse challenge people profoundly and that these difficulties have consequences.

While we all look for explanations that can reassure and provide a sense of stability and certainty, we must take care that they are not seen as universal truths and that they are not tarnished by discrimination that then enable traumas to be compounded. We must be sure that our explanations do not comfort those in power at the expense of those without.

 

Author’s Note: Some of the descriptions included in this piece have been altered to protect the identity of others.

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Matthew Morris
Matthew is the Operational Director for Stepping Stones Community Outreach, which is based in Ipswich in the UK. Stepping Stones Community Outreach is part of the Stepping Stones Community of services that provide housing with support, help for people overwhelmed by clutter in their homes, training designed to encourage new thinking and practice, and are registered with the Care Quality Commission to provide help for people that can be an alternative or complementary to mainstream services. Matthew has worked for 30 years in a variety of settings and always as part of new initiatives and trying to implement new ideas. His approach is one of trying to encourage people to harness natural human attributes and abilities in a skilful yet simple way.

12 COMMENTS

  1. Matthew,
    Your essay really touched me and I can relate to what you describe. Many of us working in the “system” are complicit and yet also victims to secondary trauma as a result of what we witness. I wish I could say, after over 30 years working in this field that I no longer have this type of experience, but I cannot. Almost every day that I go to work and witness heavily medicated people who have given up their autonomy and self definition and are , “in recovery” I wonder what we are doing. There must be a better way.

    Thank you for putting words to this trauma and reminding me that we should not “comfort those in power at the expense of those without.”

    • I’m sorry those working within the psychiatric system are also being traumatized by that system. But, as we all know, “the only thing necessary for the triumph of evil is for good men to do nothing.” And it’s all those “good” people, who have worked within “the system” and done nothing to change the appallingly unjust psychiatric system, for decades, who have aided and abetted in creating the complete evil that the psychiatric system has become today.

      http://www.naturalnews.com/049860_psych_drugs_medical_holocaust_Big_Pharma.html

      http://breggin.com/index.php?option=com_content&task=view&id=38

      There is a better way, and it has nothing to do with drugging massive numbers of children. It has nothing to do with for-profit medicine. It has nothing to do with defaming people with the made up and scientifically invalid DSM “mental illnesses.” It has nothing to do with forcing toxic mind altering drugs onto innocent, unsuspecting humans. It has nothing to do with turning child abuse victims or their family members into schizophrenics with the neuroleptic drugs, so the psychiatrists and other “mental health professionals” can profiteer as they avoid dealing with unpleasant realities.

      The solution is mutual respect. The solution is actually listening, believing, showing empathy, and trying one’s best to actually meaningfully help another human being. The solution is based upon the concept of loving one’s fellow human, rather than hating and working to divide humanity, which is what today’s US psychiatric system is all about – “finding the right diagnosis” / stigmatization.

      Divide and conquer is a war tactic, and who has paid to educate today’s medical and psychiatric communities? Internationalists, whose goal it is to divide, financially destroy, and conquer the US, and the world, or so it appears.

      https://m.youtube.com/watch?v=vNiyij2fSHU

      https://m.youtube.com/watch?v=h0CQrL5nzwo

      https://m.youtube.com/watch?v=5hfEBupAeo4

      Thomas Jefferson forewarned those in the US of this day in time.

      https://www.monticello.org/site/jefferson/private-banks-quotation

      I do so hope the psychiatric industry wakes up to the reality that “the central banks and corporations that will grow up around them” have indeed taken over the US, we no longer have a government “by and for the people.” And since the psychiatric industries’ actual goal is maintaining the status quo (which has nothing to do with medicine, by the way), they should be made aware of the reality that they have been educated by, and have been working for, the enemies of the US founding fathers their entire lives.

      I appreciate your speaking out now, Matthew. And I appreciate that so many of the English “psychiatric practitioners” are speaking out, too. The “good” US psychiatric practitioners are seemingly having a much more difficult time in doing so here, perhaps because their betrayal of our society’s values and beliefs, thus their cognitive dissidence, is so incredibly much greater in the US, than in England.

      God save the decent, and even the Queen, if she’s decent, which she supposedly was, according to my drug withdrawal induced super sensitivity manic psychosis. But we all know the psychiatrists claim all who have lived through a “psychosis” / awakening to their subconscious self never deserve an ounce of crediblity ever again in the material world.

      But what if Jung was right, and there is a collective unconscious, of which today’s bio-psychiatrists deny? Who knows, except God, but I have no doubt it’s past time for the “good” “mental health professionals” to take back the “mental health” industry from the iatrogenic illness creating psychiatrists.

  2. lectro – pharm – psychotropi – chiatry – neuroleptrified – on ice — iceing on the cake – Murphy’s Kangeroo Law – no child – nobody left behind – new world order style – buried by the shit storm .
    Maybe we can all hide as employees maybe not . Maybe we’ll all really go mad , maybe we already are. How long will this man made shit storm be going on before it passes and how many will fall ?

  3. “most important thing we can do is acknowledge what has happened to people”

    Yes, but if you acknowledge what has happened then you must be committed doing something about it.

    Otherwise it is just Psychotherapy and Recovery, and these are Second Rape.

    Nomadic

    • So true, but the problem is that psychiatrists believe that when medical evidence of child abuse is handed over to a concerned mother, that the appropriate next course of action is to tranquilize the child, rather than reporting the child abuse to the proper authorities, as is required by law, technically. And, of course, the psychiatrists want to tranquilize the concerned mother, too.

      And with 92% of “borderline” stigmatized and 82% of “psychotic” stigmatized, being child abuse survivors today, it does appear that profiteering off of covering up child abuse is a primary function of today’s psychiatric industry. Which is a shame, since that is illegal. Who would have ever imagined we would end up with an entire industry whose seeming primary function within society is profiteering off of covering up child abuse. “The dirty little secret of the two original educated professions” does die hard though.

      • “So true, but the problem is that psychiatrists believe that when medical evidence of child abuse is handed over to a concerned mother, that the appropriate next course of action is to tranquilize the child, rather than reporting the child abuse to the proper authorities, as is required by law, technically. ”

        So very very true!

        But it is not just Psychiatrists, it is also Psychotherapists who fail to understand that mandatory reporting laws also apply to them. The ones who work in the public sector, as I know, do a decent job of complying with mandatory reporting, and not becoming accomplice abusers.

        But middle-class child abuse usually seems to involve doctors. And one of the main ways that the middle-class family defines itself is by its insularity and by its children being private property. So it hires its own doctors, doctors who do its bidding. So you have doctors who will put the child on drugs. And you will have doctors who will take the child off drugs, and who will market themselves to the parents, as someone who will get the child to accept the premise that it is lucky to have such loving parents. This is really creepy.

        So Psychiatry and Psychotherapy are both Second Rape, because the client is being told that they and their unwillingness to submit to reality are the problem, not that there is anything which should be done about the unjust world that they live in. They might not say that the abuse and sexual abuse are imagined anymore, but they will say that it is morally superior not to try and do anything about it. And so it continues.

        And then for the child this is all involuntary. No one is looking out for the interests and safety of the child. And the doctors are hired by the parents and they have their own interests, and they don’t seem to understand that what they are doing is exactly why we have mandatory reporting laws.

        And as long as we the survivors remain passive, going with the pity seeking ideas of therapy and recovery, then we continue to aid those who use Social Darwinism and Eugenics to argue that we deserve nothing better.

        Nomadic

  4. Dear Matthew

    This blog is very moving for me, especially your account of keeping watch over the patient destined for ECT. It brought back powerful memories of my own experience as a hospital patient, trapped in exactly that situation. Your interpretation of what happened between yourself and the patient rings very true. At a time when I was fractured into a million pieces, hopelessly lost to the world and everyone in it, including myself, these fleeting moments of intense connection punch through, and for a few seconds everything is crystal clear. Then the confusion returns. These moments are few and far between, but they are so important because they are a reminder that you are still in there somewhere and capable of becoming whole once more.

    Thank you so much for sharing your experiences.

  5. “While we all look for explanations that can reassure and provide a sense of stability and certainty, we must take care that they are not seen as universal truths and that they are not tarnished by discrimination that then enable traumas to be compounded. We must be sure that our explanations do not comfort those in power at the expense of those without.”

    There ya go, the basis of duality, discrimination, stigma, and oppression. It’s also the most toxic element of psychiatry/psychology, to my mind. The whole basis of drugging people depends on false explanations.

    These *explanations* of people is where I find the most craziness and delusion. When a client triggers the clinician, social worker, or staff member, the *explanation* (made up story) will ALWAYS be skewed toward projecting a picture of “craziness” or “belligerence” or “threat of violence” upon the client, while keeping the staff member in a position of superior awareness or perspective or skill or knowledge or whatever–even making themselves out to be VICTIMS of their clients, which of course, is merely a reflection of the victim mentality of the clinician or other staff, projected with aggression. I have found most clinicians to be, in reality, terribly insecure, walled up, and extremely judgmental. Major superiority complex.

    These are STORIES based on inequality and power differential, as well as good ol’ fashioned prejudice and bigotry (from insecurity and snobbishness). They are, by no means, universal truth, but the terribly stilted and falsified “truth” of the clinician/staff member. I always recommend to clients that they request their notes to see how their truth is matching the clinician’s truth. Most often it is like two different clients in one–one version is the client’s version of themselves, their own story, while the second version is the clinical version, a story projected onto the client, and usually not an accurate one, and certainly not flattering.

    This is Munchausen by proxy. standard procedure in the mental health world. It is how they operate, and how they get clients for life, while literally driving them insane along the way, by *insisting* on these false projections. The more you fight it and stand up for yourself, speaking your truth about yourself, the worse they get–totally deceitful, threatening, seed-planting, and downright crazy-making. It is a very dangerous and ill-making rabbit hole, which can often lead to force. That will be explained strategically in the notes, and to staff.

    The only solution, if one wants clarity and well-being, is to get away from the system. Clarity and well-being will never, ever happen in this environment. All wounds and trauma can heal, when one is in a healthy environment, and not in the gaslighting chamber that is the system, as you so well describe.

    These *explanations* suggest a reality that one can either accept or reject. The system has created a reality based on these so-called *explanations* of people, that is dastardly and dangerous. That is because these *explanations* are always false, so they create illusions. How do I know that this is always the case? Because people cannot be explained! That alone is completely dehumanizing.

    Furthermore, these explanations are usually demeaning, ostracizing, marginalizing, and shame-based. We explain people to feel better about ourselves, and that is never going to work, it is an illusion, a false bottom. People are waking up, and I look forward to more of that.

    Life is about living, not explaining. And being human is certainly not about being “explainable.” Rather, it is about *being,* purely. When we are explaining ourselves, we are not being. And when we are explaining others, then we are not allowing them to be, in our own minds. They can only exist as a projection, and that is not who the person is.

    When this happens in a clinical setting–which it always does, it’s always about *explaining* people–the client suffers. Eventually, it will catch up to them. This is toxic, and it can linger for a good long while. It is downright insidious.

    Stop explaining and start being. That is where we find life–in our hearts, not in our heads. I stopped listening to explanations about people a long time ago, in favor of simply experiencing them. To me, that is true and authentic reality–not how we explain, but how we experience. No need for explanation, just the experience.

    • Yes, it is Munchausen’s By Proxy. Some is parents using doctors, duping them. But other times, it is types of doctors who market themselves too the parents. Some put kids on drugs, others take kids off drugs. Drugs are bad. But making a child believe that they need therapy or recovery, are also bad. And those who market themselves to parents are almost certainly violating mandatory reporting. And they may be engaging in child endangerment and child abuse as well.

      Nomadic

  6. “They arrived in the staff room and began to roll up their sleeves, unclip their ties, remove their watches and prepare for action. They had an air of anticipation, adrenaline, and ritual that I could only liken to when I was part of a team that was about to go on the pitch for a football match.”

    This also got my attention. Sadly and maddeningly, I think it’s a very apt description. I knew someone once–a friend of a friend–who worked at an agency, and at the end of the day, he’d tell of any takedowns he’d make, as though he were mounting the head of big game he had successfully hunted. He was proud, arrogant, and excited to do this, made him feel tough and superior. He had no training, he was hired for his muscle. And yet, he loved to call himself “a mental health professional,” which was purely delusional.

    I’ve met a whole lot of people over the decades who work directly with clients, one way or another, whom I shudder to think about being around extremely vulnerable and powerless-feeling people with these particular issues. This goes for clinical settings as well as advocacy settings. These are dangerous people with no perspective, boundaries, or self-control. Talk about the insane running the asylum, jeez…