The APA explains that traumatic events include ‘the direct threat of death, severe bodily harm or psychological injury that a person finds intensely distressing- such as those involved in natural disasters, life-threatening incidents -such as molestation, rape, combat experience, physical assault or abuse, or the personal experience of interpersonal violence. Psychological manifestations related to trauma experience include mood and anxiety disorders, behavioral disorders, identity disorders- eating and substance abuse, or co-occurring disorders.’ One of the central issues of trauma-informed care is that ‘traumatic life experiences are often shrouded in secrecy and denial’ and the ‘concept doesn’t fit well in traditional medical model with its focus on the biological causes of illness.’ So say Kevin Huckshorn and Janice L. Lebel in Chapter 5 on Trauma Informed Care in the book Modern Community Mental Health: An Interdisciplinary Approach ed. By Kenneth “Yeager, David Cutler, Dales Svendsen, and Grayce M. Sills.
There are challenging days/times for teens and staff alike in any setting. It’s true of the family dynamic also. Vicarious trauma is often called compassion fatigue or sometimes referred to as the ‘cost of caring for others’. ‘There are four categories of symptoms: behavioral, interpersonal, those affecting personal values/beliefs, and job performance,’ explained Pomegranate’s Phoebe Kellerman, LISW-S in the August All-Staff meetings. ‘Symptoms might manifest in a sense of isolation, staff conflict, impatience, avoidance behaviors, low motivation, increased errors, or perfectionism.’ (See American Counseling Association Traumatic Interest Network) Kellerman said there are personal strategies to cope with the stresses of constant, intense caregiving. These include seeking escape- physically, mentally- such as provided by a walk or run; rest- time with no goals or ‘to-do’ lists; and play- which lightens the spirit through laughter and other activities. Agency strategies might include additional benefits, time off, supervision/supervisory input, team building, and trainings.
Edward, one of the senior mentors of Pomegranate’s youth said it was helpful to him to remind himself, ‘It’s not me; it’s them’ [they’re having a ‘bad hair day’; something may have triggered a traumatic memory] and to ‘go to where they’re at’; to ‘walk the extra mile in understanding a teen who is struggling with an emotion or behavior.’ This brought agreement from several other teen coaches. Kellerman showed slides that trauma victims are especially triggered by use of seclusion and restraint. Clinical Director Demetra Taylor added that this is the primary reason Pomegranate does not use either. To prevent re-traumatization, there are four coping mechanisms: try to de-escalate a situation/event; utilize crisis plans, identify triggers that remind or initiate a state of anxiety or agitation, and stay calm. Key principles of trauma informed care include: 1) awareness, 2) emphasis on safety, 3) opportunity to rebuild control and 4) a strength-based approach.
As authors Huckshorn and Lebel explain, ‘PTSD sufferers often re-experience an event through flashbacks, nightmares, or intrusive memories. They may engage in avoidance or numbing behaviors, disassociate, or withdraw. They could experience hyper-arousal and fearfulness. There are neuro-biological markers as dysregulation occurs via the hypothalamic pituitary adrenal axis. There is a different response in PTSD from other mood and anxiety disorders. PTSD adversely impacts the hippocampus, learning and memory and the frontal limbic system which regulates responses to stress and fear.’ (adapted from Harris & Fallot 2001 and NASMHPD 2010; also see Van der Kolk 2001).
With research, and new discoveries brought about through advances in technology, we can legitimately say that mental illness is “not just in someone’s head”, but can be experienced through-out one’s entire being, influencing body, mind, spirit, relationships, career, and life. PTSD is one example of this. ‘Because of the sequential nature of childhood development, trauma can stop or slow a child in his/her tracks physically, emotionally, mentally and genetically, and therefore, must be taken seriously,’ concluded Kellerman and Taylor.
[photo credit: Wikimedia Commons Creative Commons 2.0. Author Ness Kerton from The Dept. Foreign Affairs & Trade at Point Moresby General Hospital Susa Mama Health Clinic, in Papua New Guinea]