We Shouldn't Have to Choose Between Support and Respect

Hello again, it's me:

A competent adult professional who happens to have a mental illness (see my story as I summarized it in a recent article here).

I've done some pretty okay things in my life. I graduated from high school at the top of my class (not relevant to anything whatsoever--I just never find any reason to share it). I earned a 4 year BA(Hon.) in 3.5 years, then got my MA in Philosophy.

I then got full funding to attend a PhD program at Northwestern University (and got admitted with funding into every other program to which I applied, except for one where I was wait-listed). That program was derailed for me because of the severity of my trauma-related suffering, but rather than give up, I wrote the February LSAT, got an excellent score, applied to the law school of my choice, was awarded an entrance scholarship, and attended there in September. I would have been permitted to return to my PhD program had I wished to, but I chose law school instead.

Despite my continued suffering, I also then earned a law degree (which included taking an extra semester of co-op education), got called to the bar, became a lawyer, and have practiced for 15 years (at both the trial and appellate level). No big deal, right?

So why all the icky bragging? I usually try not to do that, I swear Why do I feel this need to preemptively assert my competence like some kind of insecure teenager?

It doesn't come naturally to me to have to put my "competence" on display like this. When I first started as a lawyer, especially when I was a young female criminal defence lawyer, I loved to be underestimated and found ways for it to work well for me. I knew that if I did my work, I would be able to show how competent I was rather than having to strut around demanding it to be acknowledged. Being understated worked for me.

Yet now it feels unsafe not to find ways to hold up my "competence" like a shield.

Because now I'm someone with a mental illness.  

Now there are stigmatizing assumptions and outright discrimination to deal with. And it's not just hidden discrimination--it's discrimination that's still openly preached and perpetuated by powerful, perfectly mainstream, people and organizations. It's discrimination that could result in a loss of my career, my opportunities for professional advancement, and even the loss of my liberty and right to make personal treatment decisions for myself.

Sometimes it feels like my only defence is my competence. So I find myself waving it around in an awkward unaccustomed way like the only self-protective tool at my disposal. "Respect my competence, please...."

Yet it's weird because I know that I'm the same me I've always been. The same me that has--successfully--been a member of this profession for a decade and a half. I shouldn't have to prove myself again just because of my diagnosis.

But the stakes are high, and the threats are real.

 Even as I know I have to protect myself in this manner, I also realize that asserting my competence makes me uncomfortable for another reason. It feels like having to straddle a question rooted in an unfair dichotomy: Which is it? Are you competent and worthy of respect? Or are you vulnerable and in need of accommodation/protection?

Any move I make in either direction threatens to tear me apart, and also undermine the interests of others like me who may be differently situated at the moment. I fear that by making a display of my competence ("Oh hey, look at me, continuing to practice with serious health issues--so there's no problem that needs to be accommodated here!"), I may be undermining the very legitimate interests of others who, understandably, just couldn't remain competent under those same pressures: whose vulnerability asserted itself; who need support and accommodation to take time off and then return, or need to be supported in deciding whether this profession is even healthy for them. I never want to suggest in asserting my competence that there is anything wrong with vulnerability or those who succumb to it, temporarily or permanently.

And even for me: I succeeded in maintaining my professional competence. But the cost was extremely high for my well-being. It shouldn't have needed to be that high. There were times when I wondered if it was too high and if I should step away. If this profession had greater sensitivity to vulnerability, it could have substantially reduced the toll on me of maintaining my competence all those years. I will never get back what I lost. It's not okay. My continued competence doesn't mean there was never a problem.

So here's my bottom line message: Drop the dichotomy and stop making us choose between your respect for our competence and your support for the ways in which we are vulnerable. 

If we want diversity, inclusion, wisdom, insight, and strength in our profession, we need to stop reinforcing the distinction between competence and vulnerability. It is absolute nonsense. We are all human and therefore can become vulnerable at any moment. We need to stop acting like vulnerability is some kind of aberrant ticking time bomb that we can weed out, rather than a basic feature of our shared human condition that we all need strategies to face, manage, and eventually gracefully yield to. We don't do the profession or public any favors by reinforcing the myth that only some of us are vulnerable. It's dangerous and inaccurate, and leads us to avoid the real issue of how we *all* need to face the prospect of our collective and individual vulnerabilities throughout the lifespan of our careers, relationships, and lives.

As I emphasized in one of my uncharacteristically (😄) optimistic posts, "We Can Be Heroes," it is absurd for us to weed out those we identify as vulnerable on the unfounded assumption that their vulnerability makes them a liability. The vulnerable are the ones who have made it to this level despite facing hurdles many others could never even imagine let alone endure: they are the battle-tested, bad-assed warriors that this profession should welcome, embrace, and learn from. The idea that vulnerability should be equated with diminished competence is therefore laughable (or at least would be if the potential consequences of having our competence questioned in that manner weren't so severe).

Moreover, since the already-vulnerable are also the ones who have had to face the reality of the human condition in the most profound ways, they have the insight, wisdom, empathy and understanding this profession needs in facing the very difficult issues being adjudicated before us. We should be doing everything in our power to recruit, elevate and support them.

So, yes, I am declaring my competence and insisting that no one reduce me to just my vulnerabilities. Nothing about the ways in which I'm vulnerable permit the assumption that I'm less competent than those around me. Only my actual performance can tell you anything about my competence. But I'm also not allowing my vulnerability to be ignored any longer just to maintain my shield of competence. I deserve support for the ways in which I'm vulnerable (as do we all), and I deserve credit for the ways in which I've persisted despite those challenges, which is why going forward, I insist that any assessment of me (and others) look at me in my wholeness. Listen to me and learn from me, and I promise to do the same for you.

And if we can all start seeing and listening to each other that way, we'll be so much the better for it--and, with that enhanced understanding of what it means to be humans who can simultaneously be vulnerable and strong, worthy of both respect and support, at the very same time,  we will be better-equipped to serve the very human ideals, individuals and organizations to which we have dedicated our careers.

As always, please note that I am a lawyer, not a mental health professional of any kind. I have no expertise in trauma or mental health. Also, please note that any opinions and views expressed in this blog are solely my own and are not intended to represent the views or opinions of my employer in any way. For more information about the purpose of this blog, please see here and for a bit more information about my personal perspective on this issue, please see "my story" here

I am very grateful to have received a "Clawbie" Award for this blog (which reflects the importance of this topic): https://www.clawbies.ca/2019-clawbies-canadian-law-blog-awards/

For some of my external writing on this topic, see:  

• https://www.canadianlawyermag.com/news/opinion/a-more-inclusive-discussion-on-the-impact-of-trauma-on-lawyers-mental-health-is-needed/276166 
• https://www.cbabc.org/BarTalk/Articles/2020/February/Features/Speaking-Up-About-Trauma-and-Mental-Health    
• https://www.canadianlawyermag.com/news/opinion/changing-the-conversation

Unicorns, Rainbows, and Serial Killer Blood: Finding Meaning in Morbid Metaphors

"Tomas did not realize at the time that metaphors are dangerous. Metaphors are not to be trifled with. A single metaphor can give birth to love." Milan Kundera--The Unbearable Lightness of Being

I don't know if it's a trauma thing, a deep personality flaw, or the secret to my resilience (or somehow all and yet also none of the above), but I am addicted to metaphors. Metaphors help me find light in the darkness and meaning in the most inarticulably painful circumstances. Metaphors are probably the reason I'm alive and functioning. And maybe sometimes they contribute to my suffering too...

When you have so many things you're not allowed to talk about (because the consequences are too great, because you don't have supportive people around, because you just can't do it), a huge part of yourself remains in darkness: no colours, no features, no reality, no voice--just darkness. When you have to move forward and exist in the everyday world in spite of a whole lot of darkness pursuing you, a huge part of yourself gets left behind and becomes fused with that darkness (see all the metaphor-ing I'm doing already just to try to explain...).

Metaphors have allowed me to exist and explain that existence in a rudimentary way. Without them, all there would be are terrible feelings and fears I couldn't possibly describe in ways those who hadn't been through it could understand. For example, instead of saying I feel terribly alone  (which is woefully inadequate to describe the experience no matter how many "terribly"s "extremely"s and "very"s I add), I explain my situation: "I'm buried alive and part of me can project to the surface and interact in a very surface-level-way with those around me, but I'm not allowed to tell them anything about my true self and history, or ask for their help, and if I break that rule, I won't be allowed even those surface-level interactions and superficial enjoyment of normal above-ground life anymore. But sometimes I can't stand it and I want to break the rules because I know I'm not the only one trapped underground like that and I want to demand to be heard, so even if no one will help me, they might eventually acknowledge and help the others...." And when I can finally tell someone that, and when they sort of get it, then I can start to feel understood. Like I have some kind of existence in the "real" world.

Metaphors were the only thing that made it possible for me to even consider moving forward in therapy and understanding how it could benefit me, even in what felt like hopeless circumstances. I had so many other metaphors I used (because let's get real: they're never perfect so I just keep trying new ones on and modifying old ones) but let's stick with the "buried alive" one. Finding a professional I could trust (something I never thought possible before) was experienced as "still being buried alive with no hope in sight. I don't see a way out. But now there's a compassionate voice with whom I can use my voice to explain the situation, who can offer comfort and support to make an intolerable situation more bearable." Not being alone isn't automatically the same as being "fixed" but it's an extremely big deal after so many years/decades of [that buried part of myself] not being able to truly communicate with anyone. And once I started doing that, there was another unexpected benefit: being able to communicate with a trusted person gave me some strength to occasionally--metaphorically--open my eyes (which I hadn't even noticed had been tightly squeezed shut) and look at my surroundings so I could see the (still very dark) contours of where I'm buried. I still don't see a way out, but if there is one, that's a crucial first step in being able to find it...If not for that metaphor, all I would have been able to see would have been my pessimism about being incurable. The metaphor made it possible for me to be able to benefit despite how hopeless I felt.

And so we come to the title of this post. When I started speaking out about trauma through my writing, it was entirely motivated by metaphor. And like all my metaphors, it was grim and dark, because  that's the reality of my experience of trying to navigate trauma while also  trying to exist in a "normal" way in the "real" "everyday" world.

For me, I started to speak out not because I felt it would be cathartic for me (I knew it wouldn't). Nor was it because I felt it would be a way to get help, understanding and care from those around me. I knew that for me in speaking out in the only ways I know how I'd be violating the "rules" that allowed me to have surface-level existence (per the metaphor above) and there would be consequences. Socially, some people would become awkward around me and not know what to say, so they'd stop acknowledging my existence altogether. Professionally, I feared it would limit any future advancement. But I spoke anyway. Why? Because metaphor.

Before I describe it further, an explanation of why I hesitated at first to share this: A friend of mine who also truly "gets it" and I were messaging about how in the "wellness" movement, people tend to want only the uplifting stories about the people in dire circumstances who find the strength to "reach out" and then magically, heroically "presto-change-o" are transformed back into normalcy, tranquility and "wellness." After all, it's the only way the "buried-alive" are ever permitted to be seen: when they've magically already been fixed and are beautiful and butterfly-like, and truly "one-of-us." It's like a cautionary tale for those who still suffer underground: "If you haven't been transformed yet, it's because you're doing it wrong, so don't you dare complain. Just try some of that abracadabra stuff that worked for these shining examples of the power of self-transformation. Get a shovel and start digging. Easy-freakin'-peasy and we don't want to hear more from you until you do it.."

My friend wisely said, "[those in the wellness movement] just want to hear about 'unicorns and rainbows' so they may not want to hear about grim dark metaphors." It sorta sounded like a dare so I promised to write a blog entry about my most motivating, undeniably dark metaphor: the serial killer blood one. I laughed as I vowed to do it. "They won't like it. All the more reason to write it. I'm not following the rules anymore."

So here's the metaphor that motivates me in speaking out. It's quite terrible and I don't recommend it for anyone who has access to a better one but it works for me:

It's like one of those movies. I've been fatally wounded by a serial killer. It's clear that no help is coming and even if help arrives it will be too late. And yet death does not come quickly. It's slow and agonizing (maybe years or decades). There's nothing left to hope for that will take the pain away. So what do I do? It would be tempting to just remain in place on the ground waiting for the end to come: silently, barely moving, feeling the pain as little as possible. Or I could choose instead to do what I can to maybe spare others, even if it makes my death more agonizing. I can painfully drag my injured body to a location where I can use my last bit of strength to write my killer's initials in my blood on the wall, so maybe just maybe, someone will see it someday and prevent the killer from harming others. It won't be enough to save me. And the process of doing it will cause more pain and damage, not less. But it's something to cling to. It's something to keep me moving. It could be a terrible miscalculation. Maybe I was wrong about how fatally wounded I am. Maybe I should have conserved my strength. But it's something to give meaning to these agonizing final moments. When we don't have a way to escape the pain, it can help sometimes to ask, "Is that really the end of it? If I can't rid myself of the pain, does something remain that I can still do that can mean something to me? If I can't have happiness, can I still have purpose?"

Important note: I have two therapists and I think it's fair to say that they do not love this metaphor! (though they validate the fact that this is how it feels for me, while gently encouraging me to explore the possibility of seeing it some other way). I'm not suggesting anyone see themselves this way if they can help it. It's super hopeless and depressing. Yet for me it gives some reality and language to what I actually feel. And once I've given it some reality, it makes it possible for me to wonder: okay, if it's really hopeless like this, what might nevertheless remain? Something human, something meaningful, something real. And it also gives a starting point for a discussion with those who might want to suggest more hopeful ways of seeing the situation in a language that feels legitimate to me (reflecting the emotional reality of where I'm starting from). And most of all, it keeps me alive and functioning while all that can be explored. 

Note also: metaphors will never fully be apt. The "serial killer" I reference isn't a person in this case. It's a combination of the complex trauma I've experienced and the society that is often so unkind and invalidating to trauma survivors. I'm pointing to a complex phenomenon, not just naming a person (which I've personally never had the strength to do, even when warranted, and doubt I ever will). But the metaphor helps make it simple: it won't undo my wounds, but maybe it will help save others. And yes I know it's my own blood I'm referring to but "serial killer blood" felt more catchy for a title.

So here is what my metaphors have taught me: even when there is no hope, there can be a way of seeing the situation in which there can be meaning; there can be connection; there can be comfort. 

And yet as the quotation at the beginning of this post warned: metaphors can be dangerous if we fall too much in love with them and tie our fates to them or expect them to bring healing to us all on their own, but I stubbornly maintain that--if we use them flexibly--maybe they can help us give birth to a type of love that wouldn't otherwise have been possible for us. Maybe someday my ever-shifting metaphors will help me fall a little bit in love with myself or with my life, or at least help me find a way to tolerate both a bit better....

As always, please note that I am a lawyer, not a mental health professional of any kind. I have no expertise in trauma or mental health. Also, please note that any opinions and views expressed in this blog are solely my own and are not intended to represent the views or opinions of my employer in any way. For more information about the purpose of this blog, please see here and for a bit more information about my personal perspective on this issue, please see "my story" here

I am very grateful to have received a "Clawbie" Award for this blog (which reflects the importance of this topic): https://www.clawbies.ca/2019-clawbies-canadian-law-blog-awards/

For some of my external writing on this topic, see:  

• https://www.canadianlawyermag.com/news/opinion/a-more-inclusive-discussion-on-the-impact-of-trauma-on-lawyers-mental-health-is-needed/276166 
• https://www.cbabc.org/BarTalk/Articles/2020/February/Features/Speaking-Up-About-Trauma-and-Mental-Health    
• https://www.canadianlawyermag.com/news/opinion/changing-the-conversation/326240

Earning Trust by Respecting Our Fear of Engaging with Mental Health Care

After a very damaging healthcare experience (that I don't see myself recovering from for quite some time), I wrote a couple recent blog posts as a bold declaration of the kind of healthcare I require going forward, along with a (partial) explanation of why anything less will not only fail to assist me, but will be damaging and re-traumatizing.

The funny thing is the boldness of my declarations can be contrasted with the actual helplessness of my circumstances and options, since the system doesn't seem to be set up to allow for my needs.

It shouldn't really be a lot to ask. What I need is so basic. I'm not asking for access to expensive treatments. I'm just asking to be treated as an autonomous individual, worthy of consideration, dignity and respect, who gets to decide basic things, such as (1) whether to agree to a suggested treatment, (2) whether and to what extent to engage in an assessment process, and (3) the pace at which to do so. I'd also like some say in how the information about my background and needs is gathered from me (for instance, I'd like whoever provides future treatment to me to work collaboratively with the very qualified professionals who have been providing mental health assistance to me over many months, who have earned my trust and know me well.) 

I'm not asking to be given more and faster: I'm asking to have less pushed on me, and for whatever I'm offered to slow down to a pace with which I can feel safe and comfortable. As a precondition of any assessment or care, I need flexibility and I need my boundaries honoured and respected. I'm not asking for this because I'm being demanding and just want things done my way or else. It's because I know with certainty  that anything that doesn't honour those limitations of mine will not only be unhelpful, but will be deeply damaging to me (as I've recently experienced).

Yet so much mental healthcare and mental health messaging and regulation seems to be built on pressure, dictatorial "prescriptive" attitudes, dehumanization and outright coercion.

First, with respect to diagnosis: If I go in for an evaluation or treatment of my trauma, I'm not consenting to a wide-ranging invasive deep-dive examination of every aspect of my personality and psychological make-up. I'm not there because something is horribly wrong with me as a person and clueless professionals need to take apart every aspect of my personality querying--with a great sense of mystery and wonder--what it might be. I'm there for what should be very plain and obvious reasons to any compassionate and understanding professional: because of the things that have happened to me. It should be no mystery what needs to be addressed. I wouldn't go to a hospital for a broken leg and get a full-body evaluation, including of incredibly intimate parts of myself, just to see if perhaps I'm mistaken about the source of the damage. It's disrespectful, invasive and insulting. It also causes more injury (for reasons partially explained in previous posts). Me declining to participate in such a process isn't me resisting treatment. It's me protecting myself from further harm. If an examination of my broken leg included a process that involved breaking several other bones in my body first as part of the diagnostic process, you can bet I'd say no to that treatment too....

Second, with respect to establishing trust before proceeding with anything: I have respect for mental health professionals but I'm entitled to some basic dignity and privacy. I don't need to be a doctor to be confident that the power to take someone apart and tell them everything that happens to be "wrong" with them through invasive assessment measures, some of which may have arguable validity, isn't something that should be exercised over an already fragile person, suffering from obvious causes that need to be attended to, as a precondition of them getting treatment for the issue that brought them there. An already fragile person shouldn't have to surrender any more of her dignity and privacy than she's already had to through the things that have happened to her, unless truly necessary. A traumatized person shouldn't be asked a bunch of questions "Have you ever felt x, y, z," designed to find inherent problems with her "mood" or "personality" with no regard for the traumatic experiences that caused her to experience "x,y,z" on past occasions. Moreover, no one, especially a traumatized person, should be asked to surrender such private aspects of themselves before the time has been taken to build trust, comfort and safety. Diagnostic questionnaires should not be handed out in a waiting room with impossible-to-answer questions that don't allow for explanation ("yes, I felt x before, but only as a direct result of trauma") before a traumatized person has ever even met with the professional in question, let alone established a sense of trust and safety with them. No steps should be taken until the person is ready for them and consenting to them. Because doing so to someone who has already had their boundaries violated is itself a source of further harm. If a professional doesn't understand this, then the whole process is questionable from the start, and no one should wonder why some of us will resist that.

Third, with respect to understanding power dynamics: our mental health system allows for an incredible amount of power to be exercised over those who are suffering. Mental health professionals should know and expect that many of us will therefore be terrified and perhaps justifiably unwilling to engage with them, especially if we've already been damaged and had "worst case scenarios" of betrayal and abuse of power happen via trauma. We can be hospitalized against our will and any number of invasive potentially permanently damaging and profoundly traumatizing "treatment" procedures forced on us if we encounter the wrong professional who mistakenly feels the threshold for doing so has been reached. I've been assured this is very unlikely to happen to me, as I'm nowhere near that threshold, but that doesn't stop me from being terrified of it. All it takes is one risk-averse professional who misinterprets something I say. Instead of dismissing these fears, the basis for them should be reduced by truly protecting people against the prospect of them ever being used and slowly building trust with people before engaging with them if that's what they need to feel safe. Each time I encounter a professional who is careless and dismissive in how they engage with me, that fear grows because all it takes is to encounter that kind of person at the wrong moment in a vulnerable state and the results could be catastrophic. Even if professionals "know" that no such danger exists with them, they need to understand and validate our fear that it could and let us slowly build our trust with them before doing anything (not as a precondition to treatment that fearful patients hope for, but as part of the treatment process itself).

Moreover, such power can also be wielded in relation to mental health by non-medical professionals, so those who engage with mental health professionals may also fear those implications (even if they're comfortable and safe with the particular professional offering services). Professional regulators and employers may not be as understanding about mental health as they should be. Consequences can result. Family and friends may not be understanding and supportive.Social exclusion may result.

So it's a big deal to submit oneself to "assessment" and "care" by a professional and the system in general. Instead of urging, persuading and pressuring us to "reach out" anyway, professionals need to focus on their side of the equation by ensuring that as little "reaching" as possible need be involved in "reaching out" first. Slow down. Let us go at our pace. Build trust before doing anything if that's what we need, so that reaching out won't have to feel like extending our limbs over a steep cliff with no confidence in what might happen next. People are afraid for a reason. Because this is a big deal. Understand and honour that first and every step of the way and then maybe more people will feel comfortable taking that leap....Otherwise, respect our choice to maintain a distance that feels safe to us until we are ready to risk moving forward.

I have a lot more to add but I'll just arbitrarily stop there (because my coffee is done and my dogs feel entitled to a walk today....)

Overall, I'll just say this. Many of us struggling with trauma and mental health are afraid. Please stop condescendingly telling us we shouldn't be. Stop gaslighting us. And start honoring, understanding and slowly counteracting that fear at a pace that feels safe for us. I know many won't be happy with my messaging here since encouraging people's fear is seen as a barrier to them seeking treatment (which is why so much mental health messaging glibly says "Oh, hey there, don't be afraid. Reach out. It's okay. We won't hurt you...."), so maybe I might seem to be fear-mongering by describing the profoundly negative impact that such responses to me "reaching out" have had on me, especially recently. To them I say, many of us suffering are already afraid and have had that fear reinforced by experiences we've actually had. You're not going to be able to talk us out of it. We have reasons for that fear. Telling us to let it go won't make it go away. For some of us, the only safe way forward is to name, honour, and respect that fear--to give ourselves permission to feel it accordingly and refuse to engage with professionals who don't likewise understand and honour it the way we need them to. To me that's not silly or self-destructive or an indication of my unwillingness to be helped. It's health-promoting: it's self-protection and -care, which is exactly what I need. I'm proud of myself for asserting it despite the reality of how little choice I actually have right now.

Providing people with a way forward that allows them to proceed in spite of their fear, not by suggesting they're "crazy" and "wrong" to feel it, but by earning their trust slowly and assuring them that their fear will be respected at each step of the way is what will enable people like me to reach out. So I'm not sorry to be asserting that here. I'm not telling anyone that they should be afraid. I can speak only for myself. But if so many people are afraid, maybe their fear isn't the problem. Maybe it's the reaction to it that needs to change....

What I've articulated above isn't radical, or at least shouldn't be. It's basic trauma-informed care. It takes thought, caution, self-awareness and care on the part of those providing services, but it's completely possible to accommodate. So I won't apologize for insisting on it.

As always, please note that I am a lawyer, not a mental health professional of any kind. I have no expertise in trauma or mental health. Also, please note that any opinions and views expressed in this blog are solely my own and are not intended to represent the views or opinions of my employer in any way. For more information about the purpose of this blog, please see here and for a bit more information about my personal perspective on this issue, please see "my story" here

I am very grateful to have received a "Clawbie" Award for this blog (which reflects the importance of this topic): https://www.clawbies.ca/2019-clawbies-canadian-law-blog-awards/

For some of my external writing on this topic, see:  

• https://www.canadianlawyermag.com/news/opinion/a-more-inclusive-discussion-on-the-impact-of-trauma-on-lawyers-mental-health-is-needed/276166 
• https://www.cbabc.org/BarTalk/Articles/2020/February/Features/Speaking-Up-About-Trauma-and-Mental-Health    
• https://www.canadianlawyermag.com/news/opinion/changing-the-conversation/326240

Trauma: The Agony and Healing Power of Reconciling Our Vulnerability with Our Autonomy/Defiance

I have a mental health diagnosis. It's helped me a lot to have one, because:

1. It tells me I'm not alone in what I'm suffering;
2. It gives me a shorthand way of communicating what I'm suffering, so I don't have to go in circles trying to explain to others who may not get it or with whom I can't share more than a very basic explanation (e.g., because they're not willing to hear more or I'm not comfortable sharing more with them);
3. It gives some validation to me and my suffering--I'm not "weak" (whatever that means--not that weakness should necessarily be considered a moral failing, unless it is in some morally relevant way)--I have a mental health condition; 
4. It enables me to get the help I need and if I ever require some kind of accommodations, or health services, it gives me a basis upon which to seek them (since unfortunately that seems to be required for insurers, providers, and regulators, to see us as having any "rights" or entitlements--we have to be able to point to a group to which we belong, and in this case for me it is based on a particular identifiable health condition); and 
5. It enables me to find a sense of community with those who may share that same diagnosis and learn from others what may have worked for them (which may possibly help me too)

However, I want to be clear about one thing: I am not just a diagnosis. It may be a huge part of how I see myself--or not.  I do not agree to surrender my autonomy in exchange for it. I am whole and complex.

It's the paradox of being human: In some ways, I have been and remain so vulnerable. I didn't get to choose a lot of what happened to me. It helps me to recognize this. There's no shame in being vulnerable, human and fragile. It isn't my fault that I experienced many adverse effects from the things I've experienced. It isn't my fault that those effects have in many ways been difficult to overcome. I don't blame myself or others for being profoundly impacted by such effects (or at least I know I shouldn't blame myself and struggle to find ways not to). We are humans, not gods. Things that happen to us affect us. Things that happen within us (due to our biology) affect us. Our conscious mind and sheer force of will can only do so much to control that. Some of us have to experience this more than others since some of us have the privilege of controlling what happens to us more than others, but it is ultimately true for everyone.

Yet, in other ways, no matter how much I suffer, I retain some measure of freedom and power to define myself that no one can take from me, and I'm not prepared to surrender it to them, regardless of how much people purport to be "helping" me in requiring that I do so. But ahhhh do I ever need help....

Trauma for me is the painful collision of those two realities: on the one hand, I have been and am so vulnerable. On the other hand, I refuse to surrender my sense of agency in making sense of what has happened to me: my right to articulate for myself what that vulnerability does and should mean for me. But my agency can also be a source of pain, since, taken in abstraction, it can demand that I take responsibility for all things, and often seems to demand that I see myself as having more control than I do.

The anguish for me is in those two realities: I don't always get to decide what happens to me. Even more troubling for me, I don't even always get to decide how I respond to it, since what happens to me can deeply shape my internal experience and sense of who I am. It would be naive to overstate how self-determining I am. Yet, despite that vulnerability, some room for self-determination remains.  It's shaky ground to be on, as my level of actual control is constantly fluctuating, while my need for agency screams to be recognized and respected, even if self-punishment is the cost.

And the path to healing for me is in finding a way to reconcile those two seemingly irreconcilable realities that I've not only become deeply conscious of through my experiences, but that my body and brain have also repeatedly had no choice but to be jolted and injured by. Even when my smug genius of a conscious mind thinks she has the answer (especially when she reads lots of Hegel and Dostoevsky), my brain and body both can't help screaming at me in paradoxical anguish: I AM RESPONSIBLE, YET I AM VULNERABLE!!!! My mind declares: "I can choose how I respond to things" at the same time as my body and brain whimper: "except when I can't because I'm a fragile human in a world and body/brain I don't fully control." Being a human suuuuucks.....(cue "add to dictionary" here because I'm gonna say that a lot).

There's some comfort in knowing our inherent human limits, but also considerable fear, agony, and self-blame. If I am self-determining, then I'm responsible. If I suffer, it means I've failed. If I don't survive the way I feel I should have, it means I'm nothing but vulnerable. I failed. I failed. I failed.

As if it isn't enough to have to think it, I have to listen to my body and brain scream it at me every time a new situation presents itself that in any way reminds me of those past "failings." Being a human suuuuucks.....

I'm vulnerable so I need help and support. I've been harmed by the things I've experienced, and I need help healing those wounds. I can't do it alone, at least not completely. I am a fragile being, an infant, a baby bat (from now on I'm working baby bats into everything I write, because for me they are the epitome of vulnerability yet perfection).  Reaching out for support from others is a critical part of healing.

 But I'm self-determining, and my surviving sense of agency, meaning, and defiance in the face of what I've experienced is everything to me. Not only is it what has enabled me to survive to this point, it's also (paradoxically) the part of me that has been most wounded and is most deeply in need of nurturing and support. It's the proud general I sent into battle to fight against everything that stood against me, but also the part that sometimes had to retreat and lie down in defeat horribly injured when it couldn't help but be overcome by forces that stood against it. So when people offer me support (bless those few who try), then it needs to be in a way that affirms my autonomy--at the same time as acknowledging my vulnerability (in a way that helps treat the wounded general's injuries and helps it get back up into action)--or it will only further damage me: the treatment will actually be a further source of injury. It can't be something that reduces me to a series of questions on a diagnostic questionnaire or gives me only one path to healing with which I must comply. It can't be someone who tells me what I "must" do, or what my purpose in moving forward "must" be (e.g., "be happy"),  and assumes they know what I need without acknowledging the need to carefully listen to me and learn from me. I need my vulnerability supported at the same time as my autonomy is also supported. I need to be cared for in a way that acknowledges the paradox of being human that is the core of what was injured and problematized for me in my experiences. Until mental health practitioners understand this, and constantly check their behaviour and attitudes in view of it, they will be a threat to me, and I won't engage with them.That is my first critical step in caring for myself. It isn't a resistance to being treated, but the ultimate act in self-protection.

In the same way as "helpers" who only emphasize or overemphasize vulnerability are a threat to me, "helpers" who focus exclusively on my "responsibility" are no use to me, because they fail to give due regard to the ways in which I've been vulnerable, thereby reinforcing the shame and self-blame I'm already so prone to feeling and have so deeply internalized. Such "helpers" and "sources of inspiration" suggest that I can be worthy of assistance only to the extent that I deny and denounce my inherent human fragility and the particular ways in which I've been damaged. They want me to sustain myself on fiction, on an incomplete vision of my humanity. I will reject that sort of assistance too.

So healing from trauma for me is all about acknowledging and honoring vulnerability at the same time as supporting my inherent autonomy/defiance in the face of what makes me vulnerable and human. The only people who can help me will be those who embrace and nurture both. If you think that sounds really difficult to do, you're right. That's why it's so painful and that's why I've suffered so much because of it. That's why I can trust only those who are ready and willing to face that painful paradox rather than offer easy answers.It doesn't mean I blame those who don't or can't yet see it that way (as I said before, bless everyone who tries to help, even if I feel their help misses the point of how I've been injured and is therefore dangerous for me). It just means I respectfully choose not to entrust my healing to them.

In the meantime, not to fear, Dear Reader, there are a growing number of trauma-informed "helpers" who understand the above, who are willing to step into the breach with us, and help us learn to live with the paradoxes that afflict us all as human beings, and are particularly damaging to so many of us who've experienced trauma (I'd say all, but I don't want to purport to speak for everyone--so you decide). I'm lucky to have found that kind of assistance (while also very unfortunate to have been damaged and re-traumatized by some of the wrong kinds of "helpers" for me along the way).

I'm also lucky to have my Hegel and Dostoevsky to draw on, along with every other source of inspiration that speaks to me and helps me understand the paradox that afflicts me. We can't control everything with our intellect and conscious minds, but we can nurture and defend our right to nevertheless struggle and remain defiant, at the same time as we find ways to support and care for our vulnerability. It isn't easy but if there's healing to be found, in my personal view, speaking only for myself, then that it starts (but perhaps doesn't end) there.....

As always, please note that I am a lawyer, not a mental health professional of any kind. I have no expertise in trauma or mental health. Also, please note that any opinions and views expressed in this blog are solely my own and are not intended to represent the views or opinions of my employer in any way. For more information about the purpose of this blog, please see here and for a bit more information about my personal perspective on this issue, please see "my story" here

I am very grateful to have received a "Clawbie" Award for this blog (which reflects the importance of this topic): https://www.clawbies.ca/2019-clawbies-canadian-law-blog-awards/

For some of my external writing on this topic, see:  

• https://www.canadianlawyermag.com/news/opinion/a-more-inclusive-discussion-on-the-impact-of-trauma-on-lawyers-mental-health-is-needed/276166 
• https://www.cbabc.org/BarTalk/Articles/2020/February/Features/Speaking-Up-About-Trauma-and-Mental-Health    
• https://www.canadianlawyermag.com/news/opinion/changing-the-conversation/326240

Why Trauma-Informed Care Is So Important to Me

There's a lot of excellent stuff written out there about the importance of trauma-informed care. I'm not going to be able to add anything to it, except to make some first-person observations about why it's so important to me, and why any non-trauma-informed approach is so harmful to me. I personally had a profoundly damaging experience a couple days ago and this is me taking the opportunity to vent without going into the details at this time of that interaction.

I have trust issues arising from a history of repeated trauma. Due to a combination of luck, privilege, resilience, and skill, I've nevertheless managed to be very high-functioning in many ways. Yet, in other ways, my participation in life has been severely limited (particularly my personal life as I alluded to here).

My sense of self therefore includes two components: the functioning resilient version of me (the me who has made highly functional choices and adaptations in the face of things that could easily have broken me); AND, the me that is nevertheless still deeply suffering, highly limited, and could really use some help/support/understanding, but is hesitant to seek it out of fear of my boundaries/safety being violated as they have in the past.

If I'm going to receive help, as a basic precondition of ANY kind of intervention, it needs to honour and directly engage the strength, wisdom and self-knowledge that got me where I am. It can't require me to surrender the sense of agency and safety that are essential to my continued survival. Those adaptations and skills of mine are far more important than anything medical science has to offer me. Instinctively I know this with absolute certainty, and the more research I do, the more sure I feel of it (Medical science has its limits. Treatments are available but there is no one obvious "cure" that works for everyone. Also it can't dictate what counts for me as a meaningful life worth living--I get to choose.)

That's not me being a pessimist failing to act in the interest of her own mental health: that's me protecting and valuing myself and my own survival, which are absolutely critical preconditions in  healing and nourishing my mental health. Declaring and maintaining that boundary is an act of strength that promotes my mental health. Anyone who in any way suggests otherwise is not acting in my interest (no matter how much they say they are and/or suggest I'm being stubborn in resisting them and the supposed "cure/treatment" they're peddling, whether based on conventional medicine or some alternative). I'm right to withdraw from them, even if they might technically have something to offer me, if only they had approached it in a respectful non-re-traumatizing-and-demeaning way. I will not give up what is most precious and necessary to me in exchange for some trial and error treatments that may help me, or may not. (Because guess what? Medical science hasn't found one foolproof cure, let alone a one-size-fits all approach, for complex trauma that everyone agrees on. That's why new and innovative treatments are being researched all the time. We all have to just make the best informed decisions we can.)

I will not entrust my mental health survival to someone who doesn't recognize or show an interest in my own expertise regarding my lived experience, and who attempts to suppress rather than nourish and learn from my own story of agency, dignity and strength, thereby killing the part of me that enabled me to survive, and re-traumatizing the part of me that was most threatened by what I've experienced.

My agency (powerful and strong as it has demonstrated itself to be) is what got me here. It's what keeps me living, breathing, striving and functioning, despite what I've been through. I'm the one who defied the odds in that sense. No medical professional did that for me. If any medical professionals genuinely value my well-being and want to be part of my "recovery," they need to take their proper place on the treatment "team" the absolute and only leader of which is me. Everything that happens needs to happen at my own pace, when and if I feel sufficiently informed and ready to try it, no matter how slow or ill-advised or stubborn some medical professional deems that to be (and in fact if they use those latter terms to characterize my ultimate act of self-care in protecting my own sense of agency in the way that feels right for me and proceeding at a pace that enables me to maintain my sense of safety, that alone will tell me they aren't  trustworthy). Me needing time and space is not an obstacle to me receiving care--it is the very first thing in need of protection and nourishment before any other options should be canvassed or presented to me. Anyone who won't provide that to me is a danger to my mental health, and I will self-protectively act accordingly to remove such a person from any involvement in my care.

I'm not saying I will never put my trust in what may be professionally recommended to me. I understand that professionals have expertise and skill in areas that I don't. I'm saying I will only do so once a professional has earned my trust by showing that they honour my right to choose whether and how to proceed (including the option to slow down, take a break or stop altogether at any point without having to give a reason), and once the information they have given me satisfies me that the intervention they propose is something I feel safe and comfortable trying at whatever point in time feels okay for me.

So to be clear: the failure-to-accept-care when autonomy hasn't been affirmed and honoured isn't the fault of those in need of assistance for declaring a critical self-protective, agency-affirming boundary--it's the fault of those around them failing to assist them (and thereby actually harming them) by refusing to be deeply respectful of, responsive to, and nourishing of that essential health-promoting boundary. Boundary violations like that are what traumatized so many of us in the first place, leading us to need to seek out support despite our fear of being violated like that again. If medical interventions are going to replicate the harm, then us rightfully rejecting those interventions is an act to be celebrated and supported, not criticized or suppressed. We are not stubborn. We are not stupid. We are self-protective, strong and demanding to be treated better than we have in the past. Those are acts of healing we are attempting to engage in and attempting to enlist our providers to partner with us in nourishing. If that attempt at connection fails, the failure is not on us. Any professional engaging with us (and failing us in that critical way) needs to pay attention and learn how to do better.

Fortunately there are a growing number of professionals who know and affirm this. I'm not just making this stuff up based on my own stubborn quirks. Trauma-informed care is increasingly being recognized as essential for good reason. The above was just my own declaration about why I will accept no less and why I will not heed any criticism of me for enacting such a boundary. That boundary is the entire foundation of my healing and survival. I will not surrender it for some supposedly magic beans.

A note: 

I've emphasized the ways in which I happen to be high-functioning here; however, my points aren't limited to the outwardly high-functioning. Everyone who is still alive with any sense of self and agency (no matter how damaged by what has been done to them) despite suffering serious trauma has done something amazing and deserves to have their sense of self and agency nourished, respected and protected. In fact, this is something basic that we all deserve as human beings struggling to cope in a difficult world in which we find ourselves constantly vulnerable to harm (even those who haven't actually been seriously harmed).

That said, anything I've said here should be read alongside my reservations re the ways concepts like resilience/survival etc. are discussed (as I wrote here and here).

As always, please note that I am a lawyer, not a mental health professional of any kind. I have no expertise in trauma or mental health. Also, please note that any opinions and views expressed in this blog are solely my own and are not intended to represent the views or opinions of my employer in any way. For more information about the purpose of this blog, please see here and for a bit more information about my personal perspective on this issue, please see "my story" here

I am very grateful to have received a "Clawbie" Award for this blog (which reflects the importance of this topic): https://www.clawbies.ca/2019-clawbies-canadian-law-blog-awards/

For some of my external writing on this topic, see:  

• https://www.canadianlawyermag.com/news/opinion/a-more-inclusive-discussion-on-the-impact-of-trauma-on-lawyers-mental-health-is-needed/276166 
• https://www.cbabc.org/BarTalk/Articles/2020/February/Features/Speaking-Up-About-Trauma-and-Mental-Health    
• https://www.canadianlawyermag.com/news/opinion/changing-the-conversation/326240