Sunday, February 9, 2020

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:  
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