Let people tell their story, tell of their pain. And let others listen. We discovered that in telling, that people begin to experience a healing.—Archbishop Desmond Tutu, 2000
Too often—due to the stigma and discrimination that are still pervasive in our society and despite the great work of antistigma programs—individuals with mental health challenges are reluctant to share their stories, even if they convey a message of hope and recovery.
Even now, I share my story with trepidation. Yet I am doing so because it is important for me and others to come out of the shadows to talk about trauma—an issue that is gaining more attention in health care reform and within the behavioral health care arena. What we all need to agree on is the need for more services to screen for and address trauma. Especially needed are services that have proven effective and are short term, so that people who have experienced trauma can use these services and get on with their lives.
This is not to say that resolving trauma is a short-term endeavor, because it is not. Healing knows no deadline, and the time needed to resolve trauma may be lifelong for some people. My point is that the more of us who talk about our experiences with trauma and our efforts to heal, the more likely that the need for such services will be recognized.
I recently had the exciting opportunity to participate in the Traumatic Incident Reduction Workshop, a three-day training course offered by the Trauma Resolution Center (TRC) in Miami, Florida. My participation was sponsored by the National Center for Trauma-Informed Care funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), and I am grateful for its support.
To explain what the TRC has meant to me, I need to start by telling my story—at least some of it.
My experience as a psychiatric patient began when I was a teenager. Like many, I had to move forward into adulthood, earn a living, and make some kind of life for myself while dealing with psychiatric symptoms. I had support, but, essentially, it was my life to create. The only problem was that I had not considered the impact of trauma in my life. I had never stopped along the way (as they say in Buddhism) to take stock, recalibrate, and move on.
My experience as a patient and then as a consumer-survivor was fraught with danger, turmoil, depression, and many losses. Recently, I began to notice that I was becoming less interested in work, had trouble maintaining relationships, had unhealthy eating habits, and watched too much television. In essence, I had become isolated. I decided to stop smoking, after realizing that I could barely get up a flight of steps without huffing and puffing. If you sat next to me, you could hear me wheeze.
I didn’t think I was depressed, but now it is clear that I was. For some reason, I didn’t know how to enjoy my life and be happy to be alive!
Over the past couple years, I have been involved in a major clinical shift that is changing my life. After routine blood work, it was discovered that I had negative physical effects—serious and potentially life-threatening effects—from the psychiatric medication I had been taking for over 30 years. Three medical professionals—my primary care doctor and my psychiatrist, as well as a psychiatrist I saw to obtain a second opinion—encouraged me to try a variety of other medication strategies, which I did over the next several months. When these strategies were not successful, the three medical professionals agreed that I should take a closer look at other medication and consider cessation of all psychiatric medication. Friends and family were very supportive during this time, and they encouraged me to proceed with a plan. Few planning processes are available, so I decided to develop a person-directed plan (PDP) with the assistance of a peer from a local peer-operated chapter of Mental Health America. Once I had the PDP in place, the idea seemed to be easier to initiate. But I was uncertain about my chances of living without medication, and I often wondered what I would be like without it. It was a strange feeling to wonder whether I would be a different person without pills.
As I weaned myself from the medication with support from my care providers and others, I began to experience increased anxiety that was mostly physical. At the same time, it felt as if a cloud was lifting. It was challenging to have both issues in play. What seemed to be left was a “new” person with more vivid memories, including memories of trauma and also of positive events. I am new in many other ways: I am more curious and life affirming, and I have an emerging “lightness of being.” A sense that my life was indeed changing began to emerge.
I knew I had experienced trauma but had never looked deeply at its roots, nor had I considered ways to alleviate its impact on my life. I had ignored its signs and symptoms. For some reason, I did not think I needed to take a closer look; and my years of therapy, although helpful in some ways, did not specifically focus on trauma. I realize now that examining and addressing trauma are keys to opening the doors to recovery.
As I began to realize how trauma had affected me, I became more aware of the need for trauma-informed services, which are very different from traditional mental health services, such as medication and psychotherapy. I am not alone in this view. In fact, SAMHSA is increasingly focusing on trauma through its National Center for Trauma-Informed Care, and it is promoting the concept that individuals in crisis should be asked what happened to them rather than what’s wrong with them. I applaud this shift in focus and hope SAMHSA will continue to highlight this issue.
I went to TRC to acquire the skills to help others handle unresolved trauma in their lives, but I decided to stay to receive services not only to experience the program as completely as possible but also to learn, from a client’s perspective, how the model works. It was perfect timing: although my job had to be put on hold temporarily, I felt it was worth it. It had become increasingly clear that if I did not begin to address these issues, I would continue to suffer, and, ultimately, that would affect me more profoundly, including my ability to function and thrive.
During my time at TRC, I discovered a staff that was extraordinarily compassionate and dedicated to wellness. Over the course of about two weeks, I participated in nearly every service the program has to offer, including acupuncture, reiki, hiprobics, massage, breath work, and one-to-one counseling, most of which were new to me.
I believe my ability to have insight into my own experiences has been enhanced as a result of the program. For the first time, I noticed a connection between my mind and my body, and it was this experiential immersion that enabled this to occur. I can now see that understanding the mind-body connection is central to overall recovery from any ailment. I may have understood this intellectually, but I never really understood the importance of this until I had my own experience at TRC and with this life process. My readiness for change also had a lot to do with the desire to resolve issues left unaddressed for many years.
Another positive outcome of my TRC experience is that my confidence has increased by virtue of my participation in a fairly structured model of care and practicing my ability to trust others in the delivery of specialized services. I used to question professional staff and become a nuisance in medical settings—or so I thought. At TRC, I noticed that I was not defensive, and I tried very hard to trust the input offered by staff. I felt more at ease and more engaged as the days progressed. I became open to the possibility that wellness starts with me and is possible to achieve. I noticed other clients who were benefiting from the program and returning for services. There have been times when I have lost interest or motivation in treatment, but the services in this case were engaging, and my involvement with other patients and watching them recover and appear happier encouraged me to my last day at the program. I noticed a difference in how I felt and that my anxiety had been greatly reduced after using the TRC services.
I went home with practical skills to develop a longer-range plan. I now realize that a full resolution to trauma is a long journey.
I had left home thinking I would simply attend the training, and I ended up in treatment. This occurred because my symptoms were profoundly impeding my ability to function. Now, I am armed with additional tools and incredible support from the TRC. I believe the TRC services will be helpful for me. In addition, I enjoy the other tools I acquired, such as meditation. I am a beginner, and I must try to take small steps and enjoy the process. The entire message here has been extremely complex for me, but I continue to move forward. I find I have a younger outlook on life and an increased awareness of what life has to offer, including a more intense appreciation of art, literature, and nature, as well as an increased interest in a variety of other subjects. This—coming from an overworked policy analyst—is a good outcome!
What has resulted is an awareness that medical professionals ought to consider and even anticipate the need for trauma-focused services as their clients make changes to psychiatric medication regimens. Those of us who have experienced psychiatric distress, and even those who have not, have had traumatic life experiences; and our chances of living more meaningful lives in the community are enhanced when we begin to examine these issues. In addition, the medical profession has an important opportunity to invest resources to discover the causes of trauma and ways to address it before the introduction of psychiatric medication.
Trauma-informed care has been inadequately addressed and integrated into our health care systems. It’s time for a change. SAMHSA and other agencies, notably the U.S. Department of Veterans Affairs, are now focusing on this issue in the wake of the September 11, 2001, attacks on our country, combat-related trauma, and other traumatic events, such as the Deepwater Horizon crisis in the Gulf, natural disasters, and other recent tragedies.
I encourage the replication of the traumatic incident reduction model and other programs with trauma-focused interventions. Participation in TRC’s programs has been life changing for me. The experience has helped me feel more comfortable about telling my story, too.
This article was developed with assistance from Susan Rogers. Support to attend the TRC was provided by the National Center for Trauma-Informed Care of the National Association of State Mental Health Program Directors, funded by SAMHSA.