Behavioral Health is talking about trauma.
In considering treatment, one asks is it “trauma informed” or trauma focused. What does this mean?
Before we address these important questions, let’s consider what trauma is. In the medical model, trauma is acute, immediate, requiring life-saving intervention. Similarly in behavioral health, we recognize trauma as acute. Some distinguish between major trauma as capital T-trauma and minor trauma as lower-case t-trauma. Capital T-trauma might be considered life-threatening accidents, violent acts of nature, rape or any kind of attack, although medical events like heart attack, onset of cancer would also qualify as a major experience of Trauma. Lower-case trauma might be considered experiences of belittling, bullying. Experiencing condescending behavior. But imagine the impact of multiple experiences of lower-case trauma over time creating capital T trauma. We might graph it something like this at the right:
Big T Trauma and Small T Trauma
I think there is an inherent difficulty in grading or assigning value to various types of traumas, for the resilient person, who experiences significant traumatic may be minimally impacted by it and the vulnerable person who experiences minor trauma could be devastated. There seems to be more value in exploring the chronic impact of high acuity trauma as well as the chronic, albeit hidden impact of benign trauma that occurs over time.
The catchphrase used by many treatment providers today is “trauma informed.”
This means that they are aware that trauma impacts mental health and addiction, but it does not mean that they offer treatment modalities that address and heal the trauma. There is an important distinction. Asking what they treat and what therapeutic modalities they use to treat various issues will tell you whether they are trauma informed or trauma focused.
Over the past 15 years I have become increasingly aware of the impact of trauma, and more specifically the hidden impact of trauma. When trauma occurs, the brain immediately makes a unilateral decision and rewires the brain and body for survival. This is an action of the brainstem that controls involuntary processes and systems that are designed for our survival. There is no consultation with the Pre-Frontal Cortex or executive functioning part of the brain. Survival is unconscious. And, let me tell you that Brainstem is tenacious about survival. It hangs on for dear life and it often hangs on long after the threat is gone. Survival is quite creative in finding ways to change the way one feels; it finds drugs or behaviors that elevate and excite and others that take the nervous system down. The “drugs of choice” available are many: prescription and street drugs, marijuana and nicotine, alcohol, sex, porn, multiple infidelities, one-night stands, gambling with money, gambling in high-risk business, compulsive work, exercise, or high-risk sports. Even some mental health symptoms like anxiety and depression mirror the addictive cycles of “all or nothing” and manifest in obsessions or depressions. Some refer to this as “better living through chemistry” because we know that the reward system of the brain responds to dopamine rushes whether the Executive Brain is online or not. When one is making decisions to manage mood, there is no awareness that the decisions have been set in motion by the brainstem’s core commitment to survival. Until a person is willing to identify and begin to heal from the trauma or attachment wound that hijacked the executive functioning and put survival in charge, they continue to make mindless decisions about their lives thinking those decisions are conscious and connected with the Pre-Frontal Brain.
When we are surviving, we are not thriving. Survival brains don’t think about thriving; it is beyond the scope of their domain. Therapy, treatment, and healing modalities that treat trauma are somatic in nature. They are not essentially cognitive modalities because the cognitive functioning of the brain is off-line. But the body keeps the score, as Bessel van der Kolk has said. Trauma resides cellularly in the body in a chronic condition of survival until we begin to let the body tell the story and listen to the cells as they speak their truth. Then, little by little, healing comes through the cultivation of curiosity and consciousness grows, informing the brain and the body that we don’t need those survival behaviors anymore because the threat is gone.
They’ll always be there if we need them, but for now, they can sit back and relax and let us reclaim agency in our lives.