Michael – A Case Study. PART TWO
So what is the point of a case study like Michael’s in any practical sense? What is being trauma informed? Why is it important?
One statement I read in response to this discussion essay was what I have found to be typical of both clinicians and support facilitators.
“Life was really horrid but if you’re willing to get cancer, one of the vilest most fatal illnesses ever’…I don’t know what to say. I really hope that ray of sunshine you need finds you “.
Imagine you are Michael. What would you think and how would you feel when a sector professional reflects this little piece of inanity at you? I mean, certainly it is ok to feel out of one’s depth when being confronted by this level of self-destruction. But it is not OK to then place the onus for those feelings and thoughts of mortality back on the patient/client and implying that “….that little ray of sunshine you need finds you” is obviously a qualitive thing and if it hasn’t happened then perhaps you are doing something wrong. Was the person from the sector knowingly reinforcing the negative behaviour and thoughts and emotions that plague the patient/client? I don’t believe so. But the effect of these words could very easily serve as trigger to dangerous symptomology and to an unacceptable outcome.
This comment and total capitulation of responsibility by the clinician/support worker is precisely the reason for the essay. This comment was fearful, dismissive, hopeless, judgemental and in the end extremely damaging. Almost traumatising. Firstly this person assumed I was the case of study. If that was the case then this comment would only serve to reinforce the hopelessness and feelings of powerlessness, and the thoughts and compulsion to suicidality. And as Michael himself stated in regards to surviving the trauma, this person’s comment can only reinforce Michael’s statement,
“I WISH I HADN’T!”
Developmental trauma is unique in its pathology. All illnesses are unique if an argument were to be made for it. Developmental trauma though is unique because it presents in so many different ways that the diagnosis of it is more an art than a science. Though with new imaging technologies it is possible to in fact view the malformed neural structures and compare them to the images of a “normal” brain.
Getting back to the original question, what is the point of a case study like Michael’s? It is very simple. When one actually becomes more informed about the trauma and the damage done by it, one can then put aside fear provoked dismissiveness, and try to look at the larger picture.
The circumstance of Michael’s experience of child abuse over a prolonged time has caused a number of logistical problems to the support worker and clinician. Firstly, the automatic assumption, that positive thinking will do the trick is shown as being, in this case shallow or trite. Also that adherence to pharmacological regimes and therapeutic processes will overcome symptoms if the client/patient tries hard enough to be compliant. This too is a myth as complex PTSD is notorious for its extreme treatment resistance. The most immediate issue for most sector professionals is his suicidality. The reason this is so, is very primal. It is the fear of mortality transferred by the support person/clinician and therefore becomes the predominant aspect of the disorder. Treating and stabilising this becomes the whole of the treatment or support. This is understandable and very important, as one cannot treat or support a person who is deceased.
This is not flippancy, I promise you. As a youth worker for many years, I knew too many young people who completed suicide. And it is truly awful. And stays with me still.
In the majority of cases, suicidal ideation predicated by severe depression, is often a chemical issue. This could be genetic or the result of drug and alcohol use. It can also be a vicarious response to hormone levels in either puberty or middle of life changes. It can also be a response to relatively short term trauma such as being bullied or having served in the defence forces and been deployed into action. These last examples create a range of symptomology that is covered by a diagnosis of PTSD.
Domestic violence too is a major trigger for this kind of trauma response. Since most often this abuse occurs over an extended period of time and can be not only horrendous in its violence but can without real intervention be fatal. This response would fall under the label of Complex PTSD behaviour.
But again there is a marked difference between these very serious and life changing illnesses/disorders of long term and short term trauma and developmental trauma.
Developmental refers obviously, to the process of physical, intellectual, spiritual and emotional development. Growing up. That is to say these traumas actually take place over the periods of a person’s development as they physically grow from children to adulthood. This is fundamental in understanding the patient/client. Understanding the person is of such great importance that without it a clinician/worker can only ever react to the person’s actions, thought processes and responses to stimuli. As the person will display inverse responses, thoughts and emotions, it can be very frustrating for the worker/clinician to get a handle on the very basics of treating the ill or disordered person.
As mentioned in the previous essay, imagine how frustrated the person is.
Quite often because of this frustration, it is sometimes assumed that the patient/client themselves is the reason for their behaviour, thought processes and emotional range and intelligence rather than the reflection of abuse based trauma. Often this is taken on board by the patient/client due to the very trauma that is being ignored. A vicious and mortally dangerous cycle.
I recently had occasion to be invited to a sector NGO workshop conference. I decided that I would, amongst other activities during the day, sit in on a presentation regarding being trauma informed. At first, I was pleased to see modelling of the neural psychology. An explanation of the functions of the affected areas, and how that translated into thought and emotional processes and volitional and non- volitional behaviours. This is where the information stopped.
It was at this point I started to question the motivations of the presenter. This is because, the presenter then showed video and still photographs of appalling violence and tortures. There was no discussion and no explanation by the presenter about the images and video he was presenting. Just a cavalcade of the worst of humanities degradations. I sat through about 20 minutes of this. I turned to a colleague and said loud enough to be heard by most, that at this point I had not learned anything that I did not already know. That I was leaving the presentation because I did not feel that I was being instructed in being trauma aware but was being manipulated into feeling trauma by the gratuity of the material. After the presentation was over the presenter asked me what I meant by my statement. I explained that to actually see people being butchered, abused and tortured did nothing to inform me of how those persons then proceed to live their lives. Instead I believed that the presenter was simply engaging in shock tactics with a motivation in mind I could only guess at. The gentleman in question then tried very hard to berate me for my apparent ignorance. For myself, I simply use my ability as a grown human and chose to disengage.
Perhaps this is the essence of trauma; it is the inability or capacity to make a such a choice.
Compassion and empathy facilitate patience.
Being trauma informed is about understanding and empathising not with the trauma but with the effects the trauma has made in the lives of survivors. And as much as you might wish that the patient/client was more responsive to clinical or supported intervention, I can guarantee that the patient/client craves it far more than you do.
What developmental trauma leaves behind it is an inability to function fully. It destroys a person’s innate self-esteem. It creates confusion, anxiety in all its forms, dissociation, intrusive memories and images, nightmares, problems giving and receiving intimacy, somatic illnesses, sometimes a violent disposition, a necessity to suffer, isolation and ultimately a predisposition to self- harm and to attempt and complete a suicide.
That is a whole parcel of disorders existing with the single person. By understanding that trauma has intrinsic negative effects one is able to look with compassion and patience when working with a survivor. There is no doubt that it will be difficult and repetitive work. It will be triggering and frustrating. Outcomes will only be measured by how a patient/client is managing day to day. But if you can work through all that you may in fact facilitate a recovery. Not a cessation of symptomology but a modern interpretation of the dynamic. This patient/client can have an improved quality of life. On his own he slowly drowns but with compassionate and patient support and treatment a horrific past can become a meaningful present and a future filled with hope.
If nothing else, this is all that is asked of you and clinicians and support workers. Because even this slight improvement of life quality is measured by the patient/client as nothing less than a paradigm shift.