Trauma Stewardship

by Laura van Dernoot Lipsky

  “Must you precede everything you say with ‘This is your captain speaking’?”

  Admittedly, many people feel content with an identity based solely on work, particularly when that work is exclusively focused on others. Work gives us an excuse not to focus on ourselves, our relationships, or our lives, which may be precarious or falling apart. It is important to remember, however, that if we concentrate all of our energy on one area of our lives, we are likely to be compromising ourselves elsewhere. Ginny NiCarthy, a foremother of the domestic violence movement in the United States and the author of several revolutionary books on violence against women, described the tension she encountered when balancing multiple identities:“There I was, neglecting my own children while I was out trying to change the world.”

  Karyn Schwartz, an herbalist and a healer based in Seattle, Washington, describes why she sings. Despite the many demands on her time, she makes sure to perform as often as she can—in nightclubs, cabarets, and classical choirs. “A lot—maybe most—of what I do as an assistant to people’s healing is invisible. I don’t own anyone’s well-being. If I am doing my job well, nobody feels that I am doing much at all, and I become quickly obsolete, because it’s their journey, not mine. I sing because that is how I pray; I perform because I need to be applauded. All of us need appreciation, and sometimes in this kind of work the invisibility can start to feel depleting. In order to stay honest about my own need for accolades, and in order to nourish my own capacity to remain generous with my energy, I make sure to tend to the part of myself that needs to be a big diva. If I don’t, I run the risk, as we all do, of relying too much on my work for my sense of esteem. When that happens, I can start to feel dependent on other people’s suffering and their need for me to relieve it, for my own feeling of purpose. It’s hard, in that dynamic, to honestly encourage someone else to be truly whole.”

  It can be very hard to reduce our identification with work, let alone break the addiction to overwork that often results. These ways of being are feverishly supported in certain societies. When I lived in Guatemala, I’d often be invited to sit with someone’s family in a small indigenous community, high up in the mountains, and talk with them for hours. They posed many questions, but never once was I asked, “What do you do?” In Central America, Japan, Mexico, New Zealand, and throughout Europe, people ask where you live, how your family is, what crops grow near your home, what you think of their country, and so on, but not about what you do for a living.

  Having been raised in the United States, where this is generally one of the top three questions we ask upon meeting new people, I marveled at what it means not to ask this question. In the United States, we are obsessed with work; it is a cornerstone of our self-image. This difference in perspective may help to explain why workers elsewhere in the world rarely exude the same exhaustion that we do in the United States. Perhaps their cultures make it easier for them to maintain a larger identity that is distinct from their work. Their understanding that what they do is not who they are may allow them a freedom that our grandiosity about work does not afford us.

  PART THREE

  Creating Change from the Inside Out

  CHAPTER FIVE

  New Ways to Navigate

  Chance has never yet satisfied the hope of a suffering people. Action, self-reliance, the vision of self and the future have been the only means by which the oppressed have seen and realized the light of their own freedom.

  Marcus Garvey, National Hero of Jamaica and founder of the Universal Negro Improvement Association and African Communities League

  So far, we have traced trauma stewardship from our personal histories through the organizations where we work to the society in which we exist. We’ve peered into ourselves, identifying the effects of the accumulated, internalized stress from our work.

  Now let us explore what we can do with our trauma exposure response. How do we alter our course to reach a healing path? How do we prevent the ripples of trauma exposure response from continuing to spread? How do we integrate the effects of trauma exposure so that we become effective trauma stewards?

  For most of us, the answers to these questions won’t come quickly or easily. More likely, you will face difficult decisions. The wonderful news, however, is that you already possess all the tools you need for this journey. More than anything else, what we need in order to practice trauma stewardship is knowledge of our own lives—what we feel, value, and experience, and what we need to do to take care of ourselves. The more deeply we can connect with ourselves, the more likely we are to find what we need to do our work joyfully and well, even in the face of significant hardship and obstacles.

  The essence of the trauma stewardship approach is to cultivate the quality of being present, both to the events of our lives and for others and our planet. This most important step on the path to trauma stewardship is the same one that is said, in some traditions, to lead to full enlightenment. It is important to note, however, that you need not have a spiritual revelation to practice trauma stewardship. As the Tibetan Buddhist nun Pema Chödrön defines enlightenment, it is “whole-hearted, open-minded interaction with our world.”

  We all have the potential for this kind of interaction. Each of us can teach ourselves to be open, flexible, curious, and awake to our experiences. And once we accept this idea, no matter how paradoxically painful and challenging it may be to bring it to fruition in our life and work, it’s like discovering that compass in our pocket that we forgot we had. As Peter Levine writes,“No matter how highly evolved humans become in terms of our abilities to reason, feel, plan, build, synthesize, analyze, experience, and create, there is no substitute for the subtle, instinctual healing forces we share with our primitive past.”

  While our deepest instincts are ultimately to do what is best for ourselves, sometimes we need guidance to recognize when we’ve wandered away from our truest selves, and lessons to learn how to regain our bearings.

  As we map our trauma exposure response, we can shift into a more active phase of our journey—one that, as Marcus Garvey said, emphasizes action, self-reliance, and a new vision for our self and our future. In the remainder of this chapter, I will offer some general tips for the path you are about to travel. Although the questions and emphasis at each stage will be different, the basic approach remains the same. Remind yourself that it takes courage to undertake this journey, and practice compassion at every step.

  Open the Inquiry

  As we shall see, understanding where you are now may require that you look far back into your past. What events and decisions are most crucial to who you are today? Do you find any consistent themes as you look back over your choices? When I delved into my own history, I saw that my entire life had been shaped by a struggle to reconcile pain and joy. As a child, I was deeply preoccupied with the well-being of others and persistently troubled by the injustices in the world. When I was 10, my mother was diagnosed with a rare form of lung cancer, and when I was 13, she died. My brother and I were catapulted into adulthood. Although I was surrounded by love and kindness, I felt an isolation that was immense.

  Throughout my childhood and adolescence, I searched for someone who could articulate my experience that there was a tremendous amount of suffering in the world even while there was a tremendous amount of beauty. I grew up far from the teachings of Buddhism; I was surrounded by well-meaning people who tried to soothe me by telling me that everything would be okay. Their comments left me feeling disconnected from what I instinctively perceived to be the essence of life: the complex coexistence of hardship and blessings.

  When I was 18 and my professor of sociology was talking about homelessness, I experienced one of those moments when time stands still. As he told us that it was our responsibility to honor each other as humans to the best of our abilities, I felt a chord sounding deep within me. I went up to him after class and asked how I could start volunteering. I began my social work career in my freshman year of college as an overnight assistant
in a homeless shelter. Being in the company of individuals who were suffering greatly and yet could tell a joke and laugh deep and hard resonated in me in a way that began to melt my isolation. My work expanded to child abuse, domestic violence, sexual assault, and trauma as a whole.

  In graduate school, when it came time for a practicum, I felt moved by some larger force as I asked to be placed in a hospital trauma center—a place that was certain to bring up all my fears about grief and loss. Not long into my time at Harborview Medical Center, I realized that part of my reason for being there was self-serving. I was sharing in the human capacity to experience horror and beauty at the same time—on a daily basis, and on a massive scale. Even at the most devastated moments of their lives, people somehow called up their highest selves. They were suffering on a level I could relate to, and yet despite their anguish, they didn’t give up. I received an infusion of awe and hope with each and every shift.

  Over several years of graveyard shifts in this hospital, I felt my old isolation melt. Because I had the opportunity to bear witness to others’ pain while helping them to know that they could be loved and taken care of as they suffered, I experienced a profound healing. My work at Harborview gave me a gift: a deep understanding of how I could struggle in my life and yet still be able to marvel at Mount Rainier and the Cascade Mountains during my run after each hospital shift. My patients taught me how expansive life is.

  Years later, when I had the privilege of being introduced to Thich Nhat Hanh and Buddhism, I felt it all come full circle. This ancient tradition was deeply concerned with the relationship between suffering and joy that I’d grappled with since childhood and learned so much more about from my patients and clients over the years. Jack Kornfield, a Buddhist monk and educator, described Buddhism’s central tenet when he said,“It’s not easy. This human realm in which we have taken birth is halfway between heaven and earth, and it is said to have fundamentally an equal measure of suffering and pleasure, of joy and pain, of loss and gain, of the mundane and the daily punctuated by unspeakable beauty and oceans of tears.”

  You can understand how my work in the trauma center met my needs on some level. Before each shift I’d ask myself, “Given my understanding of the meaning this work holds for me, can I continue to be here, serve the patients well, and do right by them?” Each time, I decided I could, and I did, to the best of my ability.

  My decision to leave the hospital came when it became apparent (well, my loved ones would tell you long after it had become apparent) that I could no longer stay on top of the enormity of what I was witnessing and experiencing and still serve patients well. At the end of my time in the ER, the accumulation of trauma had taken its toll. I did not yet have a daily practice of mindfulness, and I was no longer able to be present for what I saw and heard each day without losing faith in the larger workings of the universe. Even so, I was deeply connected to my work, and the thought of leaving tormented me. I confided to my mentor Billie Lawson, “No matter where I go, I’m never going to forget what I’ve experienced here or what it tells me about the brutality of life. So what does it matter if I leave or stay?” We were on a walk. She allowed a long moment to pass and then said firmly, “Laura, maybe you just don’t need any more exposure.” And so, when I was able to admit that I could no longer hold out the light and hope that the patients deserved, let alone personally maintain and engage in my own life, I decided it was time to leave Harborview.

  I encourage you to ask yourself if what you are doing in your life is working for you on all levels of your being. Does it edify you? Do you use it to escape your life? Does it bring you joy? Does it support your ego? Is it a place where you can do something about the pain in the world? Does it distract you?

  “Only I can prevent fores: Jim? Don’t Jail think you sbouk! share some of the responsibility?”

  I use my own story here as a tool to illustrate the strong, sometimes subconscious relationship between our self and our work, and how deep we may have to reach for the awareness necessary to bring the best of ourselves to the choices we always have. When I hit rock bottom and slowed down, I let go of my resistance to the possibility of change. As soon as there was an opening, fresh information and support, along with ideas for new ways of being, swiftly flowed in.

  Practice Self-Care

  Even if the answers to questions about your life’s direction don’t come instantly, there are certain practical steps you can take right away. You can begin by acknowledging that your stresses are genuine and you are looking for healthier ways to deal with them. As one disease ecologist who worked in Guinea shared,“For a long while, I didn’t do anything to care for myself, as it took me some time to recognize that this was something treatable and ‘real.’ All I did was grieve for lost friends and listen to survivors’ stories.” By easing the burdens of trauma exposure, you may open the physical, mental, and emotional space to explore the deeper questions.

  In his book Psychological Trauma, Bessel A. van der Kolk identifies important differences between those who are permanently debilitated by primary trauma and those who are able to integrate the experience into their lives and adapt. He finds several shared traits among “stress-resistant persons.” Among them:

  A SENSE OF PERSONAL CONTROL. Stress-resistant people perceive a connection between their own actions and how they feel; they believe in their own capacity to influence the course of their lives.

  PURSUIT OF PERSONALLY MEANINGFUL TASKS. They are present and engaged in their lives, and this helps them to be active, instead of passive, during challenging times.

  HEALTHY LIFESTYLE CHOICES. They show “decreased use or general avoidance of known dietary stimulants of refined white sugar, caffeine and nicotine; they seek out multiple periods of hard exercise each week; and, they find time each day for a period of relaxation.”

  SOCIAL SUPPORT. They have relationships with others who can serve “as a buffer in dealing with difficult situations.”

  Bessel van der Kolk concludes that stress-resistant people are “capable of negative affect when faced with adversity, [but] a belief in their actions to resolve problems results in a general mood of well-being.” Just as there are noteworthy similarities between post-traumatic stress disorder (PTSD) and trauma exposure response, so too there is significant overlap between the coping strategies that best serve primary trauma survivors and the behaviors that can most benefit those of us impacted by trauma exposure through our work.

  As we work with the Five Directions, we begin a practice that will enable us to bolster our resources in each of the four key areas of stress resistance that van der Kolk has identified. When we focus on north (creating space for inquiry) and east (choosing our focus), we enhance the link between thought and action and our sense of personal agency; when we turn to south (building compassion and community) and west (finding balance), we look for ways to create a culture of support around us and to make healthy choices that will serve to nourish our strength rather than deplete it.

  “Eventually. I’d like to see Jail able to put yourself back logether.”

  It can be humbling to realize how much we have in common with those we attempt to help. Our pain and strategies for healing may look much the same as theirs. As caregivers, we too may find it nearly insurmountable to attend to our own well-being at times. And yet we face a challenge: How do we care well enough for ourselves to reconcile all that we are witnessing? Remembering how much we share with our clients, we might think about our clients’ heroism, courage, strength, and determination. We can listen to what comes out of our mouths as we encourage, guide, or mandate them—and stop to wonder if we would be wise to follow the same advice. If we work with animals or plants or habitats, we may remind ourselves of all the ways that natural systems have evolved to keep themselves healthy and replenish themselves. If we think of birds, we may think of their urges to sing, to mate, to eat, to fly, to raise their young, to follow the rhythms of the seasons. If we honor this life in them, we can also att
empt to honor it in ourselves.

  Be Patient

  I have heard countless colleagues express their despair, frustration, and disbelief that there’s not a simple process to follow, a neat package to open, a timed-release pill, that will make all this better. These feelings of urgency and attraction to something quick and easy are, in and of themselves, a part of trauma exposure response. In truth, we know that transformation is a process. We know that the people, animals, and environments we’re working with have a long road ahead of them. We know that our physical health requires daily maintenance, that we should do more than simply seek treatment once things go wrong. And yet when it comes to caring for ourselves while caring for others and our planet, we often choose to believe that, somehow, we are different. Somehow our capabilities must be greater. Somehow we are entitled to a less arduous, less introspective, less involved role in our own well-being. In fact, we are not. Trauma stewardship is based on age-old wisdom. It isn’t necessarily fast acting—but it is reliable, trustworthy, accessible, and doable. It requires some trust that taking the first, and then the second, and then the third step matters. American civil rights leader Martin Luther King Jr. reminded us, “Take the first step in faith. You don’t have to see the whole staircase. Just take the first step.”