Trauma Stewardship

by Laura van Dernoot Lipsky

  Charlann Hartfield, antipoverty advocate, Seattle, Washington

  Whether you call it your sangha (the Sanskrit word for community or assembly), your consultation group, your women’s group, your bar mates, or your circle of friends, it is critical to create a microculture of support around you. A microculture is simply a community, but I like the term because it reminds us that our chosen group may nurture us by emphasizing a different set of values than the culture at large.

  In The Dance of Change, Peter Senge talks about “conscious oversight,” an idea he borrowed from the Quakers: “In any Quaker community there is an oversight committee who is charged with enhancing the total health and sustainability of the community. Early writings state, ‘desirable as it is that some would be specifically entrusted with these oversight duties, an earnest concern has prevailed that all may take their right share in the privilege of watching out for one another’s good.’” Senge describes conscious oversight as being, in part, about slowing down “enough to reflect on the system and situation from a variety of perspectives and with a variety of ways of thinking. Also.Ê.Ê.Ê to bring an ongoing deliberation into everyone’s frame of reference and to support them to take the long view in the midst of day to day.”

  “Enemies, yes, but doesn’t your moat also keep out love?”

  Our microculture should support us in two ways: by showering us with encouragement and by holding us accountable. Its members must be people we can debrief with, laugh with, brainstorm with, consult with, cry with, and become better people with. Isolation is an underpinning of oppression, and by consciously staying connected with others, we are taking an important step toward trauma steward-ship. In shamanic traditions throughout the world, communities recognize the critical need for social cohesion in tending to suffering and healing pain and trauma. Often rituals involve the entire community, and the integrating of individuals or a group back into themselves and the larger social fabric takes the form of song, dance, and ultimately celebration.

  An important role of the community we create around us is to refuse to collude with our harmful internal patterns. There is a First Nations tribe on the coast of British Columbia, Canada, and like many Native communities, it will come together when someone asks to have a Circle. Anyone in the community can request a Circle, either to celebrate something or to ask for help. In this particular community, there has been an understanding: If someone in the community asks for a Circle, you show up. But it doesn’t stop there. There is an agreement that if you realize as you listen that you’ve been called to this Circle more than once before—in other words, that the same person is asking for help on the same matter for the third time—then you will get up and move 20 feet over. The entire Circle will rise and follow you. The person who’d hoped to revisit the struggle yet again will have to decide if he/she wants to sit alone or if he/she is willing to move on and join the new Circle. “Move the Circle” is now a common expression among my family and friends. We say it whenever it seems that one of us has been ruminating on something long enough.

  In the book Traumatic Stress, Marten W. deVries states: “Culture cannot prevent calamity, nor can it blunt the immediate physical power of violence and the emotional shock of betrayal. It can only help with building up resilience before such events, or with providing validation, restitution, and rehabilitation afterward. Cultural processes such as social support and self-help groups are powerful forces for restitution particularly when combined with formal cultural acceptance of the traumatic experience.”

  In my family, we have a rule that anyone can call for a family hug at any time. It doesn’t matter what you’re caught up in—if you hear someone say ‘family hug,’ you stop everything you’re doing and you go join in. We just take that moment to hold each other and be together, and then we all go back to doing what we were doing.

  First Nations health care worker

  In one model project, microcultures are used to foster the reconciliation of trauma. Rebuild, a program of the Inova Regional Trauma Center inVirginia, supports individuals, families, and communities along the entire journey from traumatic incident to trauma stewardship. Recovering patients help each other deal with the long-term consequences of their injuries through support groups, self-management classes, and mentoring of new patients. In addition, these patients provide trainings to first responders and other health care professionals, including doctors, nurses, social workers, firefighters, and rehabilitation specialists. During these presentations, Rebuild members describe their experiences with the rescue, hospitalization, and rehabilitation processes, providing valuable insight into the profound journey shared by all trauma patients.

  Recovering trauma patients can attend forums where they sit together and thank the paramedics, nurses, doctors, and therapists for their important role in the healing process. They also provide feedback about their experiences, which allows for closure and growth for both patient and caregiver. Reconnecting with patients has a profound effect on the caregivers; in a survey, they reported gaining valuable insights and feeling a renewed commitment to their chosen professions. A frequent comment was, “This is why I became a paramedic (firefighter, nurse, therapist, and so on): to truly make a difference in people’s lives.”

  I, for one, believe that if you give people a thorough understanding of what confronts them and the basic causes that produce it, they’ll create their own program, and when the people create a program, you get action.

  Malcolm X, American Black nationalist leader and founder of the Organization of Afro-American Unity

  1. Ask yourself what your ancestors and those who raised you have done, throughout time, to heal themselves and others. When they experienced trauma, how did they go on?

  2. Identify the members of your microculture. To what degree do they nurture hopefulness, accountability, and integrity? Think about whether you could use stronger role models in any of these areas.

  3. Take some time to examine how your outside surroundings connect with your internal state. Are there shifts you can make in your external reality to achieve a more peaceful and productive internal reality? What is your neighborhood like, how is your home taken care of, what food do you eat, and what role do you choose in creating wellness both locally and globally?

  PROFILE ANNA BRADFORD

  VIENNA, VIRGINIA

  CURRENTLY: Doctoral student, Johns Hopkins School of Public Health.

  FORMERLY: Rebuild coordinator, Inova Regional Trauma Center.

  The initial trauma in my life was when my friend Hilary died when I was a teenager. I think the actual evening when all of this happened was as shocking and horrible and difficult to understand as any other trauma, and I think it was managed as any other trauma in anyone’s life is managed. From that experience, I feel like I have an understanding of what it is like to go through something that horrible and scary and gross and frightening and overwhelming. What is different about my experience, however, is that when Hilary’s family did regroup, we were able to integrate this tragedy into who we were as a larger community. I believe today that I can have some impact in people’s lives because of what my experience was personally in relation to this tragedy.

  The way the Plancks decided how they wanted the funeral to be was incredibly significant in how we were able to integrate what had happened. They decided they wanted to bury their daughter on our farm, which they did in part because they wanted the process to be one that the community could be engaged in, so that everyone who’d been a part of her life could be a part of grieving her death together. She was brought home from the hospital, and while there was nothing different from how they did burials back in the day, it was very organic feeling. We were able to be very present with her and had an ability to hang out with her and touch and see her or not as we chose, but the way we handled the whole burial and processing was nicely paced, drawn out, over the course of a day or so. People decided together how to make the box for her, and they found the place to dig the h
ole. It actually takes a long time to dig a hole that big when you’re doing it with a shovel. We decided together which of the things we’d made for her would go in the coffin. We were all working together. The whole funeral was all very organic: you show up and then we figure out what to do. Nothing was preordained. We’d take the time we needed to find some nails, and then we had to figure out how to carry this big box over to the hole we’d dug, and after we had buried her we knew that we now would have some time to hang out and talk about her and be together and have some food together. It felt very genuine instead of something we felt like we should be doing.

  Then, in terms of us having time to integrate the burial and talk about it and have it not be such a bizarre thing, I’m not sure how well we did it in those months after the funeral. Her family had previously made plans to move away to another farm, and I had been scheduled to change schools. So they ended up moving, and when I changed schools I made a cognitive decision to not tell anyone what had just happened to me. When you don’t talk about the biggest thing that is going on in your entire life, you figure out another person to be, and then eventually you become that other person. And on some level I realize now that I took this opportunity to adopt some of the same characteristics that Hilary had, that I definitely did not have. She had a very cheerful, intelligent, outgoing, positive personality, and that was what I took on as my personality. It took me over 10 years to look back on that time and realize that this transformation in me had happened.

  Another thing that was distinct about what we did as a community was we got together around 15 years after her death. Her younger sister was going through a lot of challenges not uncommonly associated with someone who has experienced a great loss. Some of the process that had been so helpful to us 15 years prior was not particularly age-appropriate for her at the time, so she had inadvertently been excluded on some level. Her parents planned a gathering that was essentially a debriefing, which managed to include almost every person who had been present at the scene of the accident. It took a long time to schedule, because people were scattered around the country and around the world, but her parents just made it happen. What we did followed almost to the letter what you’d do in a critical incident stress debriefing, but I didn’t realize that for another 10 years. The first person talked about what actually happened; we went through the specific details chronologically. Everyone shared what they remembered about the facts of the case. That probably took more than an hour. After that, we pieced together the pieces—and really, this was something, because it never occurred to me that everyone else was having their exact experience of dealing with her death as well for all those years. Then we were able to go through how it affected us at the time and have everyone express how that particular experience had influenced them for the rest of their life.

  It was really a unique thing to have two families willing to do this thing together, and these two families were so good at it. It was so helpful to be able to name things. I was able to name how I felt like she continued to live in me. I remember having some sense of guilt about various things that I’d been carrying around all those years, and then everyone was totally accepting of it, and they also had their own things that they felt guilty about. Everyone was so honest that those elements then moved away. It was a great relief to have the blessing of her family in relation to all of our feelings, and to have them be so overjoyed to know that I felt like I was a continuing expression of who she was in many ways. It meant so much to all of us to have everyone’s blessing and to have no judgment about how we handled our recovery. It probably lasted more than four hours, and it was considerably more invigorating than exhausting. We literally had to drag ourselves away. I mean, how do you leave something like that? We had to acknowledge that we had to go back to living our lives, and that’s a hard thing to do.

  After that, I knew that this had to be a part of what I do. I never had any idea that I’d go back to school. I eventually went to school to be a social worker. When I heard that social workers were placed in trauma settings, I remember thinking, “The only thing that has to happen in my life is that I have to be in the ER.” I remember sitting there, and it’s funny to me how incredibly obvious it was that there was nowhere else for me to be. I knew it didn’t matter if I got paid or if they were able to give me any hours to work, I was like,“I have to be there.” It was the only thing that was an option for me. I didn’t realize why until four or five years later, when I was working there full time and I was talking with a student of mine, and I was telling her that I didn’t really know how I’d ended up in trauma. Somehow we started talking about Hilary’s death, and this student helped me connect my previous experiences with this work I was doing in my current program, which I was developing at the time. It had been very much unstated and unobserved. I never connected it. When my student first started making the connections for me, I was like, “Well, this is a bit of a stretch,” but then another 10 years after that, I’m like, “Yeah, right!” and finally the puzzle pieces fell more into place.

  In a way, the whole grieving experience we went through probably felt so natural because people have been doing this since trauma has been happening. There just wasn’t a name for it then. And for Hilary’s family, there was no theory behind what they did, and they felt just as surprised by the process as the rest of us did. I’m not sure they fully understand what a gift that process was to everyone, but they are very excited about and interested in what’s going on at Fairfax Hospital with our trauma and secondary trauma program.

  From a trauma mastery aspect, I certainly think it’s good for me to be doing this work, as well as for the people I’m working with. I don’t need to tell anyone I’m working with that this happened to me. I know for myself that it will always have a 24 hours a day, seven days a week connection for me. It doesn’t feel like work, what I do. It’s not like me to say it’s a calling, but when you have had your own connecting-the-dots experience, it definitely makes the field much more compelling. I have to be a part of it, it is so much fun for me. You know when you’ve been born again, you want everyone else to be born again. When you have the good fortune of something positive coming out of a tragedy, and when you believe it’s possible for others to heal in this way, you want them to have this opportunity. In that way it is a trauma mastery thing for me.

  Regarding how this work takes a toll on me, I feel like it takes no toll on me. I feel like it energizes me. I have figured out a plan for how much time I see direct trauma. I have an à la carte experience so that I don’t put myself at the risk of compassion fatigue. I rotate from being in the ER and seeing horrible things to working with people on the floor who are bouncing back and experiencing their resiliency and then to working with people who months and years post-injury come to us because they are very curious about how they are going to grow from this. They have self-selected to come and figure out how to move away from what is hard and be in a different place in their lives, and you can’t help but be completely inspired by those people.

  My kids would say I’m totally neurotic about head injuries and that I’m overprotective, not effectively overprotective, as they continue to live their lives the way they want to, but I’m just more anxious. I’m very focused on prevention, because I’d say 98 percent of what I see in the ER could have been prevented if someone in the mix had done something different. I can see all the things that my now-teenage boys do as a potential injury. They would say, “She’s over-the-top protective, she’s really crazy.” They don’t follow my desires and they keep climbing trees and they don’t always wear their helmets when they go biking, and it’s just their luck that they haven’t ended up in the ER. I think my husband would say that he thinks I have a really easy job because I portray it as really easy. He would say the way I’ve set it up is a piece of cake, so I’m pretty cheerful and it makes me happy to go. That is the much bigger tragedy to me, that you could live your life thinking that this is a chore and not recognizing that you ha
ve a choice. So many people live their lives that way. I have all my cycles, that’s for sure, but it’s not like I cycle into depression because of my job.

  As far as taking care of myself, I do a lot of self-pampering. I exercise a lot, and one of the reasons I do is because when I’m exercising, I have no brain work going on, and that definitely resets me. Nothing goes through my brain. That is my meditation and my way to get centered. I think that when I am exercising I am more in touch with a sense of “This is me, and that’s them.” Even if I’m not conscious of it, I think that’s largely what I’m doing. Even though I’m not aware of processing my work, I’m sure I’m passively processing somehow. With the kind of exercise that I tend to do, my aerobic capacity is so maxed that my brain just can’t work, and I’m in the zone. If I’m running with someone, then I’m socializing at the same time. I’m at high risk of being somewhat depressed if I’m not exercising at an insane level.

  I also have a fairly overdeveloped sense of denial. I’m able to be pretty separate from my work, and I don’t do a lot of replaying of the traumas I see. Occasionally I think about them a lot, but I don’t overexpose myself. I do know plenty of social workers who are overexposed, and they don’t release that exposure, and they are not very happy people. If I didn’t have this, I’d be locked up or my husband would be. I also have a great place to come home to, and I have a lot of my own time. I cook, I get massages, I do creative projects. I’m very protective of time that is just for me, and it happens to be feasible for me right now as I’m currently in a couple-year phase of having a lot of personal time. My kids are older now and my job is flexible. I have not always been this balanced. I was not quite as cheerful a person when the only time I could consider as my time was 30 minutes a day at the most. Now that I’m not raising my kids as much, I covet my time a lot more, and I work really hard to put those things in my day that I love to do. It’s possible that it took a long time for me to figure this balance out. I wish I could have figured it out earlier, because then my children would have benefited from having a happier mother.