This week I spoke at a Trauma, Healing and Resiliency Conference where a colleague asked a great question–not a new question, but a great question. I’ll paraphrase here to the best of my ability: When we work with people going through difficult circumstances; court proceedings, trauma, recovery from alcohol or drug addictions, and we tend to absorb the heaviness of the day, what can we do so it doesn’t affect us so deeply?
It’s a question with so many answers that I struggled to contain my excitement as more and more pieces of a giant, poorly understood truth flowed out. Before I get to my answers, some context:
I was presenting on adverse childhood experiences (ACEs) and the very basic neurobiology of trauma. The earlier presenters had covered the topics so well and thoroughly, I shifted to the body. I focused on how we can’t discuss the brain without discussing the body, and in my experience, we can’t discuss either without addressing the spirit.
Clinicians and specialists are people, just as our clients are. What works for our clients works for us–but when we get home at the end of a long day, our scripts get put away with our work hat. We don’t always have the energy to apply our “work tapes” to ourselves, and many of us have experienced a variation of the exact same things our clients have experienced.
We must take AIR for ourselves first, that is the only answer, and it comes down to the environments around us, paralleling what we tell our clients. We can overcome adversity when we have the support to 1) Acknowledge the historical, generational, and current-day traumas we have experienced, 2) Interrupt systems (as much as able) that keep us from thriving and drive us into illness and 3) Rewire; mindfully, gently, consistently interrupt our once-useful, but now less than ideal learned responses.
Acknowledge, Interrupt, Rewire.
Stressors and stressor-like stimuli (reminders such as the behavior/expressions of others and sounds, smells and other sensations) start a chain of reactions in our brain and body that loop us through learned, well-practiced responses. Over time we become more stressor-focused in mind and body, tighter in our muscles and tissues and more constricted in our fascia and posture. Perhaps we breathe less, drink less water, and comfort ourselves in ways that don’t help us out in the long run.
On the other hand, everyone is different and these generalizations are not comprehensive. As each plant thrives with its own unique soil composition, light requirements and watering volume, so too does each human.
At the conference, because I was speaking to a Native American community, I started with the limitations of the 1995-1997 study on ACEs, which drives much of our work on psychological trauma prevention today. See more information on ACEs here: https://www.npr.org/sections/health-shots/2015/03/02/387007941/take-the-ace-quiz-and-learn-what-it-does-and-doesnt-mean
And more here (the source of the race demographics in the table below): https://www.cdc.gov/violenceprevention/childabuseandneglect/acestudy/about.html
As you can see from the table below, of the 17,337 people studied, 74.8% were white, and there is no category for Native Americans at all. Essentially, our current interventions are based on a study that gives little to no data for our Native American populations, not to mention the small percentages represented for all others who do not identify as white. (It is also important to note that the individuals studied had access to Kaiser Permanente insurance. Not everyone has access to this sometimes frustrating, but important health advantage.)
We can speculate that the outcomes for any of the populations under-represented here are not going to match what we know from this first ACEs study. And those of us with Public Health experience, especially those focused in Indigenous Health, might speculate that we therefore know very little and are faced with an enormous opportunity.
The Association of American Indian Physicians state, “ACE scores are significantly higher in indigenous American communities than in the broader population.” https://www.aaip.org/programs/aces-toolkit/
And we know that each individual community has its own resilience factors, which do not generalize or match across the board. Opportunity. How does each community differ in the nature of early adverse experiences, the resilience factors, and the measurable outcomes? Many people are busy attacking these questions and finding both more questions AND gems of insight along the way.
Let’s be honest. I have limited insight, at best to answer that question for a Native American community. Being invited to speak to a Native American community is a blessing. It’s also complicated. I asked one of the coordinators if she’d let me know if I said anything idiotic. Her answer was, “Nope.” And we laughed and laughed. I’m still laughing. I replied, OK. I guess everyone has the right to be an idiot sometimes. Stumbling, white and invited, through BIPOC spaces has been a most humbling, beautiful experience.
My best answers to the question at hand:
First, Acknowledge. When we work to support, witness, and assist others in difficult circumstances, we must acknowledge what we are really doing. We are working in proximity to the pain of others; physical, emotional, spiritual, comprehensive. We are holding space for pain. We are supporting others to attend to and manage their own pain. And it is painful.
Then, Interrupt. Interrupt the systems that tell us we can’t take bathroom, water, or breathing breaks. That we have to be machines of services and at the same time, we must bow to the machine that employs us. That we can’t cry, process, or rage against the machine. That we can’t love our clients, families, or community members. Without a supportive workplace, all your self care is lost to the machine.
And Mindfully, gently, consistently, Rewire to break the unhelpful cycles and loops built into our ways of being. Drink the water, appreciate the water. Listen to your body for clues and cues; our posture, pain, tightness are there to help us–how many times have you ignored signals or impulses from your body today? When we ignore, they tend to amplify.
Breathe, stretch and delight in your many senses. Spread your arms wide, palms facing forward, and then raise them overhead. Watch for pain in your shoulders, and back off if you need to. Shake your feet out from time to time.
Lift your shoulders to your ears and allow them to fall back into place, shifted down and back just a little. Take walks; long or short, together or alone. Pick one–ease into it. Some of us are made to resist these acts. I know I am.
Know that sometimes, reconnecting to our bodies activates us into great discomfort and maybe even avoidance. Honor this signal too, and slow the process down. You are in control of your body, but sometimes, historically that hasn’t been the case. It can feel overwhelming to take power and agency over our own selves. Start small and know you can reach out for help. Even if you feel alone, there are free, confidential numbers you can call to find help:
National Suicide Prevention Lifeline: 1-800-273-8255
Crisis Text Line: Text CONNECT to 741741
This page has information and resources about PTSD and trauma: https://www.mentalhelp.net/articles/ptsd-hotline/
It is very important, and I am still learning to empty my backpack before I walk into my home after a day of work. Every day of work. And no, not your actual backpack…your heart and mind.
Empty out your heart, if possible. Take a walk around the block and look at the sky, listen to the birds, touch any leaves or flowers you pass. (You can tell it’s summer as I write this.) Sit on the stairs for a few minutes. Stretch and breathe. If your home doesn’t offer these luxuries, or if it’s not safe to walk or sit outside, it’s time to get creative.
How and where can you move, breathe, and purposefully honor what you went through today? Even for five minutes. What does that look like for you?
Sometimes I’ve biked to and from work. Other times I’ve had a long drive or carpool. For these I’ve been grateful, but I’ve not always understood how to use them and often I’ve compulsively continued to think about work the entire way home, then walked into the house without remembering to unpack my day.
Some of us use public transportation, and it’s not always safe enough to relax on our way to and from our work. And sometimes it is. We can use what we’ve got, and practice each in our own way.
Practice whenever you can. Maybe it’s even something as simple as interrupting the constant work-based thought loops and processing, worrying we’ll forget something. Knowing we’ll forget tasks, and those tasks are connected to people. Vulnerable people. Write it down and put it in a safe place for the next work day.
Again and again, come home to your breathing and notice it–are you holding your breath? Is that ache in your neck and back talking to you? Listen for just a moment. To give attention to your body, your self and your needs is not negotiable.
If it’s not working, or the day was just very difficult, or the heaviness is creeping, reach out and connect. Call a friend, a professional, or a family member you trust; you must. Be specific. Ask for nonjudgmental listening, or advice, or NO advice. Ask for company while you blow off steam. Honor confidentiality. (This is the most important.) If the person you reach out to is not available, reach out to another. Grow your pool of trusted people and establish mutually respectful boundaries around holding space. I am lucky to have a handful of trusted colleagues and friends in my life who exchange support with me.
And sometimes we need time alone. Trust that you’ll know exactly what you need. Sometimes we hermit and go deep inside to empty out, grieve, integrate new understandings, and reorganize ourselves. Remember to come back out!
Did I mention professionals? Sadly, not everyone has access to therapy, and sometimes it is not an option because of cost, cultural or language barriers, confidentiality concerns, or simply goodness of fit. If you have access, consider using it. If you don’t, please remember those free, confidential lifelines. Vicarious trauma is real. Incredibly real. We absorb the trauma when we work in trauma. Lifelines are there for us if and when no one else is.
Consider what you need, not what the noisy world tells you you need. Differentiating between the two is harder than we think it will be. It takes time to get to know oneself, especially when our business is removing ourselves from the equation in order to be objective, well-boundaried, and encouraging to our clients.
I’ll end with this: Today I pruned the trees and hedges in my yard. I pulled weeds and tended to the flowers. I am a machine of service. I will take that baseline into all activities. For me, this means that when I enter into my recreation and relaxation, I will forget I’m not a machine. I will ignore my body’s call for water or rest. It’s what I am used to. I will forget to go to the bathroom and I will hold my breathe. I will delight in the challenge, the focus and diligence (overfocus). I will disregard myself just as much in every single thing I do. It’s real. Maybe that’s where the practice starts, here at home, in real life. And maybe only then can it follow me into my work life. That is what I’m working on these days.