Book Review-Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others

It’s an honor and gift to be trusted by people in their most challenging moments.  The moments when they’re in the greatest distress and vulnerability are a sacred space.  They’re a space where we have the opportunity to be the best of what it is to be human.  It’s also a burden to bear.  In Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others, we learn how to accept the honor of supporting others without becoming overwhelmed ourselves.

The Privilege

Bronnie Ware cataloged The Top Five Regrets of the Dying and expressed her reverence at being able to be with people at these times.  Viktor Frankl expressed a similar sentiment about his time in the concentration camps through Man’s Search for Meaning.  Kubler-Ross, too, expressed her sense of privilege in her experiences in On Death and Dying.

I start here, because it’s easy, under the weight of supporting others’ emotions, to feel the burden more than the honor.  It’s easy to become worn down by continuous trauma dumping and difficult situations.  If we want to take care of ourselves, we must first recognize that it’s our decision to be a part of these situations – and that we both have the opportunity to say no as well as the benefit of being able to share these intimate moments.

Keeping the Chaos on the Outside

The real problem for the care worker – in whatever form – is that the chaos and insanity of the world they’re serving begins to creep into their thinking and shifts their perceptions in unhealthy ways.  Whether it’s the constant question about how people might use a place or tool to attempt suicide or it’s the belief that every parent does bad things to their children, the biased external reality becomes the cynical and negative view from which care workers see things.

Our family has a disproportionate degree of caregivers, with nurses, a physical therapist, and a paramedic firefighter.  The stories that we trade around the dinner table – without violating HIPAA – are about some of the worst things that happen in life.  We can be present for one another and listen to these stories, but not everyone could – or should.  We create this space to minimize the chance that one of us will feel as if the chaos that we see in the world is all there is in the world.

We need to recognize that for every moment that we see the depravity, there is an equal moment of awe at the love that we can see in our fellow man.

Enough

In I Thought It Was Just Me (But It Isn’t): Making the Journey from “What Will People Think?” to “I Am Enough”, Brené Brown tackles the tough issue of the doubt that causes us to wonder if we’re enough.  Care workers often are faced with overwhelming demand.  You may have helped the last person, and you may help the current person, but how long is the queue of people outside your door who’ve not yet come in?  How can you feel like you’ve accomplished something, if despite your best efforts, the problem remains – or gets worse?

Recognizing our own limitations, what we can and cannot do, and accepting that, in our world, there will continue to be suffering despite everyone’s best efforts isn’t easy.  We sometimes fall into the habit of thinking that the gap between the problem and the resolution is us – and that we must fill that gap.  There are several truths here.  First, we may never have been designed or able to fill that gap.  While we’re judging ourselves for not being able to span that chasm, it may never have been appropriate to consider it that way.  Just as we can’t take a car to the Moon, we shouldn’t assume that we should be able to fill every gap – but we do.

Second, we feel shame because we’re bad.  If we were better – or what we should be – we’d fill the gap and those we’re caring for would be better.  This is, of course, not logically correct if we know that the problem may not have been solvable by a single person, but that may be insufficient to stop those who help from believing they’re not enough.

We’ve become a world of human doings instead of human beings.  We’ve lost the ability to balance acceptance with where we are with the drive to make ourselves and others better.

Control and Faith

A wise person in a twelve-step group commented on step 3, turning over our will and our lives to a higher power.  They said, “I’m an expert on turning over control.  I do it, and then when I take back control, I have to do it again.  I’ve done it thousands of times.”  The difficulty, they seem to be saying, is in releasing control over time.  Our belief that we’re in control of our lives may be an illusion, but it’s an illusion that people like.  The idea that you’ll completely trust another person or being to look out for you isn’t easy.

As we dance through the path of maintaining our balance while caring for others who are struggling, we must constantly wrestle with our desire to control our own destiny and accepting the world as it is – in having faith that things will work out okay.  We never know they’ll work out the way we want or not.  However, there’s a peace in knowing things will be okay.

Blame

In our attempt to believe in a world of causalities, where one thing causes another, we often find ourselves looking for people to blame.  If there’s a fatal car accident, who was the cause?  Was it the driver behind the wheel?  Perhaps the auto dealer or auto manufacturer did something wrong in the repair, maintenance, assembly, or design processes that we can point to.  Maybe it was the company that built the road or who is repairing the road.  Another possibility might be the company that made the signage.  These attempts to find the cause are endless and often pointless.  Unless the factor that led to the death can be reduced or eliminated, finding fault serves no purpose.

But we want to know.  Even if we can’t or won’t do anything about it.  We want to know, so we feel as if we have the power.

Sometimes, we must look past the “enough” and the “blame” to find a place where we accept.  That acceptance, coupled with recognition of how the trauma is changing us, may be what it means to practice Trauma Stewardship.

Book Review-Transformed by Trauma: Stories of Posttraumatic Growth

Most people know about post-traumatic stress disorder (PTSD).  They’ve read an article or blog post or heard a podcast about how people are struggling to cope after a traumatic event.  However, there’s another story to be told.  Transformed by Trauma: Stories of Posttraumatic Growth tells those stories.  It explains how trauma can harm us and how we can also grow from it – sometimes both at the same time.

Primer on Post Traumatic Stress Disorder (PTSD)

While everyone may know about PTSD, that doesn’t mean that everyone understands how it works and what to do about it.  James Pennebaker in Opening Up explains that PTSD may be the inability to process a traumatic event.  In other words, it’s not what happened, it’s how we’re able to process – or not process – what happened.  Normally, as we sleep, we reprocess the day’s events, filing them away for future use.

Robert Sapolsky in Why Zebras Don’t Get Ulcers explains how sleep, and particularly the ability to get into the rapid eye movement (REM) stage of sleep, is critical to integrating our experiences into a coherent story for storage into long-term memory.  Any disruption of this process prevents the memories from being properly stored and can either make them relatively permanently inaccessible or require processing again.  Those items that are the most emotionally charged are likely to need to be processed again until the processing can complete successfully.

In traumatic events, it’s possible that the integration work of the event itself can trigger the failure to complete REM sleep.  The event may be sufficiently emotionally activating that an individual is awoken by the physiological response to the integration process.  This disrupts the process and requires that it happen again – and again.  Many PTSD suffers find that flashbacks of situations occur both while awake and while dreaming.  These flashbacks may indicate that the traumatic experience was never fully processed.  To alleviate the challenges associated with PTSD, it may be that the key is to find ways to make it possible to process the traumatic event.  (See The Body Keeps the Score for more about techniques for processing.)

Richard Lazarus in Emotion and Adaptation explains that what happens in our world is less about what it is objectively and more about how we appraise what happened.  This perspective makes it possible for PTSD suffers to change the perspective on a trauma to the point where it doesn’t emotionally activate so strongly that the event can’t be processed effectively.  The short version is that by changing the meaning – the appraisal – it’s possible to substantially reduce the emotional and therefore physiological activation associated with an event.

Consider a veteran who inadvertently kills a child during a combat situation.  The fact is not itself emotionally charged.  What’s emotionally charged is the feelings that it was wrong and that it should (and could) have been prevented – or the identification of the child as someone related to the veteran for whom the veteran would grieve.

In the first condition, because it is assessed to be preventable, the conclusion is that the person is to blame and therefore not a good person.  This sets up an inner conflict with the ego, and this conflict creates activation.  (See Change or Die and How We Know What Isn’t So for more on our ego.)

In the second condition, the identification of the child as someone for whom the veteran would feel loss, activates the grief associated with that loss.  The key is, of course, to decouple the identification, but this is substantially easier said than done.

In either condition, finding ways to stabilize the individual’s sense of self and general sense of calm can make it possible to process the events over time.  In fact, the process of developing the skills necessary to cope with PTSD may be the kernel for the development of posttraumatic growth.

Finding Posttraumatic Growth (PTG)

Posttraumatic growth (PTG) isn’t the opposite of PTSD; in fact, you can have trouble integrating an event into your world and at the same time experience the characteristic reorganization of values that accompanies PTG.  PTG is, at its heart, a renewed or changed sense of meaning and purpose.  People find that the traumas they’ve survived have caused them to experience the world differently and value things differently.

There are five areas for growth because of this new view of the world:

• Personal Strength
• Relationships with Others
• New Possibilities
• Appreciation for Life
• Spiritual and Existential Change

Sometimes, the trauma that you experience virtually forces you to see things differently.  Sometimes the one change brings a ripple effect of others that must be seen differently to come into alignment with reality.

For instance, the death of a son or daughter forces parents to recognize that they cannot always protect their children.  There’s a choice to be made in these cases: one choice is to find ways to accept the new reality and move towards creating situations of greater support and safety for them.  Conversely, it’s possible to become consumed by the specific situation that caused the death.  It can be that you see the world differently and at the same time can’t fully process the event.

In many more cases, the perspective change from the trauma is more subtle and less “required.”  It’s in these cases when the capacity to grow is most important.  Antifragile explains that growth comes from repeated strains that are of the right kind, at the right time, and to the right degree.  The greater degree to which you’re conditioned to reevaluate your perspective of the world and your values, the more readily you’ll adopt the sub-required perspective shifts that can be learned from trauma.

Victimhood

It’s one thing to have been a victim and another to feel like a victim.  It’s the difference between what has happened and how we view ourselves and the world.  One is a history lesson, and the other is a future prediction.  One of the keys to gaining PTG is to release the feelings of being a victim and find a way to accept the previous reality while also accepting that it’s not necessarily a reality for the future.  It’s not easy to decide to move out of “victimhood.”  It’s an easy place to get into but difficult to gain the courage to leave – but leaving it is important.

Leaving victimhood behind is a lot about changing your perception of yourself and your capabilities.  You can’t change the past, but you don’t have to stay there either.  Though it’s not simple or easy, it’s possible to redefine situations as growth experiences, and that opens the possibility to develop a new strength.

Distress

Experiencing PTG or coming to the other side of a traumatic event is no guarantee that there won’t be further traumatic events.  However, the goal isn’t to eliminate the traumatic events in the world that you cannot control.  The goal is to develop a set of coping strategies that prevent you from remaining in acute distress.  Whether these strategies involve asking others for help or tapping newly developed skills, the objective is to confront distress and find a way to become Transformed by Trauma – in a positive way.