There’s a few common myths about trauma that I come across pretty regularly, and this is one of them. In mental health, the role of trauma is one that is debated all over the place. For example, there’s people who argue that Borderline Personality Disorder is caused by childhood trauma, and those who argue that it is likely a genetic predisposition to an emotionally reactive way of relating to people (among other issues). Personally, I think that it’s entirely possible that there is more than one way to end up developing a mental illness – for example some people with a psychotic disorder have their first episode in the wake of a major life stress, others were just minding their own business and the world turned upside down. What we do know is that some things can be inherited, and the combination of an inherited vulnerability with a high risk environment is exactly the kind of circumstances where people are most at risk of manifesting a mental illness. Nature and nurture both play a role, and traumatic events are one of the things that can make someone more vulnerable to mental illness. While trauma is always at play in a condition like PTSD, it may or may not have a role in causing some other mental illnesses.
Some mental health staff have taken this to mean that learning about trauma and how to work with traumatised people is a specialised field that is useful for only a very few participants. That’s not my perspective. For a start, when we look at the statistics of people who are the most severely impacted by their mental illness, such as inpatient populations, the numbers of those who’ve experienced major trauma are very much higher than the general population. These traumas may not have had a role in causing their mental illness, but they can certainly make it much more difficult to manage one! So trauma sensitivity has a real relevance in mental health.
Another thing is that having a mental illness can be very traumatic in and of itself. One of our great fears is that we are going insane. Madness holds a terror for most of us, and developing a mental illness can feel like we’re going mad. We may have terrible fears about our state of mind, our experiences, trying to keep our job, worrying about how we’ll raise our children. Experiences such as being chronically suicidal can leave us afraid of ourselves, mistrusting our own mind. It’s not like this for everyone, some people become very unwell without realising it, others may be caught up in their experiences (such as delusions or mania) and even enjoy them. But for many of us mental illness involves severe emotional pain and fear.
Various interventions can also be traumatic. Being confined to a hospital, room, or bed, being medicated without any choice, not being allowed to smoke, to drink, to wear your own clothes, be with your family or pets, have internet access or your phone is effectively being kidnapped. I’m not suggesting that the intention is to traumatize people through ‘assertive engagement’. And I’m not saying that some people who are desperately unwell and a danger to themselves don’t appreciate being kept safe for a time. But the loss of control experienced in severe mental illness, and the loss of control that comes with experiences like being shackled to a bed, even when it’s done by kind and caring people, can be traumatizing, and can also replay earlier traumas.
Not everyone’s experiences getting help in the mental health system are good either. Imagine waking up in hospital from a suicide attempt to be told by the nurse that it would have been better if you’d died because they need the bed for people with real illnesses. Imagine being told by your doctor that your condition is incurable and degenerative and you will likely become less and less lucid and be unable to live independently. Imagine being told that you are faking your condition to get attention, that unless you follow through and kill yourself nobody will believe that you are genuine, and even then you would just be proving that you were a hopeless case. The oath to first do no harm is not always upheld, and some people are caused terrible suffering by the people who are supposed to help them.
When you include experiences of stigma or discrimination, attempts at disclosure that go badly, the grief and loss of having relationships break down under the strain, giving up study or losing employment because of the mental illness, the idea that there’s quite a few people with trauma issues of one kind or another really makes a lot of sense to me.
The other aspect to this is that behaving in a way that is appropriate for a traumatized person isn’t inappropriate for an un-traumatized person. Being sensitive to issues of control, proximity, touch, pacing of treatment, confinement, respect, and the need to listen doesn’t go astray for anyone. Being sensitive to the possibility of trauma is being sensitive and engaged, taking your cue from the other person and adapting to what is helping and working for them. There’s nothing inappropriate about that! Even when the condition isn’t a trauma origin one, and you haven’t been told the person has a trauma history I’d be careful in assuming that trauma isn’t relevant. There’s a lot of people for whom it is, and thoughtful sensitive support can make a big difference!