Trauma and recovery: making the links
15th April 2014
This article was prompted by a personal narrative shared with SRN by long-term recovery activist Fiona Macdonald. In it we seek to acknowledge the centrality of trauma awareness to the development of recovery approaches and ask whether it has been unhelpfully downplayed for too long, both in the recovery movement and wider mental health discourse. Fiona’s narrative describes her experience of childhood sexual abuse, which is one of many forms of trauma strongly associated with mental distress.
The first thing we wish to do is say a heartfelt thank you to Fiona for this beautifully written and moving description of her journey from trauma through to recovery. The strength and determination required to persevere, overcome the personal costs and produce this valuable text is difficult for most of us to imagine. It is important to remember that without those who are prepared to speak out the story of trauma remains untold and denied.
Initially we considered following this piece with a list of helpful trauma resources such as ‘Yes You Can’ and many more of the genuinely helpful guides and ‘toolkits’ that are available at the click of a mouse. And yet… having been aware of the key role of trauma in mental health problems over many years the most striking thought was not that we need to publish more resources, but rather address the question of why, given the prevalence of trauma among people recovering from mental health problems, does the issue remain largely marginalised?
Trauma and mental health problems
“Childhood trauma and abuse is the smoking of psychiatry. As a risk factor for mental illness it is comparable to how smoking a pack of cigarettes per day increases the risk of lung cancer and heart disease.” S. Hatcher, Professor of Psychiatry, University of Ottowa
Scientific studies confirm irrefutably the strong association between adverse childhood experiences (ACEs) and subsequent long-term psychological distress and physical illnesses. The ACE study of 17,000 people “reveals staggering proof of the health, social and economic risks that result from childhood trauma.”
SRN are committed to supporting recovery from mental health problems. Given that mental health problems are strongly correlated with past trauma there is an irrefutable logic that demands that recovery focused practice makes the links with trauma informed practice to ensure the best possible outcomes are available.
Recovery focused and trauma focused
Research tells us that the essential elements of recovery are Connectedness, Hope, Identity, Meaning and Empowerment (‘CHIME’). Relationships founded on being non-judgmental, active listening, empathy and acceptance also contribute to recovery. Meanwhile, best practice in trauma also embraces these elements, and in addition places greater emphasis on safety, including physical, psychological, emotional, safety and security. The establishment of safety is the foundation on which recovery from trauma is built. Therefore safety should be central to mental health recovery too and is worthy of greater attention. The experience of trauma tends to deliver to people the precise opposite of these recovery ingredients, leading as it does to a sense of disconnectedness and isolation, loss of hope and optimism, a shattered identity, and the sense of your own meaning and purpose being subverted by distress, shame and pain. Disempowerment is central to the kind of childhood sexual abuse that Fiona describes; and all such abuses are in fact abuses of power, which necessitates the total disempowerment of the victim.
Re-traumatising rather than supporting recovery
A kind of re-traumatising, toxic, ‘anti CHIME’ is often replicated in those services and ‘helping’ relationships that willfully refuse to witness the trauma and acknowledge its central role in the individual’s distress and anguish. The question asked still tends to be ‘what’s wrong with this person?’ rather than ‘what happened to her?’ Perhaps a fair criticism of the recovery approach and its interest in hope and progression is that it has failed to adequately recognize and work through past experiences, making recovery less likely. Bearing witness to trauma forces us to confront vulnerability, cruelty, horror and all that is unspeakable. How much easier then to bypass all that pain and deal instead with issues of symptomology and diagnosis and how best to manage these so-called ‘non-compliant’ and ‘treatment resistant’ individuals?
Recovery focused and trauma focused: the common factors
There are many areas where the values and approaches of recovery focused and trauma focused practice mesh and complement each other. Some of these include:
- Establishing safety
- Strengths based practice
- Valuing the person’s experience
- Avoidance of pathologising and labelling
- Recognising and tackling power imbalances
- Intentionally building hope and optimism
- Building on trust and mutual respect
Both also tend towards reframing ‘symptoms’ as adaptations to life events, and as solvable emotional problems. There is also a recognition of the real limitations to what practitioners can offer, as yet there is no magic solution to human distress therefore humility on the part of professionals helps ‘keep it real’ and avoid any pretence that if only people were less ‘treatment resistant’ they would make a rapid recovery.
Honouring the story
In a world that privileges and pays great respect to academic language, randomised control trials and quantitative data, the single honest story as told by a survivor can be ignored and discounted. Yet these are the very stories which need to heard and honoured. Society must acknowledge the pain and torture that has given rise to so much distress and the associated strategies that survivors use to cope. The cutting, the intoxication, the numbing, the dissociation, and a myriad of other behaviours designed for survival but often judged as deviant and anti-social. At SRN we will be doing our best to give prominence to the narrative and the wisdom therein.