Trauma Stewardship

by Laura van Dernoot Lipsky

  When I first started doing crisis intervention work, I used to be so excited to answer the crisis line when it would ring. Then it got to where I’d just watch the phone ring and I’d feel dread and I’d no longer pick it up on the first ring.

  AmeriCorps program coordinator

  Dissociative Moments

  I can see the people trying to get across that bridge just like I can see you right in front of me. I close my eyes and I can see the people who died.

  R. Omar Casimire, educator, artist, poet, and post-Katrina reconstruction volunteer

  At Harborview Medical Center as an ER social worker, I worked with a family that had experienced such a tragedy that I could not speak about it at home for days. I could not get any distance from the story, the images, the smell, and the sounds. When I finally began talking about it with my partner, he listened attentively and took in the details. We had been driving and now we had stopped to go into a store. As I continued the terrible story, I slowly realized that for the past few minutes he had been backing into a parking spot and then putting the car into first gear and moving forward. Backing in, putting the car in first, moving forward, again and again. I stopped my story and said,“Sweetie, what are you doing?” He looked at me, surprised. “Nothing, I’m just parking the car.” This is someone who has heard his share of trauma and is extremely skilled at debriefing, but for some reason, in that instance, he became dissociated and wasn’t even aware of parking and reparking the car.

  A dissociative moment can happen when a person experiences intrusive or overwhelming feelings. It is the experience of being engaged in your work and, for whatever reason, having something suddenly unhinge within you. You realize that you have not heard the last five sentences of what someone just said, or maybe you failed to track the behavior in front of you; you’re not following the story at all. Instead you’re remembering the last injured animal you couldn’t save or the day your brother became incarcerated or the time when your child was very ill. These are common occurrences. They are problematic only when we try to be stoic and plow through by pretending our reactions aren’t happening.

  We may externalize our feelings, imagining it’s the client’s fault that we feel so bad, or we may internalize a sense of worthlessness because we’re having them. If we’re so jacked up by what we’re hearing, how can we possibly help others?

  It is important to remember that any organism exposed to trauma will try to protect itself as a matter of course. In dissociative moments, we cut ourselves off from our internal experience in order to guard against sensations and emotions that could be overwhelming to our system. The Newsweek article discussed in the introduction contains an example of this phenomenon: “Like many others who work with the VA system, Bob Schwegel is a veteran himself. He helps Iraq vets apply for benefits, but it’s tougher and tougher for him to continue as he listens to their stories. ‘I get flashbacks of Vietnam. Sometimes I have to just get up and walk away.’”

  Anyone with a personal history at all related to the work they do is likely to have experienced such dissociative moments. Many workers without a personal connection also report having such experiences, often for reasons they cannot explain. No matter who you are, these moments can be expected when you are exposed to others’ suffering. It is important to notice them, avoid isolation, and seek out the support you need.

  Sense of Persecution

  What if you can’t do anything different? I’m in my fourth year of residency. What if leaving isn’t an option?

  Family medicine resident

  For our purposes, feeling persecuted speaks to feeling a profound lack of efficacy in one’s life. We become convinced that others are responsible for our well-being and that we lack the personal agency to transform our circumstances. This notion has less to do with our physical surroundings than with our internal state. We may believe that we deserve better pay, safer work environments, more respect, adequate time away from work, and greater resources, and all this may be true. We can begin to seek change and reform in ways that are earnest, ethical, and fully committed. Alternatively, we can succumb to a belief that we have no capacity to influence any outcome. If so, we consent to suffer and relinquish power over our personal experience to outside forces. For many, this belief system may be inherited. As one social services director said, “Look, I come from a martyr heritage. Both my wife and I; I mean, martyrdom is what our families are all about.”

  Mistreatment can become a self-fulfilling prophecy. We may seek it out, focus on it, and then chalk it up as further evidence of how wronged we are. It can get to a point where our sole motive in identifying persecution is to locate more proof that we are being exploited. And of course, we do live in a world that is rife with oppression and mistreatment of living beings and our planet. We never have to look far for examples. When we talk about a sense of persecution, we are talking about a state in which individuals, and eventually organizations, begin to thrive on choosing to remain powerless in the face of adversity. James Mooney, a medicine man of the Seminole Nation, is fond of the saying,“The person who wins the battle is the one who doesn’t show up.” He isn’t advocating that you should not show up for your life, but rather that you should be present in a way that refuses to engage antagonistic, reactive energy.

  “It’s always ‘Sit,’ ‘Stay,’ ‘Heel’—never ‘Think,’ ‘Innovate,’ ‘Be yourself.’”

  There is often a clear path around our obstacles if we allow ourselves to back up, untangle ourselves from the brambles, and find another way.

  This other way is illustrated by individuals and communities that have endured torment and brutality but remained in touch with their own inner strength. They have chosen to be powerful even in the face of persecution. A Holocaust survivor was asked to describe the horrors of being deprived of free will in the concentration camps. He said,“I had a great deal of freedom. I could decide if I looked up or down, if I looked to the right or to the left, if I put my right foot forward first or my left foot forward first.”

  It is not that having a sense of self-efficacy makes us immune to trauma exposure response, but it can give us many more options in terms of how we approach our life and make meaning of our experiences. Without a robust sense of being fundamentally in charge of oneself, a mindset of persecution can take root and we can lose faith in our own power to take the initiative. A community ecologist who worked in the Côte d’Ivoire after the civil war reflected, “The more common sequelae I see among my professional colleagues is an incredible inertia, something I would presume is akin to learned helplessness. So many loved ones, so many years, so many opportunities have vanished (for schooling, business, hopes for their children). Even with friends, in ‘good times,’ with resources flowing again, salaries, and normalcy, they seem unable to cope, to be proactive, to look forward.”

  I was struck by the discipline required to maintain a sense of personal agency during one of my graveyard shifts at Harborview Medical Center. It was three in the morning, and I was doing a psychiatric evaluation on someone who was in four-point restraints because he was having a psychotic break. He was calling me a bitch and trying to spit on me. The interview was taking longer than I felt it should. I wanted to get to my next patient, a sexual assault survivor. I began to feel persecuted and helpless, as if this man in restraints had all the control.

  While I knew I had compelling reasons to feel overwhelmed, a disturbing feeling came over me: I was struck by how tenuous my sense of self-efficacy was. How quickly I could forget how deeply miserable anyone is who has to show up at the ER; how quickly I could lose sight of the fact that each person deserved my respect and empathy. It’s important to remember that no one specifically needs to be doing the persecuting for us to feel persecuted. Out of the blue, forces may come to bear on us in a way that makes us feel powerless and done wrong.

  When I meet with organizations, this often surfaces in the language the employees adopt to describe their circumstances. They may be pu
blic health workers using graphic war analogies to describe their feelings about reorganizations of their agencies or domestic violence advocates using battering analogies to describe their feelings about the treatment they receive from the board of directors. If we listen to our own comments, we can gain excellent insight into our state of mind with regard to self-efficacy and persecution.

  Guilt

  I went shopping last week for a pair of shoes, and I thought to myself, “What kind of person would go shopping for a pair of shoes right now?”

  Community activist, New Orleans, nine months after Hurricane Katrina

  Personal feelings of guilt are impossible to separate from larger forces like sociopolitical context, life experiences, and philosophical/spiritual beliefs. When we try to get a handle on guilt, we have to grapple with questions like these: How do we live in a world where there is such a disparity of resources? What can we do to neutralize imbalances? How do we participate in our own privileges in a responsible manner? And finally, how can I cope with this, enjoy my life, and not be immobilized by guilt?

  “I just found an Eastern philosophy that’s very accepting of S.U.V.s.”

  There are a couple of things to note about guilt as it relates to trauma stewardship. One effect of guilt is that it can undermine the possibility for authentic connection between people. I was told by a chef who remained in New Orleans after the storm that every time residents encountered each other, they would ask, “How’d you do? How’d you make out?” This was painful for him, he said. If they made out okay, he felt sorry for his own misfortunes rather than happy for them, and then he felt guilty for thinking that way. If the other person had lost more than he had, he’d feel sick with guilt about his relative good fortune. This comparison of suffering is counterproductive, because while it’s an effort to connect in a loving and kind way, it often leaves the participants overwhelmed with guilt.

  We can see a parallel process with a trauma exposure response when workers get caught up in their discomfort about the disparity between their lives and the lives of those they serve. In a distorted attempt to shield people from our privilege, or to minimize our privilege, we can begin to purposefully diminish our radiance and wellness, hoping to equalize the situation in the short term.

  Diane Tatum, a longtime advocate for survivors of domestic violence, described returning on a Monday to the domestic violence shelter where she worked and being asked by one of the residents, “How was your weekend?”“It was fine,” she answered, unenthusiastically. Which wasn’t exactly how she felt, because she usually had great weekends and she had a great life, which, of course, was in part what allowed her to do the work she did. But she downplayed her happiness because she felt guilty that her life was going well, and she didn’t want to flaunt it in front of people who were having a difficult time. Instead of giving an authentic answer, she hedged her bets and assuaged her guilt. In that moment, she distanced herself from the women at the shelter by not being genuine. Over time, we can internalize the flat “Fine” response and start to experience our life with less abundance and joy than we truly feel.

  Back in the day in the domestic violence shelters where I worked, the survivors would remark that perhaps we, the advocates, should take time to do our nails or hair, as they did. It was a great statement that these women who had been through so much were still alive to the feelings of dignity and pleasure they could get from attending to themselves. Meanwhile, we as advocates were purposefully diminishing ourselves in an unsuccessful effort to connect with them more. Obviously we never want to flaunt the privilege in our lives:“Me and my husband who I’m legally married to and our big house? We had a great weekend!” It’s just about being honest, not pretentious, not patronizing. It’s about giving others the same honesty we’d expect if we were on the receiving end of services. It’s about being real.

  I feel guilty because I can leave at the end of the day.

  Housing rights advocate

  Guilt also interrupts our ability to take in and be present for the life-sustaining energy in our lives. Thich Nhat Hanh gives a talk in which he asks if we should have to work to appreciate the beauty in life. He replies that no, we should not ever have to work to take in what is beautiful, what is precious, what is sacred; we should simply be open to absorbing life’s blessings as often as they present themselves. Because, as he says,“Suffering is not enough.”Thich Nhat Hanh joins other masters who encourage us to be completely present for all things wonderful; if we are going to be present for life’s suffering, we will need all the nourishment and rejuvenation that comes from life’s beauty.

  Guilt is one of the strongest signs of a trauma exposure response. It can block any experience of pleasure, peace, or happiness. Some workers find it difficult to enjoy a vacation (if they ever take one) because they feel guilty that they’ve left work behind while the habitats they’re struggling to restore continue to be threatened. Others feel guilty about delighting in their children when they work with folks who, for whatever reason, aren’t able to be with their children. Still others feel guilty living in a functioning community when they counsel clients who have lost their homelands to war. Workers have told me they won’t explain that they’re late to a meeting because their car broke down; they feel guilty for having a car. Others will take off their wedding bands out of guilt for being in a relationship. Guilt is effective, then, in interrupting both our ability to be in the present moment and our ability to absorb all that is well in our lives.

  One housing rights activist and shelter worker described the joy that can come from overcoming guilt and being authentic with our clients. He explained, “I like to cook, and one night I’d brought in some food I’d cooked. I felt guilty, though, so I was off in the corner eating and really trying to hide it. One of the residents came up to me and said,‘What do you got there?’‘It’s nothing,’ I said.‘No, really, that smells good. Did you cook that?’‘Yes,’ I finally said.‘You know, I cook, too. I love to cook!’ the resident said. Well, what happened then was I set up a way for us to cook together, and now we do that all the time. Not only that, but other men have come together, and there are cooking groups in the shelter. And you know, that’s been really cool. That was never happening before.”

  Fear

  Fear is the cheapest room in the house.

  I’d like to see you in better living conditions.

  Hafiz, Persian mystic and poet

  Fear can manifest in a number of ways: fear of intense feelings, of personal vulnerability, or of potential victimization. Fear is a natural and healthy response to much of what we witness. If we lived in a society where all people were supported in the full spectrum of their feelings, if there were no right or wrong feelings for a given situation, and if, when one felt fearful, one could simply share that with others, receive support, and move through it, fear would have a different impact. Instead, what often happens is that we live with a great deal of fear as a result of our exposure or hardship, yet we may not know how to process it, and thus it occupies space inside us.

  “I liked recess a lot better before the safety helmets.”

  Fear can squelch our ability to think creatively and well. As they said in the science-fiction film Dune, “Fear is the mind killer.” Any number of damaging individual and societal trends have fear at their root. In the 1999 science-fantasy film Star Wars: Episode I—The Phantom Menace, Yoda describes the evolution of fear. He explains, “Fear is the path to the Dark Side. Fear leads to anger. Anger leads to hate. Hate leads to suffering.”

  Too many people want us to worry about too many things. I have a limited capacity for panic. It is not to be wasted on the trivial.

  John Petersen, Danish actor

  Years ago, I was able to do some work with animal control workers, who were the most honest group I’ve heard from about this. With eloquence, they described how easily fear could harden into prejudices about certain breeds of animals, then morph into stereotypes about certain people, and
finally leap into generalizations about races, socioeconomic groups, and neighborhoods. Whether the call involved neglected puppies or attacking dogs, they had to get on top of their fear. It is important to identify our fear and make the connections about what is fueling it.

  One of the reasons it is hard for us to connect with our fear is that it makes us feel so vulnerable. It may make us uncomfortable to recognize that we have so much in common with our clients, who are also often fearful. If we are working to stop pandemics or racing against the clock to save the environment, we may worry that if we open the door to fear, it will completely overwhelm us, leaving us so swamped with terror that we can no longer act at all. In short, many of us opt to disconnect from our feelings of fear because it hits a nerve of our own fragility in life. Such denial may feel like the only viable path, but it is worth holding up to question. As we have noted, the physical price we pay for distancing ourselves from this natural response may be very costly.

  When we acknowledge our own fear, we have an opportunity to deepen our compassion, not only for ourselves but also for every being that has ever been afraid. If we look deeply, many of us will discover that the fear that underlies all other fears is the fear of our own death. It is worth asking how we want to live knowing that we will die. The answer is generally not that we would quit. Rather, it is that we would embrace the preciousness of life. We would choose to be loving and compassionate, and to deepen our caring for others and the planet even in the face of our inevitable end.