Trauma treatment is a field which has evolved perhaps more radically than any other field of medicine in the last 20 years, but is still harming patients.
Driven by many breakthroughs in neuroscience we have a better understanding of how the brain as a whole works, including the effects of long term trauma and mis-attunement on the brain and nervous system, the discovery of mirror cells, the importance of nervous system and emotional regulation to prevent re-traumatisation during therapy, the significance of the therapeutic alliance, and the astonishing range of survival strategies and structural dissociations which allow humans to survive otherwise impossible ordeals. All this on top of the incredible discovery of neuroplasticity which now offers the potential for a cure to what were previously believed untreatable trauma symptoms.
New knowledge however, takes a long time to spread. For example, some health professionals still prescribe Betadine for wounds, even though we have known since the eighties that it actually irritates skin tissue and impairs healing!
Likewise, I’ve noticed that a good number of health professionals seem almost entirely ignorant of these last two decades of scientific advances in understanding trauma, still working conceptually within the old, “biological” model. The biological model, favoured by drug companies, is where one simply tips in some chemical to “sweeten” a brain that seems a little sour after trauma. Drugs, drugs, drugs. Take some more drugs, please.
This seems to be the default position today. If, after many months of trialling drugs you say don’t want more drugs, and you want to try and learn to manage the emotional distress yourself, you are somehow being a difficult patient! In fact, one of the primary drugs used for trauma patients, Seroquel, was originally marketed as Quietipine- the drug to quieten troublesome patients! So patients are apparently supposed to shut up and take their medicine.
This despite the fact that international expert bodies such as ISSTD do not recommend drugs as first line treatment for complex trauma and dissociation.
“By the way, we are going to treat you like a wilful, wayward child, not like an adult who suffers from long term serious symptoms of trauma. “Putting in boundaries” becomes an excuse to adopt a punishing stance which blames you for your trauma symptoms.” Many studies now show that the very places that people go to for help often retraumatise them or leave them feeling belittled and ashamed.
I suspect that for evidence-based practice to be possible, there has to be an open mind, space for new learning. In a way, we have to be innocent and adopt what the Buddhists call “beginners mind”. When any health professional holds the position of being “expert”, it is so much harder to learn, let alone take in the huge amount of new scientific knowledge that allows us to treat trauma safely and effectively.
As the ASCA guidelines for trauma sensitive service delivery (2012) explain, it is clear that many times, the patient, who goes to hospital or other health services for help, is actually further traumatised and re-traumatised by the very system that should be helping. I believe that unless health professionals inform themselves and adopt more evidence based practice, this will never change.
Since I wrote this blog in 2014, ASCA, now called the Blue Knot Foundation, has published another comprehensive update on best practice in the treatment of complex trauma, in 2019 (Kezelman & Stavropolous ). In June 2020 as I review this blog, I believe that today even more than before it is an ethical imperative for all health professionals to be trauma informed, especially with the world in the crisis state it is now in.