International Trauma Conference in Melbourne, 2016

I haven’t had time to attend the whole thing, but it is amazing to see over 2000 delegates here in Melbourne for the conference this week. As usual Pat Ogden, Stephen Porges, and Allan Schore are here, and inspiring.  This year I have enjoyed Martin Teicher, Dan Siegal and others. Martin shares some wonderful scientific research results on the aftermath of trauma, you can find it on Google, WordPress, by adding his name.

Trauma is still the “elephant in the room” in terms of public health policy, and is still missing from public discussions except in a very limited way. The survivor is still all too often blamed (via the rigid DSM criteria which is not evidence based, if not the Catholic church, the defence forces, etc), for their symptoms. Actually, I believe survivors are incredibly brave, tenacious and valiant to have survived, especially when we review the outcomes from the ACES study in the USA.

This study as reported by Martin shows the significant long term effects of adverse childhood experiences. Basically the higher the number of adverse experiences, the more likely the person is to have not just emotional and cognitive consequences, but also physical consequences including changes right down to the genetic level, heart attacks, addictions etc.

So this week I really feel inspired to acknowledge and thank all the scientists, clinicians and others who have travelled from US, UK and Europe to be here for the Conference. A special nod to Sue Carter re the importance of oxytocin in love and bonding. And to Dan Hughes for bringing such warmth and humour to this difficult topic.

Their long labours  research and experience in working with trauma now give us a legitimate voice to begin a more sophisticated and compassionate public discussion about how we view and treat trauma survivors. The Royal Commission into Institutional Abuse misses the great majority of abuse which occurs at the hands of family.

The science also enables us to confidently say that trauma can be healed. And finally, perhaps, we can now stop judging and blaming victims, and work together to ensure they are honoured and supported throughout the healing process.



How the Health System Harms Trauma Patients

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.