Trauma Informed Care

What is Trauma informed care? This is something I hear quite a bit about, but until recently really didn't have a handle on what it is. Trauma informed care is about having an understanding of how trauma impacts the life of an individual who is seeking services whether they be in the mental health sector or not. Traditional approaches for delivering services may actually exasperate survivors vulnerabilities and or triggers, effectively retraumatising the survivor.

From the ASCA website:

At the core of this agenda is the need for awareness and responsiveness to trauma across service systems. Adult survivors of child abuse carry a number of diagnoses and present to an array of services. Yet their trauma is often not asked about, identified or addressed. Adult survivors often experience complex trauma - trauma which is interpersonal, often extreme and repeated, and perpetrated during a child's developmental years. Complex trauma needs to be differentiated from single incident trauma or a one-off event. It is crucial for all service systems and practitioners to be educated around trauma in general and complex trauma in particular and for systems to be alert to the sensitivities, vulnerabilities and coping strategies survivors carry.

Also in line with this is the understanding that many trauma survivors, are not ill. We do not have a sickness, we are merely displaying the affects of trauma. We don't necessarily need a pill to treat us, but we do need understanding and education.
As you have heard me say previously, DID is not an illness. It is not like Schizophrenia, or bipolar, it is not a medical condition where part of the body is not working correctly. DID is the normal response, in a normal person, to very abnormal situation (trauma). In fact if we were not normal we would not have developed DID to cope with what we were going through.
There are of course secondary conditions that often accompany DID. The most common is Post Traumatic Stress Disorder. (PTSD) Approximately 80% of survivors with DID also have PTSD. Again this is a stress and trauma condition and not an illness. Depression and Anxiety are also very common amongst trauma survivors. These conditions can at times require medication to assist the survivor in day to day living, but good therapy and education on copping techniques can make a dramatic difference.
 Then there are many physical conditions that can develop due to the extra stresses on the body, i.e. high blood pressure, fibromyalga, chronic fatigue, diabetes etc. When the human body lives in a constant state of allertness or being 'on edge', it releases our fight or flight chemicals by the brain. These are great for short bursts, but the body is not designed to have them there all the time. This puts the body through immense stress and over time it takes its toll.  Many survivors use drugs or alcohol to numb this feeling, but that too is only stressing an already overworked nervous system.
In dealing with all these things it is vital that the survivors needs, as a whole, be taken into account. Denying the trauma in treatment of any of these conditions can be very dangerous, and retraumatising. We as survivors need to do our best to communicate our needs and concerns to all of our health care professionals, and in return their knowledge and understanding should be there to support and help us.
First do no harm.

ASCA Workshop

Yesterday I went to a workshop run by ASCA (Adults Surviving Child Abuse) on "Creating new Possibilities." It went for 3 hours and was near the city. I was of course very nervous, as I didn't know anyone else there, but it all payed off in the end. (for more information about ASCA please go to my PAGES section to the right and click on their name and it will take you to their very helpful website.)
The workshop yesterday had 2 facilitators and a guest speaker from Sydney, Zan, who is a Psychoanalyst. Zan was very informed and had done these for quite a while.
She covered -
Coping techniques, and if they are still working for you.
Childhood responses to threat
Dissociation
Splitting
Denial
Please or Appease
impacts of abuse
Reducing the intensity of troubling emotions
Dividing overwhelming feelings into manageable parts
Self Harm
Rejecting power, intimacy and trust
Self care
Abuse and the nervous system
Calming techniques
Getting support.
just to name a few....
The workshop was open to anyone who had experienced any type of abuse or witnessed domestic abuse. We had 6/7 participants there.

One of the things that fascinated me the most was to explanation of how the brain functions during abuse and how it affects its ability to deal with situations in the future. We can of course change the brain as we get older but it does take effort. Zan described it as a well worn path through an area of grass. We know exactly where we need to go and it is easy to follow. When we start to use other coping techniques for dealing with our trauma, we are basically trying to make a new path through the grass. If we don't use it often the path is harder to see where it was, and the brain, which naturally like patterns and 'habits', will head back to the old ways. It does take time but with persistence we can get there.

Another thing that stood out was the 'Healing needs to happen between people'. Zan says that our trauma was caused by people, so we need to heal with people. Learning to trust, maybe only one person, we start to heal.

Self Care- We didn't get the nurturing we needed as a child, and we may not be able to get all we need now from others in our life, so self care is giving ourselves the nurturing we need. We cannot always depend on others to be there for us so we must nurture and love ourselves.It is not being selfish, it is merely giving ourselves that which everyone else got but we missed out on. Self soothing is also part of that, and we may have missed this as a child. When we hold a baby in our arms and rub their back, we are releasing Oxytocin ( a hormone released in the brain that makes you feel good) in the baby and also in ourselves. For this reason stroking ourselves is a great way of self care as we are releasing the hormones we need to feel better. We of course went onto different ways to self care like exercise, listening to music,  a warm bath.

What stood out to me the most and what was hardest to accept, was the word DESERVE. We didn't ask for these things to happen to us, yet strangely we take the blame and think we must be bad and not deserving of anything good. The truth of the matter is We deserve to heal. We deserve the support that we need to heal. This is always a hard one for me. Having spent so much time in religion I have taken to the extreme that we don't deserve anything....anything we get is a gift and we are to be extremely grateful to have it. I am never good enough to deserve anything except the bad things that happen in life. To be able to deserve healing is a strange concept. To say I deserve to live a life healed like those not traumatised is so foreign to me.
For me the key word from the workshop is deserve. I deserve to heal, and that self care is merely giving myself that which I didn't get as a child.
I highly recommend attending one of the ASCA workshops if you can. It is hard to do new things but often the blessing far outweighs to difficulty in getting there.

I AM NORMAL!

 PODS ( Positive outcomes for Dissociative Survivors) is a UK organisation run by Carolyn and Rob Spring. Carolyn has DID. They provide wonderful services for people with dissociation and their families and friends.To go to their website, just click on the link here - PODS
Pods publishes a magazine ( not shinny and glossy like you would find in the newsagent) every3 or 4 months on life with DID. Rob usually writes an article about being a support person for some one with DID. It is very informative and well worth a read. You can access back copies for free, which is what I usually do.
I was reading the May 2012 issue last night,  'Parts are only part of the problem' by Carolyn, when a piece caught my eye. I will quote it for you here.

"DID is not rare; it is not unique; it is not special. It is just a logical set of symptoms to some  terrible trauma. It is a normal way to react to very abnormal childhood treatment. In fact, I only have DID because I am normal. If I had not reacted normally to chronic trauma and disrupted attachment I would not have developed DID."

As a Multiple we can feel so broken, fractured, abnormal. We feel that we are some how not the same as everyone else. Perhaps we were born with a mutant gene that makes us react to trauma this way. There are thousands of ideas that cross my mind as to why we have DID. Most of them not positive or helpful. I know I generally spend most of my life feeling broken and useless. This small paragraph really helped me to change the way I see myself. I AM NORMAL, I am just like everyone else except for one detail, I survived that which most people don't even want to talk about let alone live through. It puts the 'blame' back where it belongs...it is caused by the trauma, it is not my fault. I am not broken, I have merely had to survive in an extremely efficient way. 

Self blame is an easy road to take when you have been abused as a child. Children often take the blame for so many things that happen in the adult world. How much more so for the abuse they were forced to endure. I know we struggle with these thoughts regularly. But I am in no way to blame for this. I was a very normal little girl trying the best way I knew to get through a very abnormal situation. I find myself feeling compassion for myself and my levels of self hatred decrease. I see a small small girl with brown curly hair and a tear running down her cheek, just wanting to feel loved and safe. A normal little girl just like any other but with a determination to survive that made DID the only mechanism to make it. She is a very brave little girl and one day I hope to be proud of the strength she has.