So often, individuals who have experienced trauma have had their experiences questioned, disbelieved, and invalidated. Sadly, trauma is taking a back seat to the medical implications of COVID-19.
We need to ensure support for patients who are triggered by the loss of control as our government entities continue to implement more restrictive measures day by day, unintentionally creating further barriers for support and treatment.
Individuals are isolated, often from individual in person therapy, one of the hallmarks of complex trauma recovery.
The more individuals who have experienced trauma feel as if they are not powerless in the moment, the more hypervigilance decreases, which, in turn, likely will increase compliance with social distancing and medically suggested responses, as they are not presented as authoritative direction, but empathetic guidance.
When governmental orders are presented in such a way that they are changed every day, with subjective versus objective measures, this creates a similar dynamic to that of insecure attachment.
For individuals that already have a trauma history such inconsistency and chaos builds up and further causes a sense of insecurity and a lack of safety. Additionally, as public health officials firmly state, often in elevated vocal tones at press conferences, with a harsh cadence to “stay calm” this creates a mixed message for trauma survivors everywhere.
Essentially, the message/question is “I’m being told to stay calm, but yet there’s this person in authority with this harsh tone, and they sound mean and scary, so is it really safe for me to stay calm?”
In so many ways , this parrots the insecure- avoidant attachment that so many traumatized adults had with their parents as children. As trauma survivors become overwhelmed with stimuli and re-triggered by words of panic, it becomes exceedingly difficult to remain focused in the moment to take in the direction from public health officials.
Trauma-Informed Care Never More Important
We are at a point in time where we are not just facing a pandemic. We are facing a time when trauma informed care has never been more important. Imagine if we spent as much energy educating the public on trauma-informed care, as we did on social distancing. Imagine the safety we could create for trauma survivors. There is a real opportunity here.
As these painful moments of abandonment and loss are triggered through reminders of constantly changing expectations, guidelines and grief through COVID-19, it is important that individuals are provided with some avenues of consistency and safety that cannot be taken away, regardless of what changes are implemented.
This could occur through consistent appointment schedules, routine check ins with providers, email communication, encouragement of connecting with local businesses and building community-based comraderie and identifying trauma-informed individuals in the community.
It is fair to note that there is a distinct difference between individuals that possess the knowledge of being trauma-informed, contrasted with those who provide trauma-based treatment. As a society, we can partner to ensure that individuals who have experienced trauma are respected during this time, and provided with compassion for the experiences that they have endured.
This might mean recognizing that masks can be triggering for individuals who have experienced certain medical traumas, or specific types of abuse, and going the extra mile to accommodate alternative means of shopping and food delivery in the community.
It could also mean demonstrating an increased sense of awareness that individuals that have experienced trauma struggle with hypervigilance and might need some extra space in stores; and showing these individuals the same respect that is marketed lately with respect to “social distancing.”
Space and Boundaries Should Be Respected
Personal space and boundaries should be granted the same respect. As clinicians, we can set the tone and educate our clients in ways in which they can continue to advocate for their rights, and validate their right to self-empowerment and autonomy.
When trauma-informed care is not followed by public standards, especially when it is needed most in times of a pandemic, it is up to mental health providers to pick up the pieces and ensure that individuals who have experienced trauma maintain a sense of balance in an ever changing reality.
Furthermore, the impact on secure attachment during this time of social isolation remains devastating to many. While television commercials highlight attempts to unite families and friends apart, it is clear the security of attachment remains missing.
Individuals who have a pre-existing attachment trauma will not react in the same manner to social isolation as someone who has not experienced such trauma. Just as individuals with COVID-19 who have pre-existing conditions are being encouraged to use extra caution, we should be mindful that individuals who have a trauma history might need some extra support/precautions during this time.
A pandemic does not stop flashbacks, memories, abreactions, or triggers. In such times of uncertainty, PTSD should be considered a “pre-existing condition” and treated with the same respect that we treat Asthma, and COPD.
Trauma may not be visible, but loss of breath can occur from an intrusive thought, and gastrointestinal distress can happen from a somatic memory. By openly stating the separation anxiety that is caused by social isolation we are giving our patients a voice they might not have had before.
By encouraging individuals to process that the world is moving too fast, we can embark on a journey of healing. We can be the brakes for them, and provide them permission to grieve the isolation that is occurring through COVID-19. By refusing to succumb to pressures of the media, public service announcements, and generalizations, we can give our clients the right to be heard.
While it might appear unrealistic to keep Harry Harlow’s 1950’s rhesus monkey experiment in the forefront of one’s mind when “stay at home” orders are being put into effect, it is this very awareness of the potential of attachment trauma that can incur from social isolation that needs to be acknowledged.
Harlow proved that despite a wire made monkey dispensing food pellets, the monkeys still went to the cloth monkey, longing for the human contact (1958). As humans, there is a biological need to be close to one another, to belong, and feel safe. When this need is threatened, directly or indirectly, we react with fear, anger, and try to protect ourselves.
Living in a State of Hyper Vigilance
However when these resources are compromised, because of the government taking away such resources due to mandatory shut downs (ex. gyms to exercise, parks closing, etc.), the helplessness that ensues creates a frantic sense of panic, one that so many trauma survivors already have, living in a state of hyper vigilance.
When I find myself thinking about Harlow and his monkeys, another thought comes to mind. Harlow’s monkeys clearly demonstrated the desire to be loved and cared about, bonding with the cloth monkey, choosing attachment over food consistently (1958).
During this experiment, it is worth noting that Harlow reportedly did not shame the monkeys for making this decision; he simply reported his research findings. Yet today, we criticize and blame those who feel chafed by social distancing rules, complain about not being able to see friends and family, and look for loopholes in the rules so they can meet their internal needs for social connection and belonging.
As “essential” businesses are allowed to stay open, I have been asked by individuals, “Who are they to determine what is essential?” For some individuals, getting paints, scrapbook supplies, gardening tools, etc helps with mental health needs. The loss of control over the freedom to move is a powerful loss of control for trauma survivors.
As clinicians, we must help individuals find avenues of maintaining their sense of safety and autonomy in these moments. Often, the understanding of such loss of control will help with the mitigation efforts simply by reminding people of the control that they do have. Of the utmost importance is not to place our own clinical judgment on our patients.
We may have strong feelings in favor of social distancing, mask wearing, and believe that everyone should stay at home. However, if we have a patient who needs to go to the store because they need to purchase a journal and it is part of their trauma recovery, it is imminent that we embrace that wholeheartedly. Because of hypervigilance, they will be able to pick up every inflection in our voice, every change in breathing pattern, different verbiage, etc.
We owe our clients the same, if not better clinical care now, than before COVID-19. Our political and personal beliefs should not change the way we conduct care, now or ever, and yet, for some reason, it still feels necessary to be stated as such.
Clients Need Consistency
The world may be changing, but we don’t have to change at the core of who we are, as professionals, or as individuals. That consistency is what our clients need to see.
Telehealth has recently been raved as a wonderful alternative to in person therapy during this time. Individuals that flashback silently, have somatic memories and silently hope that their therapist will understand an eye glance across the room as they start to become stuck in a memory. I assure you telehealth is not a long-term solution. Telehealth may be a band-aid fix for right now, and staying connected to our clients in a safe way for all involved is essential, however we cannot succumb to outside pressures.
We need to trust our own clinical gut instincts. By remaining truthful to ourselves, our theoretical orientations, and our values and beliefs, we will help our patients, colleagues, and ourselves survive this challenging journey. Be safe, and be trauma-informed; our clients lives depend on it.
Harlow, H. F. (1958). The nature of love. American Psychologist, 13(12), 673–685. https://doi.org/10.1037/h0047884