Trauma-Informed Care for Marginalized Folks During COVID and Beyond
Trauma happens when something more powerful than our own capacity to fight it or flee it overwhelms our defenses. When our bodies register a threat, they attempt to orient to it. Our ears perk up, our eyes widen, our bodies tense, our hearts beat faster and pump blood into our limbs so that we can either fight it or flee it. If that threat is powerful or pervasive enough that neither of those two options are available to us, we enter more passive defenses: freeze (like a deer in headlights) or faint/fawn (like a possum playing dead) which is how trauma happens.
These states can stay stuck in our bodies as traumatic activation, leading to eventual health and medical problems. Check out the Adverse Childhood Experiences (ACEs) studies for more info on how trauma affects health. Nadine Burke Harris gives a great TED talk.
I want to highlight that just because we go into passive defenses of freeze and faint, does not doom us or predict that we will remain traumatized. It’s how we process the traumatic events that determines whether we will remain traumatized. And how we process those events is a direct function of resources available - the time, the body awareness, the emotional intelligence and support, the nutrients our body needs under added stress load, the medicines, the spiritual connections, etc.
This pandemic is highlighting the health disparities that exist for marginalized communities who are, again, disproportionately hit by unjust allocation of resources. Marginalized folks have already been living in traumatized states due to polluted water, generational trauma, institutional policies rooted in discrimination, and a government that is consistently hostile to us, which already increases our risk for health problems. Black folks are 13% of the US American population, but are dying from COVID at rates between 40-70% of the total population, depending on which part of the country we’re in. We’re disbelieved more regularly for the same or worse symptoms than white folks. The Navajo Nation has a COVID infection rate 10 times higher than their Arizona neighbors, due to the US government misallocating their resources and constant broken promises.
Compared to white folks, black, brown and indigenous people as a whole have less space in our houses and communities, and more poverty, which translates to more exposure to COVID. Some GLBT youth and adults are stuck at home with family of origin, exposed to a firehose of homophobia that does a different form of long-term damage than COVID-19. People with disabilities have even less access to the resources they need and are more vulnerable to this illness. For those who struggle with mental illness, quarantine can be devastating for the routines and rituals that help folks self-regulate. People are stuck at home with their abusers.
COVID-19 is an unpredictable and deadly virus that has taken over our way of life. We can’t see it or hear it. When our bodies cannot orient to a threat, to pinpoint it and fight it or flee from it, our bodies go into a global lockdown. It pulls in, hoping to decrease surface area exposed to threat. So, in addition to our shelter in place lockdown, our bodies can be on lockdown, too. We can feel the somatic symptoms of COVID, even if we don’t have it, because our bodies are resonating with the global threat of pandemic. The fear can create real symptoms that mirror COVID ones. We are grieving the lives we no longer have and the dreams that are even further from reach.
COVID-19 affects the respiratory system and it also affects people’s mood. “I can’t breathe” takes on new meaning. People experiencing the depths of the illness can feel severely depressed and/or anxious, even if they’ve had no prior history of mood disorders. For those who’ve been surviving COVID, it feels like it’s ending only to begin again with worsening or different symptoms. People feel deeply alone in it. They’re being told they don’t have it because they may go to the hospital outside the immediate exposure window, when symptoms are worse but tests don’t pick up on the presence of the illness. People are dying without loved ones who are unable to be in the same room, or have to say good-bye via video chat.
And marginalized communities have been stigmatized and shamed around mental and medical health for generations. So, it’s reasonable to assume that marginalized communities have financial and psychological barriers to getting the mental and medical healthcare they need during this time. They are disproportionately affected by COVID-19, with less access to getting support. So, if you are a member of and/or serve marginalized folks, what can we do about that?
Signs & Symptoms of Trauma
Trauma pushes our nervous systems higher and lower than it likes to be, but decreases our window of tolerance for those extremes. This translates to an increasingly small bandwidth for tolerable experiences and more and more anxiety and depression, reactivity, hypervigilance or flat affect. Our lives whittle down to a series of self-destructive habits that need to be repeated over and over to numb the panic, but rarely create joy or satisfaction.
When you understand trauma, you can see that oppression is a form of complex trauma. It’s a consistently invalidating environment that limits or excludes access to needed resources of stability, love, money, healing, safety, etc. Not to mention the physical, emotional or psychological abuse that systemic ideologies permit folks with privilege to enact without consequence (violence; abortion laws controlling women’s bodies even though men are needed to impregnate them; cis white males getting no jail time for raping people or killing black or brown people while black and brown people get punished way more severely for a far lessor crime; rights constantly being stripped for LGBT folks, undocumented folks, people who pray differently than Christians; pollution of food and water). It includes possible symptoms affecting mood (anxiety, depression, panic, irritability, shame), cognition (flashbacks - in this case constantly questioning whether something is happening because of your marginalized status), and behavior (i.e. avoidance of triggers, hiding, isolation, drinking/drugs). You’re constantly in a lose-lose dynamic because you can’t point out that you’re being abused without being further abused by people’s hurt feelings or overt hatred and retaliation. It’s an added trap.
And, because this pandemic scenario will bring oppression trauma for marginalized folks, there’s a relational component. It will bring more distrust. More self-preservation behaviors in the form of anger and defensiveness (fight). More chronic busyness and perfectionism (flight). More mistrust and isolation (freeze). And more spaced-out people pleasing (faint/fawn). And these folks will be coming to you—the medical or mental health practitioner, the grocery clerk, the community leader, the home care worker, the neighbor, the friend, the family member—with all this, whether they are aware of their trauma symptoms or not.
The good news about our complex brains is that we can use them to understand what’s happening and to create resources for healing. Instead of reliving or reenacting the trauma, we can access our brains and bodies to create states of pleasure, calm and connection. We can do things like yoga and meditation, singing and dancing, prayer and (online) community events. We can do movements such as weight-lifting or running that allow our fight and flee responses to sequence. We can virtually see a therapist or have a profound conversation with a friend or spiritual leader. And when we take care of our own nervous systems, we have more capacity to be generous to others when we can.
The Five Components of Trauma-Informed Care
The more people understand trauma, the more we can be a village helping each other heal. Trauma-informed care (TIC) has become an operational framework that more and more agencies and medical facilities are adopting in their standards of care. We don’t all have to be trauma experts to work with trauma effectively. It’s an attempt to change practices and workplace culture to start to dismantle and disrupt cycles of trauma. We know from the Adverse Childhood Experiences (ACEs) studies that unresolved trauma is at the root of most health issues, whether physical, mental, emotional or spiritual, so we need to address it in order to work with the whole person or community effectively. TIC works for both the clients we serve and the staff who serves them. But it’s also great for anybody or any network of people.
Here are TIC’s 5 principles:
Organization Assessment - while there are scientifically proven evaluations that measure baselines and growth arcs for how well agencies do with trauma (such as the Organizational Self-Assessment tool, ARTIC, Agency Self-Assessment tool, etc), let’s assume during this crisis that it’s not a priority to assess. Let’s just assume that we could all get better with trauma and that there’s room for improvement.
Paradigm Shift - The aim of trauma-informed care is to shift from viewing clients through the lens of “what’s wrong with you?,” and start seeing behaviors we may not understand or want to change through the lens of “what’s happened to you?” When we view someone as “wrong” we don’t serve them. We perceive them as a nuisance to tolerate at best. We write off their ails as a personal flaw. And this can be damaging when we are the ones with the power to define someone’s reality.
Instead, when we recognize that our annoyance is ours, that this person may be behaving in a particular way we don’t like or understand because of what they’ve been through, we start to get curious and to reach for understanding to offer dignity and care. The brain doesn’t always know the difference between actually dying of a life-threatening illness and being really scared that it might be. People can die from panic attacks around the fear of dying from this illness, too. So, we can create practices to be kind and to validate people’s experiences, whether our tests confirm a positive COVID result or not. That extra bit of validation and understanding goes a long way to support someone’s mental health in all this.
Principles - Trauma-Informed Care only works inside an environment that provides:
a. Safety - basic safety is a must. Safety is necessary for our brains to register that it has survived the trauma and can begin processing it. Employees and clients need to feel safe that they can ask for help and get support without being shamed for not giving enough, not knowing enough, not being self-sacrificing or pleasant enough. They can’t be or feel taken advantage of as part of their job or because they’re in the vulnerable position of needing help. Staff need to feel like their safety isn’t sacrificed in vain in the line of duty. They need to feel that they have support for the emotional labor they do.
In this time of pandemic, while no one can guarantee safety, we can certainly do our best to provide what we can in personal protective gear, policies and procedures that put staff and clients in the best possible scenario for safety. And when it’s unclear, we can be transparent and trustworthy about it.
b. Trustworthiness and Transparency - don’t gaslight people about their safety or your intentions. Share what’s about the bottom line and what’s about safety. Don’t act like the two are the same when they’re not. Act with integrity and concern for the folks in your care. Claim what you know and don’t make false statements or promises.
c. Peer Support - No one knows what you’re going through more than your peers. They share the most similar experiences, options and struggles. Make time for peers to collaborate, to hear each other out, to ease each other’s burdens.
d. Collaboration and Mutuality - We may have different roles and responsibilities, but we are all equal in dignity. When you collaborate with folks, it gives them a feeling of importance and belonging. If there are roles with different levels of power, influence can be scaffolded while still being meaningful. Community members can contribute to the overall process and you will get the best information when everyone is included. People from marginalized communities need a meaningful (not tokenized) seat at the table throughout all parts of decision-making.
e. Empowerment, Voice and Choice - people need to feel they have a choice over the decisions that affect their lives. Of course, there are always things we don’t have control over, but as much as possible and especially during uncertainty, give choice to staff and clients about how they get to implement their options. Trauma happens when we don’t have a choice to fight or flee, so allowing choice within a disempowering situation can shore people up to access their own internal resources. When people feel that their voices matter, even if the situation is not controllable, they don’t have the added layer of relational trauma to contend with. And this is life changing!
f. An Understanding of Cultural, Historical, and Gender Issues - Understand that if you are a cisgender, white, heterosexual Christian male born in this country your story, perspective and needs have historically been considered without distrust. That’s not to say that you haven’t had personal experiences in which this was not the case, but from an institutional perspective, you’ve been believed and given every benefit of the doubt. This is not the case for women, LGBT folks, people of color, undocumented folks, folks with disabilities or non-Christian religious or spiritual practices. That generational trauma and lived experience comes into play during every institutional interaction and this pandemic is no exception.
Make a concerted effort to believe folks from marginalized communities. Their stories, experiences and mistrust are real. Understand historical barriers to access, such as denial of service due to discrimination. Imagine trying to be seen for COVID and you can’t even access the bathroom or you get sent home without care because the law protects the healthcare worker to discriminate against you. Don’t gaslight or be condescending when what you see or hear doesn’t make sense from your worldview or perspective. Extend extra kindness, without condescension, during this time.
4. Employee Wellness & Self-Care - In order to avoid inevitable burnout and vicarious trauma from working with continual trauma, conscientious and consistent efforts, structures and practices need to be adopted for staff to cultivate and maintain wellness. For every hour that someone is exposed to someone else’s trauma, they need an hour of time that helps them resource and regain health. Under current crises, our frontline staff are absorbing trauma faster than they can process. They need more compensation and breaks to get support for all that they’re seeing and exposed to. They need to access states of rest so their immune systems are strengthened. They need to not feel guilted by employers or clients to spend their downtime giving more. Youth stuck at home need breaks to remember their developmental needs for autonomy and individuality, to understand who they are in relation to peers, even under quarantine.
5. Everyone - It’s not enough for one trauma expert to come in and educate or be the resource. For a true shift to happen, everyone needs to know about trauma and how to work with it more effectively, to understand their own traumas and what it looks like for others. This truly takes a village of peers and professionals working together for the collective good. Because no one wins when anyone stays stuck.
Even if we don’t work for an agency or institution, we can practice this in our homes with our quarantined family or with ourselves. We can extend kindness and curiosity for what we don’t understand at the hospital and grocery stores. We can hold space and tap into our own bodies to ground so that someone else can borrow our strength. We can make time for our indigenous or spiritual practices or wisdom traditions. We can notice signs of aggression as pleas for help that cannot be asked for directly at this moment. We can let ourselves cry or feel anger without shaming ourselves or each other out of it. We can shake and not know and show up anyway. We can choose to share our truth, even if it seems weird, because it liberates others. We can offer food or services to those around us in need. We can share resources rather than hoard them.
There’s a concept called “post-traumatic growth.” Like a wildfire that no one wanted, causing unprecedented damage, there is also unexpected good to come from tragic circumstances, such as fertile soil and new growth. While no one should have to go through trauma for positive experiences, there can be opportunities trauma provides if we take them. Trauma alters our states of consciousness so that we see things in new ways. We are more conscientious of our interconnection and the preciousness of life at times of greatest crises. May we use this pandemic time to remember that we are all human and worthy of dignity, resources and love.
