Within the past decade, the term “trauma” has become a cultural buzzword. In 2014, psychiatrist Bessel van der Kolk published “The Body Keeps the Score,” which has spent the past seven years on The New York Times Best Sellers list. And as a 2022 Vox article says, “‘The Body Keeps the Score’ is a part of the zeitgeist. Trauma is everywhere.”
Centering trauma as the primary cause of all of society’s ills has become controversial, and the Vox article cautions that the term may be losing its meaning. Van der Kolk was recently the subject of a skeptical 2023 feature in New York Magazine in which the author investigates the history of “traumaology” and, after attending a weeklong retreat, proclaims that “it sometimes seemed as if no event was too geopolitically vast or historically complex to be apprehended through trauma.”
But it cannot be denied that many in the fields of psychology, psychiatry and social work find the trauma framework to be helpful in explaining one’s life outcomes, and regardless of the controversy over its ubiquity, there has been a recognizable shift in therapy toward recognizing trauma as the source of mental health conditions such as anxiety and depression.
At UB, the Institute on Trauma and Trauma-Informed Care was founded in 2012, two years before the release of Van der Kolk’s book. Founded in 2012 by Sue Green and Tom Nochajski, the institute aims to ensure that organizations such as schools, hospitals and law offices are conscious of trauma, and to ensure that individuals are not needlessly retraumatized by these institutions. As its mission statement says, “we work with agencies to provide training, consultation, coaching and evaluation to facilitate trauma-informed culture change.”
Built into all courses taught by the School of Social Work is the Universal Precaution: Values and Principles of Trauma-Informed Care, which consists of safety, choice, collaboration, trustworthiness and empowerment.
The trauma-informed care model was pioneered by Sandra Bloom in the 1980s. At the time, she was working in inpatient psychiatric clinics with children and adolescents. Ultimately, she had to close her program due to a lack of funds because the trauma-informed care model was a paradigm shift, and many people were skeptical of it.
In 2001, Maxine Harris and Roger Fallot published a journal article in New Directions for Mental Health Services. The title of the article indicates that Harris and Fallot were visionaries: “Envisioning a trauma-informed service system: a paradigm shift.” It was Harris and Fallot who developed the trauma-informed care principles that the department adheres to.
Amy Wlosinski, project manager, believes in the global, big-picture importance of a trauma-informed lens. “Our work is around organizational change … it’s about developing this shared understanding and this way of navigating the world so that we’re not making it worse.”
The institute has quite a strong presence throughout Western New York, as it is currently working with the Williamsville Central School District, Frontier Central School District and the Niagara Falls City School District. Other partnerships include the Family Promise of WNY, an anti-homelessness organization, as well as legal organizations such as the Niagara Community Legal Clinic and Neighborhood Legal Services. BryLin Hospital is another major partner, hoping to bring a trauma-informed lens to the health care field.
Over the past few years, the institute has undergone massive growth in the services it provides. Megan Koury, project and office manager, believes that COVID-19 played a major role in the number of schools that are requesting services because they started seeing extreme behavioral shifts in students. “They weren’t socializing in the way that they were supposed to in the elementary levels, and so behavioral and mental health pieces have skyrocketed in schools, which is probably why they are interested in this concept of trauma and trauma-informed care.”
Compared to other social work departments across the country, Wlosinski believes “that UB is unique in that we do have that trauma-informed human rights focus.”
All staff members seem to agree that something has shifted over the past five decades in taking trauma as a useful framework for understanding clinical psychology and adverse life experiences.
After Vietnam, the label post-traumatic stress disorder (PTSD) was formally introduced in 1980. Megan Koury believes that this was “a huge deal because many people in their worldview were walking around thinking that trauma didn’t exist for them.” It was a novel concept that a child could undergo trauma.
Today, the Substance Abuse and Mental Health Services Administration, a branch of the Department of Health and Human Services, recognizes the “3 E’s of trauma: event, experience and effects.” Following an initial event, the subjective experience of the individual will subsequently interpret that experience, which will then translate into the long-term psychological, emotional and physical effects of trauma.
Samantha Koury says that the trauma-informed care perspective uses the 3 E’s because it is ultimately up to the individual to determine whether something has been traumatic. She stresses that trauma is a broad term, and how we perceive it continues to evolve. Despite this, she believes that many professionals are still stuck in their old ways. “There are still many professionals who still think if it’s not PTSD, it’s not trauma,” she says.
Trauma is not just an individual experience; there are broader social domains of it, says Koury: “In terms of thinking about the definition of trauma or PTSD, it also doesn’t account for things like historical trauma or racial trauma, systemic trauma … I think that our understanding as a field of trauma and trauma-informed care has changed drastically in the last 10-15 years. A lot of that is because of neuroscience. The more that we understand the nervous system, and how overwhelming, high-stress situations, crises and trauma impact people, especially over time, the lines get blurred because we have one nervous system.”
Therefore, the broad experiences about what one perceives as trauma have the same long-term mental and emotional effects. Trauma does not have to be isolated to a single experience but can accumulate throughout life.
When working with clients, Samantha Koury automatically assumes that clients have trauma because that reduces the risk of reharming someone.
Trauma-informed care is a tool of social justice. “You can’t be trauma-informed if you also don’t integrate diversity, equity, inclusion, accessibility and justice,” says Samantha Koury.
With the wide array of organizations, the staff understands that you must tailor your message to different audiences. “The way I talk about why being trauma-informed is important to a bunch of lawyers and paralegals is not going to be the same as teachers, it’s not going to be the same as social workers,” says Samantha Koury, and yet ultimately the argument can be universally effective because “‘the empathy component of ‘we don’t want to create more harm’ is enough to get people to buy in.”
In getting organizations to be receptive, borrowing from psychiatrist Bruce Perry, Megan Koury says that “there are one-third of people who are already on board, one-third of people who are dabbling on both sides, and that’s who we want to reach, and one-third who will not be on board until the entire culture shifts.”
Samantha Koury believes that the trauma-informed lens is relevant to every person and every profession: “Most professions have to interact with other people. And so even if students reading this are not planning to go into psychology or social work or nursing, and you’re going to be an engineer, you still have to engage with people … this is really about what it means to be human and how to effectively communicate and engage with people. And so I think it’s relevant for every profession … Honestly, I don’t think you can be effective at anything that you do if you don’t have this lens.”
Jacob Wojtowicz is the senior features editor and can be reached at jacob.wojtowicz@ubspectrum.com
Photo: Courtesy of Wikimedia Commons