Crap Happens. What Do We Do About It?

Crap happens. Everyday. Some days worse than others. That is the world we live in.

Crap does happen. It sure does. So much, to so many, that in recent years, a paradigm shift has begun to happen in healthcare and other service settings. Every professional who works with people needs to know about it. Every person who at some time, needs the help of a professional, needs to know about it.

We need a revolution. We’ve needed one for a long time. We need to change our thinking about “mental illness”-what it is and what it is not. Anyone who works with humans, healthcare providers, educators, law enforcement personnel, legal professionals—anyone who works with humans, needs to participate in this paradigm shift.

Don’t get put off by the big “T” word. Don’t be scared, you can deal with the crap.

Make the Shift!

Trauma-Informed approach is based in compassion and a recognition that all humans experience trauma in their lives. It requires a paradigm shift from “What’s wrong with you?” to “What happened to you?” This shift includes a change of attitude, a change of heart, for those who have been trained in the medical model.

Trauma-Informed approach recognizes that all humans possess strengths and as survivors, have demonstrated courage with resiliency. Victimization is acknowledged and validated but assets are used in an empowerment process.

When Trauma-Informed principles are engaged, every human interaction can improve and each person involved may be honored and fulfilled.

“Trauma-Informed systems and services are those that have thoroughly incorporated an understanding of trauma, including its consequences and the conditions that enhance healing, in all aspects of service delivery. Any human service program, regardless of its primary task, can be Trauma-Informed by making specific administrative and service-level modifications in practices, activities, and settings in order to be responsive to the needs and strengths of people with lived experience of trauma” (Harris and Fallot, 2008).

You’ve been out all weekend on your friends boat skiing You’ve enjoyed great friends and food but just about the time you’re ready to wind down you fall and break your arm Your friends call an ambulance and you’re rushed to the nearby emergency room You get an x-ray some Morphine and a purple cast your favorite color The support staff make sure you’ll have some help at home and give you a follow-up appointment They explain that your injury will take some time to heal but soon you’ll be as good as new

What did you just learn? You’ve been injured and you’ll recover Its all about what happened to you

When you enter a medical setting with a physical injury its obvious that something happened to you You’ve been hurt and you need some support to recover from the event You may need to engage in physical therapy and challenge yourself to focus on regaining strength and functionality You are expected to do the work but you can expect some support and a conviction from your medical healers that you’ll get better

Now consider this For several months you’ve lost your appetite you have very little energy you just want to sleep all the time you’re sad sometimes irritable at others you’ve even wished you could just not wake up tomorrow Now you see your doctor and she refers you to a psychiatrist You’re desperate so you go.

The psychiatrist asks you about weight loss or gain sleep quality mood and energy levels At the end of the appointment he announces You’ve got major depression Ill write your prescription.

What did you just learn? You’re ill and you need medication. Its all about whats wrong with you.

You may be a person who has experienced a great deal of loss suffered childhood or adult abuse and assault been raised in a household where alcoholism prevailed or in many many other ways been wounded emotionally and psychologically You too are injured But in most cases your psychiatrist crisis counselor addictions counselor or other healthcare professional wont ask you the right questions to get these answers They may ask have you been abused and accept your no answer with no further challenge They don’t understand that answering no is a human defense and helps us survive victimization But it doesn’t help us move on

Why Do We Need To Make the Shift

Why dont we assume injury rather than illness when a person manifests depression anxiety and other mental symptoms The answer to that question has a great deal to do with the medicalization of mental illness In order to legitimize the effects of emotional and psychological injury the purely medical model has been applied

For decades now the symptoms of depression and anxiety have been the focus of treatment by means of medication this has brought about great progress in some ways We no longer throw away the afflicted in institutions and asylums we have campaigns to eradicate stigmatization of mental illness and we can give hope to those who have had none However in the process we have become blind to the connections of early childhood abuse and other experience of traumatic events and circumstances with depression anxiety and mental illness

Yes we do have Post-Traumatic Stress Disorder Its the only diagnosis out of almost 300 in the DSM V the medical guide to diagnosis of mental health conditions that recognizes a pre-cursory event to symptom expression

In recent years study after study shows a high correlation of life events and circumstances with symptoms A study with rats has shown causation with early life stressors and adult depression and anxiety early-life-stress-and-depression-childhood-trauma-may-lead-to-neurobiologically-unique-mood-disorders

Whats wrong with you may be the cluster of symptoms that point to the fact that somethings happened to you

Will You Join the Revolution

The federal entity Substance Abuse Mental Health Services Administration SAMHSA has declared Trauma and Justice one of its eight initiatives for healthcare improvement

Scores of scientific studies experts and organizations have come to acknowledge that the Trauma-Informed approach what happened to you is so much more powerful than whats wrong with you as inferred by the medical model

Due to this evidence and SAMHSA’s initiative many state and county entities are beginning to require Trauma-Informed training for providers of all kinds of services to individuals children and families Others are pursuing this training out of a desire to provide the best evidence-based care to those they assist A town in Florida has even declared itself a Trauma-Informed town!

Trauma-Informed care is not just the next fad in behavioral health its not a treatment technique and its not just a topic for mandated training in healthcare and other settings

In its essence Trauma-Informed is a person-centered point of view and in most cases requires an attitude adjustment and a ramping up of compassion on the part of individuals and organizations that provide support services protection and treatment

Whats at Stake

When people are not asked about what happened to you especially in mental health settings they can become dis-empowered re-traumatized and mired down in their symptoms The very absence of the right questions can indicate implicitly that the victimization the person has experienced doesnt count They by implication are not important When the focus is on symptoms and medication the inference is that they are sick in need of an expert to treat them

Persons treated via the medical model only can become dependent on governmental programs rather than empowered to claim their lives and move forward In fact the government sponsored programs that have been utilized in modern times show evidence of having been built on the medical model-the model that says you are broken and deserve only a life of subsistence living These programs often maintain illness in recipients and do not support or encourage authentic recovery

Wouldn’t it be fabulous if the person that enters a psychiatrists office crisis center or emergency room were treated as if they’d had an injury In other words the professionals ask about the crap

You’ve suffered the loss of several loved ones through death in the last 3 years You’ve gone through a divorce and your hours at work have been cut You suffer symptoms of depression and when you seek help you’re asked about your life circumstances and real attention is given to your answers The doctor and support staff listen to you as long as you need to be heard they offer education that helps you connect the dots of your losses and your symptoms They offer short-term medication but focus more on making appointments with a therapist a job coach and an outreach worker who will come to your home to assist you to get organized get groceries and make it to your appointments This support is offered for several months until you are able to do more on your own The persons who work with you are kind and patient yet they gently challenge you to make progress They expect you to get better and they know it takes time and resources to get there With this support and expectation for recovery in a relatively short time you are able to recover and get on with your life

Success can come from utilizing a Trauma-Informed viewpoint versus that of the medical model the difference is often that a person can have a productive life Or not The crap doesn’t just go away When we don’t deal with it it keeps showing up

Will you challenge yourself to develop deeper compassion for your fellow human Will you challenge your organization to Make the Shift Its happening now don’t stay stuck in the old way of thinking

Persons in need of help

Are you a person in need of help from a Trauma-Informed perspective Visit http://storesamhsagov/product/Dealing-with-the-Effects-of-Trauma-A-Self-Help-Guide/SMA-3717 to download a free booklet to get you started

If you are in Texas, Beth may have openings for face-face or web-based psychotherapy services Visit for more information

If you need immediate help call 911 or go to your nearest emergency room You may also call the National Suicide Hotline 18002738255


Are you a human services provider such as a psychotherapist or addictions counselor TraumaCEs offers convenient affordable online courses about Trauma-Informed philosophy assessment and treatment

Visit our online courses and sign-up today!

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