After reading “The Trauma of Being Alive,” by psychiatrist and author Mark Epstein in the August 4 New York Times, I am eager to hear more from him and will when his new book “The Trauma of Everyday Life” comes out August 15. In this piece, Epstein says that “An undercurrent of injury and disaster runs through ordinary life” and that the willingness to face and lean into traumas is the key to healing from them. The poignant story he tells of his 88-year-old mother’s grief over the death of her husband beautifully illustrates that mourning has no timetable and earlier losses resurface when new losses are experienced. When the author’s father died, his mother mourned his death along with death of her first husband who died suddenly just a few years after they were married. Traumas may change but they don’t ever really go away. Trauma is universal.
Epstein asks if we as a community can keep those who have experienced severe trauma such as victims of the Boston Marathon bombings and soldiers returning from war in our hearts for all the time they are likely to need it or will we grow inpatient if they aren’t able to move on. We should ask the same question for victims of childhood trauma whose psychological and healthcare needs may last a lifetime and exceed our expectations of what should be a “normal” healing process.
The author describes how he likes to say, “if we are not suffering from post-traumatic stress disorder, we are suffering from pre-traumatic stress disorder. There is no way to be alive without being conscious of the potential for disaster. One way or another, death (and its cousins: old age, illness, accidents, separation and loss) hangs over all of us. Nobody is immune.” The question arises whether an appreciation that we all suffer trauma throughout our lives would lead us to create a community that supports the healing process for as long as it takes. I’m hopeful that such a community would be created since I share Epstein’s belief that when we are open to the depth of our own suffering, when we don’t rush to normal, we are open to the suffering of others. We will give others and ourselves all the time we need to heal.
As our understanding of mental illness and mental health grows, the dichotomy between “nature vs. nurture” will be replaced with a philosophy that recognizes that health is derived from both. This new understanding will drive organizations in the mental health advocacy world to take a broader perspective and reorder their priorities. Now there is a stark division between organizations that see their mission as serving individuals with serious mental illnesses (schizophrenia, bipolar disorder, clinical depression) and their families vs. the mental health of the general population, the former characterizing the constituency of the later derisively as the “worried well.” Divisions such as these undermine the effectiveness of advocacy at all levels—state, local and federal—where even clear, united voices compete to be heard in a noisy policy environment.
How mental health organizations prioritize issues related to trauma policies and practices also varies widely. The reluctance of some organizations to embrace the trauma movement wholeheartedly is the result in part of a lingering fear of the accepted view until the 1950s that the cold, withholding mother caused schizophrenia. This painful past still resides in the psyche of many families who were blamed for the mental illnesses of their children, making them understandably wary of opening a door to trauma-based constructs that may feel unpleasantly familiar. Fortunately, there appears to be a growing recognition that trauma-informed practices are beneficial to their loved ones, especially in the prevention of re-traumatizing experiences in the healthcare system.
The evolution from blaming parents, to seeing mental illnesses as pure brain diseases, and finally understanding the complexity of the origins and treatment of mental illness is described in the award-winning essay “Beyond the Brain” by Tanya Marie Luhrmann in the Wilson Quarterly. She writes that few clinicians talk anymore about cold, rejecting mothers but they do talk about stress, trauma and culture. They also “recognize that having a decent place to live is sometimes more important than medication. Increasingly, the valuable research is done not only in the laboratory but in the field, by epidemiologists and even anthropologists.”
A “health revolution” based on the ACEs research is underway according to the Robert Wood Johnson Foundation. A greater understanding of the universality of trauma only enhances the potential of ACEs research to fully realize that health revolution.
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