We Need to Talk About Trauma

Chiara Camponeschi is the Director of Enabling City, an international organization devoted to stimulating civic imaginaries for social change. She works with institutional and grassroots actors on anything from growing solidarity economies to supporting open governance initiatives. Read her reflections on Covid-19 and the importance of mental health and structural interventions on trauma-informed care.

Now more than ever we seem to understand on an intimate, bodily level that our health is not separate from the health of the people who surround us. The inescapability of our interconnectedness has been made painfully obvious by the pandemic, though it is a reality our institutions continue to struggle to tackle head on. Stories of praise for ‘healthcare heroes’ circulate at the same time that first responders denounce the lack of access to personal protective equipment (PPE). Community demands to cancel rent proliferate amid corporate bailouts. Calls for accessible testing grow louder while oppressed communities continue to experience alarmingly higher rates of infection.

As we confront our systems’ shortcomings and contradictions, public opinion is gradually shifting toward a more sophisticated understanding of vulnerability. COVID-19 is helping us understand that exposure to a virus is not the only health hazard we face––so are poverty, isolation, food insecurity, and other pervasive forms of precariousness that have resulted from years of neoliberal governance. As the headlines demonstrate all too clearly, these days lack of access to secure housing, a living wage, and strong community ties can truly mean the difference between life and death. 

Along with this growing realization, the novel coronavirus seems to have finally validated the importance of mental health. In the media, news articles and reports are beginning to expose the ways in which experiences of isolation, loneliness, skin hunger, anxiety, and depression are exacerbated by the pandemic and can, in turn, make us more vulnerable to disease. In a recent address, UN Secretary-General Antonio Guterres declared that “mental health services are an essential part of all government responses to COVID-19 [and] must be expanded and fully funded.” 

These are encouraging shifts, but they do not go far enough. As governments are urged to ramp up their relief efforts, we are failing to see the bigger picture: that nested within the COVID-19 crisis is “a trauma pandemic in the making”. 

For many, the coronavirus outbreak has been marked by unnerving marketplace shortages, unprecedented rates of unemployment, heightened socio-economic instability, and acute relational strain. While a handful of reports are beginning to address the wave of ‘vicarious trauma’ and PTSD facing first responders, these experiences make it clear that nurses and doctors won’t be the only ones requiring robust mental health support––all of us will. We must therefore act swiftly and comprehensively to address the myriad ways in which COVID-19 and trauma intersect and will continue to intersect long after the curve has been flattened.

Below I outline a handful of key reasons why we must invest in the promotion of trauma literacy and in the design of structural interventions that honour the tenets of trauma-informed care.

1. Trauma affects both mental and physical health

While many of us carry a mental picture of trauma as one of debilitating fear and heightened emotional distress, we seldom talk about trauma’s impact on the body. Studies show that in addition to significant psychological strain, traumatic stress gives rise to serious medical conditions that range from muscular pain to diabetes, heart disease, developmental impairment, immune dysfunction, and more (see, for example, the pioneering work of Drs. Nadine Burke-Harris, Bessel van der Kolk, and Peter Levine). 

Despite a growing body of scientific evidence, this fact remains largely unacknowledged by our institutions, though it will pose a significant challenge to our healthcare system in the months and years to come. In order to be effective, our mental health interventions must address the bidirectional relationship between mind-body health and facilitate interventions that adequately support our biopsychosocial needs in both areas.

Take Action: When it comes to both COVID-19 and climate change, examples of meaningful biopsychosocial interventions are still limited. However, others working in related fields are providing promising models to lead the way.  In Toronto, for example, Dr. Gary Bloch treats poverty, homelessness and other social diseases as part of his approach to healthcare. As he explains in a recent interview, “When you can’t afford decent food or shelter, it has a very direct impact on health”. In a similar vein, “your neighbourhood can also affect your health, like having housing and supportive, safe communities.” His intervention model acknowledges that, whatever the ailment at hand, dealing with individual factors alone will not be enough if systemic issues are not included in our understanding of health and wellbeing. Not doing so is to continue “looking at the wrong level” because, for many, “the underlying causes [of disease] are still inequality, racism, marginalization”.

2. Trauma is an ‘ecological’ issue

Because we do not exist in isolation from others, the experience of trauma is inherently a relational one. The impacts of trauma do not begin and end with single individuals but reverberate across the complex web of relationships that form the social ecosystem through which our lives unfold. As this academic study puts it, “for example, existing social services may become strained or ineffective, social support networks may be similarly stressed, and neighborhood, school, and work settings may become less effective in serving as buffers as employees and family members are absent or incapacitated.” Being able to rely on various forms of interpersonal and community bonds is precisely what helps people respond to, adapt, and integrate a traumatic experience. 

If these bonds become strained or are not available––including in the form of lack of institutional acknowledgement or support––the experience of trauma can lead to disease as well as burnout, isolation, and social exclusion––understood not just in terms of social disconnection but of diminished participation in the economy. Financial insecurity can, in turn, ripple out to affect workplaces, households, and tax bases––affecting access to and delivery of social services, and placing additional strain on the very social networks we rely on for emotional and material support. For these and other reasons, we must challenge the traditional view of trauma as an individual medical diagnosis and recognize it for the ‘bioecological’ experience that it actually is.

Take Action: Rebecca Solnit’s excellent A Paradise Built in Hell remains one of the most compelling accounts of community organizing and solidarity in the aftermath of a disaster. With examples dating back to as early as 1906, Solnit documents the creative and altruistic ways in which communities hit by tragedy have been able to meet their needs in times of great uncertainty. Her recent article in The Guardian explores the rise of mutual aid groups and the many ways in which neighbourhood collectives have stepped up to help with anything from grocery shopping to childcare as a result of the systemic shortcomings that have exacerbated the impacts of COVID-19 on the ground. Guided by the principles of kinship, empathy, solidarity, and innovation, the mutual aid interventions she documents are rooted in the belief that tragedy can rekindle relationship, and that resilience must be fueled by joy and connection in order to be meaningful.

3. Trauma does not affect us equally

We are not all exposed to trauma in the same way, and we do not all have access to the resources required to heal from traumatic experiences. For example, marginalized and racialized populations are affected by a disproportionate level of exposure to trauma. For many oppressed communities, exposure is often entrenched in intergenerational dynamics that leave profoundly devastating and harmful effects across entire family and community systems. These experiences, in turn, increase the risk of survivors for outcomes such as unemployment, addiction, poverty, and homelessness––conditions that lead to greater vulnerability in the face of disruptive events such as a pandemic. In order to be meaningful, responses to COVID-19 must take into account the ways in which structural inequality affects human health and development, and must be planned from a trauma-informed perspective to avoid causing retraumatization and further marginalization. 

Take Action: In the United States, the COVID Racial Data Tracker–a collaboration between The Atlantic and the Antiracist Research & Policy Center led by Ibram X. Kendi––is showing that Black people are dying at a rate more than 1.5 times higher than their population share. Public health authorities have been slow to collect race-based COVID-19 data, yet these are profoundly traumatic experiences that will be felt across family and community systems for years to come.  A trauma-informed approach to healthcare will be crucial in addressing the complex impacts of structural inequality.

4. COVID-19 is not our only public health crisis  

Whether we realize it or not, COVID-19 is not the only public health crisis the global community must urgently contend with. As a recent Grist article put it, “we are running out of time to flatten the curve for climate change”. As research suggests, warming temperatures will lead to more frequent viral outbreaks, contribute to a slew of complications such as asthma and heat stress, and will exacerbate eco-anxiety in daily life. This is why experts now consider climate change to be a public health matter. Trauma itself is also considered a public health crisis––particularly childhood trauma, which some already consider an epidemic, and which could be exacerbated by the intergenerational inequality inherent in climate change. This means that public health departments worldwide are poised to come into closer and more frequent contact with trauma. Trauma will become a formidable reality to contend with (and budget for) as health hazards and socio-ecological stressors continue to multiply. In order to be effective, institutional responses must acknowledge the interactive nature of these three simultaneous crises. The trauma-informed framework, particularly its bioecological perspective of hazards, is arguably the only one suited to offer solutions commensurate with the scale of the problems that we face. 

Take Action: In Canada, Nourish Healthcare works at the intersection of climate change, health equity and community resilience. The organization designs wellbeing interventions that address patient, community and planetary health through the lens of food. By working holistically to address issues often treated as separate, the organization works to empower healthcare leaders to transition to a preventative, equitable and sustainable health system by tackling the public health dimensions of climate change, the ramifications of health inequities on society, as well as the rising costs of food insecurity on both people and planet.

5. COVID-19 responses require a ‘healing justice’ approach

COVID-19 responses must be more than band-aid solutions or a ‘one-off’ intervention. Responding to the pandemic means taking into account not only economic priorities and emergency care protocols, but also the physiological, psychological, and socio-economic determinants that promote health and safety in the population. Here, the work of ‘healing justice’ advocates offers particularly valuable guidance. This grassroots movement calls for interventions that deliberately promote equity and wellbeing as the primary outcomes of healthy adaptation. In this sense, the view of healing goes beyond individual self-care and doubles as a political act through which individuals and communities can reclaim wholeness, seek empowerment, and co-create alternatives to harmful structures that promote inequality.

Take Action: The following resources are offered as starting points to learn more about healing justice thought leadership and practice:

• Black Lives Matter’s Healing Action toolkit;
• Shawn Ginwright’s excellent The Future of Healing: Shifting From Trauma Informed Care to Healing Centered Engagement;
• This Is Our (Caring) Revolution, Ai-jen Poo’s interview with Krista Tippett
• How We Show Up: Reclaiming Family, Friendship, and Community by Mia Birdsong
• Decolonizing mental health: The importance of an oppression-focused mental health system by Karina Zapata
• Healing-Centered Youth Organizing: A Framework for Youth Leadership in the 21st Century by the Urban Peace Movement
• The Healing Collective Trauma portal
• The Politics of Trauma: Somatics, Healing, and Social Justice by Staci K. Haines
• Turn This World Inside Out: The Emergence of Nurturance Culture by Nora Samaran

—

In its profound and all-encompassing disruption of everyday life, the coronavirus pandemic presents us with a powerful opportunity to question the ‘normal’ we once knew. Rather than bouncing back to the status quo, we can leverage the blueprint that trauma literacy and healing justice offer our society to spark new conversations about vulnerability, solidarity, and care. What visions of health, wellbeing, and resilience do we want to enact after the pandemic? What values do we want to uphold moving forward? Will we redesign our systems so not to separate mental health from physical health ever again? We can take stock of the insights generated by the pandemic to course-correct from a path of post-traumatic stress disorder to one of post-traumatic growth. We have a choice to make, and we’re running out of time.

---

Chiara Camponeschi
June 29, 2020