Retraumatization and cultural context

Twenty years ago, the Kaiser Permanente Adverse Childhood Experience (ACE) Study revolutionized our understanding of trauma’s impact on survivors of abuse. Today, more and more mental health practitioners are transitioning to a trauma-informed framework. For mental health professionals and activists who have been advocating a justice based approach to mental health, this is a significant victory. But what does it really mean for those seeking mental health care?

According to ACEs Aware, “trauma-informed care recognizes and responds to the signs, symptoms, and risks of trauma to better support the health needs of patients who have experienced Adverse Childhood Experiences (ACEs) and toxic stress.” Essentially, trauma-informed frameworks acknowledge the risk for retraumatization in clinical care for those who have experienced high-stress or life threatening events. 

Many people who have been through domestic abuse, natural disaster, active combat, and other traumatic events experience long-term health consequences. For example, the ACE study indicates that survivors of trauma may have decreased immune functioning. They may also have increased risk for addiction, suicide and heart disease. 

With time many of the negative impacts of trauma can heal. A safe and therapeutic socio-economic environment can help. To create such a supportive environment, we need to educate mental health care providers on how to support their clients effectively. But we also have to push for social changes that can reduce the frequency of ACEs and the retraumatization of survivors. We have to be willing to examine our social values and systems so that we are accountable to marginalized people and are committed to evidence-based solutions.

Avoiding retraumatization in therapy

Retraumatization is any event or experience which triggers the mind and/or the body to react as if they are facing a life-threatening danger. Retraumatization results in new or worsening symptoms of Post Traumatic Stress Disorder.

Research indicates that uncontrolled exposure to significant triggers and traumatic events is likely to result in retraumatization. However, controlled exposure, like that used in exposure therapies and virtual reality or video game reenactment therapies can actually heal a traumatized nervous system over time. 

There are several key factors in determining whether exposure harms or heals. First, a survivor’s self-determination is vital. Exposure to triggers must be deliberate and consensual if they are going to contribute to healing. 

Survivors also need to be in an environment where they feel a sense of safety. By providing survivors with the ability to control how and when they are exposed to their triggers with a brief alert, therapists can reduce the risk of accidental exposure and retraumatization. Aftercare, including soothing post-exposure activities like journaling, debriefs, or grounding techniques, is important as well.

Avoiding retraumatization through cultural shifts

To avoid trauma and retraumatization culturally, we need to empower and protect children. The UN’s Convention on the Rights of the Child defines a minimum standard for quality of life that all children should be provided by power of law. It requires signatory nations to submit many domestic public welfare policies for review. The UN then evaluates the policies to determine their effect on the baseline quality of life of the nation’s children. 

The Convention defines “Child” as any person under the age of 18 unless the nation’s age of majority is below 18. It prohibits capital punishment for Children and protocols regarding children’s involvement in the military. Organizations like UNICEF and OECD release reports documenting the quality of life of children internationally using welfare criteria based in the guidances of the Convention.

The United States fails children

The United States contributed to the Convention. However, it has refused to ratify it for years. Administration after administration has failed to submit the Convention to the Senate. The United States does not follow many of the Convention guidelines. For example, it remains legal to sentence minors to life without parole.

It is likely that the US’s own failings play a significant part in its failure to ratify international treaties under which its policies could be reviewed and found wanting. In November of 2017, The Organisation for Economic Co-operation and Development (OECD) reported that the US ranked in the top third of countries studied internationally in only 3 categories related to child welfare. These included:

1. Number of adolescents who expect to complete a university degree
2. Number of adolescents regularly engaging in rigorous exercise
3. Average disposable household income for children. 

In contrast, the US ranked in the bottom third of countries studied internationally in TEN categories. These included three critical criteria:

1. Number of children in relative income poverty
2. Infant mortality
3. Adolescents skipping meals

In addition, children of marginalized communities such as indigenous communities, and LGBTQ+ children, are still disproportionately represented in the United States foster care system. This is evidence of America’s failure to address its history of discrimination, oppression, and genocide.

Discrimination and mass retraumatization

In discussing retraumatization, we must discuss the issue of mass retraumatizations. 

Mass retraumatizations are events which send ripples of trauma through entire communities, some bound by region and some by identity or demographic. State violence against marginalized citizens, major weather events or environmental shifts as a result of climate change, hate crimes and white supremacist violence, school shootings, and other similar acts of violence or destruction to communities can traumatize hundreds, thousands, or millions at once. 

Modern news cycles often exacerbate trauma with their reporting methods. Each wave of coverage can become a secondary trauma to the initial event. 

Mental health professionals have a responsibility to put in place better therapies that will not traumatize survivors. But they also need to work with justice and civil rights movements around the world to prevent children and marginalized people from being abused and traumatized in the first place. By working towards social justice, mental health professionals can contribute to the cultural shifts needed to develop truly trauma-informed communities.