Trigger Warnings & Trauma-Informed Care

trigger warning (n): a statement at the start of a piece of writing, video, etc. alerting the reader or viewer to the fact that it contains potentially distressing material

Back when I worked in an urban clinic there one doctor would be rostered to cover ‘police cases’ i.e. cases of sexual assault. I dreaded this duty. We all have our weak spots, and sexual assault is one of those scenarios where it’s impossible for me to maintain professional detachment. But it was part of the job at that clinic, and it didn’t seem like an opt-out deal.

I wondered, what if I was a survivor of sexual assault? I was already so uncomfortable, how would I have managed if this was actually a trigger for me? Do our supervisors check to make sure we’re psychologically prepared for this kind of duty? Or is graduation from medical school supposed to guarantee a certain level of psychological fitness?

Recently I participated in a training session for healthcare workers on mental health. The group was discussing self-harm and suicide, a topic that was bound to come up in any kind of training around mental health. But the attitude of a few group members caught me off guard; they were dismissive and flippant. When someone used the phrase “attention-seeking” I had to step outside.

The debate around trigger warnings has gained in velocity and vitriol in recent years. Opponents of trigger warnings label and shame people with mental illnesses as weak. Social media has watered down the phrase so that it’s become a joke, a meme or a gif. Still survivors and their supporters try to carve out safe spaces, where people coping with trauma and depression can exist without sudden and painful reminders.

Should work be a safe space?

For healthcare workers, that would be impossible. We can’t predict what issues the next person will have. The patient is our first priority and we create safe spaces for them.

But what if we could create a work environment that protected the mental health of patients and staff too? What if we went to work acknowledging that other people might be dealing with trauma? What if we recognized the impact of trauma and proactively tried to reduce harm?

I don’t think trigger warnings are the best way forward. Jamaican society exists in a constant state of high tension, repeated trauma and triggers. Trigger warnings at work would be undermined by newspaper headlines, radio talk shows and social media. The added stigma against mental health would make the suggestion laughable at best and condemned at worst. But there might be a middle ground.

The mental health training session wrapped up with an introduction to trauma-informed care, a novel approach that will hopefully change the way we do things. Trauma-informed care emphasizes psychological and emotional safety for providers and survivors. A trauma-informed system realizes the widespread impact of trauma, recognizes signs and symptoms of trauma in patients, families, staff; integrates knowledge about trauma into policies, procedures and practices and avoids re-traumatization.

In a world besieged by natural disasters, civil wars and states of emergency, we need healthcare that is attuned to the realities of our experiences. If we are traumatized as a society we need a system that supports everyone, patients and providers, in achieving good health. Ensuring our organizations are trauma-informed is the best way forward.

Back to the House of God: some short reflections

1.

Final exams loom, a distressingly diminishing number of days away. Calendars are the enemy now and every sunset inspires a mixture of awe and resentment. Days and weeks and months are finite, fickle creatures.

2.

I reread Samuel Shem’s cynical exposé on medical training in North America because I needed to remind myself what I was working toward in the weeks after exams. House of God isn’t a particularly encouraging novel, but throughout the story hope rises like the Wing of Zock: unstoppable and overpowering.

3.

In this season of fasting (not Lent) I will have to give up so many of my vices: novels, writing, the internet, sleep. Oh, sleep, I will miss you. A fourth year student asked me what I would do come June 3 when the last of my exams are over.

“I’d run naked,” she suggested. Oblivious to our incredulity, she continued. “As I walk out of the exam, I’d be unhooking my bra, pulling down the straps.” She trailed off in slow-motion speech, lost in a fantastical daydream.

I intend to sleep the sleep of the guilt-free. It’s been so long since I had guilt-free sleep, I’m probably going to get an ulcer. Just one time I would like to put my head on a pillow and not have the voice in my head (which sounds uncannily like one of my friends) demand that I cease this nonsense and get on with studying.

4.

This morning while waiting on the bus that shuttles us to the hospital, I stared across the expanse of sea and horizon, thinking.

I feel like I’m being wound-up, I wrote in my journal, like an old-fashioned wrist watch. Will I fall apart when the time comes, or spring smoothly into action like some well-oiled gears?

Do any of us know how we will perform when we need to? I think everyone feels some tension at this point, regardless of ambition. Even those of us who are certain of passing (there are always some) are still anxious about graduating with honours or distinctions.

There’s so much at stake, so much at risk. I calm myself by remembering that this too shall pass.

*

P. S.

Thursdays have sort of turned into book sharing time, so I’m sorry if this wasn’t what you expected. But! If you read this far, know that I have been reading way more fiction than I should, and if you want a recommendation Neil Gaiman’s Trigger Warning is absolute soul-disturbing perfection and you should go read it now (Also, he and Amanda are pregnant so yay).

It’s so rare that I recommend a newly published book – am I doing it right?