It’s Much Worse Than What You Have in Mind

At least 90% of what I do at work is trauma work. It takes a while to realize this. It’s just the nature of community mental health. It’s hard to believe at first. I see only Medicaid clients currently and during my internship I saw only clients with no insurance at all. If you’re like me before I started this work, you hear “trauma” and you think about people who have survived rapes, etc. I see very few people who have only a few traumatic experiences. The reality is much, much, worse. Many of my clients have life histories where most of this fits (for some clients that I see, their experiences are much, much, worse than this outline):

• Patient is born whole into a supposedly “safe” culture during one of the largest stretches of “peacetime” and prosperity. Born into cities and counties with “modern” public health safety nets.
• Mother or father is often absent.
  • Or, if either mother or father was nurturing, the nurturing one dies in some ultra-tragic and messed-up way.
  • Or, turns out, one or both parents aren’t the biological parent and no one told the child until about 10-13 years old.
  • Or, if there is one parent and things start off good, some major disruption causes the single good parent to become severely impaired, which opens the door for subsequent horrible stuff to happen to the patient.
• Sexual abuse happens usually before the teen years.
  • Usually not one incident.
  • Usually not one abuser.
  • If not sexual abuse, severe physical abuse. Usually sexual, physical, and emotional abuse.
  • The person who is responsible for the child almost never responds to abuse in a supportive and nurturing way. Almost never gets the child help.
  • The parent or guardian denies that the abuse occurred. Or worse, blamed the child for being: seductive, disobedient, a liar, a troublemaker, the reason for all of the problems/disruptions in the family
• Because the home is severely dysfunctional, the patient becomes responsible for taking care of younger siblings (or the parent).
  • Cooks meals for siblings.
  • Steals things or hides food so that younger siblings don’t starve.
  • Tries to protect siblings from abuse (sometimes taking abuse in place of siblings).
• Patient gets bigger. Learns that anger is a good defense mechanism. Anger becomes its own thing.
• Patient learns in pre-teen years that alcohol, pot, or other substances can help with coping.
  • Alcohol and drug use become their own things…. become a part of the self.
  • Patient is out of sync with peers. Feels like a grown-up at 12 years old. Struggles to have friends, problems at school. Grades plummet.
• Patient briefly dates someone her own age, who is good to her. Quickly doesn’t work out.
  • Usually drops out of school. May get GED.
  • In mid-teen years, patient “dates” much older men.
• Moves in with older man at 15, 16, or 17 years-old. Older man is often one of the first grown men who looked safer than the original abuser. Older boyfriend may have been protective toward the patient against existing abusers in family.
  • She has his child
  • Or gets pregnant and pregnancy doesn’t work out
  • Or loses child to children’s services
  • Or loses child in some ultra-tragic and messed up accident
  • Or has the child and the child has ADHD, is on the autism spectrum, or has other intensive and special needs, which the patient is uniquely ill-equipped to manage.
• Gets married.
  • Turns out, he’s just as bad as the original abuser. Is physically, emotionally, and sexually abusive.
  • Stays married for 2-10 years.
  • Gets a divorce, usually after a particularly severe beating, assault, or near-death experience.
  • By early adulthood, many of the patient’s childhood “friends” are dead from ultra-tragic and messed up causes, as are many uncles, aunts, and cousins.
• Ex-husband usually dies in some ultra-tragic and messed up way (shooting, overdose, wreck)
• Other abusive intimate relationships happen.
• Life continues for a while and patient “manages.”
  • Maybe all through the 20s
  • Or 30s
  • Or 40s.
• Then something happens that “knocks the feet out from under” the patient.
  • Maybe the abuser dies.
  • Or, the mother of the abuser (aunt/grandmother) dies.
  • Or the patient is in an accident and slows her down (so she can no longer stay ahead of it).
  • Or, supportive grandparents die.
  • Or decades of stress hormones flooding the body cause fibro, or degenerative disc diseases. Chronic pain.
• Everything that happened between early childhood and now catches up to the patient all at once. Things that had been seeping start to pour. Emotionally, all hell breaks loose.
  • Severe anxiety.
  • Severe depression.
  • Severe PTSD symptoms of flashbacks, re-experiencing, trauma saturated dreams (have been happening, now much worse).
  • Substance use as coping really becomes its own thing and brings bad problems.
  • Other/healthier coping mechanisms go offline.
  • Thinks seriously about suicide.
  • Realize that if she wants to live (usually for sake of children), she need to get help.
• Patient walks into my office in crisis.