How Previous Trauma Can Affect Healthcare

Telling your story can be a very powerful experience. However, the doctor’s office is a place where the ability to tell your story can be impacted by trauma, childhood neglect, and instances of racism which can inadvertently result in misdiagnoses, lack of care, and insufficient treatment which all lead to poor outcomes in spite of the best intentions of healthcare providers and their patients.

doctor with patient
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It is a well-documented fact that there is an implicit bias among the health care community. Research has shown that healthcare providers tend to favor White appearing patients and have more negative attitudes towards people of color. Many times, healthcare providers are not even aware of their own biases and assumptions which negatively affect the health outcomes of their patients. This can result in an increase in negative physical symptoms including prolonging physical ailments, higher likelihood of death among patients of color, and poorer overall health. For this reason alone, I believe it’s important to address the issue of storytelling within the medical setting.

It’s not just people of color who have a hard time telling their story within a healthcare setting. People who have experienced trauma, neglect, abuse, and oppression may either hide or minimize their symptoms, worried that they might be seen in a negative light or not be taken seriously. Trauma in all of its spectrum can affect people’s ability to communicate, trust other people, and feel safe, especially in a setting that by its very nature exposes the common vulnerabilities of our human nature.

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For a person who has been sexually abused, any exam that involves touching, removing articles of clothing, or talking about body parts or physical functions can elicit feelings of shame, alarm, and hyperarousal. A doctor’s tone of voice, physical movements, and the question he or she asks and the way they ask it can all make the difference between the ability to form trust in a patient who has been sexually abused or leave the patient feeling ashamed, terrified, or upset.

People who have been physically abused may be on high alert inside a medical office, and may flinch at the slightest touch, be less accepting of treatment until a bond of trust is formed, and devalue their symptoms. They may be out of touch with their body and not able to form words to describe their physical symptoms.

Victims of neglect have learned that their needs are not important and will carry that belief into the doctor’s office. Some symptoms of victims of neglect may include a quiet or passive demeanor, not being forthright or specific about their symptoms, and appearing tearful or emotionally overwhelmed. Often, they will not ask questions that will help them advocate for themselves. On the surface they might agree to the treatment but they may not follow up on treatment protocols, due to poor time management, low self-esteem, and self-sabotaging behavior.

People who have experienced racism either within a medical setting or outside of it will struggle with sharing their symptoms, especially if the provider is the same race as the person who has hurt them. Those who have experienced racism or microaggressions within a medical setting may be reluctant to seek medical help and will wait until symptoms are more severe instead of taking a more preventative approach. Patients of color may be more likely to seek out alternative medicine providers to alleviate their symptoms after losing faith in the traditional medical establishment. Tearfulness, aloofness, brusque behavior, and a stoic attitude in a patient of color can all be manifestations of the emotional pain they carry within them.

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Of course, it’s rare to find a patient with just one ACE (adverse childhood effect). Patients will come with a variety of traumas and other issues that are left unspoken until they find the right doctor that builds up trust in the doctor-patient relationship. A good trauma-informed doctor encourages the patient to tell their symptoms in such a way that helps the doctor better understand the patient’s background and arrive at the correct diagnosis. The following are a list of ways that medical providers can help patients tell their stories so that they can share vital medical information with their doctor:

How to Help Patients with Trauma

  • Speak in a gentle voice
  • Speak slowly
  • Assess patients for their ACE score
  • Ask the right questions (see below)
  • Ask clients what they think might be the cause of their symptoms.
  • Avoid rapid physical movement
  • Avoid standing too much as that can appear dominant in relation to the client. Sitting can show receptivity towards the patient.
  • Look patients in the eye
  • Tell patients that their story is important and that you care what they have to say.
  • Ask patients for permission to ask questions or perform procedures, especially if they seem nervous, withdrawn, agitated, or have an ACE score.
  • Ask for feedback on how you can provide an improved patient experience.
  • Assess for and validate the reality of a client’s previous negative medical experience. You are not responsible for medical trauma caused by other providers, but you can provide healing to a client who has experienced medical trauma, simply by providing a positive experience for the client where they can be heard.
  • Give patients as much time as you can and apologize if you can’t continue the conversation due to time restraints. Allow the patient to tell you the rest of the story via some other form of communication. This shows the patient that you are interested in what they have to say.
  • Respect a client’s culture and be aware of the assumptions you may be making. For example, some clients may not be aware of the basics of nutrition if they were neglected as children. A person who was adopted may not feel comfortable talking about their genetic history, as it reminds them of their loss or what sets them apart from other people.
  • Ask patients what would help them feel more comfortable sharing their information.
  • Self-disclosure, when done appropriately, can help a patient form a bond with their doctor that helps the patient feel more comfortable disclosing vital information.

Trauma-Informed Questions for Doctors to ask a Patient

  • Is there anything you think I should know about?
  • Is there anything in the past that might be affecting the symptoms you have now?
  • Why do you think this is happening right now?
  • Is there anything that makes this hard to talk about?
  • If you find it hard to talk about it, is there a better way to tell me what you think I might need to know? What would help?
  • Have you ever experienced difficulty receiving medical treatment before?
  • Are there things that currently get in the way of being able to receive medical treatment?
  • Is there anything else that might make it hard to follow the medical plan?
  • If you come up with any more thoughts or concerns on this, could you please let me know?
  • How are you feeling today?

Ways to Tell Your Story in a Medical Setting if You Have Experienced Trauma So You can Get the Care You Deserve

  • Find the right provider. It’s so important to find a provider who you feel comfortable talking to and who listens to your story. Don’t be afraid to try out several until you find that right fit.
  • Take time to prepare ahead of time for your visit with questions you might have. Think about what struggles you may have with talking to your doctor and how you can overcome these challenges.
  • Tell your doctor if you are feeling uncomfortable talking about certain things. This can help your doctor understand you better and might help you feel more comfortable talking about it after all.
  • Ask the doctor if they have any training or experience in trauma-informed care.
  • Remember that you have a right to say no to any treatment.
  • All feelings are valid, whether they are physical or emotional. Sometimes talking about your emotions first can help you identify and talk about your physical symptoms.
  • If you are worried that your doctor will not believe you, be open with your doctor about it. This will give your doctor a chance to allay your fears and validate your symptoms, thus reducing your negative cognitive distortions and improving your relationship with your doctor.
  • Find a type of treatment that is more trauma-informed. Functional and integrative medicine providers, along with naturopaths, tend to have more training in mental health along with a more open, problem-solving approach. However, some more mainstream medical providers are becoming more aware of Adverse Childhood Experiences (ACE) and incorporate that into their practice.

Can I Be Too Tired To Be Anxious?

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Someone once asked me if it was possible to be too tired to be anxious. In other words, could you tire yourself out so much that you could reduce anxiety? In a nutshell, yes, but not necessarily for the reasons you might think. Some people tend to have more anxiety when they are used to being so busy as a way of numbing their natural emotions, including anxiety. When they finally have down time, they struggle with their uncomfortable feelings, and the panic of not having their normal means for numbing their feelings.

One of the reasons it’s always important to take time for ourselves where we are not purposely busy, time to just be, is because our mind needs time to wander, our heart needs time to ponder and to just feel whatever emotion comes our way. We need time to refresh and renew. A lot of anxiety can come from just being too busy and not taking time to let those thoughts and feelings, however uncomfortable, come to light and exist before they disappear.

If we constantly busy ourselves, those strange and alarming thoughts come to us at night when we finally have time to rest, keeping us from being able to sleep as they try to grab our attention. It’s much better to give time to think and feel during the day, even if it is just for a few minutes. I sometimes wonder if some of the symptoms of ADHD come from a life filled with constant stimulation and no time to pause and let our minds and hearts be moved by the world around us and inside of us.

Physical exercise, good time spent with loved ones, a pleasant time spent working on hobbies are all great ways to spend our energy. When we have a good day we can reduce our anxiety, which in turn makes it easier to sleep at night, knowing that we are loved, the world is safe enough, and life is good enough.

Anxiety left untreated and ignored can lead to us feeling very worn out. When we constantly worry and feel on edge, as our thoughts take us down some very bad paths, it is easy to feel discouraged, hopeless, and depleted. Anxiety is natural for everyone, but when it sticks around for a long time, it can wear out our body, cause physical damage, and take away our joy. That’s when it’s time to seek help and take back your life, so that you can enjoy life again and have energy for the things that matter.

What to Do When You Don’t Feel Creative

It’s been a long, hard, traumatic road for a lot of people this past year in America. I can’t even speak for the rest of the world. A global pandemic, race riots, our beloved Capitol being attacked, being stuck at home, mandates after mandates, masks, hand sanitizers, job loss, and a lot of time on people’s hands. What’s one to do?

Some people have tackled house projects, taken on new creative pursuits, and gotten back to the basics. A lot of other people felt like the wind was taken out of their sails and they have been stuck in the Bermuda Triangle for almost a year.

side of sailboat
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Even though we can smell change in the air, for better or worse, we wonder if we will ever enjoy the things we used to enjoy again. If you are one of those people struggling with writer’s block, or any other creative pursuits that just can’t make it past an idea and a few well-intentioned purchases, here are some tips to supercharge your creative engines:

How to Find Creativity Once Again

Do Something Out of Your Comfort Zone: If you are a writer, try painting. If building things is your passion, try baking. Do something different, unusual, never been done by you before. Focus on the process, not the outcome. Along the way you will either a) really long to do what you know what to do or b) find a new creative outlet

Pick Up that Really Long-Lost Project: You know that sweater you started knitting for your high-school boyfriend. Yeah, that one, the one stashed away in your attic. How about that novel you planned to write 10 years ago, sitting in some hard-drive somewhere? How about that model train kit you planned to build with your son who is now 30 and living his own life? Nostalgia can be a great inspiration for further projects and there is something satisfying about picking up long-lost projects and remembering the good times once again.

Remind Yourself Why: When you are feeling stuck, it’s easy to stay in the stuck zone. Behind every project is a reason, an ideal, an image, an emotion of something pleasant. Remember what inspired your drive to create in the first place. Were you planning to give a gift to someone, pursue your own knowledge and skills, make the world a better place, or just have fun?

What is the Difference Between Burnout and Depression?

Let’s face it, millennials are burned out, triggered by being underpaid, overworked, and overdigitalized. Authors are finally beginning to talk about the issues, such as how millennial burnout happened in the first place, and how to succeed in spite of everything.

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What Are The Signs of Millennial Burnout?

Signs of burnout in millennials may include:

  • Working hard, often several jobs, and just barely being able to pay the rent/mortgage/bills, etc.
  • Feelings of hopelessness
  • Lack of motivation
  • Overuse of technology
  • Feeling drained by digital communication
  • Having a hard time concentrating and setting clear goals
  • Feeling constantly pressured
  • Exhaustion
  • Mental fatigue
  • Mental cloudiness
  • Feeling constantly irritable, tense, and restless
  • Feeling stuck
  • Constant negative thoughts that won’t go away
  • Not being able to relax/Always having to be “on”
  • Never feeling satisfied
  • Having a hard time accomplishing even minor tasks
  • Thinking you are not good enough
  • Feeling guilty for not doing enough or wasting time

What is the Difference Between Burnout and Depression.

Burnout can look a lot like depression, because symptoms of depression can also appear in someone who is burned out. One of the main distinguishing factors is that burnout can be resolved relatively quickly with self-care and rest, whereas depression generally lasts longer and can take longer to resolve. Burnout is generally related to work, whereas symptoms of depression cover all areas of life. Burnout can lead to depression, if left untreated. If you suspect you may have depression, burnout, or both it is best to consult with a medical doctor to eliminate any underlying conditions. Seek an experienced therapist to help you find ways to reduce stress, find out what is really going on, and explore ways to recover mental wellness.

How to Spot a Covert Narcissist

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Unfortunately, many people do not realize that they have been under the sway of a covert narcissist until it is too late. By the time they recognize it, they have lost their job, their spouse, their self-worth, and their trust in humanity, to name a few possible effects after the Great Discard. The following are a few ways to identify covert narcissism before it is too late:

Procrastination: A CN will show up late or not at all to an event that is important to you. They show you time and again that you are not important to them. When you ask about it, they make excuses or place the blame on you.

-Pretend to be virtuous: A CN will go out of his or her way to look virtuous, often engaging in what look like saintly acts, but are done only for self-gain. They will donate to charity, be amazingly sweet with vulnerable people, and tip when people are looking. When there is no one to admire them, they will snub and ignore those same people and charities.

Fish for compliments: A CN will put themselves down, and then pause so that others can prop up their fragile egos by complimenting them.

-History of failed relationships: CNs often leave behind a string of failed marriages, abandoned friendships, and relationship chaos seems to follow them wherever they go.

-Feeling of being special: CNs ooze out that feeling in a room that they are gifted with intuition, understanding, healing power, knowledge, academic intelligence, compassion, etc. and other people “just don’t understand.” Their emotions become their truth and won’t let logic and facts get in the way of their false narrative.

Lack of attention: When a CN does not feel that something is to their advantage they show their boredom and lack of concern in a myriad of ways. They may yawn during a heartfelt talk, have a glazed over look when you present an important concern, appear distracted, and even start looking at their screen when you try to engage them.

-Manipulation of information and triangulation: If you start to notice that the facts just don’t add up, or that you are told one version of a story by the CN and another person is told a completely opposite version of the story, chances are good that you and the other person have been played by the CN. A CN likes to feel special by sharing “secret information” with other people, telling them the version they think that person wants to hear. When the two victims finally talk to each other (and the CN will do a lot to prevent this!) there is a lot of misunderstanding, confusion, and a strong feeling of betrayal and lack of trust.

-Perpetual victimhood: CNs always have great, believable sob stories. Like the Joker in the Batman move, they change their story based upon who is hearing it and what they believe is most likely to move the listener. If one were to do more research into the story (which the CN will do everything possible to keep you from doing!), one would find a significant amount of embellishing, outright lies, and shaming of others who don’t deserve it. That is one reason why CNs are so adamant on controlling the narrative, and keeping the facts from others. They are not above lying to control others’ perception of themselves as the heroes and significant others as villains.

If you think that you might be in a toxic relationship with a CN, don’t despair. The hardest part is identifying the problem. Once you have identified that you are dealing with a CN in your life, you can take action to heal yourself, arrive at the truth, get support, and set good boundaries. Because you are worth it.

How to Spot Toxic Perfectionism

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Brene Brown talks about living in a culture where we are expected to be perfect, and what it’s like to be our own worst enemy. There is a lot of change happening between generations, and I am seeing a lot of hope within that change. I am seeing people embracing natural hair, acceptance of all body types, no or minimal makeup, body hair, skipping college debt, and talking about race. In other words, slowly a younger generation is saying it’s okay to be you, warts and all.

However, we all have an inner critic to contend with, even if the culture around is starting to accept individual differences. This inner critic can be a “drama queen”, telling us how bad everything is going to be, why we shouldn’t even try, and a host of other lies. The inner critic can be so convincing that it’s hard to step back and realize that these thoughts are not true. It’s so much easier to be negative and hard on yourself than to believe that good things are possible and it’s okay to be vulnerable and fail every once in a while. The following are a few ways to spot when the inner critic has gone too far and taken over your life:

Signs of Toxic Perfectionism

-Nothing is ever good enough.

-You are sure you will fail, so you don’t even begin something.

-You spend way too much money on trying to impress other people.

-You don’t feel good about yourself and wish you could be someone else.

-You berate others for not living up to your own standards.

-You suffer from anxiety and experience stress when called upon to perform.

-You have a hard time making a choice, constantly fearing you are making the wrong choice.

-You put yourself down, before other people can (and you are sure they will, even if evidence is to the contrary.)

-You can’t accept compliments.

-You are irritated or embarrassed by other people’s vulnerabilities and flaws.

-You are constantly measuring yourself and comparing yourself to other people.

-Putting on an appearance of being someone you are not.

-You see things in black and white.

-You place your self-worth in what other people say about you.

Toxic perfectionism can often be a result of emotional abuse, neglect, trauma, culture, social or academic settings, or growing up with narcissistic, or emotionally immature parents. It’s important to realize that we all struggle with an inner critic, even people who seem put together. Find someone that you trust to share your struggles with, so you don’t have to fight your battles alone. Perfectionistic habits can be hard to break, but learning to be okay with yourself is a reward in itself.

How Does Trauma Lead to Anxiety?

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Anxiety is a pretty common symptom of Post-Traumatic Stress Disorder. In fact, research has shown that most anxiety is caused by some type of trauma. If someone has gone through a serious trauma, the brain goes into hyper-alert mode, even months or years after the traumatic event took place.

The amygdala, a small part of our brain that alerts us to danger becomes over active. When even small events that remind us of the trauma or seemingly unrelated occurrences happen, the amygdala hijacks our brain, disrupting the connection to our prefrontal cortex, the part of the brain that helps us be logical, strategize, assess for real danger, and plan. Instead our limbic system gets stuck playing the same tune and it becomes hard for us to think critically, take action, and unfreeze our brain.

Anxiety has a way of taking over our life. The first way to address anxiety is to be able to identify what it looks like.

Symptoms of Anxiety

  • Avoiding people or places
  • Isolation
  • High blood pressure
  • Hypervigilance
  • Becoming easily startled
  • Emotional volatility
  • Negative or unrealistic thoughts
  • Headaches
  • Overloaded schedule
  • Fatigue
  • Feeling numb

If you suffer from anxiety, it’s good to get help. Whether you read a book on anxiety, talk to a friend, or seek therapy there are a variety of ways to reduce or even eliminate anxiety from your life.

Fall Musings

cozy picture of feet on wooden deck with leaves, blanket, coffee, a book and pumpkin
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Fall is a season of change, of loss, of letting go. This year it feels like fall has happened already, again and again. We have lost our normal lives, our ability to feel comfortable in the normal actions we used to take for granted. There is an increase in anxiety, grief, and what will later be understood as societal trauma, not unlike that of the Great Depression.

The great question is, “Where do we go from here?” We can’t predict with certainty what will happen in politics, schools, health, or jobs. We can however, look to what we can know. We can reach out to each other (even if not literally, even if only over a screen) and be there for each other. We can ask for help. We are not alone, even if it seems like it.

We can take this extra time to reexamine our lives and our priorities. Often it’s easy to ignore our problems when we have places to go and things to do. Now is a time for healing and growth.

It’s also a great time to take risks and change things up a bit. When everything is different, it’s a good time to get a new perspective on life and try new things.

Enjoy the small moments. No matter what happens, beauty is all around us, if we can take the time to savor it.

When Helping is Not Helping

It’s great to be able to help a friend, neighbor, or family member in a time of need. If you have ever been the recipient of a home-baked meal during a family emergency, a gift card when you lost your job, or strangers offering to fix your flat tire (it happened to me in college in the winter), you know how good it feels to have your faith in humanity restored and know that even if just for a little bit, things are going to be okay. You are going to survive for another day.

The evil twin of helping is enabling. It’s favorite disguise is good will and perfectionism. You see, from a young age children slowly and with lots of mistakes learn to do things on their own. In healthy parenting, parents allow their children to explore (within reason), try new things (according to their age level and risk), and take on projects. Parents can challenge their children to do their developmental best, thus letting them know that they believe in them.

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When my daughter was younger, I saw too many parents on the playground not letting them go down the slide by themselves, not letting them experience the soothing and balancing effects of nature (mud, wind, rain, etc), not letting their babies cry even for moment as they turned away for a minute, pacifying their toddlers with screen distractions, and not letting their babies experience the effects of gravity as they tried learning to walk on soft grass. In other words, enabling starts at a young age.

The effect of enabling is crippling. In adulthood, it leads to lack of confidence, anxiety, anger issues, depression, lack of motivation, panic attacks, and poverty. When people are constantly told, “You can’t do this, you need my help,” through other people’s words and actions, there are a variety of responses. Some turn to anger and acting out as a way to put up walls and fiercely protect their natural need for independence. Others feel lost and helpless, so they learn to manipulate others into doing things for them, all the while suffering from depression and low self-esteem. They are really good at looking like helpless victim because that is the role they were taught from a young age. Other people may internalize and believe that they are indeed helpless. This can lead to a variety of mental health problems including OCD, bipolar disorder, and dependent personality disorder all based on an intense need to get real needs met in unhealthy ways, resulting in feelings of helplessness, loss of control, and interpersonal problems.

If you have been an enabler, it is never too late to turn to healthier ways of helping. Focus first on self-care for yourself, and acknowledge the effects of enabling. Find ways to achieve balance in your life, and how to truly build up others in a way that acknowledges human freedom and capability and does not deplete or diminish you or the person receiving your help.

If you have been shackled by the chains of enabling by others in your life, it’s never too late to find your freedom. Learn to set good boundaries and say no. Develop healthy social relationships with others who respect your free will. Take credit for the hard work that you put into developing yourself. Set achievable goals for yourself, and don’t be afraid to ask for help when you are ready, from the right people.

What to Do When You Have a Narcissistic Family Member

I wrote this post to help people struggling with how to survive and thrive around narcissistic family members. There is so much more I could say on this topic, but I wrote this last-minute after spending many days staying up late working on an application for contract work. Maybe more to come…