When Trauma Takes Charge

by Mitch Radin, Clinical Psychologist

brainThe amygdala is a little portion of our brain that is responsible for our survival. It evaluates threats in a matter of milliseconds and reflexively prepares us to fight, run, or simply freeze to defend ourselves. All of these are important and appropriate responses in the face of danger, and hopefully the right reaction is triggered in the event of an imminent threat. For people who have a history of trauma, however, the assessment of what constitutes a threat is often distorted, as experiences are filtered through an amygdala that has been hijacked by stress, and the reflex to fight, flee, or freeze happens when it’s not necessary.

This has profound implications for health care, as being sick or hurt is an inherently vulnerable experience, and a common response to trauma is to become hypervigilant in an effort to defend against vulnerability. It may not seem obvious, but fighting, fleeing, or freezing might play out in the form of lack of adherence with medical treatments or medications, missed appointments, poor self-care, and even overtly self-destructive behaviors. We want our patients to be full participants in their care, but when that amygdala has been activated and set permanently on high alert, the most benign request by a provider can make someone feel vulnerable and out of control, overwhelmed, or even assaulted. If we understand this, we can begin to help people who have difficulty accepting it.

There are five things we can do to help people in the medical system, from front desk staff all the way up to administration, to address the complicated work of helping people struggling with responses to trauma:

  1. First is patient empowerment, where the focus is on identifying an individuals’ strengths to engage them in the development of their own treatment.
  2. We can emphasize choice when we educate and include patients in choosing the types of treatments they receive.
  3. Collaboration maximizes communication among health care staff, patients, and their families in organizational and treatment planning.
  4. Considering safety takes into account each individual’s unique needs when thinking about what feels safe, both physically and emotionally.
  5. Finally, and maybe most importantly, is trustworthiness. Providers outline clear expectations with patients about what proposed treatments entail, who will provide services, and how care will be provided.

Trauma-informed care works to present an all-encompassing picture of a true client centered approach. This is good practice in general, but for people suffering the aftermath of trauma, to be seen as a whole person goes a long way towards feeling in control, rather than at the mercy of their medical care. If executed correctly and compassionately, that amygdala may be able to kick back and relax for a change.