Hospitals, libraries, PTSD and the importance of being trauma-informed

Hospitals, libraries, PTSD and the importance of being trauma-informed

In the last two months, I’ve been in hospital more times than I have in years and during my hospital stays I’ve been thinking a lot about health services, libraries and other services that are trauma-informed; and how important being trauma-informed as a professional and member of society truly is.

‘Trauma’ is defined as an emotional or psychological response to a terrible or deeply distressing event. Trauma can stem from different life events, including bullying, assault, death of a loved one, neglect, accidents, natural disasters and illnesses. It’s important for all library workers to be able to recognise trauma, especially those who work with children or people who have experienced childhood abuse, because ‘adverse childhood experiences’ (ACEs) are shown to drastically impact the health, development, education and future opportunities of children – all of which libraries play a pivotal role in nurturing.

Trauma is a disruption of two basic needs: safety and community. Libraries aim to embody the needs of safety and community. However, when we work with people experiencing trauma we need to re-evaluate our services and whether we are operating from a trauma-informed service model. Cause here’s the reality – we all experience trauma at some point in our lives. However, if trauma extends beyond six weeks, individuals may be experiencing Post-Traumatic Stress Disorder (PTSD) or Complex-Post-Traumatic Stress Disorder (C-PTSD).

Data and science tell us a lot about trauma and its lasting impacts. According to the federal Substance Abuse and Mental Health Services Administration (SAMHSA, 2017), before the age of 16, three out of every four children will have experienced or been exposed to a traumatic event. Additionally, according to Mental Health First Aid Australia PTSD is the most common form of anxiety among adults. Trauma is a prevalent part of life and society, and librarians need to be trauma-informed and acknowledge the depth and intersectionality of trauma.

Trauma Informed Practice is a strengths-based framework which is founded on five core principles – safety, trustworthiness, choice, collaboration and empowerment as well as respect for diversity. Trauma informed services do no harm i.e. they do not re-traumatise or blame victims for their efforts to manage their traumatic reactions, and they embrace a message of hope and optimism. The trauma-informed model is based on four Rs:

  1. Realise the widespread impact of trauma and understand the diverse roads to recovery. Debunk the myth surrounding trauma (e.g. militaristic experiences are the most common cause of PTSD – this is not true – in fact, car accidents are the most common cause of PTSD, with medical experiences also being a high catalyst of trauma. Additionally, we all experience trauma at some point in our lives – so trauma-informed services are beneficial to everyone).
  2. Recognise the signs and symptoms of trauma
  3. Respond by integrating knowledge about trauma into practices and policies
  4. Resist re-traumatisation for those experiencing trauma

This approach is based on knowing the impact of trauma and aiming at ensuring environments and services are welcoming and safe for all. Libraries need to be trauma-informed due to our roles within our communities. I think we can do this through the power of stories, the power of choice and the power of words.

The power of stories

Psychologist Keith Oatley believes that stories can work as training instruments to help us navigate our problems and emotions (Jackson, 2016). This is otherwise known as bibliotherapy, which is defined by poetry therapist Wendi Kaplan as “promoting growth and healing through language, symbol and story,” (Jackson, 2016) Bibliotherapy is not new to the library domain. In fact, it evolved between the library profession and the medical profession in the 19th century when books were prescribed for particularly concerns. Today, bibliotherapy is widely used by social workers and therapists, and I think libraries should re-claim the practice they started. Nowadays bibliotherapy “is interactive and moves beyond simply reading and into discussion and expression. It includes the use of literature of all kinds, including poetry, book passages, quotations, songs, storytelling, even segments of movies and video to help a person focus on what personal meaning it holds for them, and then to express themselves through journaling, writing, painting, dance, movement, or art in ways that help them bring themselves to deeper understanding and awareness,” (Jackson, 2016).

Bibliotherapy has a humanising effect on trauma survivors. It teaches them to deal with emotions like pain, shame or heartbreak, while showing them that their experiences aren’t unique and they are not alone.

The power of choice

Often when someone experiences trauma a loss of control, choice or space is involved. Make sure your library offers choices – diversity in the books people read, the activities people do, and even the spaces people occupy. Sometimes, just letting a patron sit where they want in library can make them feel more empowered and gives them some of their choice, power and control back. In practice, trauma-informed libraries should be predictable environments, with planned transitions, clear boundaries, and compassionate staff. Make your library a safe place, where trauma survivors can reflect, pull themselves together and regain the control, choice and space they sometimes do not have.

The power of words

Words contain a lot of power, and being trauma-informed means we recognise the power of our words in order to resist re-traumatisation for others. Investigative or opinionated comments like “…but didn’t you see the red flags?” or “…but what were you wearing?” or “But…you took that risk.”

As soon as we add a “but…” we are adding personal responsibility onto the person that they are either responsible for their trauma, responsible for the way they act because of trauma or responsible for healing their trauma. These are all untrue. Brene Brown states that empathy rarely starts with the words, “At least…” and I also think this applies to the word “but…”

I think we also need to be more cautious of the messages we tell. For example, the quote “Although we can’t always choose what happens to us, we can always choose how to respond.” To me, this statement is false. Being trauma-informed does not mean all existing theories of human behaviour are accurate. Fight, flight and freeze behaviours are unconsciously reflective. We need to stop perpetuating the myth that we are always in conscious control of our actions. It hurts and shames those who face trauma, or endure the aftermaths of trauma. Fight, flight and freeze are natural behaviours in the face of threats, and I know those who experience PTSD or C-PTSD can attest that people do not always get to choose how they respond.

Instead, practice seeing that all behaviours are adaptive in the right context. For example, explain how fight, flight, or freeze reactions are sometimes the best responses for survival in the face of an actual threat. Recognise that the person has survived past trauma, and therefore they have strengths to harness. Validate them and be curious about acknowledging the strengths inherent in the person’s story. Use validating and compassionate language.

“It wasn’t your fault…” or;

“I don’t know what to say, but I’m really glad you told me.”

Humans need to feel safe, strong and connected. Trauma informed services understand the dynamics of traumatic stress, survivors in the context of their lives and the role of coping strategies. They feature safety from harm and re-traumatisation, emphasise strength building and skill acquisition rather than symptom management, and foster true collaboration and power sharing between workers and those seeking help at all service levels.

I do not think librarians should play therapeutic roles, but I do think everyone in society should be aware of trauma, its impact and the importance of preventing re-traumatisation. The provision of trauma informed services like libraries must also be supported by trauma specific services, which provide specific interventions to address the consequences of trauma, like mental health services.

Fixing a client’s or loved one’s problem is not often what is needed, nor is it necessarily your job or even within your ability to do so. Sharing a listening, caring ear is something most people can do. When people feel heard, cared about, safe and understood, things can feel a little better.

References

Jackson, K. (2016). “Bibliotherapy: The Healing Power of Words,” in Social Work Today, 16(6), p 10.

SAMHSA. (2017). Understanding Child Trauma. Retrieved from https://www.samhsa.gov/child-trauma/understanding-child-trauma

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