February 9, 2011

It can cause a student to dive under her desk at the sound of a siren on the street. It can keep a man up at night, unable to fall asleep or awakened with night terrors. It can lead to depression and distraction, or rage and confusion. It’s trauma, a powerful response to terrible events in a person’s life and a condition that is more common than most of us realize. Seeing or experiencing violence first-hand, living through a natural disaster or a brutal accident—certainly all of these can be traumatic. But so can suffering through extreme poverty, being homeless or threatened with homelessness, or living in the shadow of danger.

“With trauma, the past continues to invade the present,” says Thad Rydberg, the clinical manager of a Heartland Alliance program that provides community-based mental health services for refugees and asylum seekers. “It can be enormously disruptive, impacting someone’s ability to live their life.”

The participants who come to this program have typically been through multiple traumatic events, from fleeing war to living in refugee camps. “There can be a significant amount of violence in the camps, and being held for years in limbo is traumatic as well,” Rydberg says.

Trauma Comes From Many Places

A great deal of the power of trauma is feeling a loss of control during painful and frightening circumstances, whether it’s a wife facing an abusive husband or the father of a family living in poverty, who never knows if he’ll be able to pay the rent next month.

“When being free of pain or fear is out of someone’s hands, that’s traumatic,” says Ed Stellon, the director of community development at Heartland Alliance. With nearly 20 years of experience in the field, Stellon says that trauma is both a cause and an effect of living without a home or of “hidden homelessness,” where a person or family is able to stay off the streets but don’t have their own place to live.

“Think about housing at the most primal level,” Stellon says. “It’s safety; it’s literally a door that can be locked and keep danger out. That’s a big reason homelessness is generally very traumatizing.”

A Life Held Hostage

The symptoms of trauma can vary as much as the cause. A person who has been traumatized can become hyper-sensitive to a stressful situation, alert for danger at a moment’s notice, flooded with stress hormones. Or they can have difficulty concentrating or remembering. Some people get very sad or tearful, others become distant and don’t show much emotion at all. Children who have been traumatized can have difficulty controlling their emotions or forming close relationships later in life. Some survivors experience repetitive, unwanted remembering—including “flashbacks” to an event—sometimes triggered by a similar experience.

“For rape victims or with instances of violence, for instance, people may avoid the place where they were attacked, or places associated with those events,” says Karen Batia, the chief clinical officer of Heartland Alliance. “For people from other cultures, who might not have the language to talk about it in mental health terms, they’ll often have physical complaints—stomach problems, their arm hurts, they don’t want to eat or can’t sleep.”

For Libelula* trauma began early in her life in Mexico. Her mother made it clear she was unwanted, and had her working by the age of four, taking the money she earned cleaning and cooking. She was married off before she was 16, and her husband bullied and occasionally hit her. When she came to the U.S. to escape, the man she met in Chicago was cruel and abusive as well.

“He slapped me, and told me I was not able to go out and speak to anyone or he’d be sure I was deported,” Libelula says. She heard that there were alternatives. One day three years ago, she gathered her courage, and with her two children left for a shelter for women who had suffered domestic violence.

Strength and Recovery

Despite the many ways that trauma can manifest itself, there is one constant that survivors share: A resiliency and capacity to continue. At Heartland Alliance, that asset is at the core of the recovery process. Today, Libelula and her children live on their own, and she says she’s happier than she ever thought possible. Working with a trauma support case manager at Heartland Alliance, she has faced the events that kept her in fear for so long.

“I’ve learned to take care of myself and I’ve learned I have the courage to see that I am not less than anybody. I’ve learned how to help my children,” Libelula says. “I was scared for so long about the world, about my life. I’m not afraid anymore about anybody.”

“Across our programs, as therapists and as a partner, we bear witness to the journey they’ve taken and recognize their resilience,” Batia says. “The person in front of us is a survivor, not a victim, and that strength is the basis of our work together to help each person be able to live the life they choose.”

Batia is the primary author of the Heartland Alliance Philosophy of Care (see sidebar), which includes a focus on trauma-informed treatment. Across the many services that we provide, our practitioners begin each relationship knowing that the participant may have survived trauma. For some survivors, recovery includes understanding the traumatic events and recognizing their effect. Others prefer to deal with the manifestations of the trauma without ever delving deeply into the past. Because much of trauma’s impact comes from a loss of control, the goal of our programs is to help the survivor decide how to proceed.

“We’ve learned that what works best is our ability to adapt to what the participant needs,” Rydberg says. “They’ve been through things that make someone ask whether they can even trust human nature. We connect them to services, help them find their way, build a trusting relationship with each participant. All of it helps rebuild a sense of safety.”

* Some participant names have been changed to protect their identities.

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