The discovery that microbes were the etiological agents behind many killing diseases brought about a revolution in health care and the birth of public health prevention from vaccines to clean water to poverty and healthy eating (Bloom, 2016). Germ theory was a paradigm shift that led to global changes in practice and policy. Trauma theory, argues Sandra Bloom, is creating a similar paradigm shift in how we understand health, pathology and human nature. A paradigm shift is ‘a change in the underlying principles on which belief, understanding, attitude, practice and policy are built’ (p. 384). Learning problems, substance abuse, depression, criminality, heart disease, cancer, stroke, personality disorders and much more can be viewed not as disconnected but as complex and often interacting outcomes of childhood trauma. Stress during critical periods of development create a wide array of developmental adaptations that can only be understood within the multi-level contexts of a person’s life.
Bloom (2016) writes of her experience realising that over time it became clear stress was going to be the major public health challenge of the 21st century: “I believe the most fundamental question of our time is whether we can create cultures that address and prevent the relentless stresses of poverty and discrimination; the toxic stress of childhood adversity; and the traumatic stress resulting from all forms of interpersonal violence, including warfare” (P.385). We cannot prevent natural disasters that are starting to accumulate as a result of climate change, but there is a lot of suffering we can prevent.
Changing paradigms requires a new integration of mind, heart and spirit (Bloom, 2016). Deep rooted change is unlikely to happen without a significant shift in government policy. Primary, secondary and tertiary interventions can be strategically helpful. Intervening at all three levels would constitute a social movement. For decades attention to individual biology and psychopathology has dominated the mental health system as if the context of human experience did not exist. Trauma-informed approaches sees the person and the environment as deeply interconnected. Bloom cautions against organisations just doing a training and being ‘trauma-informed’ but argues what is needed is changing paradigms in how we act towards each other, what we value, and our social norms. It also requires much more that therapists in a setting who are trained in trauma treatment. To increase precision of what we are talking about here Bloom suggests a continuum of designation that corelate with the different public health intervention levels: Trauma-informed (Primary), trauma-responsive (secondary) and trauma-specific (tertiary).
The attainment of knowledge is not enough, we must also change what we are doing (Bloom, 2016). There needs to be increased responsiveness to the needs of people who have been exposed to trauma and adversity, derived from that knowledge. In hospital-based violence intervention programmes and criminal justice settings it is not enough to be trauma informed, these organisations need a resource base that enables them to be trauma responsive. Trauma responsive means aiming to not make things worse and ideally improve things for those they serve. It means also connecting people with community resources and trauma-treatment. Leaving trauma untreated when we know integration and resolution is possible is ‘unconscionable’. Bloom compares it to getting a splinter in some part of your body. While it is there you adapt, adjust (perhaps by avoiding, limping etc.) in order to avoid aggravating it. Trauma is a splinter in the psyche and trauma-specific treatment is about taking the splinter out of the psyche. It is vital that we advocate for trauma-specific treatment approaches.
‘Is it that we don’t have the solutions to our problems or that they are impossible to solve?’ asks Bloom (2016). Or are we as a society not willing to do what it takes? The German researcher Dr. Wolfgang Seibel argues that the human services delivery system get delegated by the larger society to fix problems that the society does not really want to fix. Society funds the sector just enough so it survives but never enough that it thrives. This, he calls, a ‘successful failure’. It all comes down to social will. A true public health approach to prevention of trauma and adversity “requires an altogether different vision to the society that already exists” (p.392). Explicit policy in this area can: outline a vision for the future; clarify priorities and expected roles of different groups; and build consensus and inform people. There is little guidance on how to translate trauma research into policy and even less trauma policy research. Primary prevention is left out of discourse at policy level, as if such a thing is impossible. Trauma responsive policies could be designed to minimise damage and maximise healthy growth and development. Such policy-making could be directed towards creating and maintaining effective interventions that reduce exposure and promote healing.
Bloom, S. L. (2016). Advancing a national cradle-to-grave-to-cradle public health agenda. Journal of Trauma & Dissociation, 17(4), 383-396. https://doi.org/10.1080/15299732.2016.1164025