Recovering from trauma-informed care
September 23, 2013
By: ANNETTE HANSON, M.D.
Full Article here Clinical Psychiatry News
One of the most influential experiences I had as a medical student was the opportunity to work with a psychiatric patient with multiple personality disorder during my inpatient rotation at a tertiary care center. Already inclined toward psychiatry, I had read every popular book I could find about the brain, human behavior, and mental disturbances in additional to my regular textbooks. Multiple personality disorder was a popular topic in the mainstream paperback press then, but I never thought that I would meet someone with the disorder.
My resident at the time felt he had scored a coup, because he was the only one of the patient’s many psychiatrists to consider and diagnose her rare condition. At the time of intake, she had been diagnosed with three alternate personalities. By the end of my rotation, about a year later, she was reported to have nearly 20. As a medical student, it never occurred to me to ask why her condition had gotten worse over time rather than better.
The 1980s brought other disturbing and dramatic events to the forefront of mental health care. Therapists in disparate parts of the country began to report cases of patients who suddenly recalled horrific memories of degrading and violent sexual abuse committed by organized cults. These reports of satanic ritual abuse led to intense investigations by local law enforcement as well as the FBI. Families were torn apart, as falsely accused members were alienated from one another or even criminally prosecuted.
Eventually, the drama died down. A series of malpractice suits were filed against trauma recovery therapists based upon negligent use of hypnosis, failure to recognize the effects of suggestion, and improper diagnosis. Juries awarded some of the highest damages ever recorded for psychiatric malpractice. To this day, the FBI has found no evidence of any organized satanic child abuse rings.
Trauma-informed care means being cautious and conservative with regard to the use of physical interventions or other measures that could inadvertently reenact a previous traumatic event.
According to this training, trauma-informed care would require the clinician to assume that a patient who presents with these problems has had a history of abuse or other traumatic experiences.
I’d be more comfortable with mandatory trauma-informed care training if the trainers would recognize and acknowledge certain risks inherent in their approach.
Failure to differentiate between historical truth and narrative truth was a key issue in the development of the satanic ritual abuse debacle.
This leads me to my final point: There is nothing specific to trauma-informed care that is specific to a history of trauma. The need to be sensitive and humane, and the need to be cautious and judicious about physical interventions, is just good psychiatric care. And we don’t need a law to require training in humane care.
Dr. Hanson is a forensic psychiatrist and coauthor of “Shrink Rap: Three Psychiatrists Explain Their Work” (Baltimore: The Johns Hopkins University Press, 2011). The opinions expressed are those of the author only, and do not represent those of any of Dr. Hanson’s employers or consultees, including the Maryland Department of Health and Mental Hygiene or the Maryland Division of Correction.