Passability in Trauma, what not doing well can also look like

At the end of my first interview to work in sexual violence response, I asked the Clinical Director for suggestions of books that I should read before beginning a new position. I was given two initial titles, Waking the Tiger by Peter Levine, and Trauma Stewardship by Laura van Dernoot Lipsky. The former situates trauma responses within evolutionary science, emphasizing the purpose and appropriateness of natural responses to a trauma. The latter situates those same responses in the context of advocacy and first responders. Both are concerned with the factors they lead us to get stuck in those responses.

In the introduction of Trauma Stewardship, the author describes a vacation scene where she is standing on a bridge and looking out over a beautiful view. Instead of her mind thinking of beauty, she thinks of suicide, and how this spot she is standing must frequently encounter that, and she goes through the mental Olympics of trying to think of the logistical response systems that must be in place for those crises. Her second thought as she pauses, is how abnormal it must be that her reaction is to go to crisis.

Earlier in this season of This Is Us, Kevin Pearson’s character takes a trip to Vietnam with his girlfriend Zoe. There’s a scene of her in the bathtub, nauseous, and him seeking to be supportive. In the scene earlier they’d gotten into a fight prompted by her defensiveness to personal questions he was bringing up. He approaches the rim of the tub in an attempt to clear the air, offering, “I want to be able to tell you anything and hear anything about you, but if I can’t that’s ok.” In response she discloses to him that she is an incest survivor. He reaches out his hand to extend closeness, fumbling as he trips over the words, “I didn’t know, you always seem so strong.” She interrupts him with, “I am strong,” and he neither interjects or pulls away. He receives his mistaken assumption, and his desire to remain connected. The scene ends with both of them silent, dwelling but not drowning in the spoken seriousness.

Last night’s episode of Grey’s Anatomy includes a scene between Dr. Hunt and his sister, who was a Prisoner of War for several years following their overlapping tours of duty. Alone in a staircase after completing a surgery together, they resume an argument about avoidance in their own lives, Megan Hunt offering to her brother, ‘” Someone has to tell you the truth.” He continues, “that I’m an idiot,” and she counters with, “that you need help.” He resists and offers, “well I’m sorry we can’t all be perfect.” Her voice gets stern and she replies, “Owen, shut up, seriously. I see a talk therapist once a week. I see a somatic PTSD specialist once a week. Riggs and I see a couples’ therapist once a week because I want to be as happy as I can for the life I have left. Don’t you?” “I’ve done therapy,” he says plainly, to which she retorts, “not enough.” She grabs his face and offers emotionally, “You’re not well, do the work to fix that; okay?” The scene ends with him finally holding her eye contact, hearing and not verbally recoiling or agreeing. What we see as viewers is two people standing together, having at last the same conversation.

In the third season of Private Practice, trauma therapist Violet Turner returns to her clinical practice after a violent attack. In one of her first days back, a rape survivor who she’s supporting in couple’s therapy discloses to her partner that she is pregnant as a product of that rape. She, in her own confession, crosses a line, influencing the survivor to schedule an abortion as she projects some of her own beliefs as a survivor, and as someone who is triggered presently. She is reflecting in her office later, pretending that a glass of water is something stronger. Her coworker comes in to join her, feeling sheepish about his own poorly handled client interaction right before. She shares as they talk, “I thought this was one thing I could still do well.” He says to her only, “at least you’re here, or you want to be here.” She sits with his comment briefly, and then asks to be out of the hot seat and talking about him.

Later in the episode she comes back to address her conduct with her client, acknowledging that she made a projection and that crossed an important boundary. The client offers, “what you said made sense,” not immediately seeing the breach or the consequence of it. Violet clarifies, “What I believe my role is as a therapist is to help you know what you feel,” not to drive or judge those feelings from my own experiences.

Later in this season Violet has an opportunity to testify at the hearing of her attacker, influencing the type of treatment and sentencing the court will issue. She is torn, wanting something different personally and professionally, and she articulates this tension to her best friend and coworker, commenting that only one of those voices can get on the stand, not both. He responds as he listens, “Doctor Turner is the smartest therapist I know, but I want Violet to be ok.” He admits a preference, while also inviting her to advocate for what she needs to heal. He wants her to be supported personally, and well as a result. What she articulates, though without resolving or committing to acting on, is that her beliefs professionally transcend her beliefs personally, creating the further disconnect and angst.

I offer this sequence of TV moments as a vantage point of connected themes: the assumption that doing well and not doing well with your trauma is clearly delineated, and that the boundaries between the two are easy to maintain and define. Easier to define professionally, I’d add, though as seen here usually not. More accurately, the feedback we get shapes our embrace of our own reads on our inner lives, making us tamp down or succumb to insecurity, pendulum swings between ‘only I know best’ to ‘everyone knows better than me’.

The markers are disconnected from set labels, making it hard to take care of ourselves when not visibly in crisis, and making it hard too for others to recognize and support us when we’re in those states.

The challenge we face is to acknowledge and challenge our assumptions, and make it easier to ask for help and receive help without conditions. When we tether support to our natural biases, we reek undue influence on how someone copes, and how someone conceals or masks their crisis needs from others. Sometimes those masks are internalized to the point that we forgot we had them on or felt we needed them, and our anxieties and defensiveness have kept us alienated. Or instead of alienated, maybe we’re completely surrounded by support, and we’re afraid of trusting ourselves more than we trust others. Or maybe we are savants at presenting as not in crisis, and training our environments to believe that too.

Practically speaking, passing in any context refers to complying well enough not to stand out, for the purpose of being included in a designation or group. In the context of trauma, that means seeming functional and able to be left alone in deciding how to take care of yourself. Our survival feels threatened when that is encroached on. The flip side of that is of course feeling invisible as you flail, seen as too capable to be offered support. How can we notice these dynamics in our conceptions of trauma responses, and how can we question and replace some of our existing assumptions? How can we initiate more accountability, more flexibility, and more curiosity towards each other’s needs and coping?

I make it a commitment to reread books like Trauma Stewardship annually to ground myself in resetting my assumptions, and relearning my own stress responses. I validate how easy it is to remain accustomed to being in crisis, and the responses that do and do not always serve me now. I pay attention to our relational advice on how to integrate trauma sensitivity practically and responsively, and frequently my thinking is shaped by images and examples constructed on tv and in books as well as anecdotally. As you consume messages and messengers about how to cope with trauma, what are you learning about yourself? What would you like to see differently represented? What needs do you hope we can see and validate? What responses would you like to change? What do you assume or label as only one thing? Could there be more to see and examine than we’ve addressed? Could we sit in our unsureness, and not feel a compulsion to conceal that from ourselves or one another.

Might we be able to come back and say to one another, how do you feel, and what do you want me to know? How can I start or stop showing up for you that I’m not already?

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Amanda Lindamood

Writer. Thinker. Facilitator. Advocate. Invested in accountability for power based violence, creative initiatives, and meaningful, nuanced dialoguing.