Trauma-informed care
Northern Exposures – Manitoulin Island
Little Current, ON
28 October 2015
Alexandra King, MD, FRCPC
Nipissing First Nation
Senior Physician and Researcher – Vancouver Infectious Diseases Centre
Hep C Specialist – Cariboo Memorial Hospital
GIM – UBC Hospital
PhD Student – Simon Fraser University
“Each man’s and woman’s
liberty was absolute and
inviolable. He was untainted
by civilization, did what he
liked, and was moved only by
natural impulses, and if, the
Nipissing was not a free man
and independent man, then
there was no absolute
freedom or independence
on earth.”
– Jean Recollet in The Jesuit Relations
Desmond (Algonquin, Mattawa FN), Mary
(Ojibwa / Mohawk, Nipissing FN) and
daughter Mary (my mother)
Outline
• Trauma
– Definition
– Types
– Highly contextual, cultural specificity
• Trauma continuum
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–
–
–
–
PTSD, spectrum
Shattered identities, disrupted relationships
Neurobiology
Outcomes
Epigenetics
• Working with trauma
• Disclosure and silencing
Trauma – hallmarks
Unexpected+unprepared+uncontrollable
Often multiple, repeated, chronic
Micro, macro
Shame, horror, betrayal -> secrecy, negative
coping behaviours
• Processing, integration needed
•
•
•
•
Trauma continuum
• PTSD components:
– Reliving
– Avoidance
– Arousal
• Spectrum
– Mild through severe/complex
• Severity depends on:
– Age/development
– Source
• If interpersonal, relationality/proximity/power
• Versus external (natural disasters, accidents, war, …)
– Perceived roles
– Single versus repeated, multiple, chronic
• Concurrent mental illness (depression, anxiety) and addictions
• Can be delayed, triggered
Types
•
•
•
•
Interpersonal
External
Historic
Developmental
Cultural specificity
• Highly contextual
– Experiences
– Manifestations
• Specific peoples:
– First Nations, Inuit, Métis
– Immigrants
– Refugees
• Intersectionality
Shattered identity,
disrupted relationships
• Individual: isolation, alienation, shame, self-hatred,
internalised racism, shattered identity, low self-esteem,
loss/grief, negative coping mechanisms (substance
use/abuse, self-harm, suicidality),
relationality/authority fear, disrupted relationships
• Family: loss/grief, disrupted relationships, loss of
unity/stories, negative coping mechanisms (family
violence)
• Community: loss of language/traditions/history, loss of
cultural continuity and collectivity, loss of control/selfdetermination, dependency, negative coping
mechanisms (communal violence, internalisation)
Neurobiology
• Increased stress (physical, mental, emotional)
• Hyper-arousal (hypothalamic–pituitary–adrenal–
gonadotropic axis)
– Neuroendocrine control
– Affects digestion, immune system, mood and
emotions, sexuality, energy storage and expenditure,
circadian rhythms
• Brain remodelling
• Worsened health outcomes (mental illness,
addictions, IHD, COPD, CKD, …)
Behavioural epigenetics
• Increased gene
methylation (suicidality,
early-life poverty, PTSD)
• Stress suppresses
maternal behaviour
• Without a DNA code
mutation, can
methylation cause longterm, heritable change
in gene function …?
– Eggs >> sperm
Working with trauma
• TIC principles: acknowledgement, safety,
compassion, patient/client-centred and
controlled, patience, resilience
• Mindfulness
• Identity strengthening, self-care (trust,
regulation, compassion, soothing)
• Relationships, relational and communication
skills, healthy/safe limits
• Scenarios, scripts, options
Working with trauma
• TI organisations
• True multi/inter-disciplinarity
– Indigenous
• Indigenous knowledges and Ways of Knowing
• Elders, Healers, Medicine people
• Indigenous counsellors
– Other knowledge systems and cultures
• Referrals
• Advocacy
Questions?
Contact: [email protected]