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Symptoms and behaviors aren't people

Hands in heart shape

Written by Judy Bankman

Sometimes we do or say things that we wish we hadn’t. While we may experience some regret, we know that these poorly-executed actions and words are not “us”. They are simply actions and words. We hope to be forgiven and to be seen as a whole, good person by those we may have hurt.

Let’s say you arrive at work and your morning has already been stressful. You forgot to take out the trash, the dog peed on the carpet, AND you got a speeding ticket. Then your coworker does something that rubs you the wrong way, and you explode. But this angry explosion is not really about your coworker. You already had a number of things build up to piss you off, and your coworker was the unfortunate target of your outburst. While you definitely owe your coworker an apology, you’d probably want her to understand that this angry outburst is not “you”. Your dog peed on the carpet! And you got a speeding ticket before 9 AM! You have reason to be a bit ruffled!

As health care professionals, we interact with people of various backgrounds who exhibit many different health habits and behaviors. Sometimes we might feel troubled by certain behaviors, or we may even judge some of our clients’ behaviors, even though we don’t mean to. For example, let’s say I have a client, Mike, who tells me over and over he wants to quit smoking. But every time I meet with him he smells like cigarette smoke. Eventually Mike tells me he has quit, but my nose tells me he’s lying. My reaction might be, “What’s wrong with him? If he wants to quit so badly, why can’t he do it? And more importantly, why is he lying to me?”

Trauma-informed practices (TIPs) encourages me to see that Mike’s behaviors are simply those: behaviors. They are not a reflection of who he is as a person, though they may give me some information about what he has endured up until this moment. TIPs encourages me to dig a bit deeper and ask, “what happened in Mike’s life that may have led to his tobacco use”? and “what happened in Mike’s life that makes him feel the need to lie?” Maybe lying was a coping mechanism he developed at a young age that actually helped him survive in an unsafe household. Maybe he still lies sometimes even though he doesn’t want to, because it’s such an ingrained habit and he knows it works. 

Often, trauma that happened long ago can impact our lives years later. According to the Centers for Disease Control and Prevention, adverse childhood experiences (ACEs)and other traumas increase the likelihood of later developing chronic diseases, substance use, and mental illnesses. For example, experiencing ACEs in any category increased the risk of suicide 2-5 fold, according to a study published in the Journal of the American Medical Association(JAMA). Higher ACEs scores are also associated with higher rates of tobacco use. In the scenario above, knowing this information may help me better understand Mike and his current behaviors around tobacco. 

When we acknowledge the evidence-based link between trauma and health outcomes, it helps us have greater empathy for those managing illness or addiction. Just like I would hope my coworker sees beyond a misplaced angry outburst, we can see beyond our clients’ “bad” behaviors and perceive them as whole people who have suffered. Just like all of us.