In Times of Global Crisis: Caring for Yourself

Only two short weeks into this new year and we know it’s been a tumultuous whirlwind of tragedy, stress, uncertainty, and even some real terror. From attacks, to blizzards, to the unconscionable California wildfires, to the kinds of violence whose published words alone would prevent these resources from getting to you – these times of crisis can make even steadiest of us feel frenzied, panicked, and lost. …overwhelmed to the point of disorientation, hopelessness, or shutdown.

For survivors of complex trauma, these heightened responses to others’ suffering, or their very own real danger, can swell far beyond one's window of tolerance. And, for survivors of organized or spiritual abuse, things can even take on a truly surreal or existential quality that's difficult to subdue. No one deserves to suffer in this way. That includes you. So. How do we make it through these times of extreme chaos and disorder? How do we keep both our heads above water and our feet on the ground? How can we ensure our own wellbeing if we’re to have any hope of helping others ensure their safety?

While we recognize anything less than crisis management and relief care is unlikely to be of much help to those in immediate danger, we still really want to extend support to those on the outside looking in, those supplying aid, anyone reliving past traumas of similar events, and/or those simply trying to cope while bearing witness as a supportive, connected human.

Here are four tools that we here at Beauty After Bruises utilize in times of global crisis:

1. Validate your fears

Counterintuitive as it may seem, validating our rational fears reduces our brains’ need to keep alerting us at all hours - afraid we’ve forgotten or are no longer paying attention. It is healthy to acknowledge that you have every right to feel afraid—to feel lost, overwhelmed, or even distrustful of your surroundings. You are just trying to make sense of circumstances with no blueprint or, seemingly, any ready solutions. You aren't ‘crazy,’ ‘just paranoid,’ being ‘too much,’ or irrational.

People are suffering. Tensions are high. Any normalcy we once knew is rapidly shifting or has maybe even evaporated by now. It is normal to feel uneasy, to ask questions, to feel inconsolable, or be unable to look away. You aren't wrong; these situations are wrong. We weren't built to cope with this much human suffering all at once. You are having a normal reaction to many abnormal situations - some that may even mirror events or emotional periods of your past.

Instead of fighting your mind or invalidating yourself, we can actually take pause to thank your brain for doing its job to protect you. It’s done a valuable service. But, now, we can let it know that it’s okay to rest and trust you’ve not forgotten. You’re staying vigilant. You’ve got this. And, your remaining awareness will be better served elsewhere.

2. Find your footing

We protect ourselves and those around us best when we are our most present, alert, and stabilized selves. No one is effective in a state of panic, unmanaged dissociation, or hopeless paralysis. It’s okay to slowly step back into your body. Take the first breath you’ve drawn in for far too long. Shake out the frenetic, electrified anxieties coursing through your limbs. Release your jaw. Feel fresh blood fill your cells and rejuvenate you.

To face these global crises, we need access to all of our faculties. And, we can all benefit from the occasional time-out. To just pause. Re-center. Come up for air.

Our bodies also cannot take all this on without getting sick, either. We don’t want to make them a casualty of our self-sacrifice or passionate commitments to others. We need to be our best, strongest selves - rooted, alert, grounded, and healthy.

Ask yourself what do you need? Release what is no longer helpful. Find this present moment. Lift your chest. Look up and around you. Feel your sense of security and competence return. You are in control. You are no longer just along for the ride. You are competent and able.

3. Seek the good

When every direction we look holds a sea of tragedy, with no seeming end in sight, it’s easy to pick up a pair of morose-colored glasses. These impressive lenses scan and magnify the suffering for us. In response, we have to be intentional about seeking out the hope, the joy, and the good-ness. It is out there - including that in our own lives.

Keep a list of your wins and accomplishments; the meaningful moments, the things you’re grateful for, the nights you laughed to tears. Revisit it in times of pain. Step outside of the sophisticated, well-targeted doom-scroll and search for the laughter, the rescues, the positive policy changes, recovery journeys, reunifications, and evidence of the Helpers. They’re out there. We promise.

No one can see in the dark. We all have to turn on a light to know where we're headed. And, holding onto hope does not invalidate or ignore suffering; it just gives us the chance to heal it.

4. BE the good

Few things immobilize us quite like traumatic helplessness. While we don’t believe everything happens for a reason, using our worry, empathy, hurt, and attention for good - to better the lives of another - is an opportunity to make meaning from otherwise senseless suffering.

Help where you can. Show up with kindness, aid, resources, activism, or even just more love for the world. Call a friend. Compliment a stranger. Tell those you love that you love them. Be of service. Donate where you are able. Share and volunteer for relief efforts. Send a thoughtful text. Give a neighbor a smile or laugh.

Make the days brighter for someone in ways you wish your own could be lifted. You'll often find you feel lighter for it and, in effect, bring incontrovertible evidence to those in need that there is good in the world. You. And everyone else like you. Be the Good.

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We know these few things are somewhat simplistic, but they can truly be a stabilizing force when things have become all-consuming. But, before we go, as a bonus number five - anything you can do with and for a body in duress is a victory. Get it out. Shake that stress and panic out through your fingertips. Rock, move, dance, sway, stim, shake; yell, hum, sing, groan, scream it out. Replenish with sleep, a healing shower, your medications, and a good, nourishing meal. You need and deserve fuel to get through these tough times.

Gift yourself the permission to care for yourself. And, if you need any other mental health resources, please do refer to the list included below:

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Please know that our hearts, minds, resources, and actions are with the countless communities in disrepair. …as well as with the first-responder and crisis-relief crews out protecting the vulnerable, those who’ve survived similar things in the past, and anyone left to stand by helplessly. We see you. We are here for you. The trauma care you may need now or long after exists, and we are eager to help you secure it. You deserve no less. We are sending all we can to lighten your burden.

Sending strength, solidarity, and solace,
🌻 The BAB Team

MORE POSTS YOU MAY FIND HELPFUL:

  ✧  Grounding 101: 101 Grounding Techniques
  ✧  Distraction 101: 101 Distraction Tools
  ✧  Flashbacks 101: 4 Tools to Cope with Flashbacks
✧ Self-Care 101: 101 Self-Care Tools
  ✧  Nighttime 101 and Nighttime 201: Sleep Strategies for Complex PTSD
✧ Color Breathing 101: How to Calm Overwhelming Emotions and Physical Pain
  ✧  Imagery 101: Healing Pool and Healing Light
  ✧  DID Myths: Dispelling Common Misconceptions about Dissociative Identity Disorder
  ✧  Modulation 101: Using Dials to Modulate Intrusive Mental Health Symptoms
 
  ❖  Article Index  ❖

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Modulating Intrusive Mental Health Symptoms

Whether you are struggling with overwhelming emotions, racing thoughts, intrusive images, panic attacks, self-harm urges, flashbacks, physical pain, or just so much clutter in your head it's hard to think, turning to the skill of modulation can be one way to drop your anchor amidst a raging sea. Incorporating dials, specifically, into your mental imagery can take things one step further and put you in control of the very sea itself.

But, first things first! What is imagery?!

Imagery is a symptom management technique that uses the act of bringing images to mind - in a very vivid, intentional, and specific way - to improve our current circumstances. Typically, it aims to target a distressing symptom through creative means and bring it to a more manageable, peaceful place. To improve our chances of success, there are two important things we need to remember. First, we need to give ourselves the permission to commit fully to the process — truly believing that the things we're calling to mind are real, capable of making a difference, and as effective as we make them. …even when they seem silly or impossible. Second, as we begin to flesh out the scenery in our minds, we want to use as many of our senses as we’re able—bringing things into crisp, hyperrealistic detail, so much so you could almost reach out and touch it.

Okay! But, What is modulation?

Modulation is another coping tool that allows us to adjust the intensity of our experiences - capable of slowing things down or speeding them up, making things louder or softer, more crisp or blurrier, brighter or darker, more sensitive or completely numb. This can be incredibly helpful for any symptoms that feel out of our control or "too much". Modulation allows us to make careful, finely-tuned adjustments at our executive direction. It can be performed using physical objects, body movements, mental imagery, audio/musical input, or any combination of the above! (See our article on Color Breathing for another example!) Today, we're looking at modulation via imagery with dials.

With your mind's creativity as your only limit, there are infinite ways to incorporate dials into the wrangling of distressing symptoms. You can visualize ones that are attached to other objects - like the tuning and volume knobs of a radio that’s blaring the scratchy static, negative self-talk, or distressing sounds of a trauma into your skull. Or, you can imagine the knobs of a video projector - one that’s playing your flashbacks or the intrusive images you don't want to see up on a screen.

See the scene clearly in your mind's eye.
Watch yourself slowly turn the knobs - noticing the effect each one has on the clarity, pace of the audio or flickering images, and volume; the distortion of quality, amount of competing background noise, and ability to identify who is in it.
Keep turning them until you've made it unrecognizable - shrunk the images off-screen, cut the audio to a low hum, or created total silence.
Now, keep turning the knob until you hear - and feel - that satisfying CLICK into the off position.
Feel the relief wash over you.
Notice the silence.
Take a look at the blackened screens before you. Feel free to stand in the peaceful nothingness OR even turn different knobs to put pleasing imagery in its place—your favorite song, a slideshow of your safest places or loving pets, a silly gif, comedian to spark a laugh, or the sound of a reassuring mantra that keeps you rooted in today. Confident. Calm. In control.

You can also create dials that have never existed before. Realism can go out the window with imagery! So long as you believe it is capable of the tasks you've assigned, it's got you covered! Imagine instead a set of unique, customized knobs that are attached to any limbs currently in pain - ones you can turn any time you need relief. Or, escape to the cogs and gear systems right inside your mind, just behind your eyes. Dials on your temples could slow down internal noise or thoughts that are coming too fast. A pressure gauge and release valve could let out pressure that's built up in your skull - great for intense headaches, anxiety, and various chronic illnesses.

You can also combine imagery with physicality to amplify its physiologic impact. Perhaps, you could install a speedometer gauge on your chest, one that's connected to any time you 'pump the brakes' with your foot. This could be used to help slow down intense emotions, bring to a halt any unsafe impulses that were building up in your body, or just simply slow your panicked, racing heart. Adding in the tactile, and grounding, physical action of pushing your foot into the ground to ‘press the brake pedal' can amplify this strategy's effectiveness. You can also use pedals and odometers to rev things up, too - be it to amplify emotions if you've been too numb, increase the amount of pain relief you’re sending to hurting areas of the body, or boost the flow rate of positive self-talk, hope, or patience you may need. The same can be helpful just before scary tasks that may require difficult-to-access resources like motivation, confidence, or bravery.

Knobs lain out on a control panel within your body - like just behind your eyes or ears - can also distort the clarity of disturbing images, minimize them away from sight, turn off the flickering feature of a flashback, or swipe them out of the way completely. You could also place dials on body parts known for self-harm. While you may not feel ‘allowed' to turn some urges off entirely, you could spin the impulse through a color wheel gradient instead (after assigning colors to its intensity or type). You could also add buttons that release cold or warm sensations to the area under attack, numbing agents that would neutralize the "benefit" of any harm done to it anyway, or a surplus of TLC to any part of the body whose urges have already gone too far into the red. Similar options to these - like salves, anesthetics, relaxants, etc - can be employed for chronic pain, various disabilities, and acute injuries as well! Imagery and modulation skills can bring real relief to more than just psychological distress.

There are so many options at your fingertips when it comes to modulation and imagery. Get creative! (But, we do want to acknowledge that for some it just doesn’t come naturally. We also have a forthcoming article for those who have aphantasia or who just can’t quite get the hang of it!) Consider trying out multi-sensory knobs, like the ridged old TV knobs that make a hard, satisfying thunk when they're off. Or, experiment with more recent tech dials instead. Try out laptops or earbuds that make quieting tones each time you tap the volume down, or note the key clacking as you send information required to make factory machines and cogs move. The dials could also be futuristic, bio-mechanical, or involve android parts - things no one's ever seen! The important thing is that it feels accurate and beneficial to you and your symptoms. When it comes to reducing suffering, as well as adding more color to our lives, whatever works best for YOU is always the right choice.

We hope you feel a little freer to explore some new ways of managing your unruly symptoms as well as making the joy a little louder! Our minds are more powerful than we often give them credit, and we want to be sure you are armed with a tool belt as vast as you are.

Please feel free to share your ideas with others below! Your personal go-to hack for your most stubborn symptoms may be someone else's magic trick solution! Good luck, and as always, know that we're right here should you have any questions or need some fresh ideas!

Happy dialing!

MORE POSTS YOU MAY FIND HELPFUL:

  ✧  Grounding 101: 101 Grounding Techniques
  ✧  Distraction 101: 101 Distraction Tools
  ✧  Flashbacks 101: 4 Tools to Cope with Flashbacks
✧ Self-Care 101: 101 Self-Care Tools
  ✧  Nighttime 101 and Nighttime 201: Sleep Strategies for Complex PTSD
✧ Color Breathing 101: How to Calm Overwhelming Emotions and Physical Pain
  ✧  Imagery 101: Healing Pool and Healing Light
  ✧  DID Myths: Dispelling Common Misconceptions about Dissociative Identity Disorder
  ✧  Trauma and Attachment: 3-Part Series on Attachment Theory with Jade Miller
 
  ❖  Article Index  ❖

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Color Breathing 101

What is color breathing?

Color breathing is a coping skill that combines a little mental imagery with intentional breathing to help modulate intense feelings, stabilize panic, soothe pain, slow rapid thoughts, or even get you more grounded. It's an invaluable tool that truly everyone can use, but it's especially beneficial for those who struggle with emotion dysregulation, flashbacks, dissociation, and more. So, how do you do it?!

There are many ways to use color breathing, so not only is customization the fun part but it's also the key to its success! One of the most common ways folks practice it is to first imagine a very calming color (perhaps cooling deep blues or purples, or warming yellows and golds for others). Then assign a color that matches the upsetting or painful emotions/sensations you're experiencing - perhaps reds, oranges, or blacks.
Slowly inhale the calming shade deep into your lungs. Watch it effortlessly locate all the areas of unrest, anxiety, or pain inside of you. See it just as easily envelope them, soothe them, heal them. As the color you see representing your distress gets extracted from every cell, space that it invaded, or place it radiated off of you, begin your exhale. Watch that color, in all of its shapes and textures, leave you through as long a breath as you can manage. It may leave in a rush, like it was almost expelled from your chest, or instead find itself slow and difficult to release as you contend with its resistance.

Repeat this deep inhaling and exhaling of colors until you feel more at ease. You may even find that the colors change a bit as you start to improve - with reds dialing back to oranges then yellows, its jagged edges softening. Or instead see black tarry sludge becoming thinner, lighter, and easier to lift out. This version is most commonly used for anxiety, panic attacks, anger or budding rage, and physical pain. But, some find it helpful for all overwhelming (or dysregulated) emotions - like grief, sadness, embarrassment, shame, or even apathy and numbness - similarly opting to inhale invigorating, light colors and exhale the weighted colors of misery, loneliness, or guilt.

Another method is to concentrate mostly on the exhale—inhaling any clear, healing breath, and with each exhale of the negative feelings, watch the colors change like a gradient. Shifting from bright fiery shades to cooler tones, or from dark, fully-opaque colors to light, whimsy translucence. This is particularly useful if you haven't been able to identify which feelings you're experiencing or have no idea "what you need" to make things better. You just know that what you're dealing with is intense and you want it out of you. Quickly. So, instead, put all your energy into exhaling any highly active colors until you either get to the calmer end of the 'rainbow'. Maybe can’t even see your breath at all. This can be a really effective way to still dial things down. (You can also dial up, and use quicker breaths, if you need the reverse to combat numbness!)

There are many, many other ways to customize this tool to work best for you. The more you can truly visualize the practice and believe in its effectiveness, the more successful it will be - physiologically! There are also countless ways to apply this template beyond colors alone. Incorporate speeds for racing thoughts or your pounding heart rate that needs stilled and quieted. Bring in different textures, medicinal properties, magic or fantasy elements, sounds, or physical gestures to go along with the flow of your breath. Fully connect with your body and be active in shifting what it is experiencing. Help yourself feel more in control—owning your emotions, your body, and your healing.

For those who are not naturally inclined toward creative imagery, have aphantasia, or don't yet know what to assign their internal experiences, holding physical objects - like color wheels/dials you've made for yourself or colorful photos you like or have on your phone - can be helpful. You can use them as both a visual reference as well as a tool you can manually change - matching it to the color you either just achieved, are aiming to get to next, or need to pull from in your current inhale. These are great ways to make this technique more accessible to you. Modify it to be exactly what you benefit from most!

How would you go about color breathing?
Sharing new ideas, suggestions, or personal experiences - especially from other survivors -
can often be just the thing that makes new techniques click for someone else!

Happy, easier breathing!

MORE POSTS YOU MAY FIND HELPFUL:

  ✧  Grounding 101: 101 Grounding Techniques
  ✧  Distraction 101: 101 Distraction Tools
  ✧  Flashbacks 101: 4 Tools to Cope with Flashbacks
✧ Self-Care 101: 101 Self-Care Tools
  ✧  Nighttime 101 and Nighttime 201: Sleep Strategies for Complex PTSD
✧ Color Breathing 101: How to Calm Overwhelming Emotions and Physical Pain
  ✧  Imagery 101: Healing Pool and Healing Light
  ✧  DID Myths: Dispelling Common Misconceptions about Dissociative Identity Disorder
  ✧  Did You Know?: 8 Things We Should All Know about C-PTSD and DID
  ✧  Trauma and Attachment: 3-Part Series on Attachment Theory with Jade Miller
 
  ❖  Article Index  ❖

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Inpatient Trauma Care is in Crisis

Since Beauty After Bruises’ inception, we have been speaking to the dire need for more specialized, trauma-competent care for survivors with Complex PTSD and Dissociative Disorders. Not only a need for more therapists, psychiatrists, medical doctors, and healthcare services at large, but most critically, inpatient care. We were distressed by the lack of inpatient trauma units available back then, but following so many recent, rather sudden closures, it is no longer alarmist to say: This is a crisis.

So, what on earth is happening? Why are these units closing? And, what do we do from here if we’re to have any hope of keeping our complex trauma survivors alive?

Hopefully, this in-depth look can shed some light on a rather complex problem - starting with how grave the situation we were already in many years ago truly was.

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Though there are thousands of psychiatric hospitals, facilities, and individual units across the United States, there are now less than five who are equipped to treat the nuanced, highly specialized needs of survivors with Complex PTSD and Dissociative Disorders. Devastatingly, we have had to sit back and watch in horror as some of the leading mainstays in trauma and dissociation closed their doors one-by-one. Others have downsized, greatly limited who they accept (based on patients’ location or level of care needed), changed leadership (and thusly, the structure and quality of their programs), or merged units with other psychiatric populations. This is unacceptable, worrying, and - truthfully - dangerous for all survivors in critical need.

WhY A specialized TRAUMA UNIT?

It may be easy to assume that survivors can go to any unit, or at least the next best thing - particularly if their life depends on it. But, 'just going somewhere else' often isn’t a safe or viable option; it may even jeopardize their lives further. Even units claiming they “are trauma-informed,” “see patients with DID,” “have a trauma track,” or simply “treat PTSD” are rarely, in fact, trauma-competent. We know it is possible to leave even the highest-rated inpatient programs with more trauma than the day you arrived, but when missteps and failures happen in the care of those who erroneously think themselves equipped to process trauma, bring child parts out of flashback, or talk time-disoriented alters down from active safety crises, the consequences can be fatal. They already have been. Intellectually knowing ways trauma can affect a mind and body versus having the skills, training, staff, environment, safety protocols, infrastructure, and detailed curricula to treat or engage with a traumatized patient are very, very different things. This distinction exponentiates when caring for survivors with Dissociative Identity Disorder or who have organized perpetrator groups still active in their lives.

Other psychiatric units and residential programs unintentionally place complex trauma patients in danger when they do not have specialized treatment teams, properly-trained unit staff, quiet and low-trigger atmospheres (separate from other psychiatric populations), and/or locked units capable of handling both safety threats from outside the building as well as dissociative or wandering patients inside the building. It requires a very nuanced education to, first, correctly identify, and then safely engage with a survivor who is in crisis versus a flashback, switching between self-states, having an immediate safety threat, or experiencing a medical emergency. These are all delicate concerns of life and death, particularly when patients are already coming onto the unit at a critical low, with their symptoms and safety impulses most unmanaged. This is not merely the difference between a 3- or 4-star review.

Unfortunately, because there are no other options, many survivors are sent to these other locations. Or, they’re left to roll the dice in gen-psych in hopes of either stabilizing in 3 days or - at the very least - adjusting necessary medications and quickly returning to their outpatient therapists. Rarely is any true therapy or treatment provided here, only attempts at acute stabilization. Other survivors are forced to come up with tens of thousands of dollars to try a more trauma-centered residential program. But, many of these locations run into the very same trouble as those above — particularly their inability to take on clients struggling with critical safety issues, behavioral outbursts, or co-occurring eating disorders, substance abuse, or medical illness. While not being a locked unit can offer survivors more freedom, it also means staff are unable to prevent elopement and are woefully under-equipped for any external safety threats, intruders, or even belligerent visitors. This not only jeopardizes the life and wellbeing of the patient that these nefarious folks may be after, but also the lives of everyone else in the program, staff included.

It should also be noted that this sincerely tragic and heartbreaking state of affairs is not limited to the United States. This is a global crisis. Most countries have exactly zero trauma units. Some have one or two, though often of questionable caliber. Healthcare systems set aside, most nations encounter these very same complications internationally. It is unacceptable that, right as we are all becoming more trauma-aware and trauma-educated than we’ve ever been, this is when doors begin closing left and right. So, what is happening? And why is it happening? Let’s examine.

WHY ARE TRAUMA UNITS CLOSING EN MASSE?

Unfortunately, like most things in life - particularly healthcare - it is multifactorial. With so many moving parts, people, institutions, dollar signs, and powers that be, it’s tough to summarize such a complex issue. That doesn’t mean we shouldn’t try to at least identify all we can discern, otherwise we delay working on the elements within our means of influence. It is not hyperbolic to say survivors will die each day we fail to understand and, most importantly, begin to rectify this crisis.

An incomplete list of known reasons:

• Hospital budget cuts. The simplest answer will always be money. And, when it comes to hospital systems, trauma units are often the easiest to cut when they need to trim margins - even if the program is in high demand, always full, and has a waitlist a mile long. They are usually the most niche focus in the entire hospital. They are also hard to advocate for amongst suits who have no knowledge of trauma or dissociation broadly, let alone how widespread it actually is.
  
  Moreover, in order to be an effective and therapeutic environment, they are kept small (usually amassing no more than 15-20 patients in a particularly large program) and thus, they become easy to excise. Expansion - be it to serve more survivors desperately waiting at home, or to prove its profitability to a hospital - isn’t truly viable. It drastically compromises the quality of care, patient atmosphere, and overall safety of everyone when too many struggling and dissociative survivors are congregated in one space.
  

• Expertise comes at a price. The caliber of trauma professionals required to adequately staff a trauma unit - from the doctors, therapists, social workers, nurses, and accessory therapy leaders, to the round-the-clock mental health workers - is extremely high. They need and expect to be paid accordingly for their expertise, hours of training, and broader qualifications obtained to work there. As they should. Few to no other psychiatric units in any medical center carry this amount of professional weight, nor do they require this much funding to support.
  

• Training. Related to but separate from above, the amount of training focused on the nuances of trauma and dissociation that day-to-day unit staff must receive - as well as the hospital-wide art, music, occupational, movement, and/or psychodrama therapists; the medical directors, doctors, and pharmacists; and the RNs, unit nurses, residents, social workers, and other specialized positions - in order to safely aid this population, takes time. And quality instruction. And those things cost money. But each staff member that enters a trauma unit, no matter how briefly, needs to understand the differences that this floor maintains in terms of environment, patient rules, and detailed safety protocols that likely don’t exist on the other units.
  
  Float staff often require a crash course. Medical doctors, coverage psychiatrists, and rotating nurses need to be taught about dissociation, switching, and the shifting brain chemistry that patients with DID can experience, which may affect their medications and/or medical health. Outside-unit staff called in for emergency health or behavioral codes need careful instruction on the rules surrounding physical touch and chemical/physical restraint, as well as how patient engagement and deescalation work differently here. (And, to be fair, these should be hospital-wide policies, not solely applied to the trauma unit, but we can’t fix all of psychiatric care here at once!)
  
  Above all, the daily unit staff need to be fully educated on PTSD, triggers, dissociative disorders, switching, flashbacks, grounding, child parts, emotion dysregulation, internal communication, and safety safety safety. To not only recognize, but mitigate and/or teach, these things to patients who will need to learn how to do these things for themselves when they leave. It takes time—often shadowing for weeks. It takes dedication. Patience. Compassion. Loyal, focused staff. All of which are not only dollar signs to a hospital, but just hard to come by in general. Because…
  

• Inpatient crisis-care is grueling and painful. Staffing a trauma unit is hard. There was already a steep imbalance of trauma-competent or even -aware professionals versus the number of survivors in need since the beginning of time. But, inpatient care is emotionally and mentally intense. These brave souls see patients at their absolute worst, at a time their symptoms are the most unmanaged, emotions most dysregulated, and safety concerns most grave. The latter alone can be internally frightening. They are people - with big, warm, compassionate hearts. It’s a requisite for this work. They hear, on repeat, the worst crimes of all humanity, against the most precious of innocents this world has: children. And, they do it for years. It is hard on a mind.
  
  Burnout, vicarious and secondary trauma, or consciously opting to dedicate just a few years to this work before stepping down to outpatient care are all very common. The folks with these unique qualifications, talents, and now the one-on-one experience can find it more lucrative and rewarding to either start their own practices, join a collective that offers adjunctive trauma therapies, or step down to a day program so that they can help survivors integrate what they’re learning into their day-to-day lives. So, not only is staffing a trauma unit hard from the jump, retaining the staff you’ve built there is even harder.
  

• Healthcare worker burnout: 2020-edition. We are currently amidst a period of mass global trauma. Healthcare worker burnout in all fields and practices is occurring at such an accelerated rate it’s impossible to plug the leak. As clinicians and HCWs from other specialties leave (or have passed on themselves), those remaining must step in for them to fill the gaps. They are then spread even thinner, begin to burn out, and leave—rinse, repeat. Trauma populations just happened to be so much more vulnerable to this to begin with.
  
  Having your own active trauma, on top of your clients’ past trauma, on top of their fresh and ongoing trauma is…a lot. Units are just unable to cope right now; and, as they have thinned out, not only did the quality of programs decline, but more severely, so has their safety. Patients leaving more traumatized than they came in, or suffering catastrophic lapses in safety whilst there (or immediately upon discharge), aren’t things we can risk. Compromising unit integrity can cost lives. It’s a snowball effect that compromises everyone involved and only ends in disaster. Closure, or program reduction-and-refocus, is the only ethical choice.
  

• Lack of awareness that dedicated trauma programs exist at all. The consequences this unfamiliarity to complex trauma care brings are twofold. First, most training psychologists and psychiatrists don’t even know trauma disorders are a specialty they could pursue. This makes them even less familiar with the option of completing their post-doctoral fellowship (or comparable residency) on a specialized trauma disorders unit. Second, the treating therapists of survivors are largely unaware that dedicated treatment centers exist for their patients in crisis to go. Combined, this creates an impossible equation. It not only increases the disparity between the number of survivors in need to the number of treatment providers available, but also makes it impossible to accurately measure the scope of their need. Reliable figures to represent the demand for trauma care are impossible to gather so long as clinicians aren’t attempting to admit their patients to programs they don’t know exist. Even waitlists fail to illustrate just how many are going without acute, crisis care. We, inevitably, are losing far more patients than we can possibly know.
  
  Additionally, while ignorance to trauma and dissociation is prevalent in all of healthcare, those who are already in the field are too often unaware of what separates a “trauma unit” from any other program. Trauma disorders programs are as different from an adult general psychiatric or even dual-diagnosis unit as, say, an eating disorder or adolescent program would be to each of those. Not only from the staffing, rules, and unit atmosphere, but in the work that is done there. Daily schedules are filled to the brim - including things like educational groups on coping skills; the incorporation of DBT, CBT, and sensorimotor tools; broader psychoeducation on trauma, child development, and medication management; processing groups to share heavy emotions, struggles with safety, sexuality and intimacy concerns, the challenges of comorbid addictions and/or compulsive behaviors, as well as even walking through trauma narratives; expressive therapies to work with one’s inner child and/or parts inside, connecting with your body safely, or creatively depicting important emotions; as well as an abundance of relapse prevention-based groups. Individual therapy may be 3-5 times a week and psychiatry is usually daily. It is hard, intense, grueling work. Stays are often 2-3 weeks at minimum but can easily become months depending on the program and level of care needed. These units do more than just stabilize patients; leaving prematurely can be quite dangerous, which is, of course, why they stay longer.
  
  So. How do we prove the value and necessity of trauma units when far too many have never even heard of their existence? How do you staff an entire unit, and fill it with the survivors desperately needing to be there, if you don’t even know it's an option?  …sadly, it’s become almost too accurate to say they don’t actually exist and aren’t an option.
  

• Pioneers of trauma hospitalization are retiring. Most of the leading trauma units began in the 80s-90s, with the pioneers of trauma and dissociation research as we know them at the helm. They built their programs from the ground up, trained those under them for decades, and remained in leadership until very recently. It’s now time to retire, step down, or focus solely on education. When they leave, finding quality leadership to fill their shoes can be a messy, disruptive, chaotic transition. While some found balance, others didn’t at all. Even those who seemed to at first lost what they had over time. And, when there’s disruption at the top, it seeps into everything beneath it - like syrup soaked through a pancake stack. That’s when patients suffer. And, when patients begin to suffer instead of heal, that’s when you’re failing oath number one of any good medical practice: Do No Harm.
  

• Ever-evolving fields create change and conflict. The true understanding of trauma and dissociation is not only a relatively new, ever-evolving landscape, but the preferred treatment models are steeply in flux. The various treatment facilities we’ve had often disagreed with one another, had different modalities, rules, groups, and patient atmospheres. But, that was largely a good thing, because patients could then choose the model that was working best for them through the guidance of their outpatient teams. That’s the benefit of having so very many locations.
  
  Patients aren’t a monolith. And certainly not those with dissociative disorders. But, when that disagreement is occurring internally, within one program, and they’re unable to settle on best practice or a modality, things break down. Programs unravel. Staff leave. Patients are failed. You know the tune by now.
  

• Long stays, long waitlists, long everything. Trauma units are most effective when they don’t merely stabilize a patient and send them on their way, but instead supply them with a modest amount of treatment. First: robust tools, coping skills, trauma education. For some, a diagnosis at all. Many learn for the very first time, only whilst hospitalized, that they even have any trauma at all, that they dissociate, or that they possess an entire OSDD/DID system within them. It can be a HUGE, life-altering shock—one that requires a delicate, gentle hand to help them digest and process it through. Others need a safe place they can go to work through a piece of trauma content that has continually destabilized them outpatient. This, too, requires great care and - above all - time.
  
  Stays can become quite long. There is little turnover compared to other units. Their waitlists are often so long that those in crisis can’t actually get in when they need it. They’re forced to go elsewhere - even if it’s an eating disorder, substance abuse, or other subspecialty program that includes some trauma care. This isn’t ideal for anyone, but hospital systems don’t like it either. Insurance companies above all don’t like it. Patients can’t afford it when they’re either cut-off too soon or before they can get in at all. The model just isn’t sustainable.
  
  Doctors and therapists don’t want to have up fight so hard just to keep their patients there. Accepting a pro-bono or halved rate to save a client’s life gets messy when you’re doing so repeatedly. Reimbursements dwindle. Many would rather just….frankly? Not fuss with it. Their time, patience and fight could be put in elsewhere for the benefit of survivors. It’s just one more reason we need MORE units, not less. But, since that didn’t occur, the strain on those already here was inevitable. Breakdown follows.
  

• Bad apples. Simply put? We’d be remiss to not acknowledge this very plain reality. Awful people exist everywhere. That sadly includes trauma care, be they leadership or unit staff. Sometimes they come as wolves in sheep’s clothing, others are merely ignorant but still harm all they touch. All it takes is one or two morally grey folks to step onto a unit before everything starts turning toxic. Y’know, “spoil the whole bunch” and all. Some units fell victim to this early and disintegrated, others later on. It became particularly evident in some locations when patients were coming out with horrid experiences by the handfuls. The consequences of this are just so much higher with already-traumatized clients. Therapists would avoid or warn against them. Eyes widen at their name. It, heartbreakingly, happens and was the downfall of some, just as it can be the downfall of any.

There are so many more spokes to this wheel that, while a disappointingly honest thought to end on, we could no doubt list more and more for hours to come. But, our fingers are admittedly tired, hearts just aching with pain, and whole selves yearning for solutions or a light to crack through the darkness just as much as you are. So, let’s take a moment to consider a few ways we can begin to turn this around. Breathe. Find fresh air.

What can we do to change this?

No action in this crisis is too small or insignificant. Whether you yourself are a survivor/patient, or instead are a clinician, concerned loved one, donor, legislator, or just a stranger with a heart, there are things we can do. And, we hope you share your own ideas below because we are in this together and thrive when we unite in collaboration, not independence.

An also-incomplete list of actions you - no, we - can take:

• Spread the message. Educate. Inform! Share this grim reality, and all the knowledge therein, with everyone you can. Help it find the hands of those in a position to make some real movement. Make noise, kick and scream, get attention. Be seen. Refuse to be overlooked. There are, no doubt, those whom this directly affects that don’t even know how dark things have gotten—how few resources they’ll have should they find themselves in crisis. Much of the world is most certainly not aware how bad it has always been. Each person it reaches is a chance for change, a flicker of hope. When we all shine at once, we burn brighter and are impossible to ignore. Go light your world.
  

• Support and raise awareness of trauma- and dissociation-dedicated organizations, like ours. Survivors won’t stop being in critical need just because there are few places for them to turn. And the public will still need reliable, accessible places to go to expand their education on trauma. We need to have a more robust supply of resources to offer everyone, to ensure they can get at least enough, even if it’s not everything they need or deserve. For our survivors who are able to access therapy, we need to guarantee they get to attend regularly, and don’t reach crisis points. For those who inevitably require inpatient care, we need to assiduously secure what is still available to them. We are only able to supply that with the aid of others. We must be the bridge to safety that’s been knocked down for them elsewhere. [Some organizations/efforts you may wish to direct your support can be found here and here.]
  

• Contact to your local hospitals. Write, call, message, whatever is accessible to you - or do all the above! Explain the need for them to open a specialized trauma unit or day program in your area. Share the high demand, vital urgency, and how complex trauma care differs from the needs of a general psychiatric population. Urge them to consult leaders in the field and work together to build quality programs. Make them aware of how their whole hospital benefits from becoming trauma-informed.
  

• Contact your community leaders, legislators, change-makers. Make them aware of the actions we need to see locally and nationally in regards to all mental health services, trauma care, and access to healthcare in its entirety. Ask them to support programs that keep folks out of crisis. Ask them to fund hospitals, mental health programs, training services that create more professionals and nonprofits who are making a difference in the lives of trauma survivors. Ask them to amplify and remedy this current trauma care crisis.
  

• Vote. Be counted. Seek elections at all levels, from the smallest and most local, to the largest, most national. Seat those who will help move the needle for all mental health care - in schools, hospitals, communities, states, countries. Prioritize the needs of complex trauma survivors who are being sorely neglected.
  

• Congregate together. Therapists, nurses, psychiatrists, mental health workers, everyone who’s ever had a dream to open up a unit or day program. Find one another and see if it’s something you might actually be able to bring to life together. What may have always been a private pipe dream on your own could actually materialize when you have an entire crew of passionate hearts with you, ones who are no longer willing to wait. Consult organizations like ours, ISSTD, An Infinite Mind, Blue Knot, and more to help design centers that will best serve our precious communities.
  

• Start small. While we need more inpatient units, and quickly, prevention is the best medicine. There are countless services that trauma survivors need but are missing that can keep them out of crisis. “Simple” things like: reliable food, utilities, transportation to appointments and sessions, community, friendship, sober activities or accountability partners, safe housing, consistent phone or internet access, medical devices, help filling out forms, some laughter in their day, etc. See where you can lend a hand or support. If you can’t do it yourself, reach out to those who may be able. Generate noise there as well. Let people know who is in need.
  

• Keep your spirits up and eyes on the goal. We know this is painfully crushing and feels rather dismal. It is extremely easy to become demoralized beyond belief or the ability to be effective. But we can’t get lost in the overwhelming sense of futility. Make sure to actively engage in self-care. Friendship. Community. Goal-setting. Active movements forward. Reflection at the progress. Gratitude. Hope-restoration. Do things that instill your faith in humanity or at least in yourself. Don’t let that dazzling spark, the one that was so invested in change that you made it all the way to the end of this article, fade out. You’re made of the brilliant stuff.

So, lets do this. Together.

You are not alone and we won’t leave anyone behind. We refuse to.

We have the ability to redirect this ship, and if there is one thing that survivors have in abundance, it’s determination, grit, and FIGHT. But you’ve never had an entire army of the same on your side. Uniting together as one front, charging ahead—that is one helluva force. One that those in our way could never have seen nor imagined. So, let’s press onward. Advance. It’s time to claim what’s yours. …ours. What we as survivors and those dedicated to them have always needed and deserved: Protection. Safety. Hope.

MORE POSTS YOU MAY FIND HELPFUL:

  ✧  Grounding 101: 101 Grounding Techniques
  ✧  Distraction 101: 101 Distraction Tools
  ✧  Flashbacks 101: 4 Tools to Cope with Flashbacks
✧ Self-Care 101: 101 Self-Care Tools
  ✧  Nighttime 101 and Nighttime 201: Sleep Strategies for Complex PTSD
✧ Color Breathing 101: How to Calm Overwhelming Emotions and Physical Pain
  ✧  Imagery 101: Healing Pool and Healing Light
  ✧  DID Myths: Dispelling Common Misconceptions about Dissociative Identity Disorder
  ✧  Did You Know?: 8 Things We Should All Know about C-PTSD and DID
  ✧  Trauma and Attachment: 3-Part Series on Attachment Theory with Jade Miller
 
  ❖  Article Index  ❖

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The BASK Model of Trauma Memory

In previous articles, we have talked a fair bit about flashbacks, particularly offering several tools and strategies to manage them. We have also discussed the more specific and unique phenomena of Emotional Flashbacks and Body Memories — all in the hopes of providing a few ways to work through them! But, we haven’t taken a proper detour into the mechanism behind all flashbacks, to really solidify the ways traumatic memory gets stored differently from regular, unfractionated, safe memory. To do this, we look to something called The BASK Model of dissociation and memory.

When a traumatic event occurs, for many folks, strong dissociation steps in as a means of self-protection. It helps compartmentalize the experience, or cast parts of it far outside of conscious thought, where it cannot be reached. It would be too distressing to be fresh on your mind, or even easily-accessible, when you're trying to go to work or are just making dinner. But, memories are made up of a vast, colorful array of mental, physical, emotional, and sensory experiences! Simplistically, we recognize them in four main categories: Behavior, Affect, Sensory, and Knowledge (BASK). We break down each of these further in the graphics below.

Let’s break those down a little further!

• Behavior — What was the action in this memory? What did you physically do - or feel the overwhelming compulsion to do - with your body? Hide, flinch, run away, attack, duck/cover, stop speaking, yell, isolate, use self-destructive behaviors, go to a certain place, turn to stone, etc?

• Affect — What were your emotions in this moment - even those stifled or shut-off? Were you sad, afraid, angry, worried, calm, disgusted, helpless, ashamed, enraged, suspicious, defeated, conflicted, intimidated, or even entirely numb or apathetic? Try to discern them from what you feel about the moment today.

• Sensory — What were the sensations in your body? Racing heart, physical pain, thirst, trouble breathing, chills, numbness, clenched jaw, dizzy, sweaty palms, nauseous, muscle tension, off-balance/spinning, intoxicated, exhaustion, etc? Were you smelling anything in particular? Hearing specific things? Keys, footsteps, loud bangs, painful silence, whispering, creaking in a floor or door, cars, extreme weather, music, etc? Did you have any tastes? External feelings against your skin?

• Knowledge — What were you intellectually aware of at the moment (the who, what, when, where, how)? The narrative, information, sequence of events? Additionally, what were your thoughts at the time? Even those that you later found out to be incorrect? What did you believe was happening or think to yourself as this moment was occurring?

During the unconscious process of putting thick dissociative barriers around this extremely sensitive material, some of those pieces scatter apart into far corners of the mind. They may each be fully detached from one another or linked up in unique, and sometimes perplexing, combinations. We know that a defining trait of PTSD, and one of its criterion for diagnosis, is "re-experiencing". When we push anything out of our awareness long enough (like when we stuff our feelings or pretend they don't exist for awhile) - but particularly if we've had to traumatically dissociate it away - it is likely to be intrusively thrust upon us against our will at some point. ...aaand typically when we're most vulnerable, least expect it, and it's the most inconvenient!

When we look to the BASK Model, and some of the unusual pairings that traumatic information can become linked, you can see how having them suddenly surface and come alive in your body without other important contextual pieces, can be deeply disorienting. It is understandably confusing, sometimes quite scary, and often easier to explain away by a hundred other things. You can now understand how this can manifest in symptoms like Body Memories (S + sometimes B), Emotional Flashbacks (A), or the ability to recount your trauma to someone without a single emotion or attachment to it in the world (K without A, and sometimes no B or S, either). Conversely, you may have every single indicator of a deeply terrifying event - it’s erupting in your thoughts, your skin, your emotions - and you know a trauma has to be there by context clues alone, but you’ve got zero intellectual awareness of what it is or where it's coming from (B+A+S). These scenarios only magnify in complexity when they’re become additionally scattered amongst parts of self in DID and OSDD systems.

The goal of traumatic processing is to find and link - or integrate - all these pieces to one another into one full, complete memory, then further integrate them into your self-concept, your narrative, the story of your life. If you're missing any vital pieces, not only are they still likely to revisit intrusively, but you may be drawing incomplete or inaccurate conclusions about the very trauma itself or what it means in the broader context of your life. You may believe a certain person in your life is much safer or more helpful than they really are; that you "didn't even react" when you maybe did so in a very powerful way; that you're at fault, when you unequivocally were not; that what occurred never hurt or 'wasn't that bad', when it very much did and absolutely was; that you felt fine, content, or enjoyment, when you really felt anger, disgust, or betrayal. The truth may completely reshape how you see yourself and everything around you. There is so much to be gleaned from these pieces coming together, and you deserve to know them in full, even though they're painful and difficult.

You also deserve to have control over your mind - no longer at its mercy when it throws these things at you when your guard’s at its lowest. Until then, we hope the some of the tools we have offered elsewhere can help to mitigate some of their effects (such as Flashbacks 101, Healing Pool/Light, Color Breathing, or Imagery with Dials), and additionally arm you with a different kind of strength and control over your symptoms.

Let's help take that power back!

MORE POSTS YOU MAY FIND HELPFUL:

  ✧  Grounding 101: 101 Grounding Techniques
  ✧  Distraction 101: 101 Distraction Tools
  ✧  Flashbacks 101: 4 Tools to Cope with Flashbacks
✧ Self-Care 101: 101 Self-Care Tools
  ✧  Nighttime 101 and Nighttime 201: Sleep Strategies for Complex PTSD
✧ Color Breathing 101: How to Calm Overwhelming Emotions and Physical Pain
  ✧  Imagery 101: Healing Pool and Healing Light
  ✧  DID Myths: Dispelling Common Misconceptions about Dissociative Identity Disorder
  ✧  Did You Know?: 8 Things We Should All Know about C-PTSD and DID
  ✧  Trauma and Attachment: 3-Part Series on Attachment Theory with Jade Miller
 
  ❖  Article Index  ❖

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