How should we view trauma? We live in a society where we have a pharmacological agent for almost every ailment, real or imagined. When we are sick, we go to the doctor and we get a prescription for a drug. Prescriptions are usually written, but can be a verbal order. The drug is prescribed to heal an illness, or disease, or at least, to provide some relief. What happens, though, when an ailment is so deep within one’s core that it cannot be treated by any medication?
As a seasoned pharmacist, I have always been intrigued by the manner in which therapeutic agents act on the intended targets. Drugs exert effects on cells and tissues within the body through varying biochemical ways. Some act at specific binding sites, through receptor activation or inhibition; some, through increasing or suppressing enzymatic activity. In the mind of a pharmacist, it all makes sense. I remember well a time in my second year at the University of Illinois, at the Chicago College of Pharmacy, my Professor stating that it was our responsibility, as pharmacists, to make sure the right patient receives the right drug for the right disease. I had that down pat as I progressed through my career journey as a pharmacist. Through several different professional pharmacy settings - retail, hospital, and ambulatory care - I was motivated by that core concept – the right patient, the right drug, the right disease state.
One day I had a life changing moment - an epiphany. I was offered a contract position as a polypharmacy pharmacist for the Department of Defense. It was a pivotal moment in my practice. I began to look beyond the world of pharmacotherapy. I began to look at each patient’s disease beyond the molecular level in which their medication exerted effects on their moods, sleep, and well-being. In my epiphany, I began to ask myself what could be done at a deeper level – deeper to the core of the whole person – than just at a molecular level? To explain a little further, for context, my job description as a contract pharmacist was to assess military service members medication profiles to determine if the medications that they were prescribed were effective and if there was any duplication in the medications they were being prescribed, and, also if the patients were experiencing any adverse effects. While meeting with those valiant men and women service members who had been exposed to combat, there was one underlying resonating consistency. In my sixty-minute interview assessment sessions with them, the singular common denominator was a history of being exposed to serious trauma.
Trauma is a deeply disturbing or distressing and injurious event or series of events. Trauma results in profound physical and emotional harm that has long term effects on an individual’s ability to function. Examples of common trauma that occurs frequently include:
- Acts of domestic violence, including witnessing domestic violence, whether physical or emotional, or both
- Community neighborhood shootings, including, mass gatherings and school shootings
- Sudden or violent loss of a loved one, either to an accidental incident or an intentional act of violence
- Physical or sexual assault, such as being wounded by a knife or firearm, or sexually molested or raped
- Living in a chaotic environment, e.g. homelessness, and, possibly, living for a period in a shelter
Soon, after leaving my contract position, I began to reflect on my own experiences within my native city, Chicago. I began to appreciate with greater understanding and conviction the similarities between experiencing combat engagements in war arenas and the violence that is occurring in the most distressed cities in the United States. Tragically, our youth are the most vulnerable to those acts of violence and are most likely to henceforth become violent themselves, in the future, after having been exposed to violence. Yes, it is a self-regenerating cycle.
Some cities in the United States are reporting escalating rates of violent crimes and ever-increasing involvement of deadly weapons among our youth between the ages of 15-24. The National Center of PTSD revealed that 77 percent of children exposed to school shootings and 35 percent of urban youth exposed to violence develop Post-Traumatic Stress Disorder (PTSD), a rate far greater than soldiers deployed to combat areas, largely due to those youth being in the formative and, hence, more vulnerable developmental stage of their lives. The rates of youth violence are disproportionately higher in impoverished communities, ones that are underserved by healthy lifestyle recreational facilities and programs and lacking in social, psychological, and clinical medical providers and services, standard retail stores, restaurants, and food markets, and that are lacking a sound and healthy economic base.
Demographically, homicides among the youth population in inner cities of the United States has taken more lives than suicides, heart disease, HIV and unintentional injuries. We, as a society, must no longer continue with the same approaches and attempts at solutions and expect to get different results. As Susan B Anthony said,” organize, agitate, and educate must be our war cry.”
Ultimately, I began to ask myself what my role as a pharmacist should be. I had witnessed the effects of overmedicating adults who had been exposed to trauma. Could that also be occurring with our children? How are we treating those who have been exposed to the trauma of neighborhoods shootings, police brutality, gang violence, and poverty? A pill is not the answer – it never was. If we are going to find ways to break the cycle of violence in our communities, we must begin to look at the root causes of violence. As a Robert Wood Johnson Clinical Scholar, I have joined the movement to treat trauma as an health issue; and continue to develop a model with interventions that recognize the significance of treating the whole person - the mind, the body, and the spirit.
Lachell Wardell Pharm.D.
Creighton University MPH Candidate 2018
Comments (8)