Joyelle Brandt is an author, speaker, artist, and relentless advocate using lived experience to push the trauma informed movement even further. In this article, she uses insight from a visit with her primary care doctor to give us insight into what actual "best practice" should look like, and why it doesn't at this current time.
Fed up with having to start the conversation about trauma she experienced, she created a form that she could provide to her doctor that would make the situation more comfortable. She also created a form for doctors that will help educate and assess patients for adverse experiences that may be impacting their health. She graciously shares links to both in her article.
"I know the research shows that having a history of childhood trauma has significant impacts on health across a person’s lifespan, increasing the risk for chronic disease, mental illness, violence and being a victim of violence, and even shortening a person’s life expectancy by up to 20 years. This is critical information that needs to be shared with health care providers, and yet myself and most other survivors I know struggle to share this information.
So let’s take a look at some of the reasons why patients do not disclose their mental health and trauma histories to their health care practitioners.
- Cultural Stigma (Fear of being labeled and/or judged)
We have come a long way in recent years in mental health awareness. But the cultural stigmas around mental health and trauma are still strong, and no one wants to be “the crazy one.” The fear of labeling is about being pre-judged or dismissed because of your history, which leads to the next point:
- Fear of how it will be received
Most, if not all patients with a mental health or trauma history have had a negative experience when disclosing their history, not just to health care practitioners, but to anyone. Some of the reactions have included:
-accusing the person of lying (imagining their mental health or trauma issue)
-telling the patient they are just overly sensitive (dismissing or minimizing)
-using the information as an excuse for other medical conditions without doing any diagnostic investigation
– attributing health issues to the patient ‘just wanting attention’ or being a hypochondriac
-visible discomfort and avoiding eye contact with the patient after hearing the information
These are just a few of the painful reactions that patients have faced when trying to convey this very important information. I once had a doctor flip through my chart after I requested to see a female gynecologist. I was 16 years old and going for my first pap smear. His response to my request was to look through my medical history until he found the information he was looking for, and then say to me: “Oh, no wonder you want a female doctor. You’ve been tampered with.” This was in reference to the fact that I was sexually abused as a child.
- Avoiding fight/flight/freeze response
For trauma survivors, even talking about their trauma histories can trigger their bodies into the fight/flight/freeze response. This shows up in the body as increased heart rate, tremors, difficulty breathing or swallowing, nausea, etc. Given that lovely series of symptoms, it is understandable that they avoid talking about it whenever possible.
- Trained to secrecy
For survivors of childhood abuse, the fight/flight/freeze response can be even more pronounced because abusers train children into a culture of secrecy. In order to silence their victims, abusers will threaten not only the children’s lives but also their loved ones lives. They will tell the child that if she/he says anything, it will be the child’s fault and the child will get in trouble. Abusers will say anything to keep them silent. And even 30 or 50 years later, that early programming is very hard to break, as it was hardwired into the brain at such an early stage in brain development.
- Practitioners don’t ask
Finally, there is simply the issue that most health care practitioners never ask about mental health or trauma. This is understandable, given the lack of training in this area. But mental health and trauma are not something separate from physical health. They interact with and inform each other. Take for example the findings of the Adverse Childhood Experiences Study, which discovered that not only does early childhood trauma have a role in later chronic health and mental health ailments; it can shorten a person’s lifespan by up to 20 years. This is significant information that needs to be included in a patient’s chart, and taken into account when diagnosing and treatment planning."
Read Joyelle's full article on the Parenting with PTSD website.
The vital information that is left out of your patient’s medical history that could cost their lives.