If the trauma we experienced as children was severe enough, we may, as adults, at one time or another, require residential psychiatric care (such as inpatient treatment on a psychiatric ward in a hospital, as was necessary in my own case on several occasions).
Obviously, the quality of the care we receive in psychiatric facilities can vary very considerably; unfortunately, this means that, if we are unlucky, we may find ourselves in an environment that not only fails to be therapeutic but is actively retraumatizing.
In What Ways Can A Psychiatric Facility Retraumatize Us?
According to Fallot and Harris (2001), the ways in which we can be retraumatized in psychiatric institutions can be divided into two main categories; these are :
1) BY THE SYSTEM (policies, culture, procedures, rules, etc). For example :
2) BY THE RELATIONSHIPS WE HAVE WITH THOSE ENTRUSTED WITH OUR CARE (e.g nurses, psychiatrists, etc)
Let’s look at each of these in turn :
1) RETRAUMATIZATION BY THE SYSTEM. Examples of how this may occur include :
– lack of choice regarding treatment; for example, being prescribed medication when a form of psychotherapy may be more appropriate and more effective.
– not being given the opportunity to give feedback to the professionals caring for us about how we feel in relation to the treatment we are receiving
– being treated impersonally and not as an individual but, instead, according to how one has been ‘labeled’ by one’s diagnosis (two individuals with the same diagnosis may manifest very different symptoms and have very different needs. In the case of those who have been diagnosed with borderline personality disorder, such individuals may experience the additional trauma as being regarded as ‘a trouble maker’ due to misinterpretation of the true causes of their behavior.
– constantly having to retell personal details relating to one’s psychological condition.
2) RETRAUMATIZATION BY THOSE ENTRUSTED WITH OUR CARE. Examples of how this may occur include :
– betrayal of trust
– feeling one is not being listened to and/or is being rushed when explaining one’s condition
– feeling one’s views are being dismissed /not taken seriously / invalidated
– being spoken to disrespectfully, insultingly or inappropriately
– being subjected to punitive ‘treatment’ methods (e.g. locked in isolation room without toilet or proper bedding)
– lack of communication/collaboration between patient and staff
My Own Experiences :
SECTIONING: When my illness was at its worst, I was sectioned (despite my ardent protests) because it was felt I was a high suicide risk (which, in truty, I was) ; however, being sectioned accentuated feelings of powerlessness, humiliation, and loss of autonomy
AGGRESSIVE/THREATENING PATIENTS: Unfortunately, some patients one is exposed to in psychiatric wards can be aggressive and intimidating, leading to feelings of being unsafe and constantly under threat
UNPROFESSIONAL STAFF: Sadly, occasionally one comes across staff who are not above behaving unprofessionally; this can exacerbate feelings of mistrust
ELECTRO-CONVULSIVE SHOCK TREATMENT (ECT): Because I was so ill – utterly unable to function and, indeed, almost catatonic at times, as well as a very high suicide risk, I was strongly encouraged to undergo ECT treatment ‘voluntarily’ on several occasions; in fact, though, there was no genuine choice as I was told that, if I did not undergo it ‘voluntarily,’ I would be sectioned and the act of sectioning me would, in turn, give the hospital the legal right to administer the treatment even without my consent. Due to the controversial nature of ECT treatment, this was an intimidating, degrading, and, quite arguably, dehumanizing position in which to be placed.
COMPULSION TO ABSCOND: Indeed, I often found the conditions to which I was confined so intolerable that, on three occasions, I absconded (each time with the intention of committing suicide.
Obviously, vulnerable patients who find themselves compelled to abscond, as I did, potentially expose themselves to a high level of risk in a multitude of ways.
The Trauma-Informed Environment :
Tailor and Fallot (2001) state, based on the main ways in which retraumatization may occur, therapeutic environments that cater for the traumatized (e.g. those suffering from PTSD or complex-PTSD) should be trauma-informed. Trauma-informed environments should :
1) Be calm and comfortable
2) Provide the patient with choice
3) Empower the patient
4) Recognize the strengths and abilities of the patient
5) Involve the patient, as far as possible, in all decision-making processes.
The study that tells best of the need for trauma-informed care throughout the health system is the Adverse Childhood Experiences Study which you can read about by clicking HERE.
David Hosier BSc Hons; MSc; PGDE(FAHE).