Caregiving Is Not Immune From the Effects of Trauma

Every September, National Recovery Month is dedicated to raising awareness and understanding around mental (behavioral) and substance use disorders and celebrating the people who recover. Sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), tools and resources for Recovery Month are available at www.recoverymonth.gov. This article, unabashedly, draws from that knowledge base.

Trauma Survivors is one of four special populations outlined in the National Recovery Month Toolkit (NRMT).

My work as a clinical psychologist has led me to understand that trauma may account for the lions’ share of recoverable substance abuse and behavioral health disorders.

I prefer the term “behavioral health” rather than “mental health” in this context for the same reasons Elana Premack Sandler, LCSW, MPH outlines in her October 28, 2009 Psychology Today blog Promoting Hope, Preventing Sucide:

• “It's a way of being inclusive. Behavioral health includes not only ways of promoting well-being by preventing or intervening in mental illness such as depression or anxiety, but also has as an aim preventing or intervening in substance abuse or other addictions.
• Perhaps the term "behavioral health" is less stigmatized than "mental health," so a kinder, gentler name opens doors that might otherwise remain closed for folks.
• Behavior is an aspect of identity that can be changed, so "behavioral health" might be a more hopeful concept for those who experience mental illness or addiction and who may have felt that these diseases were permanent parts of their lives.”

Taken from the NRMT, “Trauma can be defined as an emotional response to an event or set of circumstances that is physically or emotionally harmful or life threatening, and that has lasting negative effects on a person’s mental, physical, social, emotional, or spiritual well-being”.  

Although not included in the following list of causes, based on the above-mentioned criteria, caregiving could qualify as a traumatic event, due to the depression and anxiety that sometimes afflicts the one providing care.  Certainly caring for a family member who perpetrated a traumatic event, not an uncommon circumstance, can affect a caregiver’s ability and willingness to provide quality care.  Untreated trauma may cause a caregiver to punish the caree, resulting in elder abuse.  On the other hand, there can be closure, healing and forgiveness that accompanies this dynamic.

According to the National Recovery Month Toolkit, 61% of men and 51% of women report exposure to at least one lifetime traumatic event, including physical and sexual abuse, neglect, bullying, community-based violence, war, and acts of terror. Additionally, about two-thirds of the U.S. population reported experiencing at least one personal traumatic event before the age of 18, and one in four children were exposed to at least one form of family violence during their lifetimes.

Trauma can affect individuals regardless of age, gender, socioeconomic status, race, ethnicity, or sexual orientation. Trauma can also affect communities, for example, through a natural disaster or act of violence.

Reactions to traumatic events can vary, and can appear immediately or over time. Trauma survivors may experience stress, fear, and anger, hopelessness about the future, detachment or lack of concern about others, trouble concentrating or making decisions, feeling jumpy and getting startled easily, or have disturbing dreams and memories or flashbacks.

Some people may turn to unhealthy behaviors and use alcohol or drugs in an attempt to cope with trauma and its effects. It is not uncommon for people suffering from Post-Traumatic Stress Disorder (PTSD), for example, to develop substance use disorders.  For people with mental and/or substance use disorders, ignoring trauma can hinder recovery and lead to poor physical health as well.

SUPPORT

Resilience is the ability to bounce back, cope with adversity, and endure during difficult situations – most people will show resilience after a traumatic event. For some, however, the journey to recovery can be challenging and can also affect their families and loved ones. When a survivor turns to unhealthy coping strategies, like using drugs or alcohol, these issues may be exacerbated.

Caregiver support groups are available in most major cities and some outlying areas.  Other helpful resources are Codependents Anonymous (CoDA), ACA (Adult Children of Alcoholics), and Al-Anon meetings.

As family members adjust to the emotions and stresses of caring for someone in recovery, some of the best support often comes from others who are or were in similar circumstances. Trauma survivors and their families can share their experiences, as well as read others’ stories of hope and resilience at www.recoverymonth.gov/personal-stories.