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“Child trauma refers to a scary, dangerous, violent, or life threatening event that happens to a child (0-18 years of age)".

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More than two-thirds of children reported at least one traumatic event by the time they reached the age of 16. These traumatic events included: psychological, physical, and sexual abuse, community or school violence, witnessing or experiencing domestic violence, witnessing or experiencing domestic violence, national disasters or terrorism, commercial sexual exploitation, sudden or violent loss of a loved one, refugee or war experiences, military family-related stressors, physical or sexual assault, neglect, serious accidents or life-threatening illness.

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At least 1 in 7 children have experienced child abuse and neglect in the past year. In 2019, 1, 840 children died of abuse and neglect in the United States. More than 1,000 youth are treated in emergency departments for physical assault-related injuries. In 2019, 1 in 5 students reported being bullied on school property in the last year. 8% of high school students had been in a physical fight on school property one or more times during the 12 months before this survey was done. Each day, about 14 youth die from homicide. The impact of child traumatic stress can last beyond childhood. Learning problems, lower grades, and more suspensions and expulsions are a few things that trauma survivors may experience.

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Childhood Trauma and the Brain | UK Trauma Council

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Children Experiencing Post-traumatic Stress Disorder 

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Children Experiencing Post-traumatic Stress Disorder 

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Children may experience post-traumatic stress disorder due to encountering a toxic stressor (Newman & Newman, 2018) due to their LHPA axis being unable to balance due to their trauma. The LHPA axis is supposed to stay balanced while we are under stress, but childhood trauma can affect the way this part of the brain responds when someone has been through something at an early age (De Bellis & Zask A.B., 2014). Research has proven that children that have been raised in an environment that is domestic has trouble developing empathy, self-control, and mature problem solving skills (Newman & Newman, 2018).

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A student explains his experience within the school shooting, which these tragic events can lead to PTSD in children.

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'I played dead': Kid who survived Texas school shooting recalls gunman saying 'you're all gonna die'

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Traumatic events that cause emotions of fear, loss or distress can impact a child's developmental health.

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According to research, 13% of children will have experienced a traumatic event by the time they turn 9. The effects of a traumatic event can cause the children to undergo nightmares, and distress when the event is brought up. Children also isolate themselves from the people, places, or/and activities that serve as a reminder of the event (Cummings, 2017). Such events can cause children to lose developmental skills, such as toileting and talking (Cummings, 2017). Children are also susceptible to losing sleep, having decreased concentration, and losing their sense of a social life due to their experience (Newman & Newman, 2018), in which their emotional development is affected and their social skills are at risk of developing. When children undergo a traumatic event during their developmental stage this can affect the way their brain develops (De Bellis & Zask A.B., 2014).

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Early adversity has lasting impact on health (ACEs)

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Early adversity has lasting impact on health (ACEs)

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How childhood trauma affects health across a lifetime

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How childhood trauma affects health across a lifetime

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Understanding how exposure to adversity affects developing brains in children

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How childhood trauma affects health across a lifetime | Nadine Burke Harris | TED

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Adverse Childhood Experiences (ACEs) Study

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Adverse Childhood Experiences (ACEs) Study

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Childhood trauma is also known as adverse childhood experiences. Dr. Vincent J Felitti of Kaiser Permanente and Dr Robert Anda of the CDC conducted a study that compares current adult health status to childhood experiences decades earlier.

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Adverse childhood experiences (ACEs) can have a tremendous impact on future violence victimization and perpetration, and lifelong health and opportunity. CDC works to understand ACEs and prevent them.

Adverse Childhood Experiences (ACEs) Prevention Strategy Plan [3 MB, 20 Pages]
This resource outlines CDC's specific goals and objectives for ACEs prevention and response. The goals and objectives aim to prevent ACEs before they happen, identify those who have experienced ACEs, and respond using trauma-informed approaches in order to create the conditions for strong, thriving families and communities where all children and youth are free from harm and all people can achieve lifelong health and wellbeing.

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Adverse childhood experiences (ACEs) can have a tremendous impact on future violence victimization and perpetration, and lifelong health and opportunity. CDC works to understand ACEs and prevent them. Adverse Childhood Experiences (ACEs) Prevention Strategy Plan [3 MB, 20 Pages] This resource outlines CDC's specific goals and objectives for ACEs prevention and response.

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Centers for Disease Control and Prevention

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All children may experience very stressful events that affect how they think and feel. Most of the time, children recover quickly and well. However, sometimes children who experience severe stress, such as from an injury, from the death or threatened death of a close family member or friend, or from violence, will be affected long-term. The child could experience this trauma directly or could witness it happening to someone else. When children develop long term symptoms (longer than one month) from such stress, which are upsetting or interfere with their relationships and activities, they may be diagnosed with post-traumatic stress disorder (PTSD).

Examples of PTSD symptoms include

Reliving the event over and over in thought or in play

Nightmares and sleep problems

Becoming very upset when something causes memories of the event

Lack of positive emotions

Intense ongoing fear or sadness

Irritability and angry outbursts

Constantly looking for possible threats, being easily startled

Acting helpless, hopeless or withdrawn

Denying that the event happened or feeling numb

Avoiding places or people associated with the event

Because children who have experienced traumatic stress may seem restless, fidgety, or have trouble paying attention and staying organized, the symptoms of traumatic stress can be confused with symptoms of attention-deficit/hyperactivity disorder (ADHD). Read a guide for clinicians on deciding if it is ADHD or child traumatic stress.

Examples of events that could cause PTSD include

Physical, sexual, or emotional maltreatment

Being a victim or witness to violence or crime

Serious illness or death of a close family member or friend

Natural or manmade disasters

Severe car accidents

Learn more about PTSD
Treatment for PTSD

Learn about the guidelines for diagnosing and treating PTSD

The first step to treatment is to talk with a healthcare provider to arrange an evaluation. For a PTSD diagnosis, a specific event must have triggered the symptoms. Because the event was distressing, children may not want to talk about the event, so a health provider who is highly skilled in talking with children and families may be needed. Once the diagnosis is made, the first step is to make the child feel safe by getting support from parents, friends, and school, and by minimizing the chance of another traumatic event to the extent possible. Psychotherapy in which the child can speak, draw, play, or write about the stressful event can be done with the child, the family, or a group. Behavior therapy, specifically cognitive-behavioral therapy, helps children learn to change thoughts and feelings by first changing behavior in order to reduce the fear or worry. Medication may also be used to decrease symptoms.

Get help finding treatment

Here are tools to find a healthcare provider familiar with treatment options:

Prevention of PTSD

It is not known exactly why some children develop PTSD after experiencing stressful and traumatic events, and others do not. Many factors may play a role, including biology and temperament. But preventing risks for trauma, like maltreatment, violence, or injuries, or lessening the impact of unavoidable disasters on children, can help protect a child from PTSD.

Learn about public health approaches to prevent these risks:

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Post-traumatic Stress Disorder in Children | CDC

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Children may experience very stressful events that affect how they think and feel. Learn about Post-traumatic Stress Disorder in children.

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How peer support can impact a child dealing with trauma.

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are you okay? | Award-Winning Short Film

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Natural disasters affect an average of 224 million individuals worldwide.

Mental health: Researchers have found mental health problems and conditions such as depression, anxiety, and general distress in disaster survivors of all ages. Children are different from adults physically, socially, and developmentally which makes the need for disaster response services needed specifically for children of particular age groups. Research has also shown that children experience severe reactions to stress following a natural disaster, including clinical needs and behavioral issues such as PTSD (posttraumatic stress disorder), functional impairments, traumatic stress symptoms, and other mental disorders (Koplewicz & Cloitre, 2006). After a disaster children are at a greater risk than adults to develop psychiatric disorders.

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https://www.nctsn.org/sites/default/files/resources/is_it_adhd_or_child_traumatic_stress.pdf

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Is is important to understand the difference between ADHD and symptoms of trauma in children to ensure they receive the appropriate support.

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The current generation experiences effects from the recent pandemic in terms of life fulfillment and beginning work (Gould & Kassa, 2020), versus the older generation worrying more about health since the older generation is more susceptible to attracting the virus (Luo, Cheng, & Sui, 2021).

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Why the coronavirus recession hit young workers so hard

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In terms of life expectancy following a crisis, females are at a lower mortality rate than males (Vigezzi et al., 2022).

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Mass shooting in Buffalo New York at a supermarket was a racist hate crime police say. 

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Mass shooting in Buffalo New York at a supermarket was a racist hate crime police say. 

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Trauma that affects communities and cultures covers a broad range of violence and atrocities that erode the sense of safety within a given community, including neighborhoods, schools, towns, and reservations.

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10 Killed In Buffalo Supermarket Mass Shooting

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How Systemic Racism, Protests & Police Brutality Impact Childhood Trauma

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Useful websites with resources on ways to support children who experience crisis & trauma:

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Useful websites with resources on ways to support children who experience crisis & trauma:

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Trauma-informed support for Children https://www.echotraining.org/trauma-informed-support-for-children/

Supporting Traumatic Stress Resiliency in Children https://neurabilities.com/supporting-traumatic-stress-resiliency-in-children/

Helping Children and Adolescents Cope With Traumatic Events https://www.nimh.nih.gov/health/publications/helping-children-and-adolescents-cope-with-disasters-and-other-traumatic-events

6 Guiding Principles To A Trauma-Informed Approach https://www.cdc.gov/cpr/infographics/00_docs/TRAINING_EMERGENCY_RESPONDERS_FINAL_2022.pdf

Caring for Children in a Disaster https://www.cdc.gov/childrenindisasters/schools.html

Helping Children Cope with Emergencies https://www.cdc.gov/childrenindisasters/helping-children-cope.html

Helping Children Cope https://www.cdc.gov/mentalhealth/stress-coping/help-children-cope/

Helping Children with Disabilities Cope with Disaster and Traumatic Events https://www.cdc.gov/ncbddd/disabilityandsafety/trauma.html

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"Historical trauma is multigenerational trauma experienced by a specific cultural, racial or ethnic group. It is related to major events that oppressed a particular group of people  such as slavery, the Holocaust, forced migration, and the colonization of Native Americans."

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Problems we have can be generational. "Generational Curses" affect families and different races from past trauma that has not been healed. It is important that these generational curses are broken for the future generation of a family/community to build from.

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"Historical trauma can generally be thought of as “the cumulative emotional and psychological wounding over the lifespan and across generations, emanating from massive group trauma."

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With the recent news about Native American deaths and burials at former Indian schools ( read Dr. Cam Shriver's blog post about Boarding Schools here), this is an appropriate time for a discussion of the impacts of Historical Trauma (HT) on Native communities. First and foremost, from the perspective of the Nipwaayoni Acquisition and Assessment Team (NAAT), we tend to work from a strengths-based approach that identifies and fosters the strengths of our community. However, innate to this conversation about historical trauma is a deficit-based approach that focuses on the problems within a community and how to overcome them. I will further elaborate on the difference between these two approaches in a future blog post, but our work thus far has suggested that identifying and promoting the resilience and the numerous strengths of our community is most effective for promoting health. As a result, we can use HT to help us understand particular components of our collective experience, but it does not stand alone in how we address living well for Myaamiaki. At the same time, it is important to not overlook the significant impact that these types of trauma can have on tribal communities.

Young shaker is assisted by her father and grandfather in tying her cans for the Miami Tribe of Oklahoma's 2019 Winter Gathering Stomp Dance.
Photo by Doug Peconge

What is Historical Trauma?

Within both the scholarly community and broader society, the concept of HT is not well-defined partially due to the sheer number of terms that have been used to describe the general concept, including but not limited to "Historical Trauma," "Intergenerational Trauma," "Transgenerational Trauma," "Collective Trauma," "Intergenerational Post Traumatic Stress," and "Multigenerational Trauma". Because every scholar seems to call it something different, there are also varying definitions of what it means, methods of measuring it, and conclusions about how it impacts Native communities. As a result, the ability to make conclusions about the impacts of historical trauma on Indigenous communities is largely based on lived (individual- and community-level) experiences rather than empirical conclusions. However, those lived experiences are incredibly powerful and important and provide us with a baseline understanding of this experience.

Ester Miller Moore (middle row, third from left) with fellow students from the Carlisle Indian School class of 1889.
Courtesy of the Carlisle Indian School Digital Resource Center and the Cumberland County Historical Society

Historical trauma can generally be thought of as "the cumulative emotional and psychological wounding over the lifespan and across generations, emanating from massive group trauma". This theory generally makes four assumptions:

1. The mass trauma is deliberate in nature.

2. The trauma is ongoing, not an isolated event.

3. The traumatic event(s) impact the whole community.

4. The expanse of the trauma(s) disrupt the community across generations.

Inherent within this deliberate mass trauma is the idea that the trauma (oppression or conquering of the targeted group) is directly tied to their shared (ethnic) identity. Native people, including Myaamiaki, have faced such trauma on a community level including forced removal, boarding schools attendance, and environmental destruction.

Historical Trauma Response

Psychologists have noticed that traumas experienced collectively by large groups have intergenerational effects and tend to result in similar reactions or "symptoms". I want to be clear here that, in general, these reactions are not all necessarily negative or abnormal, rather they can be normal reactions to significant extended oppression and trauma. Yet, they can impact our daily lives in a variety of ways.

Different people and communities have varying reactions to these historical traumas, differential access to resources, varying levels of ongoing traumas/discrimination/oppression, different ways of making meaning out of the traumatic experiences, and many protective factors that promote resilience in the face of said traumas. However, here I intend to share what some of the most commonly identified responses to HT are. It is unlikely that a single person would feel or experience all of these, but rather the following describes the wide array of cognitive, psychological, and behavioral responses that could result from HT.

Cognitive Symptoms

Individuals tell themselves stories about their own life and their experiences, attempting to make meaning out of the various elements of their life. Individuals who are descendants of those who have experienced significant traumas do the same, attempting to make meaning out of something that impacts them but did not directly happen to them, which can lead to common cognitive patterns or ways of thinking. For example, many Native people feel a sense of survival guilt in which they feel guilty or ashamed that they survived when their ancestors and/or community members did not. This is often accompanied with questions of "why me?" and contemplation of existential concerns. Additionally, some people just want the guilt or shame or whatever they are feeling to go away or they ignore it. This is most likely the brain/body's way of separating the self from the heavy emotional burden that accompanies traumatic experiences.

Trauma also tends to have a direct impact on an individual's identity and sense of self. Because it is common to become fixated and/or preoccupied with the traumatic experiences, descendants of ancestors who experienced significant traumas reconsider what that means about themselves. Consequently, some people feel a loyalty to their ancestral suffering in which they become highly attached to and have difficulty separating themself from that suffering. They begin to define themselves by this traumatic experience (victim identity), which can complicate the coping process. Their entire being becomes defined by their victim or survivor status. At times, this even progresses to feeling like they cannot thrive or do well because their ancestors were denied that opportunity. This tends to keep people in a negative emotional state that can be resistant to support or receiving help.

Psychological Symptoms

Psychologically, historical trauma operates much like other traumatic events, but can be less overt yet persistent. Historical Trauma can be very difficult to identify because the symptoms can look very different for different people and there is a lot of overlap between multiple types of issues or problems. Mental Health professionals who do not have an understanding of Native history will often overlook, misunderstand, or hyperfocus on characteristics of folks experiencing outcomes of HT.

First, some people experience similar symptoms as those who have Post-Traumatic Stress Disorder (PTSD). This can consist of experiences of nightmares, emotional distress, hypervigilance, avoidance of thoughts of the trauma, self-blame, isolation, apathy, and much more. Additionally, some people experience symptoms of depression or anxiety. There is also some research suggesting that descendents of individuals who have experienced significant trauma are more vulnerable to life stressors. Essentially, when they experience an acute stressor or trauma themselves, they are more likely than the general population to develop a mental health condition, like PTSD, as a result.

Behavioral/Physical Symptoms

Individuals who have experienced HT might exhibit certain behavioral responses both as a means of coping with the traumas as well as through learned and perpetuated behaviors. Many of these behaviors are self-destructive in nature including substance abuse, physical abuse, and suicide. Importantly, when children are torn from their homes (such as with boarding schools) and not given the opportunity to experience the full range of intended parenting and caregiving behaviors of their community, they use the experiences they did have when they become parents as a model. This at best leads to parenting behaviors inconsistent with those of their tribal community and at worst perpetuates abuse and other negative behaviors they themselves faced.

Physically, it is common for people with HT to experience physical symptoms including headaches or stomach aches as the mind and the body are highly connected. In fact, the belief of mind-body separation that is common within America isn't shared across cultures. Furthermore, HT and chronic stress are related to a compromised immune system, biochemical abnormalities, and nutritional stress which can lead to other health concerns (malnutrition, heart disease, diabetes).

Intergenerational Transmission of HT

One of the primary distinctions between Historical Trauma and other traumatic experiences that an individual might have is the intergenerational transmission within families and communities. But how does HT get passed on from one generation to the next? Research addressing this question has been fascinating. The transmission occurs via multiple interconnected pathways including biological, psychological, and social means.

Click to enlarge
Reprinted by permission from Michelle Sotero, "A Conceptual Model of Historical Trauma: Implications for Public Health Practice and Research," Journal of Health Disparities Research and Practice, Vol 1(1), (2006), 93-108.

Biological Transmission

The first route for intergenerational transmission of trauma is biological in nature. One route is the epigenetic impact; epigenetics is the study of how one's environment impacts their genetic expression. These genetic changes do not alter an individual's actual DNA, but rather the way the body reads that DNA sequence. For example, the level or quality of attachment a child has with their parent(s) when they are young (environmental impact) essentially can alter the development of individual differences in stress responses in the brain (genetic expression). It is then possible to transmit this epigenetic effect to future generations, particularly if the change occurs within the sperm or eggs. While the exact epigenetic mechanisms of the impact of trauma for American Indian people (or other experiences of mass trauma) are not fully clear yet, it is clear that epigenetics plays a primary role in the intergenerational transmission of trauma.

Second, it is clear that trauma in general is related to higher rates of disease and mental health concerns. When an individual experiences a trauma, their body's stress response goes into overdrive, which impacts multiple functions within the body. Once those diseases and/or mental health "disorders" develop, we know that some of those conditions can leave their children with a predisposition that means they have a higher chance of also developing that disorder. As a result, parents who have experienced significant traumas often develop and pass down mental health and other chronic illnesses to children and this leads to greater vulnerability of these same diseases across generations.

Psychological Transmission

Psychologically, as previously stated, survivors of trauma experience symptoms of many mental health conditions including PTSD, depression, anxiety, and many others. These can be inherited in subsequent generations. In addition to the genetic contributions, these symptoms are then understood within the context of the traumatic experiences and parents/grandparents tell these stories to future generations. While it is critical to carry on these narratives to future generations, it can also inadvertently lead to secondary psychological suffering from the vicarious experiencing of the trauma through these stories. The narrative of trauma and suffering can become rooted within individual- and community-level self understanding.

Additionally, the ways in which people speak with children about the world can significantly impact their psyche and their meaning-making process. When children learn that suffering due to ancestral pain is inevitable and something that cannot be avoided, this may perpetuate identity and emotional concerns across generations.

Finally, for many reasons, Native people were not able to properly grieve the many losses they experienced as a result of these numerous traumas (loss of life, land, culture, language, etc.). This inability to process the grief often leads to an intensification of the emotional reactions of the grief process (anger, guilt, sadness, helplessness, etc.). As a result, subsequent generations experience historical unresolved grief, characterized by collective, generalized pain and intense emotions.

Social Transmission

Societally, cultures that experience mass trauma experience loss of their ways of living and being in many arenas of life. Many Native communities experienced a loss of language and culture as a result of these traumas, creating a ripple effect that spans multiple generations. When communities no longer practice their rites of passage, live out their value system, and/or their ceremonies (among other lifeways), many of the defining characteristics of the community disappear and the people live on the remnants of what once was. This keeps living communities striving for the past or of "better times" and restricts societal evolution and growth. More tangibly, many individuals experienced economic struggles in trying to maintain their family and community, at times leading to high levels of poverty and unemployment.These economic struggles unfortunately have been maintained across multiple generations due to many factors, and largely to the ongoing exploitation, discriminative policies, and oppression of many Native communities.

Uses/Benefits of Understanding Historical Trauma

The theory behind historical trauma benefits Indian Country in many ways, some difficult to put into words. First and foremost, this term puts words to an experience that many Native people live with on a daily basis. When people have a common experience that manifests psychologically, it is common for them to keep that to themselves and it becomes isolating. However, naming the experience brings it into collective consciousness and enables people to connect about their own experiences and narratives, talk about them openly and ideally heal from those traumas. Thankfully, naming HT has also enabled people and communities to realize and release the guilt and self-blame they sometimes feel for the health disparities that their communities face. It contextualizes the many factors that have contributed to these disparities including numerous collective traumas throughout history and ongoing oppression and discrimination.

Additionally, this theory has forced the world of Psychology to take a look at the ways in which Indigenous people are treated for mental health concerns. It compels these professionals to examine attitudes and previously held ideas about Native populations, recognize the importance of history and lived experience, and determine optimal ways of supporting the health and mental health of these communities. From this new lens or way of thinking, mental health and health professionals are reinventing their way of intervening and addressing problems presented to them by oppressed communities and discovering new ways to prevent problems and promote resilience, and strengthen and leverage community assets by using culture as a positive tool in itself. Using culture as an intervention in itself, encouraging Native people to attend tribal events and ceremonies, and involving important tribal leaders and educators in the therapeutic process all stem, at least in part, from this discourse.

Kathy Carter Young and several of her grandchildren at the Miami Tribe of Oklahoma's 2019 Family Day
Photo by Karen Baldwin

Critiques of Historical Trauma

As previously stated, not all scholars view HT is the same way, and there are multiple critiques about its definition and usefulness as a concept. Additional critiques stem from the difficulties in empirically studying historical trauma. Because we cannot necessarily measure the intergenerational transmission of the trauma symptoms, there is no way to single out past traumas as the cause of the experience. Furthermore, because the symptoms span the full range of many mental health disorders, it is not possible to achieve any level of specificity in terms of classifying the experience for treatment. Essentially, even if we acknowledge that HT exists, the complexity of the theory does not add any clarity for clinicians who are trying to treat those with such a wide array of experiences. However, interdisciplinary professionals and academics use this theory for many reasons, many of which do not require such specificity.

Some people believe that HT theory perpetuates a victim identity and suggests that the cycle of passing on symptoms throughout generations cannot or will not end. If this cycle is unable to be treated/stopped, then any interventions that emerge from this theory won't be helpful for treating symptoms of HT. In the same vein, it has been argued that with HT theory, trauma has transformed from a cause of suffering to a resource for sufferers. Rather than being explanatory in nature, helping individuals to understand larger societal and contextual factors within the community, it has been co-opted as a means to explain their negative life experiences.

Finally, HT theory ignores the vast diversity of trauma experiences that Native communities have experienced and relegates them to one common experience. Because every community had their own nuanced experiences throughout history, this likely leads to different experiences that could be specified if we examine each community individually rather than defining a collective HT experience.

In conclusion, I hope that this article can serve as a starting point for us to consider the potential ways that myaamia experiences of historical trauma may impact the myaamia community. In future posts, I will discuss the strength- and deficit-based approaches to health-based research and intervention and another on coping with the effects of historical trauma.

Disclaimer

This blog post is intended to be for informational and educational purposes, primarily for the Myaamia community, and should not be considered or utilized for therapeutic or treatment purposes. I am not able to provide clinical opinions regarding any questions or comments that may arise from this post and engagement with this does not constitute a professional relationship. If you find yourself in need of psychological services, I strongly encourage you to reach out to a clinical provider in your area. Use this by Psychology Today to find practicing clinicians in your local area. If you believe you are in need of immediate assistance, please utilize the resources listed on this website.

Bibliography

[1] Maria Yellow Horse BraveHeart, Josephine Chase, Jennifer Elkins, and Deborah B. Altschul, "Historical Trauma Among Indigenous Peoples of the Americas: Concepts, Research, and Clinical Considerations," Journal of Psychoactive Drugs, Vol 43(4), (2011), 282-290.

[2] Michelle Sotero, "A Conceptual Model of Historical Trauma: Implications for Public Health Practice and Research," Journal of Health Disparities Research and Practice, Vol 1(1), (2006), 93-108.

[3] Karina L. Walters, Selina A. Mohammed, Teresa Evans-Campbell, Ramona E. Beltrán, David H. Chae, and Bonnie Duran, "Bodies Don't Just Tell Stories, They Tell Histories: Embodiment of Historical Trauma among American Indians and Alaska Natives," DuBois Revies: Social Science Research on Race, Vol 8(1), (2011), 179-189.

[4] William E. Hartmann, Dennis C. Wendt, Rachel L. Burrage, Andrew Pomerville, and Joseph P. Gone, "American Indian Historical Trauma: Anticolonial Prescriptions for Healing, Resilience, and Survivance," American Psychologist, Vol 74(1), (2019), 6-19.

[7] Teresa Evans-Campbell, "Historical Trauma in American Indian/Native Alaska Communities," Journal of Interpersonal Violence, Vol 23(3), (2008), 316-338.

[9] Natan P. F. Kellerman, "Epigenetic Transmission of Holocaust Trauma: Can Nightmares Be Inherited?" Israel Journal of Psychiatry and Related Sciences, Vol 50 (1), (2013), 33-39.

[10] Ian Weaver, "Epigenetics in Psychology," in Biswas-Diener & Diener (Eds), Noba Textbook Series: Psychology (Champaign, IL: DEF publishers, 2021).

[13] Maria Yellow Horse Brave Heart and Lemyra M. DeBruyn, "The American Indian Holocaust: Healing Historical Unresolved Grief," American Indian and Alaska Native Mental Health Research, Vol 8(2), (1998), 60-82.

[16] Haley Shea, G. Susan Mosley-Howard, Daryl Baldwin, George Ironstrack, Kate Rousmaniere, and Joseph E. Schroer. "Cultural revitalization as a restorative process to combat racial and cultural trauma and promote living well." Cultural Diversity and Ethnic Minority Psychology 25(4), (2019), 553-565.

[18] Krista Maxwell, "Historicizing Historical Trauma Theory: Troubling the Trans-generational Transmission Paradigm," Transcultural Psychiatry, Vol 51(3), (2014), 407-435.

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With the recent news about Native American deaths and burials at former Indian schools (read Dr. Cam Shriver's blog post about Boarding Schools here), this is an appropriate time for a discussion of the impacts of Historical Trauma (HT) on Native communities. First and foremost, from the perspective of the Nipwaayoni Acquisition and Assessment Team...

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The Impact of Historical Trauma and Mistrust on the Recruitment of Resource Families of Color

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The Impact of Historical Trauma and Mistrust on the Recruitment of Resource Families of Color

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https://www.tandfonline.com/doi/pdf/10.1080/10926755.2016.1149536?needAccess=true

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"Historical trauma has emerged as a critical area of study in understanding and addressing long-term health problems in communities."

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by Marcos J. Martinez, Ph.D., MSW, and Elisa Kawam, MSW, Ph.D.
To be effective in the work that we do as social workers at all levels, it is important to understand ecological and social context. One such context in particular, the historical realm, can provide further depth in appreciating antecedents to social and behavioral problems that have an impact on our communities and clients. Our previous article on trauma-informed care highlighted the fact that social workers often work with individuals who may have complex histories of abuse and violence alongside their biopsychosocialspiritual needs (Kawam & Martinez, 2016). Individual trauma histories are encapsulated within a larger trauma narrative; over time, this narrative may accumulate into a multigenerational shared account of events that have harmful effects on functioning and quality of life.

The notion of a shared story over time is deemed historical trauma (Mohatt, Thompson, Thai, & Tebes, 2014). Important to illustrating sources of risk and markers of reduced health/mental health, historical trauma places importance not just on the individual, but in the communities' experience of a negative event or events (Sotero, 2006).

Historical Trauma

Those with individual histories of trauma may be more likely to experience negative behavioral health outcomes, as well as decreases in daily functioning and quality of life. Compounding individual trauma is historical trauma, defined as the "cumulative psychological and emotional wounding across generations... [emanating] from massive group trauma" (Brave Heart, Chase, Elkins, & Altschul, 2011, p. 283). Starting in the 1960s, knowledge of historical trauma emerged from the stories of those who endured the Holocaust and its impact on subsequent generations, as well as the experiences of Japanese Americans placed in internment camps after World War II (Evans-Campbell, 2008; Sotero, 2006). Finding that these two groups had endured persistent mass trauma and that their children's mental health was affected was groundbreaking at that time and built the foundation for historical trauma research today.

In a study on Lakota elders, it was found that both individual and family-wide mental health was affected by trauma. Elders reported experiencing depression, difficulty showing emotion, shame, over-dependence, isolation, anxiety, sadness, avoidance of culturally significant places, loss of concentration, and constant thinking about historical loss (i.e., language, indigenous land, and so forth) and how alcoholism was affecting the community (Whitbeck, Adams, Hoyt, & Chen, 2004). This research provided rich qualitative evidence of the long-term impact that historical trauma had on the psychological and emotional well-being of the population affected.

Populations that have historically experienced mass trauma tend to have a higher prevalence of chronic disease several generations later (Sotero, 2006). Generally, historical trauma consists of three elements: 1) a traumatic event, 2) the shared experience of the trauma by a group of people, and 3) the multigenerational impact of such trauma (Mohatt et al., 2014). Historical trauma is described as collective trauma that is inflicted on a group of people based on their identity or affiliation related to ethnicity, religious background, and nationality (Evans-Campbell, 2008). Some examples of collective/mass trauma include the experience of indigenous boarding schools, forced relocation of people, enslavement, biological warfare, ethnic cleansing, incarceration, and genocide (Evans-Campbell, 2008; Mohatt et al., 2014; Sotero, 2006). These experiences can be damaging on a physical and/or emotional level for the group/community, and the trauma can then be transmitted epigenetically to future generations, especially if descendants strongly identify with their family culture/heritage (Evans-Campbell, 2008).

Historical Response and Loss

Although many conceptualizations of trauma in general have focused on the individual effects, namely the micro and mezzo levels, historical trauma originates as a macro-level concept for investigating how a population exposed to long-term mass trauma is affected over time and generations (Sotero, 2006). Historical Trauma Response (HTR) refers to the reactions that individuals and communities experience as a result of such long-term oppressive events. Some HTRs include survivor's guilt, depression, intrusive thinking about past events/loved ones, emotional numbing, dissociation, and unpleasant thoughts/nightmares (Evans-Campbell, 2008).

Most historical trauma research/prevention work over the past two decades has focused on Native populations, although the concept has been applied to groups of people who have been oppressed historically, including Armenian refugees, African Americans, and Palestinian youth, as a few examples (Mohatt et al., 2014). In the Native American context, historical trauma is usually associated with the experience of mass genocide/forced relocation inflicted by white colonists (Brave Heart et al., 2011). Historical loss in this regard is one way in which historical trauma is measured/assessed, specifically the loss of life and culture/language. A previously mentioned study by Whitbeck and colleagues (2004) found that individuals who were many generations removed from the mass trauma still showed intense emotional suffering.

Recent research has been helpful in assisting with the conceptualization, measurement, prevention, and treatment of historical trauma in profound and culturally specific ways. As an example, recent research has found that the presence of historical trauma and HTR is linked to a greater lifetime experience of interpersonal traumatic events. In this sense, interpersonal trauma can be thought of as an HTR. Often co-occurring with alcohol and substance use, the presence of past and current trauma can mean worsened mental health, most notably in the areas of PTSD, depression, unresolved and/or prolonged grief, chronic disease, and premature and/or violent death (Brave Heart et al., 2011).

Individual, Family, and Community Effects

Historical trauma occurs at all levels-individual, family, and community. Although each level is distinct, they are all interrelated. Individual responses to historical trauma are influenced by the experiences/responses of family members; individual and familial experiences coalesce to make up the collective community response. Thus, actions at the individual and familial levels reinforce the way the community responds (Evans-Campbell, 2008). The multidirectional impacts of historical trauma at the familial level include reduced family functioning and increased parenting stress. Likewise, community level responses can include the cessation/loss of traditional culture including loss of cultural values, and traditional rites of passage, high rates of chronic disease, and high rates of alcoholism (Evans-Campbell, 2008).

Although empirical evidence is not yet available, it is thought that community level responses to historical trauma include the weakening of social structures, alcoholism, and suicide. Historical trauma has a pervasive impact on individuals, families, and communities, underscoring the need for trauma informed work with populations at risk. In the 1990s, Brave Heart and colleagues (2011) developed interventions to address historical trauma in Native populations through the processing of unresolved grief via the reincorporation of traditional practices/customs, traditional healing approaches, and peer group support (Whitbeck et al., 2004).

In addition to group work, working with individuals and families is also critical in addressing past trauma and its impact on a community. Protective factors that have been identified in helping individuals, families, and communities process and heal from historical trauma include having a strong connection to family/community, integration of spirituality/traditional healing practices, and strengthening individual/cultural identity (Walters, Simoni, & Evans-Campbell, 2002).

Conclusion

Historical trauma has emerged as a critical area of study in understanding and addressing long-term health problems in communities. It can be thought of as a macro level factor that has direct implications for micro and mezzo level processes. Although most trauma intervention models are deficit based, current efforts explore how communities maintain wellness after experiencing trauma. These efforts focus specifically on how communities have been resilient despite the experience of mass trauma (Evans-Campbell, 2008; Walters et al., 2002).

Specific to Native communities, there is a renewed focus on the positive aspects of recapturing lost culture in addressing historical trauma. A goal of these efforts is to promote psychological well-being and the ability to process and share accounts of past trauma. Through this process, individuals become more attuned to their past, present, and future, thereby developing a sense of self and cultural continuity as a result (Mohatt et al., 2014). Similarly, a prominent protective factor is the engagement of those in the community in rebuilding and helping others heal. The impact of the collective in this sense cannot be emphasized enough (Mohatt et al., 2014).

References

Brave Heart, M. Y. H., Chase, J., Elkins, J., & Altschul, D. B. (2011). Historical trauma among indigenous peoples of the Americas: concepts, research, and clinical considerations. Journal of Psychoactive Drugs, 43 (4), 282-290.

Evans-Campbell, T. (2008). Historical trauma in American Indian/Native Alaska communities: A multilevel framework for exploring impacts on individuals, families, and communities. Journal of Interpersonal Violence, 23 (3), 316-338.

Kawam, E., & Martinez, M. J. (2016, Summer). Trauma informed care in social work. The New Social Worker, 23 (3), 18-20. Retrieved from http://www.socialworker.com/feature-articles/practice/trauma-informed-care-in-social-work/

Mohatt, N. V., Thompson, A. B., Thai, N. D., & Tebes, J. K. (2014). Historical trauma as public narrative: A conceptual review of how history impacts present day health. Social Science Medicine, 106, 128-136.

Sotero, M. M. (2006). A conceptual model of historical trauma: implications for public health practice and research. Journal of Health Disparities Research and Practice, 1 (1), 93-108.

Walters, K. L., Simoni, J. M., & Evans-Campbell, T. (2002) Substance use among American Indians and Alaska Natives: Incorporating culture in an "indigenist" stress coping paradigm. Public Health Reports, 117, S104-S117.

Whitbeck, L. B., Adams, G. W., Hoyt, D. R., & Chen, X. (2004). Conceptualizing and measuring historical trauma among American Indian people. American Journal of Community Psychology, 33 (3/4), 119-130.
Marcos J. Martinez, MSW, Ph.D., is a social work graduate of Arizona State University and a research scientist in the Prevention Research Center at the University of New Mexico. His work focuses on culturally sensitive drug use and risky sexual behavior prevention programming that targets Hispanic and American Indian families. Elisa Kawam, BSW, MSW, Ph.D., is Executive Director of NASW, New Mexico chapter, and teaches at Western New Mexico University and Arizona State University Schools of Social Work.

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Historical Trauma and Social Work: What You Need To Know

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by Marcos J. Martinez, Ph.D., MSW, and Elisa Kawam, MSW, Ph.D. To be effective in the work that we do as social workers at all levels, it is important to understand ecological and social context. One such context in particular, the historical realm, can provide further depth in appreciating antecedents to social and behavioral problems that have an impact on our communities and clients.

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Understanding trauma to prevent violence

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Understanding trauma to prevent violence

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Reimagining Justice This Month highlights stories about effective responses to violence – responses that disrupt cycles of violence, heal trauma, and address structural racism.

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Protesters gather in Newark, New Jersey. June 2020. Image by Kalani Mackson [https://www.afrolombian.com/a-fight-for-change]

Reimagining Justice This Month | February 2021
Reimagining Justice This Month highlights stories about effective responses to violence - responses that disrupt cycles of violence, heal trauma, and address structural racism.
Evaluation Reports Newark Community Street Team's Efforts are Effective in Crime Reduction Few cities have done as much as Newark, NJ, to think about how trauma affects its community, and that thinking is central to the city's commitment to community-led violence prevention. A new study has assessed the work done by our allies at the Newark Community Street Team as a "national best practice."

Bonus: check out this video of Will Simpson, our director of violence reduction initiatives, in action with the Newark Community Street Team

Vital Signs: Generational Trauma Takes Toll on Mental Health in the Black Community, Historical trauma from slavery and racial violence creates standard ways of surviving that are passed on across generations. This generational trauma becomes the foundation for other mental health issues, and many Black people don't have adequate access to mental health resources - a recent study found that only 1 in 3 Black people who need mental health services receive them.

"Nothing that we do that is worthwhile is done alone," Mariame Kaba, a long-time community organizer and author, has been reimagining justice for years, and cultivating the next generation of changemakers. Her many initiatives show us that the work of reckoning with violence and transforming justice to create healing and repair must be done through collective action and driven by collective responsibility

We three were on death row and we're a lesson in the need to take care on capital punishment Clemente Aguirre and Herman Lindsey were both exonerated after years on death row. As members of our Trauma & Healing Network, their voices give powerful testimony to the fact that the death penalty only perpetuates cycles of violence. Until it is gone, there can be no true justice. In a month when another exoneration further exposed the racism of the death penalty system, and the justice system as a whole, their appeal to Florida is timely and important.

How the Torture Archive, Justice Center are Helping Survivors Heal , Black Chicagoans experienced vile racism via the torture they suffered at the hands of city police officer Jon Burge. Remembering that history is part of repair, and a newly launched digital archive documents the history and struggle of survivors. These stories, plus the holistic programs of the Chicago Torture Justice Center, show us justice reimagined as healing and addressing the trauma of police violence.

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A city's commitment to understanding trauma to prevent violence

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Reimagining Justice This Month highlights stories about effective responses to violence - responses that disrupt cycles of violence, heal trauma, and address structural racism. Evaluation Reports Newark Community Street Team's Efforts are Effective in Crime Reduction Few cities have done as much as Newark, NJ, to think about how trauma affects its community, and that thinking is central to the city's commitment to community-led violence prevention.

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"Historical trauma can be passed on from one generation to the next, potentially through epigenetics—the study of how your experiences, including your behaviors and environment, can alter how DNA is read or expressed."

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Related Condition Centers

Recovery requires an individualized approach, experts say.

Nearly two years into the pandemic, Darianne, a 35-year-old mother and house cleaner, found herself sitting on her couch looking for some way-any way-out. After living through past sexual abuse, she'd turned to drugs and alcohol to cope during her younger years. Diagnosed with post-traumatic stress disorder (PTSD) as well as anxiety and depression, she'd tried multiple therapies while in and out of treatment centers. But nothing worked well enough to give her lasting relief. Due to COVID-related loss and isolation, Darianne relapsed for a little over a month after being sober for six years. Then she remembered information she'd seen online for a new PTSD treatment using ketamine, an anesthetic that can produce hallucinogenic effects. She had been experiencing suicidal thoughts and was desperate. Why not give it a try?

Darianne's story is just one of many that illustrate how deeply challenging this time has been. We've seen a deadly virus strike poor and historically oppressed communities the hardest, leading to stunning losses and deepening socioeconomic inequities. There's also the weight of the news cycle. "Right now, the war in Ukraine is triggering a lot of people who are from Holocaust families," Rachel Yehuda, PhD, director of the Center for Psychedelic Psychotherapy and Trauma Research at the Mount Sinai Icahn School of Medicine, tells SELF. For survivors of war and political unrest, watching the conflict unfold can be especially distressing. "You think you're over something, you process something, and then boom -there it is again, and it's very real," Dr. Yehuda explains. A reminder or trigger "activates a certain muscle memory for trauma, like your body knows the script."

Amid a mental health crisis with growing shortages of health care providers, researchers say there's an urgent need for new approaches to PTSD treatment in particular. But what does trauma actually mean? How do traumatic events affect the brain and body? And what can the often-winding journey to healing look like?

Everyone faces trauma differently, but there are specific symptoms to pay attention to.

Trauma refers to an extremely distressing experience that "overwhelms our usual capacity to cope," Thema Bryant, PhD, president-elect of the American Psychological Association (APA), director of the Culture and Trauma Research Lab at Pepperdine University, and author of Homecoming: Overcome Fear and Trauma to Reclaim Your Whole Authentic Self, tells SELF. This can include the death of a loved one, physical or emotional abuse, experiencing or witnessing domestic violence or sexual assault, combat or political violence, a natural disaster, or a serious accident, injury, illness, or birth experience. Researchers are also discovering how systemic oppression can feed into the development of trauma in marginalized communities.

"Trauma is now recognized and validated far more than in earlier eras," Lisa Najavits, PhD, director of Treatment Innovations and adjunct professor of psychiatry at the University of Massachusetts Medical School, tells SELF. "But the flip side is that the word is sometimes now used to refer to anything stressful or difficult. Life presents stresses and challenges to everyone, but trauma is meant to describe a serious, devastating event. I like to use the terms stressor and trauma; otherwise if everything is lumped together as 'trauma,' it can unintentionally minimize the serious traumas that people go through."

In the aftermath of a traumatic event, it's normal to feel numb, anxious, angry, depressed, or like you're wading through a fog as your mind replays the experience over and over again. This is common and most people will recover from the emotional fallout, according to the National Institute of Mental Health (NIMH). But about 6% of Americans will eventually be diagnosed with PTSD, which means they have a collection of physical and emotional symptoms that have been interfering with their lives for at least a month. Sometimes though, these feelings don't creep into a person's life until months or years after the initial incident.

Imagine waking up in the middle of the night drenched in sweat, heart racing, muscles tense. Another nightmare. And it doesn't just impact your sleep. During the day you find yourself lashing out at people you love, startling easily. The event that triggered these symptoms is simultaneously hard to remember and impossible to forget. That's how insidious PTSD can feel.

Kelley, 43, a licensed clinical social worker and survivor of sexual violence, recalls feeling isolated and overwhelmed-like she was "going to die"-after she was randomly assaulted in her 20s. "I remember just being so afraid in my own city," she tells SELF, "in my own skin, of being alone."

The definition of trauma continues to evolve as we better understand how our identities shape our lives.

Recognizing the complex facets of a person's identity-gender, sexuality, race, ethnicity, and potential disabilities, among others-and how that can uniquely lead to or exacerbate traumatic life experiences has been a crucial development. Social movements and the decades of study they've led to have simultaneously sharpened and expanded how experts define trauma.

Organizing by veterans and doctors after the Vietnam War brought unsettling post-war struggles into focus. Feminist movements, including the rise of #MeToo on social media, have cast much-needed light on sexual assault and domestic violence. The Black Lives Matter movement, which gained stronger support in the wake of George Floyd's murder by police as well as other prominent instances of police brutality against Black people, in particular, has also highlighted the impact of racial trauma and the subsequent need for culturally competent care.

Intergenerational trauma is another area of focus that experts are exploring. It spotlights how trauma can be passed on from one generation to the next, potentially through epigenetics-the study of how your experiences, including your behaviors and environment, can alter how DNA is read or expressed-as well as the sharing of family stories and navigating the history of your lineage in the present. Much of the study behind this phenomenon has been focused on people whose cultures have been systematically taken from them, such as Indigenous communities and other communities of color, as well as those who have experienced or have been exposed to genocide, ethnic cleansing, or war, such as Palestinians and people from countries that were part of the former Yugoslavia.

Experts are also learning more about how trauma can impact a person's health in a multitude of ways.

Trauma can wreak havoc on the mind and body. Some estimates suggest a staggering 80% of people diagnosed with PTSD have at least one other mental health disorder, such as anxiety, depression, or substance use disorder. Many people end up self-medicating with alcohol or drugs, which can trigger a vicious cycle. Darianne says using drugs compounded her trauma, and many situations in which she was under the influence were targeted in her therapy.

Traumatic experiences can also radically change the way a person thinks of themselves and the world at large. Feelings like overwhelming guilt and misplaced self-blame are common. Shattered beliefs in concepts like justice or the inherent goodness of humanity can make it difficult to connect with others or solve problems. These changes can lead to self-isolation, setting the stage for a greater risk of self-harm and suicide attempts. Kelley, for example, says she eventually developed an eating disorder due to her past sexual abuse and assault, which she says was a way to "show" those close to her how badly she was hurting.

A whole host of physical side effects have been linked to trauma too, from disturbed sleep to tense muscles to persistent fatigue-some people may even deal with gastrointestinal or cardiovascular issues. This physical manifestation of deep-seated emotions is known as somatization, which is when your body expresses pervasive and distressing feelings through bodily symptoms.

Healing from trauma requires an individualized approach-and reimagining what care can look like.

"Recovery from trauma requires multiple channels," Adrienne Heinz, PhD, a trauma and addiction research scientist at Stanford University, tells SELF. The most research-backed options include psychotherapies that either address trauma's effects through talk therapy or through coping skills that don't require revisiting traumatic memories. Antidepressants and off-label medications are also a common addition to treatment plans.

But for those whose symptoms linger, return, or fall below the threshold of a PTSD diagnosis, there are many other healing modalities to consider. Research on a variety of treatment options is especially pertinent for some of the most vulnerable people with PTSD, including those who struggle with severe substance use disorder or self-harm.

"The available approaches we've developed-which have very good empirical evidence behind them-don't fully solve the problem [for some people]," says Dr. Yehuda. "The future is not only developing new therapies, but maybe we need to think about completely new approaches, new paradigms of care." Here's what that might look like:

In light of the emotional turmoil caused by the COVID-19 pandemic, researchers are working even harder to make self-help tools accessible. In early 2022, a team of experts at the Stanford University School of Medicine launched Pause a Moment, a digital well-being program geared toward helping health care workers who are at an increased risk of PTSD manage symptoms of stress related to on-the-job struggles. Based on a self-reported questionnaire, the platform suggests personalized coping mechanisms to help ease feelings of anxiety, guilt, and depression. The National Center for PTSD has also introduced online programs as well as apps like PTSD Coach, PTSD Family Coach, Insomnia Coach, and Mindfulness Coach, all of which provide tools that can help a person form restorative habits and track progress.

Online and text-based therapy

Telehealth and mobile apps are making trauma-focused therapy more accessible, Shannon Wiltsey Stirman, PhD, an associate professor of psychiatry and behavioral sciences at Stanford University, tells SELF. Researchers are working to innovate traditional talk therapies to boost their effectiveness in tech-based forms. For example, a pilot study is in the pipeline to determine whether texting your therapist at any time and getting a response will outperform text-therapy-as-usual (scheduled text therapy appointments) for people with PTSD. Dr. Wiltsey Stirman, the study's principal investigator, says her team's findings suggest this approach is more discreet and convenient-meaning you could step away from a triggering situation to send a text or log on to do a lesson at midnight. For people who face barriers like lack of child care, money, free time, transport, or nearby clinics, that could make therapy finally possible.

Psychoactive drug-assisted psychotherapy

Combining psychedelic drugs, which launch you into an altered mental state, with traditional forms of psychotherapy is a promising new approach that needs to be carefully investigated, Dr. Yehuda says. Ongoing studies suggest certain drugs with psychedelic properties like ketamine, MDMA, and psilocybin may have the potential to help alleviate PTSD symptoms, although more research is needed to understand how these drugs work and for whom. Dr. Yehuda says her lab has begun enrolling participants for an upcoming MDMA trial and hopes to start recruiting for a psilocybin study as well.

Esketamine, a ketamine-based nasal spray, has already been approved by the U.S. Food and Drug Administration for treatment-resistant depression-and clinical trials are underway to further explore ketamine's effectiveness for conditions like PTSD, as previous research suggests ketamine "may prove to be a viable tool in treating PTSD for those who fail more conventional treatments." After "a hell of a couple years," Darianne remembered reading about ketamine online and was curious to give it a shot, so she made some calls and found a local clinic that offered the therapy for a low copay. She found that the 40-minute ketamine IV infusions gave her an immediate but brief mood boost that motivated her to practice calming habits like yoga and meditation. "There's obviously still struggles in my daily life," she says of her progress. "But they've been much more manageable."

"People have been healing and coping with trauma since long before the formal field of psychology," says Dr. Bryant. Indigenizing therapy, in which certain cultural healing practices are embraced, is one way some researchers are helping people reconnect with positive ancestral knowledge-and studies have shown that this culturally sensitive care can lower symptoms of historical trauma and substance use.

For example, Teresa Naseba Marsh, PhD, RN, a psychotherapist and yoga and meditation teacher, worked with tribal elders in Canada for a year to create a "two-eyed seeing" approach to therapy for Indigenous people who were being treated for intergenerational trauma and substance use disorder. She merged a trauma- and substance use-specific counseling model with traditions like sweat lodge ceremonies and sharing circles with smudging, drumming, and teachings from elders.

Lisa, 43, of Henvey Inlet First Nation in Ontario, participated in the 12-week therapy with Dr. Marsh while in treatment for substance use disorder. "This program helped me find what I needed in my life-and it was my culture and ceremonies," she says. One month after completing treatment and personal work to stay sober, she regained custody of her three-year-old daughter.

Peer support groups and intensive retreats

The recovery process doesn't have to be a solo endeavor. Enter peer support groups, "where you have these shared experiences that are far more powerful than going it alone or on a one-to-one basis," says Dr. Heinz. While these groups, as well as intensive, retreat-based therapy models-like completing several days of therapeutic sessions in a safe environment-shouldn't be used as a treatment for trauma on their own, they may be especially helpful if you're seeking connection, understanding, or new perspectives.

Kim, 37, was diagnosed with complex PTSD-characterized as prolonged trauma that repeats for months to years-in the wake of severe postpartum depression and anxiety that developed into postpartum psychosis. Along with therapy and medication, she says she's also benefited from a weeklong survivors program in Arizona. "Being in a group setting facilitates greater healing because you hold space for others and allow them to do the same for you," she tells SELF. " Childhood trauma is very isolating but being in a group setting allowed each of us to know we were not alone."

The path to healing isn't linear-but it is possible to find hope and community in the wake of trauma, no matter how long it's been.

Resilience-or the ability to bounce back from traumatic circumstances-isn't just some glittery personality trait that acts as a shield against adversity. "Resilience is more than 'I don't have a diagnosis,'" Dr. Heinz explains. "It's present when we can still find a way to function and relate to others in the face of trauma." This takes time and intention. What's more, "trauma and addiction are based in economic realities that are much broader than the individual," Dr. Najavits says. Research shows strong social support can be crucial, and experts emphasize the importance of finding a new community or a meaningful mission as part of the healing process.

Over time there's the potential for what's known as post-traumatic growth. After trauma rocks an individual's core belief system, the struggle that follows can be transformative as they find a new story for themselves. "Certain events really start to make people question what they've always believed and how they lived, and those questions can lead to changes that they come to value," Richard Tedeschi, PhD, a clinical psychologist who helped develop the concept of post-traumatic growth, tells SELF. "Post-traumatic growth is not a destination. It's a way of living."

And all of the women SELF spoke to prove that it's possible to build a life worth celebrating in the aftermath of trauma. Kelley, who was inspired by her therapist to become a licensed clinical social worker, now gives others the validation and empathy that was so reparative for her in therapy. She's also teaching her children to understand their bodies and boundaries, giving them the support she wishes she had growing up.

Lisa is also raising her children differently: "I want my children to know who they are, and where they come from," she says. Together, they continue to attend traditional ceremonies, teachings, and gatherings while Lisa actively works on a degree to become an Indigenous social worker.

A handful of months into ketamine-assisted therapy, Darianne says she's just beginning to figure out what's next for her, but she's glad to still be here. "I feel more positive, more connected to myself," she says, "like I'm a different person in a good way."

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If you or someone you love is in a crisis, you can get support by calling the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or by texting HOME to 741-741, the Crisis Text Line. You can also contact the Substance Abuse and Mental Health Services Administration's national helpline at 1-800-662-HELP (4357). If you have been the victim of sexual assault, you can call the National Sexual Assault Hotline at 800-656-HOPE (4673) or chat online at online.rainn.org.

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The Definition of Trauma Is Evolving-Here's How That Can Help Us Heal

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Related Condition Centers Recovery requires an individualized approach, experts say. Nearly two years into the pandemic, Darianne, a 35-year-old mother and house cleaner, found herself sitting on her couch looking for some way-any way-out. After living through past sexual abuse, she'd turned to drugs and alcohol to cope during her younger years.

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Intergenerational Trauma as a Lens for Practicing Social Change

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Intergenerational Trauma as a Lens for Practicing Social Change

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In the 1860s, American abolitionist Frederick Douglass noted that people invested in social change " endeavor to remove the contradiction" between "what ought to be" and "what is." This contradiction seems ubiquitous today as social change advocates struggle to address multiple, overlapping crises. Systemic racism, climate change, the forced displacement of millions of people, a devastating global pandemic, and other widespread social issues highlight how far we are from "what ought to be." And each of these problems requires urgent and sustained attention.

At the same time, another problem is inhibiting and limiting sustained attention to these complex crises: trauma. We are learning that trauma, or distress resulting from exposure to chronic or extreme mental or physical stress, is a common human experience with the power to spread across people and time. Research reveals that if nothing is done to mitigate the influence of traumatic experiences, individuals afflicted by today's challenges may pass their trauma to the next generation. This kind of transfer, known as "intergenerational trauma," isn't new to human experience, but research on it didn't begin in earnest until the 1960s. Currently, the American Psychological Association describes it as "a phenomenon in which the descendants of a person who has experienced a terrifying event show adverse emotions and behavioral reactions to the event that are similar to those of the person him/herself." Intergenerational trauma can persist long after the memory of the initial traumatic event has faded.

Centered Self: The Connection Between Inner Well-Being and Social Change

This series, presented in partnership with The Wellbeing Project, India Development Review, The Skoll Foundation, and Schwab Foundation, explores this important but often overlooked connection between inner well-being and effective social change. FOLLOW THIS SERIES

Related concepts about the way sources, experiences, or effects of trauma include but are not limited to individuals also sheds light on the problem. Collective trauma, for example, is a shared traumatic experience that can negatively affect entire communities. The "demoralization, disorientation, and loss of connection" of survivors at the Buffalo Creek disaster of 1972 is just one example. It can also refer to mass suffering incurred by the kind of high death rates and economic and social shutdowns we've seen during the COVID-19 pandemic. While researchers and others make appropriate distinctions between terms such as collective, historical, cultural, multigenerational, transgenerational, and generational trauma based on context, each expresses the phenomena of inherited or shared trauma.

As previous articles in this series have discussed, change makers-those actively engaged in building a healthy and just society-not only face and address trauma among the populations they serve, but also commonly experience personal harm and trauma as a result of their work. There is also growing evidence that these experiences impair their ability to foster organizational and social change, and that supporting personal well-being lies at the heart of effectively addressing social challenges. Until we better recognize the impact trauma has on individuals, organizations, and society, those working for social change will be limited in their ability to support human dignity, well-being, and resilience. Indeed, we must better understand trauma, discuss it, and integrate awareness of it into the culture of social change if we are to effectively address issues in which trauma and intergenerational trauma are factors.

With this in mind, a think tank launched by The Wellbeing Project and Georgetown University recently started a research program to better understand the connection between inner work (including self-inquiry, reflection, and self-care), outer change (work that individuals do to effect change in the world), and intergenerational trauma. The program is exploring intergenerational trauma with the idea that understanding its impact might advance the well-being of individuals working toward social change and the communities they work with, as well as increase the impact of their work. An initial field scan and literature review conducted in 2020 has revealed a diverse range of perspectives on intergenerational trauma through human stories and a variety of research-based disciplinary approaches. Here's a look at what we've learned so far.

Defining the Challenge

Intergenerational trauma was initially documented in 1960s and 1970s studies of the Holocaust. Helen Epstein's article " Children of the Holocaust" investigates how the experience and wounds of Holocaust survivors effected the lives of the following generation. Over time, the field has expanded to examine intergenerational trauma as a result of war, genocide, refugee experiences, health disparities, apartheid in South Africa, India's caste system, American slavery and its legacies, poverty, and the oppression and violence against Indigenous Peoples. These and similar phenomena have been the source of mass trauma that has directly or indirectly affected multiple generations. However, intergenerational trauma doesn't necessarily result from widespread social calamity. It can also result from unresolved trauma endured by mothers, or from trauma experienced by parents, grandparents, and further descendants, who can, knowingly or unknowingly, pass it down through feelings, memories, and even language.

Defining the problem isn't just about identifying historical or ongoing instances of violence that cause this sort of trauma; it's also about using the questions, methods, and tools of different fields and disciplines, as well as human stories, to examine and ultimately heal the damage at hand. A range of documented cases that incorporate epigenetics, or the study of heritable changes in gene function that aren't part of the genetic code, show that stressors and trauma can change gene expression, and thus pass between generations. Historical trauma, such as trauma resulting from the forced displacement and destruction of Native American communities, has deleterious effects on physiological, psychological, and social dimensions of generations of lives. In addition to biology, this complex challenge is therefore also a concern of psychology, economics, and education. Given the relationship between social media, mental health, and democracy, the spread of trauma is also a concern of technology and ethics.

We are all situated in relation to historical and cultural narratives. If marked by trauma, the narratives people tell themselves and concepts of self can be maladaptive and can become mechanisms of historical trauma. The arts and storytelling are necessary tools for creating healthier narratives, and for creating narratives that honor the past but enable healing in the present and future. Going forward, researchers and practitioners must use a wide spectrum of interdisciplinary approaches informed by cross-sector and global perspectives to explore and document this topic.

Intergenerational Trauma as a Lens for Practicing Social Change

Over the past year, we've gleaned five initial insights about the connection between intergenerational trauma and the social change sector. In addition to undergirding our future research, we hope these insights can offer thought-provoking framing for current social change leaders.

1. Finding root causes and compounding factors. Recognizing intergenerational trauma can help spotlight and define the roots of social change issues.

Consider the high costs of poverty in the United States. Getting to the roots of the problem includes recognizing that the problem is not simply about individual failures and shortcomings. Addressing poverty requires that we ask questions about underlying systemic factors, such as structural racism, which compounds impoverishment by the mechanisms of discrimination and racial health disparities. It also raises questions about the unequal distribution of power and wealth, which affects economic, social, and political agency, including mobility in any of these areas.

Poverty also creates major challenges to mental well-being, not only due to lack of access to vital resources, but also because the chronic stress of living through poverty can lead to atrophy of the prefrontal cortex, an area of the brain needed for higher reasoning and control, judgement, and decision making. In other words, trauma caused by poverty itself can become a compounding factor that makes it more difficult to exit the cycle of poverty.

By looking at root causes and compounding circumstances, social change makers can deepen their understanding of the challenges they wish to solve and, in turn, shape more effective, future interventions.

2. Supporting change makers and the communities they serve. Addressing intergenerational trauma can help support change makers who have experienced intergenerational trauma themselves, including those who have chosen to work in social change partly to address the source of their trauma.

During the Rhodes Must Fall movement at the University of Cape Town (UCT), for example, student activists demanded the removal of a statue of imperialist Cecil Rhodes, who implemented policies that enabled the institutionalization of apartheid. Although many of the students were born after apartheid formally ended, the legacy of apartheid and colonial trauma remained. In 2016, the students created The Fall, a play about two UCT movements: Rhodes Must Fall and Fees Must Fall. These activist-artists found the process of creating the play and sharing their experiences therapeutic and healing for both themselves and their audience.

This type of process, which links the inner work of confronting intergenerational trauma with social change focused on its effects, is an effective way to both enhance well-being for change makers and broaden the reach of social change.

3. Recognizing trauma in the interconnectedness of the world. We are also learning that there are porous boundaries between the social problems we face today and the collective trauma that exacerbates them. In some instances, foundations of trauma cascade across seemingly unrelated areas of life and society.

Road congestion and gridlock in Atlanta, Georgia, for example, have roots in its interstate's design to accommodate racial segregation while prioritizing white neighborhoods. They also reflect resistance to expanded public transit access from predominantly white areas. More broadly, capitalistic mechanisms that lead to increased economic mobility for certain populations (for example, educated or corporate groups) have negative impacts on personal health and families and the futures of low-income children.

For social change leaders, examining interconnectivity adds nuance to the social problems they work on and expands the possible types of resources that may address these issues. The interconnectedness of the world necessitates the use of many disciplines and human perspectives in concert with one another.

4. Activating healing from trauma. In his book, "The Body Keeps the Score," trauma expert Bessel Van der Kolk explains that trauma compromises a person's agency and ability to cope with overwhelming situations, implicating the well-being of the body, brain, and mind. However, it's important to note that factors such as social support can mitigate the degree to which trauma takes hold in any given individual, and how it impacts even those who experienced the same event or conditions. And while trauma has the pernicious ability to become a vicious cycle, the pursuit of agency, dignity, and well-being can create the reverse-a virtuous cycle of healing.

The story of Desmond Meade, president of the Florida Rights Restoration Coalition, provides an example on the individual level. Voting for the first time in 2020 motivated him more than ever to continue restoring millions of other people's right to vote. The agency he experienced when voting helped him reconnect with a sense of dignity-his inherent value as a participant in the democratic process. It also helped his psychological well-being, particularly as he considered the challenges of both his life and the lives of his historically disenfranchised Black American ancestors.

Another example is the therapeutic storytelling practice Testimony Therapy, which has helped survivors of war and political violence, and political refugees heal from trauma by sharing their personal stories in a way that rigorously documents and preserves their testimony.

Social change initiatives of all kinds can also incorporate measures to heal trauma. For example, restorative-justice initiatives such as the Truth and Reconciliation Commission in South Africa and the Colombia Peace Process both included reparation and rehabilitation measures, with the aim of giving formerly oppressed people a voice and fostering agency. And from their inception in the United States, both the civil rights movement of the 1950s and 1960s, and the current Black Lives Matter movement have asserted the dignity of all, and demanded political, economic, and social agency for those who have been oppressed and excluded.

These examples illustrate how social change leaders can develop their own initiatives and movements in ways that use agency, dignity, and well-being as methods for addressing cycles of trauma.

5. Honoring the role of time and connection. When American civil rights leader Rev. Dr. Martin Luther King Jr. emphasized the maxim, "Justice too long delayed is justice denied," he recognized the role of time in achieving justice. In a similar way, healing that is too long delayed not only is denied, but also can allow problems to worsen. The longer people experience traumatizing conditions or unresolved trauma, the more trauma can compound, and the more it can fatigue people, even spreading to others who otherwise may have remained resilient or whose particular experiences were radically different.

Scholar Suraj Yengde has described the traumas he and other generations of Dalits have endured from the caste system. In addition to shared conditions of diminished mobility, poverty, abuse, and cultural erasure, Yengde notes how trauma can even limit the dreams and aspirations other community members. Time is therefore of the essence when it comes to healing. And just as unaddressed trauma can permeate through generations over time, addressing trauma requires sustained attention and support.

Connection-between body to mind, one human to another, one generation to the next, and inner selves to outer environments-is another distinctive element of healing. Interoception (awareness of what's going on in the body), somatic therapy (grounding in the body through movement), and relationships and a sense of belonging all facilitate healing by re-establishing connections that are fundamental for humans.

Writer and founder of the Academy of Inner Science Thomas Hübl suggests that one of the most important connections for healing collective and intergenerational trauma is between science and spirit, which he argues brings together the "double helix of ancient wisdom and contemporary understanding." Humans experience well-being when we have agency, dignity, and health, and are connected to ourselves, each other, and our world in sustainable and life-giving ways. Trauma is the disconnection from these things. Those working on social change, therefore, need to identify the connections and disconnections in the issues they care about. They also need support when they experience disconnection in their own lives.

A Call to Action

The social sector needs to take a few steps to address intergenerational trauma, and achieve the inner well-being of individuals and communities. First, we must recognize intergenerational trauma as a widespread challenge to achieving well-being at scale-one that requires ongoing attention and healing in different forms for different human experiences. Second, we need to advocate for the active exploration of intergenerational trauma within the social change sector-indeed, for it to become a core focus, integrated with mainstream work. Third, we must deepen scholarship on intergenerational trauma using an interdisciplinary approach informed by a range of diverse human experiences and stories. And finally, we must develop methods and practices for healing that join inner and outer work, and connect dignity, agency, and well-being to avenues for social change.

Over the next year, The Wellbeing Project and Georgetown University-in conjunction with a global, multidisciplinary panel of experts and associate voices-will continue to explore the effects of intergenerational trauma on individuals, communities, and the social sector, with the following principles in mind:

1. Examine the roots, not just the symptoms of these problems. Instances of intergenerational trauma can often be broken down into a multitude of interrelated factors.

2. Synthesize a range of perspectives and connect them in new ways. This includes using many disciplines, examining many sectors of human life, and listening to many human stories to understand how intergenerational trauma begins and unfolds.

3. Establish a range of approaches to healing, including using varied forms of therapy or well-being practices, using the arts and storytelling, bridging cultural divides, advocating, researching, enacting policy, and changing laws.

4. Engage and contribute to the work of various sectors, including social change, policy, and education.

In a November 2020 interview, former US President Barack Obama said that the country will continue to fall short in the change Americans seek if we only address symptoms and ignore the underlying causes of social problems. He described how the deaths of too many Black Americans "is part and parcel with a legacy of discrimination, and Jim Crow, and segregation," and that the only way to address the injustices of the criminal justice system is to look at the economy, housing, and other interconnected factors that impede progress. "The good news," he said, "is that we can all take responsibility." These insights also apply to social change leaders addressing intergenerational trauma and well-being. We can begin to address traumatic experiences that have permeated communities through identifying root causes, supporting change makers' healing, and understanding interconnected problems and outcomes. The ubiquity of these obstacles means that the opportunity for change is ubiquitous as well.

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Addressing Trauma as a Pathway to Social Change (SSIR)

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How understanding intergenerational trauma can help people working toward social change solve problems more effectively. Part of the Centered Self series.

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