Shared Historical Trauma – Weathering, Numbing and Reality
By Dr. Jim Deutsch
Jim Deutsch, MD teaches and practices child psychiatry at the University of Toronto and is a member of Public Health Liberation
We all hear about the increasing burnout and “moral injury” in healthcare workers resulting from the current contradictions in healthcare and public health. About the feelings of helplessness in encountering individual trauma and suffering. At the same time, how do we healthcare providers make good use of our indignation at the obvious impacts of the systemic wrongs, blindness, and injustices? How can we turn cynicism and pessimism at the transparent prioritizing of profits and power over prevention and protection? Healthcare and the people we serve continue to be commodified as “value” to be extracted from bodies.
Many in the healthcare sector are searching for avenues of effecting change, in contrast to leaders and influencers selected/elected on the basis of their harmful narcissistic and charismatic traits, rather than on their level of adult maturity and parental caring. Our governments and media cloud minds and pollute the proverbial hegemonic water that we swim in, counting on passive acceptance of their thinly disguised callousness and brutality.
Public health can be distinguished from individual health, in calling out current and historical factors that manifest as illness in groups of individuals, while calling in those with the life experience, and those with will, resources or capacity to stop the harms. The “cure” must consider the larger context. Indeed, the proliferating interest in “Adverse Childhood Experiences”(ACEs) originated with a single doctor’s curiosity about why his medical interventions did not result in lasting change. He found a high prevalence in his patients of histories of various adverse and traumatic experiences, which later became included in a checklist for the use of front-line practitioners, and highlighted widespread, individual issues.
Unfortunately, checklists may not highlight systemic issues. An example would be a child meeting criteria for ADHD, without considering factors such as crowded classrooms, overworked teachers, mind-numbing repetitive work, as well as stressed, overworked or incarcerated parents, experiences of abuse and neglect, prenatal exposures, lead in the water, “toxic stress” and “allostatic load”, and inadequate nutrition and housing.
In the clinic, we often see and hear individuals numb with emotional and physical exhaustion, worn down and “weathered” by the sheer effort of resisting or merely existing. How can we acknowledge the individual impacts of such difficult experiences but not lose sight of the historical and societal roots?
Recently some of us participated in a discussion of the 2021 paper: Ventres W, Messias E. From ACEs to ASHEs: Adverse Shared Historical Experiences and Their Impact on Health Outcomes. Southern Medical Journal, 2021 Nov;114(11):719-721. Rather than pointing to individual posttraumatic stress or Adverse Childhood Experiences, ASHEs highlights historical, collective trauma, such as slavery, colonization, and forced migration. But where does the “historical” begin? How to comprehend, let alone find the words to express, massive harms? We first listen to the story. Differences in language, culture, and traditions gradually yield to a mutual and empathic form of understanding, evoking shared experiences, as experienced with music, movement and dance, and the most moving written and oral history.
Equipped with the stories, we can resist leaders’ soporific and distracting alphabet soups such as Equity, Diversity, and Inclusion (EDI), or Environmental, Social, and Governance (ESG). One of the authors of the above paper, who practices in a rural area, told how the electronic health record (EHR) of their hospital now has a pop-up on the screen prompting the clinician to record relevant social determinants of the patient’s health (SDoH), which leave out structural determinants. Actual structural change requires more than boxes for the busy practitioner to tick through, with little to offer beyond medicine with sympathy.
How can we help each other to see more clearly? To see, yes, historical trauma that is shared, but also our complicity in the charade: accepting small crumbs of reform that come with a healthy dose of tracking and surveillance?
We humans are born helpless, with cycles of immediate, urgent needs, dependent on caregivers, in a vital relational and social context. And ultimately, we die. Beginning prior to birth, state and social actors intervene, helpfully or not, in our ability to meet each other’s human needs, including water, food, air, and family/social connection.
Health and medicine are inherently political-economic; symptoms are often downstream effects of political-economic decisions being made upstream. Our biological and social environments impact our very genetic expression, over multiple generations, meaning that each of us is inscribed with an inscrutable story passed on through epigenetic and cultural-historical legacies. Archaeology, paleogenetics, and anthropology are revealing how our genetic characteristics, selected over countless generations of injustice, can perpetuate inequity. But genetics are not destiny.
The political economy and the public health economy impact life and death in unnatural ways. Our powerful stories are repeated consciously and unconsciously, subject to power relations, a process termed variously as internalized racism and colonization, and, familiar to Hub readers, hegemony, illiberation, and estrangement.
We often talk of the "right" to health and existence. But who grants this right? While public health claims to address quality of life, we are doing life, striving for a sense of agency and mattering. A truly global public health extends outward, from the inner, private experiences of humiliation and shame, to confront ethnic/racial/colonial cleansing, financialized removal and gentrification, genocide, maiming and killing, exclusion, social and slow death, and dehumanizing terms such as “collateral damage” and “taking out”. Economists erase large segments of humanity via algorithms and data collection bias, for example, those in public housing, communities slated for gentrification, or those deemed as inconveniently in the way of land and resources.
Given how it is integrated with entities that rely on profits and intellectual property, as well as satisfying the expectations of investors, is institutional/academic public health up to the urgent task? The beginning is to study, expose, and resist the political and economic ”water” that pubic health swims in.
