Two Steps Forward, One Step Back (Isn't Even That Great of a Metaphor)

Yesterday evening, I got pretty deeply triggered, and stuck in some old trauma. We experience trauma not only from things that happen directly to us  - "I was hurt, I could have been killed, my boundaries were deeply violated" - but also from what happens to the people around us - "I see her being hurt, I see him almost being killed, I see them being targeted"- and in our experiences of helping other people to deal with and start to heal from their own trauma. This vicarious trauma is just as real as what we directly experience - by seeing other's pain, and by working with them on it, to do this at all, we need empathy. And to do it well, we need a great deal of compassion, a word that comes from the Latin for co-suffering. None of us (healers of any sort) get in and stay in this for the money; a lot of the actual work of helping people heal is unpaid, and a lot of the most physically demanding jobs in health care are poorly paid. The well-paid work requires extensive education, and there are easier ways to make a buck with that level of education. We are healers because we can't not be - we see suffering in others and we can't help but want to help alleviate that suffering.

But in addition to the toll the conditions of our work can often take on us - the modern hospital can look a lot like a factory floor, and everyone has too many patients, and too much they're supposed to do for them to not, at the very least, be completely worn down by the end of the shift - the trauma we bear witness to everyday takes its own toll, and can bring our own trauma back to the surface. And it doesn't necessarily matter how similar or different our experiences are - caregiving is emotionally intense work, and being truly present and compassionate means that we're going to be affected by what we witness.

So, back to the title of this post. I'm really fond of telling people that recovery from emotional trauma isn't linear, and that doesn't just mean we'll occasionally have setbacks. To present the analogy of a physical wound, a wound can be fresh and bleeding - that's acute trauma. It can also be oozing a bit, still not through the initial healing process, where we hopefully process it and recover enough to go on with some sort of regular rhythm of life, whether it's the old one or a new one. Or it can be an old scar, that we think we're through with...but sometimes we have to break up old scar tissue because it's putting restrictions on our life, and sometimes scars ache.

Just because we're breaking up that scar tissue - or even if some change in our life makes that scar ache intensely - doesn't mean we've taken too many "steps back" in our own process of recovery. And forgetting that lesson, that truth that I've told so many other people, had me beating myself up for a while - something that was far more harmful to me than being triggered - until I could say to a housemate that I had gotten triggered, and was greeted with acceptance and concern, and not judgment. Only then could I realize that I wasn't treating myself with acceptance, but with judgment.

Burnout is an ever present danger for caregivers - in the past, when I was street medicing intensely, and supporting people who had gone through incredibly traumatizing experiences, I began to feel it not when those things made my own experiences of trauma ache, but when I couldn't accept those aches as a part of being human. Instead, I saw them as a weakness on my part. Being a strong, competent healer doesn't mean never suffering ourselves - it means being able to be compassionate to others, and then, going and being compassionate toward oneself. If I'm not being compassionate to myself, I'll have too much going on with my own emotional wounds to be able to put my own concerns aside while I'm working with someone else - and I won't be able to make, in the moments I'm working with them, their own needs my true focus. As my own unprocessed trauma piles up, I'll be a patient trying to take care of other patients, and the first rule I learned about street medicing is "don't create another patient".

I think the most important lesson I've been taught in the last couple of months was one thing a preceptor had us repeat when she was showing us Emotional Freedom Technique ("tapping") - every time she had us mention an anxiety we had, it was always in the form of "even though ______, I completely love and accept myself". No amount of intellectual understanding of how our own experiences of trauma work, and how we can be affected by vicarious trauma can replace telling that message to ourselves like we mean it, until we really mean it.

More and more, I think the two best guardians against burnout are, first, not pushing down our own feelings, and, second, being part of a community that will remind us that we need to be compassionate toward ourselves when we forget to be. Learning to say "yes, even though I have witnessed suffering, and that suffering sometimes stirs up my own past experiences of suffering, I completely love and accept myself. The scars I bare are a part of what makes me the person I am today, a unique being worthy of compassion just like every other human being. I completely love and accept myself, scars and all" is vital. I could probably do this work for a while without completely loving and accepting myself, scars and all - but to do it for a lifetime, compassion needs to not be a solely outward facing thing, and I'm glad I've got people in my life who will remind me of that anytime I forget. After all, I do the same for them.

Opening the Heart

It's fair to say I've been having a pretty rough time as we power through the second half of our marathon RN year of nursing school. A significant part of the problem for me is that I've been so immersed in the world of western allopathy that on a deep level I've been losing touch with where I came from. That disconnection from an approach that is both holistic both on the personal level and on the level of society and nature has even strongly affected how I do self-care. I'd started falling into a pattern where I would see various self-care practices like pills - do activity X to deal with complaint Y. Which is neither fun nor particularly effective.

Psychiatric nursing has probably been where this conflict has been most intense. On one hand, in my clinical rotations, I'm praised for my wariness of the mental health system and my seeing patients as having their own unique experiences of trauma, extreme mental states, and so on, where the psychiatric diagnosis is a contested and shifting attempt for a flawed system to get a handle on people. There, my seeing the common humanity and the connections between myself, my fellow students, the staff, and the clients is praised, and I feel like I'm being drawn back to the calling that got me started on this road in the first place: assisting people in healing and integrating their experiences of trauma.

In psych lecture, I see people continually reduced to diagnoses, and get drilled on the outdated even by the standards of mainstream psychiatry standards that the NCLEX tests on. I constantly feel the subtext that the patient is The Other and that nurses, psychiatrists, and the whole host of other mental health providers are never, ever, patients. The patients are "ill" and the providers are "well", and never the two shall meet. And, continually, in the back of my mind, I think "am I allowed to give care anymore? Or am I too broken?" when all the scarred over wounds were a big part of what made me good at what I do in the first place.

Hopefully these two opposed experiences will resolve into making me a more skilled and more compassionate nurse, rather than someone who runs away screaming from psych, because no matter what exact road I take, I want to help my future patients by integrating care of the body and mind. I've been trying to consciously get back to my roots lately, returning to herbalism. And approach to herbalism of helping the whole person return themselves to balance, both internally and with the world around them, rather than a set of knowledge about plants to be used like western allopathic medications, except "natural".

So I read this wonderful account about hawthorn, and when I got home at the end of a long day, I took all the jars of tinctures and dried herbs out of the bin I'd stored them in, and got busy reorganizing them, which started out looking something like this:

Thankfully, I subsequently got it a lot more organized, and pretty quickly identified the tincture that had leaked a bit as elderberry (which is a pretty easy one). With the herbs sorted and a few empty tincture bottles refilled, I took 2 ml of hawthorn berry tincture.

Immediately, I felt an emotional/spiritual tightness around my heart lift, and all these feelings that have been just sitting there, endlessly being analyzed but not being allowed to do what feelings are for - being felt all the way through, from beginning to end - get gently on their way.

Now to put some mugwort under my pillow and take a bath scented with an essential oil or two and actually relax, for a change.