Dr. Audrey Stillerman: Trauma and Recovery

In this episode, I sit down with Dr. Audrey Stillerman as we explore a difficult topic that everyone has experienced in some shape or form: trauma. In every episode we discuss whole person care, but today we discuss a more specific type of whole person care called trauma-informed care (TIC). Audrey shares how clinicians can care for their patients understanding that many patients have faced past trauma although they may or may not display behaviors or conditions related to trauma. She reminds us that as clinicians we do not need to know the details of a patient’s trauma to care for them with compassion and to create a healing plan to work toward recovery. The goal is to create a safe space where power is shared, and to avoid re-traumatization.

Dr. Audrey Stillerman is an Integrative Family Physician and Clinical Assistant Professor of Family and Community Medicine at the University of Illinois Chicago, as well as the Medical Director for the Mile Square School Health Center program where she leads the clinical work of 5 school health centers offering integrated medical and behavioral health services. She serves as a clinician, educator, researcher, administrator, and activist. Since 1991, Dr. Stillerman has provided compassionate, holistic care for families across multiple community-based public practice settings while advocating for equity. 

SAMHSA Trauma Informed Care: https://store.samhsa.gov/product/SAMHSA-s-Concept-of-Trauma-and-Guidance-for-a-Trauma-Informed-Approach/SMA14-4884

CDC VitalSigns Adverse Childhood Experiences (ACEs) https://www.cdc.gov/vitalsigns/aces/pdf/vs-1105-aces-H.pdf 

Trauma-Recovery Books: 

• The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma by Bessel van der Kolk

Check out the book: "Healing and Cancer: A Guide to Whole Person Care"
Visit https://www.healingandcancerbook.com/ for more information.

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Visit Healing Works Foundation www.healingworksfoundation.org for more information.

Dr. Wayne Jonas is a board-certified physician and Dr. Alyssa McManamon is a triple-board certified hematologist/oncologist. The opinions expressed on this show are those of the hosts and guests and do not necessarily represent the views and opinions of their places of employment, the Department of Veterans Affairs, or the United States government. The opinions expressed on this podcast are meant for entertainment and education and should not be used to diagnose or treat any medical condition nor should they be used as a substitute for medical advice from a qualified, board-certified practicing clinician. Dr. Wayne Jonas and Dr. Alyssa McManamon have no relevant financial disclosures.

Transcript

Please note that this transcript is produced electronically and may not be an accurate representation of what was said. It may not be reproduced, edited, altered or modified in any way without prior written permission. Any use of quotes or excerpts from this interview requires explicit permission from Healing Works Foundation. Please contact us at healing@healingworksfoundation.org if you would like to use any part of this transcript for quotes or other purposes.

“How Healing Works with Dr. Wayne Jonas”

Interview with Dr. Audrey Stillerman - Trauma and Recovery

Dr. Wayne Jonas:

It is a tremendous pleasure to introduce my guest today, Dr. Audrey Stillerman to the program. Dr. Stillerman is an integrative family physician and clinical assistant professor of family and community medicine at the University of Illinois Chicago. Since 1991 she's provided compassionate, holistic care for families across multiple community settings, delivering and advocating for not only healing, but equity. She's also a co-founder of, wait for it, the Center for Collaborative Study of Trauma, Health Equity and Neurobiology. I'm not going to say that again, but you don't either because it's abbreviated the THEN Center. It is, I would say a unique, probably one of a kind center in what it combines for the care of trauma, equity and linking it to the neurobiology, what happens in the body and the brain.

We're here together today to discuss how clinicians and patients can adjust their medical care by understanding trauma, and it's link to recovery, both past traumas and present, and how it can inform us about how healthcare occurs, health outcomes occur, and recovery and healing. Welcome, Audrey. Thank you so much for joining us today.

Dr. Audrey Stillerman:

Thank you, Wayne. It's so great to be here. I really appreciate the opportunity.

Dr. Wayne Jonas:

Well, I'd like to start off these talks by getting to know you and letting the listeners get to know who you are and how did you get into this? I mean, you're a physician, so a little bit about how that happened, but then how did you specialize in the area of trauma and why did you do that?

Dr. Audrey Stillerman:

Yeah, so great question. So I am from a family of people who provided direct service in a variety of ways. Some teachers, some lawyers, some psychologists, and actually a musician who I think we don't necessarily think of as a direct service provider, but somebody who helps heal the spirit. And so I think that was kind of the background that felt like a natural place for me to go. I was interested in science. I was growing up in the seventies, so women were trying to do things that they hadn't been able to do before. So anyway, so that's kind of the beginning of how I went into medicine.

I think that because I had this aunt who was a psychologist, and so I was always kind of interested in the brain and the body. And so as I started working with patients, I was interested in their stories, and I kind of always had a feeling that there was something that I was missing. There was something behind the curtain of how they were presenting that I couldn't quite grab onto. And I remember in particular, there was one family, it was a mom and a daughter, and the daughter was, she actually worked at the post office. She had a full-time job. She was married, she had children, but she kept getting into these motorcycle accidents. And I felt like there's got to be some, there's something up here that I can't figure out, but this is odd that she's getting into all these accidents.

Again, she's a woman doing this kind of high risk activity. I didn't really get it, but I knew there was something, and her mother was struggling with controlling her alcohol use and was sort of depressed. And there was some kind of vague talk about perhaps things that had gone on in the past. Anyway, I'm holding this in my mind. And around 2010 or so, another colleague introduced me to the Adverse Childhood Experiences study, which is a very important public health study linking childhood experiences, difficult and painful ones in particular with adult health. And I felt like that the light went on, the blinders were off, and this is in fact what I had been kind of sensing but couldn't articulate. And that was really the beginning.

Dr. Wayne Jonas:

So you were seeing the consequences of this, but you didn't really know they were the consequences of this, right? I mean, you didn't know what the cause was-

Dr. Audrey Stillerman:

Exactly. Exactly.

Dr. Wayne Jonas:

... at the time in those multiple manifestations. We'll talk a little bit about that more in a minute because we now know that the trauma can affect multiple things and the mechanisms of it through inflammation, and the brain can then manifest in lots of different conditions. So that's part of the difficulty in recognizing it as a cause. I have to say in my own family, I personally witnessed at least the trauma of war. I'm a four generation military family, and my grandfather was with Patton in World War II, running across Germany, witnessing horrific things. My father was a three war chaplain actually in the military in the Pacific and Vietnam and Korea, and their responses were remarkably different.

After my grandfather got back from World War II, he sort of checked out. They went down to live on the beach. He never really got employed again afterwards. He was a bit antisocial. He just got out of there and checked out of life in many ways, although he continued to live every day. My father, on the other hand, I would say checked in. He decided to become a chaplain and actually go into where the traumas were. He became a hospital chaplain, then a prison chaplain, and then worked with the homeless in many ways, responded in sort of a post-traumatic growth. Neither of them were really seriously physically injured in the wars, but boy, the psychological trauma of that was incredible. And their responses were almost the completely opposite component, being exposed to very similar things.

And so how you experience the trauma and how you respond to the trauma really is, it's not totally independent of the actual trauma, but there's lots of different kinds of trauma, right? I mean, war is one of them, but medical exposure is one of them. Childhood neglect and abuse is one of them. Isolation is one of them. Can you talk a little bit about what do you mean by trauma and how do you get your hands around it as a possible cause?

Dr. Audrey Stillerman:

Yes, absolutely. No, I think that's a terrific question and a really good way to begin. So the substance abuse and mental health services administration defines trauma in a way that I think is very useful and that is that trauma is any event that we experience as threatening or harmful and that has effects on multiple dimensions of our being, usually over time. And so as you say, it could be war, it could be child abuse, it could be bullying, it could be racism, it could be poverty, it could be Holocaust, something that happened in the past but has changed our ancestors and the way that they interact with us.

So the nice thing about this definition is that it really can fit anybody. It's not just the list of whatever, 10 or 20 things and if you didn't have it, then you didn't have trauma. This really allows us to kind of individualize and really let the person decide what is this thing for me?

Dr. Wayne Jonas:

Yeah. And that's fascinating. I mean, that experience is really a social, emotional, spiritual type of thing, isn't it? It's kind of like pain. Only the person can tell you when it's there and it's that experience. And it's also dependent on past experiences and training and education and this type of thing. And those are all different. Those are all unique in many ways. So the experience of care, that effect that occurs into the person down to their soul, if you will, it sounds like is the key to the definition. And you have to listen to the patient and hear what that is rather than just judging the experience from your perspective, which wouldn't be at all the same. Is that right?

Dr. Audrey Stillerman:

No, that's exactly right. And I think the other piece of it too is that we can invite whoever it is that we're talking to to share with us, but we can't expect or demand that they disclose whatever until they're ready. So this is really about offering an opportunity and then waiting and allowing the person to really pace their sharing with us or not to share at all.

I think this is a very difficult concept for us because we're used to asking questions, particularly as doctors, asking questions and getting answers when we want them. But there's a few reasons why that may not be the best strategy. One is that the person may not be ready to share whatever it is we're asking, and so we may actually injure them to some degree if they're telling us something that they're not ready for.

The other thing that we were talking about this a little bit earlier is they might not remember. If this event happened when they were too young to really have declarative language or it was so horrific that they're kind of natural, innate, inborn powers of dissociation occurred. They're not going to have explicit memory of that event. And the other piece of this is that it's very important for us to allow people to have agency in their own care so that we really can spark those innate powers of healing as well.

Dr. Wayne Jonas:

Yeah. So somehow the absorption of it has occurred. It's occurred deeply, very often. It depends on them. Their ability to recover also depends on them and whether they can accept and acknowledge this. Again, we can't force them to do that. What you're saying is that we could actually cause harm or damage if we didn't actually work with them on helping them to develop their recovery process. Do they need to re-experience or somehow acknowledge or reengage with the trauma in order to heal from it?

Dr. Audrey Stillerman:

Probably at some point. But there's a lot of things that can happen and need to happen before that. Often people who have experienced trauma and not had enough sort of protective buffering experiences to really help their nervous system kind of have the capacity to manage whatever it is. And of course there are things that none of us, an earthquake, a war, those are things that are sort of beyond anyone's capacity. But we can begin to help to settle down their nervous system, their stress response system, their whole physiology through a series of things that sound a lot like sort of the golden rules or the things we talk about in integrative medicine.

But it is a daily routine, making sure that we get enough sleep, engaging in positive relationships, moving our bodies, having something that's meaningful to us, eating nutritious food as opposed to stuff that comes in packages that gets called food. But all of those things actually are part of the multi-layered solutions. And then there's activities too, walking, singing, drawing, dancing, things that have rhythmic and repetitive qualities that are sort of accepted by our cultures, easy to access. Again, these are very individual. I might like walking, you might like drawing, but having these kinds of things as part of our regular day in and day out are the things that start to help people settle down a little bit so then they can engage in a therapeutic relationship and any number of things that modalities that might be healing.

And ultimately when the traumatic memory is above the surface enough and they're strong enough that then it may be time to face it again at their pace and with their direction.

Dr. Wayne Jonas:

Yeah. The things you've just named are sort of fundamental things that we now know just keep you healthy and well.

Dr. Audrey Stillerman:

That's right.

Dr. Wayne Jonas:

The same things that keep you healthy and well also then are the foundation for how you heal trauma. Is that what I'm hearing you? [inaudible]

Dr. Audrey Stillerman:

Yes, that's correct. I mean, I think that's one of these weird dichotomies. But on the one hand, trauma is very complex. All experiences are very complex, and human beings are very complex as well. And at the same time, it's very simple. You mentioned this earlier, our experiences can lead to a whole host of outcomes regardless of the flavor. If we're talking about traumatic experiences, they've been linked to six of the 10 leading causes of death. They are connected obviously to mental health stuff. They're connected to social wellbeing, being able to get along with people or manage your job or your finances.

So this kind of least common denominator is connected to all these manifestations in the same way, this least common denominator of prevention and solution activities. I mean, you might mix and match them again, depending on who the person is. But really it is this foundational truth. And I think the thing that's also mind-blowing for me, again, exhilarating and maddening, is that this is what all the wisdom traditions say too. It's not like we didn't know. We've known this for millennia, except we keep forgetting or getting distracted by other stuff, but this is really it.

Dr. Wayne Jonas:

So I have patients that come into my office with the six of the 10 leading causes. Yes. What are those? Should I be alert to a certain types of conditions? And should I then go about trying to screen for trauma in that? What should I look for?

Dr. Audrey Stillerman:

So right. These are the things that we say. So chronic illnesses, particularly if they begin early. So cardiovascular disease, cancer, autoimmune disease, these kinds of things. Rare diseases, multiple medical and mental health problems. So the person who has diabetes, high blood pressure, arthritis, depression. Weird presentations or things that you can... Multiple symptoms that you can't get a hold of, any severe illness that's happening at a young age. Somebody gets lupus at 20 or something like that. So there's a very long list, which I won't give you, but-

Dr. Wayne Jonas:

We can put it in the link for those who want more where they can go and do this.

Dr. Audrey Stillerman:

Yeah, right, exactly. I mean, the people who have done the ACE work, the historian and through the research, more than 40 conditions are connected to, and they're really categories of conditions. But I think for us as clinicians, we can be suspicious. Again, somebody showing up on a bunch of medicines, has a long problem list, weird stuff going on, can't really explain it. Doesn't really seem to be getting better. All these kinds of things can clue us into something must have or some things must have happened to this person.

And the thing again that I think is so hard for clinicians is to realize we actually don't need to know what the details are about what happened. But if we know that likely this person has faced some very painful things, we can have compassion for them and also we can begin again to create that kind of multi-layered sort of regulation healing plan with them.

Dr. Wayne Jonas:

Yeah, no, that's fantastic. So this is all part of what's called trauma-informed care, and we'll put a link in for that. But could you define or describe what trauma-informed care is? Is there a formal training in trauma-informed care?

Dr. Audrey Stillerman:

So yeah, this is actually, it's kind of the question of the moment. So trauma-informed care is really a systematic application of science, scientific principles around epidemiology, developmental psychology, neuroscience, social science, and it's an application to really could be any kind of setting. So it could be clinical care, could be education, be the carceral system, could be social services. So trauma-informed approach is what we're talking about.

But what SAMHSA, again, the Substance Abuse and Mental Health Services Administration, says is a trauma-informed approach recognizes how common trauma is, realizes that it's not just about the patients, but it's really about all of us. It puts the science into practice and it avoids re-traumatizing patients. So that's the beginning. And then they have some principles too, which are about safety, sharing power, involvement of people with lived experience, social justice. So these are all components.

Now, the thing that gets complicated and the AHRQ is actually launching on a systematic review of all this stuff right now, is SAMHSA prepared this lovely set of guidelines, but we're not really sure what do you do first? What do you do second? What are the core components of this thing? What kind of outcomes can we expect, who should be involved, et cetera? There's some recommendations and they make sense. We're still developing the body of literature to really support using this approach. Although again, what SAMHSA said in an early presentation is trauma-informed care is really just good medicine. And frankly, that's true. If we think about, again, what were those golden rules that we were taught? This is what they are.

Dr. Wayne Jonas:

Yeah. Do no harm and again, the foundation of the basic holistic wellness principles that you've talked about are forming the basis of that, allowing the person to heal. So as a clinician, especially if I'm working in environments that are pretty chaotic and there's a lot of illness and a lot of physical trauma and other types of things, a lot of suffering, I like to think of myself as empathetic and hearing and listening. Am I putting myself at risk? Am I more likely to get trauma myself like my grandfather and father did by witnessing all those traumas every day in my practice?

Dr. Audrey Stillerman:

So the answer is yes. And also you're a human and you talked about your multi-generational family. You walked in with exposure as well, and there are things that we can do for ourselves and for each other that help to protect us because otherwise this wears us out. Again, experiences that feel threatening or harmful and overwhelm our ability to cope, this is the definition. So what do we need to do? Those things that I listed for patients, we need to do them too. So we need a daily routine. We need to get enough sleep, we need to engage in relationships that are important to us and have fun and do things that are meaningful for us.

I think also what we can do together, this is not happening as much as it probably should, I think it happens in some primary care residency programs, but really we should all be required to do this. But a structured support group like Balint is really, really a way for clinicians to get together and debrief with each other and support each other and engage in reflective practice. So saying, "What are we talking about? What does it mean and what do we do about it?" This is a really important access. I mean, we can do it ourselves in our diary or with our friends or colleague or something. But having sort of a structured thing that really, again, as part of our routine is so important.

And even we can take mini breaks throughout the day. We can look out the window, we can engage in a short breathing practice, we can go outside, we can drink some water, we can push against the wall. I mean, there are many, many, many things that can help reset our stress response system so that it's not on overload either by being overly checked in or withdrawn. So I think that we also really need to hold our organizations accountable to provide us with physical space and also time to do this kind of stuff so that we can keep going.

Dr. Wayne Jonas:

Yeah, no, and the cultural acknowledgement that this is important, right? Give you permission to recognize that this kind of trauma is occurring in day-to-day practice and therefore time to recover, time to heal is essential. I know one of the approaches that I learned is mindfulness. That has been very effective in keeping a buffer between myself, my thoughts, my thoughts, and how it affects me more deeply in my experiences, but then also allows me to maintain empathy and listen.

Dr. Audrey Stillerman:

Yeah, that's right.

Dr. Wayne Jonas:

And that type of thing in those areas, but I had to actually work at it. I had to take formal training in it. I had practice in it, I practice it every day, et cetera, so that it's easier to pop in and out of it when I see that I'm not doing it in those areas.

Dr. Audrey Stillerman:

Right, exactly. I think practice is critical. It's critical for us and for our patients, because you're right, then we can haul it out at the moments that we need. And there are lots and lots of formal activities that you really can do for just a few moments. There's another, it's a somatosensory set of skills. It's called the Community Resiliency Model, and it's been studied actually as burnout prevention in nurses, and it's really easy to learn. The strategies just take a few moments and you could do them on the bus, you can do them on the ward. Nobody really knows what you're doing and things like that are great to have in our pockets.

I know Sandra Bloom, who's one of the actually kind of pioneers of the trauma-informed approach, she set up an inpatient psychiatry unit, I think in the late eighties and early nineties. But one of the things that her staff did was they created, well, they had a buddy, so there was somebody who was their go-to if they needed to, and that person could come to them too, but they made little reminders for the back of their ID badges of their sort of safety plan. So smell lavender, go get a glass of water, get a hug from... Whatever it was, but they had a little list so that if they forgot, they could just flip their ID over. Oh yeah, that's what I need to do when I'm feeling off.

Dr. Wayne Jonas:

One of the things I've taught, and I teach medical students and residences, is to do a gratitude journal. And that's been shown to help with that, but we need to go beyond that sort of self-care. It sounds like self-care is the core of how to do that in your day-to-day practice, but we got systems that don't respect that, do they?

Dr. Audrey Stillerman:

No.

Dr. Wayne Jonas:

I mean they want to flog you and tell you to be tough. But what I hear you saying is that it's very important to have resilience and recovery to embrace the weakness that all human beings have and the susceptibility that they all have and the trauma that they all get all the time. We somehow need to shift so that our systems acknowledge that. And unlike my military father and grandparents that worked in a system to say, just be tough, no gain without pain type of thing, that is wrong, isn't it?

Dr. Audrey Stillerman:

Oh, it's completely wrong. And I think this is a big, how shall I say, task for all of us. And I really believe, and certainly we've seen it throughout history, it really requires collective action. I mean we need a movement about this. And I think doctors, doctors in particular, not necessarily other healthcare professionals, we're kind of like, historically we've been lone wolves, but we really need to give that up and work together with each other and keep demanding that we get what we need.

Again, remember, we didn't always have nursing rooms and breast pumps in hospitals, but we do now, and I think probably when you were in training, Wayne, the craziness of a hundred-hour work weeks were probably still going on. We don't have that anymore. So things can change, but it really requires all of us to have solidarity and work towards common goals, which again, affect the bottom line. It means that we retain workers better, they're more satisfied, they don't make as many errors, all these things. So I think it's putting the pieces together and then just continuing to bang on the door.

Dr. Wayne Jonas:

Yeah, that's fantastic. So this isn't just a nice thing to have.

Dr. Audrey Stillerman:

No.

Dr. Wayne Jonas:

This actually is essential for good quality medical care and lowering costs even.

Dr. Audrey Stillerman:

Right. I mean, I think this is a route to, I mean, we're never going to completely achieve the quintuple aim, but this is a way to get there. And too, it's the way... A couple of things. It's the way to get the right answer about what's going on with your patient. A lot of times we are, if we don't know this, we're thinking a whole bunch of different things, and we're actually ordering the wrong tests, and we're ordering the wrong treatment. And so this helps us actually get it right. And we're all high achievers. We like to get it right, so it makes us feel better. It's good for our morale. When people get better, you have optimism, you have hope, so then you don't feel so burnt out and overloaded.

Dr. Wayne Jonas:

No, I think many wise physicians of the past, like William Osler and others have said, the key to listening to the patient is listening to the patient, and the key to knowing about the patient is listening to the patient. And that requires giving the time and the space and the humility to actually hear that, isn't it? A phrase comes to mind as you were speaking that might summarize some of this, is that we have to embrace vulnerability as a virtue.

Dr. Audrey Stillerman:

Right.

Dr. Wayne Jonas:

It's not a weakness, it's a virtue. It's something that we all need to acknowledge, cultivate, and engage in as a society, as a collective society.

Dr. Audrey Stillerman:

Right. And I mean I think we're talking about the same thing, but I think we need to embrace what it really means to be a human being, not a machine or a robot or something like that. And this is about being human.

Dr. Wayne Jonas:

So we better redefine what a human being actually is. I'll go back to Maslow's needs and say, all right, what are each of those needs addressing in a human in those areas? Well, it won't matter anyway because AI's going to take over.

Dr. Audrey Stillerman:

Oh, God!.

Dr. Wayne Jonas:

[inaudible]

Dr. Audrey Stillerman:

No, I was listening to a very scary story this morning of a threat of annihilation of the human race, and I just thought-

Dr. Wayne Jonas:

Oh, I know.

Dr. Audrey Stillerman:

Are we in a science fiction story or what is going on here?

Dr. Wayne Jonas:

Yeah. Well, this is fantastic. We've traveled really through a lot of different things in a very short period of time here. Your center, THEN Center. What does it do? How do we learn from it? Where can we get information about it? What would you like to tell our listeners about it?

Dr. Audrey Stillerman:

Sure. Yeah, thanks for that. And I want to put a pin in something else. You asked a question about screening for trauma, which I want to go back to after we answered this.

Dr. Wayne Jonas:

Oh, yeah. Screening.

Dr. Audrey Stillerman:

So the THEN Center, it's a virtual nonprofit. We just exist on the... I mean, we're human beings, we're not robots, but we exist on the internet. And what we decided to do was we collected a group of clinicians, researchers, activists, students and patients to create a multidisciplinary, interprofessional, multi-generational, a diverse group of people to think about how we could develop information, particularly for healthcare professionals, but really for anyone about how experiences influence our brains and bodies and how to best set up prevention and healing strategies so that people can be at their best.

And so the way that we do that is we have a website that's completely free with all kinds of resources on it available for everybody. We do teaching of all kinds. We've taught community groups. We teach people on FQHCs and rural health centers. I do some formal teaching at the medical school. We've done some small group tutorials. We've done some faculty development via things like Echo, that tele-mentoring program or in person, so a lot of curricular development and teaching. And then we're writing some academic papers as well.

Basically, we just talk about this, if people don't tell us to be quiet, we're talking about it, whether they're sitting on the porch or in a meeting or what. And the goal really is to revolutionize the healthcare system with these kinds of concepts and practices so that we can actually have what we want and what we deserve to have in terms of our care system.

Dr. Wayne Jonas:

So you started with a story about a person on a motorcycle, and what did you learn from that? And can you tell us about that?

Dr. Audrey Stillerman:

Sure. Well, once I started learning about how our childhood experiences really can affect everything about us, I thought about this family, this mother/daughter pair, and I realized I didn't know exactly what had gone on for them, but this kind of risk-taking behavior and multiple injuries. So sort of this almost dissociative way of going about things, and then substance use and depression that they must have suffered significantly, both of them in multiple generations.

This was actually an African-American family, so one of the things that I knew about them, of course, was that their legacy was the legacy of slavery and Jim Crow. And so in that sense, I knew that at the structural level, they had had trauma, and I imagined that they must have also had interpersonal trauma. Although unfortunately, I didn't get a chance to talk to them about this because by the time I had learned about it, I wasn't caring for them anymore. But I was able to put things together in a way that I hadn't been before.

Dr. Wayne Jonas:

Great. I would like to hear a little bit about screening and how that then leads to those resources because we've developed and now have taught and published the delivery of something called the HOPE Note, which is asking patients the fundamental aspect of what matters to them in life, and then exploring those basic wellbeing, and now I understand trauma resilience processes with every patient that walks in.

I have one question that's embedded that asks about their social support, and then it asks them about how their childhood was. And sometimes they'll say, "Oh, fine," or sometimes they won't, and that type of thing. But if that creates a flag or a discussion around that, where do they go from there to get more detailed screening and resources to support that possible trauma?

Dr. Audrey Stillerman:

Right. No, I think that open-ended question is absolutely perfect. There's a lot of controversy right now about checklists screening, and many of the experts are feeling like that isn't necessarily a great way to go for a few reasons. One is trauma's really common, really across the world. When we use even a 10 question checklist, about two thirds of people have had at least one of those experiences. And if you leave it open, everyone's had something so why would we screen if everybody's got it? As we talked before, sometimes people aren't ready to tell us about it, so this can be injurious for them. Sometimes they don't remember, so we might not be getting an accurate perspective. Again, it's something that clinicians often feel good, "Oh, I've got my checklist, I'm doing what I'm supposed to be doing." But that open-ended question really seems to be the way that everybody can feel included and also tell us what they want to tell us when they want to tell it to us.

And so if somebody says, if you say, "How was your childhood?" And they say, "Not so great." I think the thing for us to do what we can do is to say, "I'm really sorry about that. Would you like to tell me more?" And then if they say no, we can say, "That's fine. I'm here if you'd ever like to talk to me about it." Now, what we're also noticing, even if they didn't tell us anything like that, is looking at their problem list and how they presented. And again, if their problem list is 20 items long and they're on all kinds of medicines, or they told us they can't sleep or they've got a weird... we already know something was up, but when they say, my childhood wasn't so good. Now, if they do say, "Yes, I would." Then we can decide as clinicians, how deep do I want to go in that?

Do you want to talk to me about it or would you like me to refer you? I mean, again, I think we don't want to say, "Oh, I'm going to refer you to somebody," because then people think like, well, why don't you want to talk to me about it? But we can offer both. And there's some really amazing trauma specific treatments that are available now. They're not available to everybody, but things like eye movement to sensitization and reprocessing, things like neurofeedback, even hypnosis, which we were talking about a little bit earlier, are all fantastic treatments.

I'm just going to name a couple of books that I'm thinking about off the top of my head that I think are fantastic. The second half of a book called The Body Keeps the Score, has a whole bunch of stuff about different trauma treatments, which are really fascinating. The first part of the book is outstanding also, but a little heavy. There's a book called The Last Best Cure by Donna Jackson Nakazawa, which is about her recovery from a very weird illness, Guillain-Barre, and of course, trauma features very importantly in her story. And then another recent book, which is very interesting in terms of sort of the societal and cultural impact on our body, but it's called What My Bones Know. It's by an author named Stephanie Foo. But in both of those first person accounts, there's a whole description of the recovery process and the kinds of activities that both of those women engaged in to go from really being quite ill to being well.

Dr. Wayne Jonas:

Yeah, that's fantastic. We will collect some of those resources and we'll make them access to our listeners here. I think the fact that The Body Keeps The Score has been on the bestseller list for over a year, says something about what people know [inaudible].

Dr. Audrey Stillerman:

No, that's right.

Dr. Wayne Jonas:

In terms of how trauma does affect the whole person, the body, mind, and spirit. Well, thank you so much. These are really, really helpful concepts and tools and discussions in those areas. I think they're very consistent with the whole issue of whole person care. I see now why you call yourself holistic doctor. Let's all be holistic doctors in those areas. And for patients that are listening, if any of these things resonate with you, you can address them. You can go to the THEN Center. You can look for individuals that have been trained in trauma-informed care.

And one of the things that I recommend to a lot of my patients, if they're not sure or they're concerned or they don't want to go there, is to simply do self journaling. Just journal, and there's a link on my website on how to go about basic journaling, because that can often then open up and allow folks to be aware, and of course, self-aware and self-care, the key approaches to being and staying well and healing trauma when we feel ill. So thank you, Audrey. I really appreciate your discussion today and look forward to further interaction about this extremely important and fundamental topic.

Dr. Audrey Stillerman:

Yeah, thank you so much. This was a great conversation. I really enjoyed it.

Dr. Wayne Jonas:

Okay. Bye. Bye.

Dr. Audrey Stillerman:

Bye.