Trauma and Resilience
Trauma is not necessarily what comes to mind when one thinks of lawyers and judges. Yet a surprising number of us come from traumatic backgrounds and childhoods. In fact, many folks who enter the legal profession do so precisely because of the historic trauma we have experienced. Maybe we want to work in the child welfare arena to stop the type of abuse or neglect we experienced as a child. Or maybe we want to prosecute criminal cases because of an attack we suffered years ago. Trauma is inextricably intertwined in our profession and for many of us as practitioners.
Today, in the fall of 2021, most lawyers understand and easily accept the concept of secondary or vicarious trauma and compassion fatigue in our numerous practice areas. Not so 10 years ago. To say LAP’s CLE on these topics was revolutionary at the time we began presenting it in 2012 is not hyperbole. These topics are gaining more research traction and hitting mainstream legal parlance. The Wake Forest Law Review recently held an excellent five-hour, free CLE symposium on Secondary Trauma in the Legal Profession.
Trauma, all forms of it, is taking center stage. Lawyers and judges can benefit from understanding it, both personally and professionally. I recently had the pleasure of attending a UNC School of Government training for District Court Judges on the topic of toxic stress and trauma informed court. “Trauma informed” is exactly what it sounds like. Practitioners, from teachers and healthcare workers to police officers and judges, are starting to understand the human trauma response and how it affects behavior and health (both physical and mental) across one’s lifetime.
More important than categorizing the type of stress encountered is our response to it. What is a tolerable stressor to one person, might be a debilitating stressor for another. This discussion is therefore best informed by measuring our responses to stress. We have three types of stress responses: positive, tolerable, and toxic.
The following framework is taken from the National Institute for Health for how to categorize stressful events and the toll they take on our bodies and psyches. I have edited for brevity but at times included the child development language because it adds important dimensions.
The stress response is a physiologic response to an adverse event or demanding circumstance and includes biochemical changes to the neurologic, endocrine, and immune systems. A positive stress response is a normal stress response that is infrequent, short-lived, and mild. We gain motivation and resilience from every positive stress response, and the biochemical reactions that occur with such an event return to baseline. Examples include meeting new people or learning a new task.
Tolerable stress responses are more severe, frequent or sustained. The body responds to a greater degree, and these biochemical responses have the potential to negatively affect brain architecture [especially when we are young children]. Examples include divorce or the death of a loved one. In tolerable stress responses, once the adversity is removed, the brain and organs recover fully given the condition that [we have empathetic and] responsive [personal] relationships and strong social and emotional support.
Toxic stress results in prolonged activation of the stress response, with a failure of the body to recover fully. It differs from a normal stress response in that there is a lack of support, reassurance, or emotional attachments. The insufficient support prevents the buffering of the stress response or the return of the body to baseline function. Examples of toxic stress in children include abuse, neglect, extreme poverty, violence, household dysfunction, and food scarcity. Caretakers with substance abuse or mental health conditions also predispose a child to a toxic stress response. Exposure to less severe yet chronic, ongoing daily stressors can also be toxic.
Implications of exposure to chronic, toxic stress for long-term health and developmental effects are critical, including increased risk for stress-related and inflammatory-related diseases, like heart disease, stroke, cancer, and even some autoimmune conditions. [Most relevant for our discussion here,] the toxic stress response is believed to play a role in the pathophysiology of depressive disorders, behavioral dysregulation, PTSD, alcoholism, increase in suicide attempts and psychosis.[1]
The phrase toxic stress developed out of the CDC-Kaiser Permanente Adverse Childhood Experiences (“ACEs”) Study, which was first conducted in 1998. The research has since been expanded from the original 17,000 (mostly white, middle class, with health insurance) participants to now hundreds of thousands of people across all demographic and socioeconomic groups.
There are 10 types of childhood trauma measured in the CDC-Kaiser Permanente ACEs Study. There are many other types of trauma, but these experiences were the focus of the original study. Five are personal — physical abuse, verbal abuse, sexual abuse, physical neglect, and emotional neglect. Five are related to other family members: a parent who is an alcoholic, a mother who is a victim of domestic violence, a family member in jail, a family member diagnosed with a mental illness, and experiencing divorce of parents. Each type of trauma counts as one. So, a person who was verbally abused as a child, with a depressed parent, and parents who divorced has an ACE score of three. The higher the ACE score, the greater risk for disease in later life, both physical and mental, across almost every disease one can name.
Hidden within all this discussion of trauma is the topic of resilience. In fact, the documentary highlighting this research and the ACEs study is entitled, Resilience. Most resilience is born out of suffering, out of overcoming difficulty and adversity.
Resilience is the capacity to bend without breaking and the ability to bounce back. George Valliant (1993) defines resilience as the “self-righting tendency” of the person, “both the capacity to be bent without breaking and the capacity, once bent, to spring back.” The American Psychological Association defines resilience as, “the process of adapting well in the face of adversity, trauma, tragedy, threats, or even significant source of stress, such as family and relationship problems, serious health problems, or workplace and financial stressors, it means ‘bouncing back’ from difficult experiences.” Resilience is primarily defined in terms of the presence of protective factors (personal, social, familial, and institutional safety nets) which enable individuals to resist life stress. Later research has examined how positive childhood experiences (“PCEs”) (or protective factors), such as your teachers taking great interest in you, can mitigate the impacts of a high ACE score and can help develop resilience.
So how does this play out in our profession?
First of all, those of us who became lawyers in the face of the trauma that we experienced in our youth, are pretty resilient. We had to be in order to get here. I saw a meme that showed a cartoon wolf pup collapsed, with an arrow in his back, bleeding out and a mama wolf standing over him with 15 arrows in her back that said, “Life doesn’t get easier, we just get stronger.” Memes circulate because they resonate.
If we had alcoholic parents, were raised in domestic violence, or had a parent who was severely depressed or had other mental health issues, we probably score pretty high in ACEs. Yet many of us had enough protective factors or PCEs to get where we are today. It is well documented that being raised in an alcoholic home creates PTSD for the surviving children. Many do not begin to recognize and resolve the PTSD until much later in life, if ever. For many of us from alcoholic or abusive homes, we have enough resilience to have a fulfilling legal career and never really need to resolve the PTSD.
In other cases, the PTSD that results from many of the ACEs, creates a hyperadrenalized, hypervigilant state in us. Moving to a hyperadrenalized, hypervigilant profession just feels normal. Many of the lawyers we work with do not self-identify as having anxiety, per se, because in reality, it’s all they’ve ever known.
For those of us who parlayed our childhood trauma into this profession, where we diligently work to rectify the pain of the past, it will not heal our personal wounds. That is different work, that if left unaddressed, can be a real set up. We must recognize that as noble and important as our work is, if we are not healed internally, we will be re-traumatized over and over again by the cases we encounter.
I don’t normally share information about the lawyers with whom we work, but I will share this story because the lawyer is deceased. She came from a horrific childhood abuse situation. She worked in the child welfare arena. She was a stalwart child advocate in court. I’m not sure that anyone knew she was crippled by debilitating PTSD, depression and anxiety. Surprisingly, there was no substance use disorder involved. In most cases like this, the lawyer is heavily medicated, whether self-medicating through alcohol or taking a cocktail of prescription meds. Had she been self-medicating to ease the pain she might still be alive. We explained the neuroscience of what was happening and that she was being retraumatized over and over again. We explained that the work she was doing would not heal her inner pain. We first encouraged and later begged her to get trauma treatment (yes, there is such a thing). We first encouraged and later begged her to change her practice area. She refused. She was on a mission. Until one day she could not take any more pain, and she took her own life.
Like many of my illustrations, I see her as a canary in the coal mine. How often do we ignore, shove back and press down our personal pain or discomfort with grim determination and carry-on like it’s business as usual? We often must hit a personal crisis point, usually with staggering collateral and professional consequences, that forces us to squarely address these issues. But it does not have to unfold this way. We can seek help earlier in the process. If we have a bum tooth, better to go to the dentist early, rather than have a dull pain turn to sharp turn to agonizing over months of discomfort – where we wind up in the dentist’s chair anyway.
But what about those of us who do not come from an adverse childhood experience-based background?
Many lawyers are experiencing toxic stress, and not from adverse childhood experiences. “Toxic stress results in prolonged activation of the stress response, with a failure of the body to recover fully. It differs from a normal stress response in that there is a lack of support, reassurance, or emotional attachments. The insufficient support prevents the buffering of the stress response or the return of the body to baseline function.” In CLE and LAP columns, I have detailed the prolonged fight or flight response that is present not only in the profession, but that Covid exacerbated. The world has gone through a collective trauma. We are all hyperadrenalized and hypervigilant (i.e., feeling on edge) right now. It is imperative that we learn to calm our nervous systems so that we can return to a homeostasis or normal baseline function. Our brains and bodies need that restorative time to repair themselves.
A key differentiating factor between tolerable stress and toxic stress depends upon whether we have social supports and healthy emotional attachments in place. Because of the competitive and adversarial nature of the profession, very few true professional social and institutional supports are in place for most of us. The ABA Task Force Report on Lawyer Well-Being is advocating for structural change within the profession to provide more social and institutional supports. Many mistakenly believe that the Lawyer Well-Being Report talks about yoga and mindfulness. It does not. But I digress.
Lawyers fare far better and are more resilient if they have strong, genuine, and authentic family support and/or thriving, genuine connections in a church or recovery-based community and/or strong friendship alliances (often referred to as a family of choice). LAP involvement provides the latter in that it is a recovery-based community of lawyers-as-friends, supporting each other in practicing and positively reinforcing recovery tools and resilience skills.
Covid has shown us that we are all in this journey together. By “this journey” I mean this journey of life and a profession in law. Our collective trauma through Covid may have surfaced a personal trauma long buried. Fear not. You are not alone. In fact, you are in quite good company. There is no need to go it alone any longer. Don’t let the tooth abscess. Give us a call or reach out by email.
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4928741/
Tags: ACEs, anxiety, judges, lawyers, Recovery, resilience, suicide, trauma Posted by