there's the growing up process so that's actually structural and then there's a cleaning process or healing process so if growing up is about going up healing is about going down right because you because you need to go down into the body because that's where all the TR that's where all the trauma is held

There are four types of trauma: Acute trauma develops in response to a single event (like a car accident, sexual assault, or natural disaster). Complex trauma develops in response to prolonged and repeated traumatic events (such as child abuse or neglect, domestic violence, or civil unrest). Secondary/vicarious trauma develops in response to witnessing someone else’s trauma (typical among therapists, first responders, health care providers, and so on). Generational trauma is passed down from one generation to the next, particularly when it’s experienced by a collective group (as in slavery or genocide).

These searing questions, which invaded me, which I could not help asking, do not undermine or disrespect the ceremony at the Centrale Markthal. They make the need to remember more relevant than ever, the certainty that never again should humanity witness terrible war crimes without demanding accountability, as the prosecutor of the International Criminal Court in the Hague has done. More relevant, also, because those who acclaim Hamas — a murderous, theocratic, misogynistic, oppressive organization that also massacres children and holds innocent hostages — those who share its dreams of ridding the region of its Israeli enemies, would do well to attend memorials like the one I was at on May 4 in Amsterdam.

How could a state that had been founded by the survivors of the Holocaust be inflicting starvation on its Palestinian neighbors? How could its armed forces massacre children who, unlike Max, had nowhere to hide, no one to take them in? How could so many Israelis feel indifferent to such grief and afflictions — an indifference that, alas, recalled how so many Germans (and Dutch people, and millions around the world) had turned a blind eye to the sins of the Nazis?

BOULDER COUNTY IMPACT:Building and Sustaining Policy, Practice and Improvement Standardsfor a Multi-Program, Multi-System Collaborative

immediate & ongoing data-driven case planning Moving away from always least restrictive to matching

Behavioral Health Administration (BHA) Rule UpdateRule Volume 2 CCR 502-1, Chapter 1

using the best availablescience, to maximize physical and psychological safety, facilitate the recovery of thechild and family, and support their ability to thrive.”

F742*, §483.40(b)(1), treatment/service for mental/psychosocial concerns (1) A resident who displays or is diagnosed with mental disorder or psychosocial adjustment difficulty, or who has a history of trauma and/or post-traumatic stress disorder, receives appropriate treatment and services to correct the assessed problem or to attain the highest practicable mental and psychosocial well-being;

Trauma-Informed Care Regulations and F-tags   The regulations and F-tags that apply to trauma and trauma-informed care

Trauma-informedServices are provided under a trauma-informedorganizational structure and treatment framework

A trauma-informed approach to care acknowledges that health care organizations and care teams need to have a complete picture of a patient’s life situation — past and present — in order to provide effective health care services with a healing orientation.

My methodological approach comes from thinking along with Sara Ahmed’s work on complaint. By “complaint”, I mean grievances we lodge within our workplaces, which can look both like formal complaints made to human resources (excuse me, I mean “people operations”) and informal complaints which we hold between our peers, comrades, and friends. Anyone who has engaged in the process of a formal complaint can tell you how exhausting it is to register one, how management and decision-makers can stall, and how much one has to relive their trauma to do so.

China’s Mao Zedong and Romanian dictator Nicolae Ceaucescu also had brutal childhoods, with consequences that, in Mao’s case killed 35 million people, and in Ceaucescu’s case, forced women to have unwanted children, Miller pointed out. We can add others: the members of Myanmar’s junta who have murdered millions, mostly Rohingya as well as other minority groups; the Chinese leadership that is imprisoning hundreds of thousands of Uyghurs in prison camps….the list goes on,  

Stalin was also brutalized by his father when he was a child, she pointed out. Stalin was an only child. Like Hitler he was the first child to survive after three siblings who had died in infancy. His irascible father was almost always drunk and laid into his son from an early age. Despite the fame and power he later achieved, Stalin suffered throughout his life from a persecution mania that drove him to order the killing of millions of innocent people. Just as the infant Stalin lived in fear of sudden death at the hands of his unpredictable father, so the adult Stalin lived in fear even of his closest associates. But now he had the power to fend off those fears by humiliating others

This was Hitler’s OWN PERSONAL BRAND OF MANIA. And it is traceable to the insecurity of his existence in his own family, the insecurity of a child constantly living under the threat of violence and humiliation. Later millions were to forfeit their lives so that this child – now a childless adult – could avenge himself by unconsciously projecting the grim scenario of his childhood onto the political stage.

what’s also evident is what he didn’t seem to get: appropriate attachment—the strong and requisite bond between a parent and a child that leads to a healthy life and without which children can die or be damaged.

The reality is that Ukraine didn’t attack Russia, had no plans to attack Russia, and why would it? Russia’s military is 10 times larger AND they have nuclear weapons. It’s clear that Putin has created his own reality about the situation, one that isn’t shared by people who operate in facts. Besides, his actions cannot be justified merely because he believes his reality. He’s a damaged person who needs to stop what he’s doing before he shatters the lives of millions more.

How Vladimir Putin’s childhood is affecting us all

animals after experiencing a near-death experience with a predator lie down and shake their body to physically release the trauma

Sergio: Why did your family migrate to the US?Rodolfo: The reason why my family moved to the US was because both my grandfather and my biological fathers struggled with addiction, with alcoholism and drug abuse. They were just not very... Mostly my biological father, he really wasn't always there, and he was always very violent towards my mother. My mother had me when she was 14 years old. When she got pregnant everybody decided well, okay, she messed up. She is this, that, like very, very taboo. She wasn't really accepted in the family anymore. It wasn't so much my family and I moving to the US, it was just my mother and I when she was 16 and I was two and a half years old. They weren't really interested in what was going on with me or my mother. She just wanted a better quality of life for her and for myself.Rodolfo: In Mexico at 16 years old, with no type of education past probably middle school, she knew she wasn't gonna get very far. I guess she made that decision in order to have a better quality of life for her and myself, she went on. She was 16, and I don't know how she did it. I don't know the details and all that, but she met the right people, or she got in contact with the right people, and she went over there. She went to the United States. To this day, I still remember a lot of the things, even though I was very, very young. It's something that I always tell everybody that I meet, it's not just for this interview.Rodolfo: I always remember the bad things that happened or the very... I don't know if it's because it had such a big impact in my life and my mother's life or just because of how everything was set up. I remember everything that happened from start to finish. From the beginning where we got picked up, to being in the desert. I still remember eating cereal with water. It was... I don't know, it was very, very... I feel like it was... it obviously had an impact psychologically, because I still just have a lot of anxiety when I'm in certain places that I'm really accustomed to. A two, three year old in the middle of the desert, it definitely had to have an impact on me.Sergio: How old were you when that happened?Rodolfo: I was two and a half years old, so that's why I'm saying it's very odd for me to be able to remember that at a very, very young age. It wasn't only that, just even when I was here, when I was two, two and a half, I used to remember asking my mom certain memories that I had. She would say, "Oh you were one year old, one and a half years old, how did you remember that?" It was always very, like a violent, violent memory that I had. It was more so like my father being drunk or high or whatever and coming in the house. Taking any little money my mom made for the week, in order for him to keep on doing what he was doing. Just coming in and just tearing up the place.

Luisa: I told my mom about this and I remember vividly having a conversation with her and telling her, "Hey, you know what? This is happening at school," but I think my mom was going through so much stuff that she didn't know how to deal with it or she didn't … there wasn't enough of my mom to go around back then. I know now. I forgive her, but certain things … [Pause] I forgive her a lot for it now because I get it. It was extremely traumatizing. She had a lot of health issues and then this man who was her entire world just dumped her aside and she had to leave her whole life behind and everything she knew, all the comforts and work. She had never worked in her life [Chuckles]. I respect my mother a lot. She started going to design school for designing clothes and it’s pretty great.

I didn't really have a relationship with my family. When there was a family events or anything, I felt like an outcast. I would never go to them. Christmas, I was always in my room. Every little... It's just weird man. Everything messed me up. I feel like traumatic. Just the trauma of everything.

5The Missouri Model for Trauma-Informed SchoolsA school that only addresses the impact of trauma on students will struggle with staff burnout, turnover, and compassion fatigue. The science around trauma is clear: the most powerful resource for young people is a supportive, unwavering relationship with an adult. Adults in schools must be capable of being unwavering supports for students. This means addressing the vicarious and secondary trauma experienced by staff-not as an afterthought, but as a focal point of the trauma-informed journey.

An accountability model of discipline employs behavioral supports and restorative practices to enable individuals to develop the skills they need to be successful in an educational setting.

A trauma-informed pedagogy enables us to recognize that amid a pandemic, our students may have a difficult time completing basic tasks they normally would, including keeping track of the slightest changes in our classes, making decisions about their learning, being motivated to study or to show up, prioritizing assignments, engaging with classmates or the subject, managing their time, or simply not quitting.

Unfortunately, saying, "Build a relationship" is too vague and leaves too much up to the teacher's instincts.

Between the self and other, between where you come from and where you end up, between the personal narrative and collective history, between genders and cultures and languages and countries and the similar calls for dignity and recognition contained in stories

Sure. So I do want to start by just reminding listeners that talking about trauma, learning about trauma, can bring up some feelings, which is a very normal reaction to that. So I just want to remind people, if you notice that, that it’s okay to take a rain check on listening and engaging in this conversation. I also do recommend that even if you feel okay to engage with a discussion about trauma that it’s recommended that you do so in small doses, especially during these very challenging times.

Patients at risk for an esophageal injury should undergo bedside esophagoscopy or soluble contrast esophagography followed by barium examination to look for extravasation of contrast

For penetrating thoracic trauma, physical examination, plain posteroanterior and lateral chest radiographs with metallic markings of wounds, and pericardial ultrasound will identify the majority of injuries.44 Injuries of the esophagus and trachea are the exceptions.

Pneumomediastinum following blunt trauma that is identified on CT imaging is a poor predictor of aerodigestive injury; selective workup is appropriate

After blunt trauma, a hemothorax is usually due to multiple rib fractures with severed intercostal vessels, but occasionally bleeding is from lacerated lung parenchyma, which is usually associated with an air leak

Thrombosis of the internal jugular veins caused by blunt trauma can occur unilaterally or bilaterally and is often discovered incidentally because most patients are asymptomatic. Bilateral thrombosis can aggravate cerebral edema in patients with serious head injuries; stent placement should be considered in such patients if ICP remains elevated.

Vertebral artery injuries due to penetrating trauma are difficult to control operatively because of the artery’s protected location within the foramen transversarium. Although exposure from an anterior approach can be accomplished by removing the anterior elements of the bony canal and the tough fascia covering the artery between the elements, typically the most efficacious control of such injuries is angioembolization. Fogarty catheter balloon occlusion, however, is useful for controlling acute bleeding if encountered during neck exploration.

The Third-Generation normalized the process of dialogue. Bar-On and his team developed a paradigm for how to work through the Holocaust through knowledge, understanding, emotions, attitude, and behavior. What they discovered is that for the Third-Generation, the Holocaust either has no relevance, which they call “under generalization” or “over generalization,” where everything is seen through the prism of the Holocaust. A more normalized reaction to a Shoah family background is the “partial relevance,” an “in-between” and more balanced perspective.

The Third-Generation in America (or “3Gs,” as they are known) have only recently started to become a visible group, but not with the same intensity as the Second-Generation. Age-wise, they span the gamut from newborns to forty-year-olds. Among them, those in their twenties and thirties are grappling with identity formation, with establishing intimate relations, and with having children.

From the psychological research the only significant finding is that grandchildren of survivors as a group, are higher achievers than their peers. In 2002 Ellisa Ganz found that Third-Generation individuals are twice as likely to choose an occupation in the helping professions. Ganz also found, however, that those 3Gs who are in therapy are in treatment for longer periods than a comparative group.

Yoslow observed that the Third-Generation has a deep affection for humanity, which is a transformation of the post-Holocaust trauma. This process is the ability to transform the emotional effects of the Holocaust by letting go, and thus increases the quest for meaning in ones life and concern for social issues.

Today, Third-Generation individuals whose professional lives have been shaped by their grandparent’s ordeals are found in the creative arts, in helping professions, human rights work and in Jewish studies and communal work. The Third-Generation members are no different from those in the Second-Generation, who gravitated towards the creative arts in order to remember the barbarity committed against the Jews living in German-occupied countries and , the Jewish life that was destroyed, and to raise consciousness about present-day racism, human-rights violations, and genocides.

Flora Hogman conducted a case study of Second and Third-Generation, and in her sample of the grandchildren of Holocaust survivors she noticed that they feel a sense of pride and awe of the survivors. This awareness of the suffering is part of the fabric of their lives, but is channeled into empathy, political activism, greater consciousness of others suffering, and a reluctance to intermarry.

Trauma-Informed Screening and Assessment Tools

“The greatest hope for traumatized, abused, and neglected children is to receive a good education in schools where they are seen and known, where they learn to regulate themselves, and where they can develop a sense of agency.”

“trauma produces actual physiological changes, including a recalibration of the brain’s alarm system, an increase in stress hormone activity, and alterations in the system that filters relevant information from irrelevant”

“Under normal conditions people react to a threat with a temporary increase in their stress hormones. As soon as the threat is over, the hormones dissipate and the body returns to normal. The stress hormones of traumatized people, in contrast, take much longer to return to baseline and spike quickly and disproportionately in response to mildly stressful stimuli. The insidious effects of constantly elevated stress hormones include memory and attention problems, irritability, and sleep disorders. They also contribute to many long-term health issues, depending on which body system is most vulnerable in a particular individual.”

“After trauma the world is experienced with a different nervous system. The survivor’s energy now becomes focused on suppressing inner chaos, at the expense of spontaneous involvement in their lives. These attempts to maintain control over unbearable physiological reactions can result in a whole range of physical symptoms, including fibromyalgia, chronic fatigue, and other autoimmune diseases. This explains why it is critical for trauma treatment to engage the entire organism, body, mind, and brain.”

“Children who don’t feel safe in infancy have trouble regulating their moods and emotional responses as they grow older.

“Sadly, our educational system, as well as many of the methods that profess to treat trauma, tend to bypass this emotional-engagement system and focus instead on recruiting the cognitive capacities of the mind. Despite the well-documented effects of anger, fear, and anxiety on the ability to reason, many programs continue to ignore the need to engage the safety system of the brain before trying to promote new ways of thinking. The last things that should be cut from school schedules are chorus, physical education, recess, and anything else involving movement, play, and joyful engagement.”

“We have learned that trauma is not just an event that took place sometime in the past; it is also the imprint left by that experience on mind, brain, and body. This imprint has ongoing consequences for how the human organism manages to survive in the present. Trauma results in a fundamental reorganization of the way mind and brain manage perceptions. It changes not only how we think and what we think about, but also our very capacity to think.”

Trauma victims cannot recover until they become familiar with and befriend the sensations in their bodies. Being frightened means that you live in a body that is always on guard. Angry people live in angry bodies. The bodies of child-abuse victims are tense and defensive until they find a way to relax and feel safe. In order to change, people need to become aware of their sensations and the way that their bodies interact with the world around them. Physical self-awareness is the first step in releasing the tyranny of the past.

“As long as you keep secrets and suppress information, you are fundamentally at war with yourself…The critical issue is allowing yourself to know what you know. That takes an enormous amount of courage.”

Thalamus: Our Thalamus is like a cook.  It takes in info from all the senses and then blends it with our autobiographical memory. Breakdown of the thalamus explains why trauma is primarily remembered not as a story with a beginning, middle, or end, but as isolated sensory imprints: images, sounds, physical sensations that are accompanied by intense emotions usually terror and helplessness. In normal circumstances, the thalamus also acts as a filter or gatekeeper. This makes it a central component of attention, concentration, and new learning—all of which are compromised by trauma. People with PTSD have their floodgates wide open. Lacking a filter, they are on constant sensory overload. In order to cope, they try to shut themselves down and develop tunnel vision and hyperfocus. If they can’t shut down naturally, they may enlist drugs or alcohol to block out the world. The tragedy is that the price of closing down includes filtering out sources of pleasure and joy as well.

All of us, but especially children, need … confidence that others will know, affirm, and cherish us. Without that we can’t develop a sense of agency that will enable us to assert: “This is what I believe in; this is what I stand for; this is what I will devote myself to.” As long as we feel safely held in the hearts and minds of the people who love us, we will climb mountains and cross deserts and stay up all night to finish projects. Children and adults will do anything for people they trust and whose opinion they value. But if we feel abandoned, worthless, or invisible, nothing seems to matter. Fear destroys curiosity and playfulness. In order to have a healthy society we must raise children who can safely play and learn. There can be no growth without curiosity and no adaptability without being able to explore, through trial and error, who you are and what matters to you.

The challenge of recovery is to reestablish ownership of your body and your mind — of your self. This means feeling free to know what you know and to feel what you feel without becoming overwhelmed, enraged, ashamed, or collapsed. For most people this involves (1) finding a way to become calm and focused, (2) learning to maintain that calm in response to images, thoughts, sounds, or physical sensations that remind you of the past, (3) finding a way to be fully alive in the present and engaged with the people around you, (4) not having to keep secrets from yourself, including secrets about the ways that you have managed to survive

Nobody can “treat” a war, or abuse, rape, molestation, or any other horrendous event, for that matter; what has happened cannot be undone. But what can be dealt with are the imprints of the trauma on body, mind, and soul: the crushing sensations in your chest that you may label as anxiety or depression; the fear of losing control; always being on alert for danger or rejection; the self-loathing; the nightmares and flashbacks; the fog that keeps you from staying on task and from engaging fully in what you are doing; being unable to fully open your heart to another human being.

Securely attached kids learn the difference between situations they can control and situations where they need help. They learn that they can play an active role when faced with difficult situations. In contrast, children with histories of abuse and neglect learn that their terror, pleading, and crying do not register with their caregiver. Nothing they can do or say stops the beating or brings attention and help. In effect they’re being conditioned to give up when they face challenges later in life.

When our senses become muffled, we no longer feel fully alive. […] In response to the trauma itself, and in coping with the dread that persisted long afterward, these patients had learned to shut down the brain areas that transmit the visceral feelings and emotions that accompany and define terror. Yet in everyday life, those same brain areas are responsible for registering the entire range of emotions and sensations that form the foundation of our self-awareness, our sense of who we are. What we witnessed here was a tragic adaptation: In an effort to shut off terrifying sensations, they also deadened their capacity to feel fully alive.

The body keeps the score: If the memory of trauma is encoded in the viscera, in heartbreaking and gut-wrenching emotions, in autoimmune disorders and skeletal/muscular problems, and if mind/brain/visceral communication is the royal road to emotion regulation, this demands a radical shift in our therapeutic assumptions.

Despite the well-documented effects of anger, fear, and anxiety on the ability to reason, many programs continue to ignore the need to engage the safety system of the brain before trying to promote new ways of thinking. The last things that should be cut from school schedules are chorus, physical education, recess, and anything else involving movement, play, and joyful engagement. When children are oppositional, defensive, numbed out, or enraged, it’s also important to recognize that such “bad behavior” may repeat action patterns that were established to survive serious threats, even if they are intensely upsetting or off-putting.

Social support is not the same as merely being in the presence of others. The critical issue is reciprocity: being truly heard and seen by the people around us, feeling that we are held in someone else’s mind and heart. For our physiology to calm down, heal, and grow we need a visceral feeling of safety. No doctor can write a prescription for friendship and love: These are complex and hard-earned capacities. You don’t need a history of trauma to feel self-conscious and even panicked at a party with strangers — but trauma can turn the whole world into a gathering of aliens.

In trauma survivors, Van der Kolk notes, the parts of the brain that have evolved to monitor for danger remain overactivated and even the slightest sign of danger, real or misperceived, can trigger an acute stress response accompanied by intense unpleasant emotions and overwhelming sensations. Such posttraumatic reactions make it difficult for survivors to connect with other people, since closeness often triggers the sense of danger. And yet the very thing we come to most dread after experiencing trauma — close contact with other people — is also the thing we most need in order to regain psychoemotional solidity and begin healing.

This, he points out, is why we’ve evolved a refined mechanism for detecting danger — we’re incredibly attuned to even the subtlest emotional shifts in those around us and, even if we don’t always heed these intuitive readings, we can read another person’s friendliness or hostility on the basis of such imperceptible cues as brow tension, lip curvature, and body angles.

teach-ers are generally not prepared to address the intersections of healing, politics, and emotion in classrooms.

A common lament among educator-survivors is the way that personal boundaries shift within the school community. Abbey Clements, who taught second grade at Sandy Hook, says that after the shooting, she would take her entire class to the bathroom at the same time, so that no one would have to leave her sight. But as they drew their students close, she says, she and her colleagues distanced themselves from one another. “You’re afraid that if you start talking about your own trauma, you might trigger someone else’s,” she says. “You’re also afraid of looking weak or unstable, afraid you’ll be asked to leave or take leave if you admit how much you’re struggling.” As a result, many teachers bury their fear and anger and guilt, until it changes into something else entirely. The question of where to erect a memorial, or when to take one down, can create fierce divisions. So might similar questions about how long to allow comfort dogs on campus, or what to do with the mountain of gifts and condolences that pile up. Students may come close to blows over whether to discuss the shooting during class time. Teachers may feel close to doing the same. “It’s not all ‘Kumbaya,’ ” Clements says. “When the system is cracked by a trauma of this magnitude, a lot of stuff leaks out. It gets messy. And it can change relationships.”

Teachers are at the quiet center of this recurring national horror. They are victims and ad hoc emergency workers, often with close ties to both shooter and slain and with decades-long connections to the school itself. But they are also, almost by definition, anonymous public servants accustomed to placing their students’ needs above their own. And as a result, our picture of their suffering is incomplete. We know that the trauma that teachers experience after a school shooting can be both severe and enduring. “Their PTSD can be as serious as what you see in soldiers,” says Robert Pynoos, co-director of the federally funded National Center for Child Traumatic Stress, which helps schools coordinate their responses to traumatic events. “But unlike soldiers, none of them signed up for this, and none of them have been trained to cope with it.” We know that teachers who were least able to protect their students in the moment tend to be especially traumatized. “For teachers, the duty to educate students is primary,” Pynoos says. “But the urge to protect those students is deeper than that. It’s primal.” And we know that their symptoms can include major sleep disturbance, hair-trigger startle responses and trouble regulating emotions.

Unlike many of my peers, I do think that there are direct and relevant connections between efforts by progressive students to regulate content Look: I have already said more about trigger warnings than I want to. I will simply note that every trigger warning necessarily contains ideological presumptions and political baggage. Someone I know said “I don’t want to ban American Sniper on campus, but I do want it to carry a trigger warning as war propaganda and Islamaphobia.” That trigger warning preempts the very critical conversation that we should be having about it! It’s a classic “when did you stop beating your wife?” tactic. It’s tautological; it presumes precisely the issue in question. Clint Eastwood, who made the damn movie, called it an antiwar film. I disagree with him; I quite despised it, actually, and for political reasons most of all. But I don’t pretend that my opinion on this question amounts to proof positive. Every trigger warning ever devised makes presumptions about the nature of trauma, the treatment of PTSD, and which kinds of content are potentially offensive. You would think that a bunch of close-reading academics would recognize that.

The result? Students’ sense of vulnerability is skyrocketing.