Trauma Outside the Box: How the ‘Trauma-Informed’ Trend Falls Short

Noel Hunter, PsyD

Increasingly, it is becoming fashionable for mental health agencies and practitioners to become “trauma-informed.” Ostensibly, this is a good thing. But what is happening in reality is far from ideal.

There is a pressing need to understand how things such as abuse, poverty, oppression, injustice, racism, and other adversity impact our mental health and overall well-being. Common sense, of course, would tell us that it essentially drives a person mad over time. But in this day and age common sense is perceived as juvenile or less-than “science.”

Regardless, it’s imperative that any person or system in a helping position consider the context of suffering and what has happened in a person’s life that led to his or her current state of mind.

The thing is, this is time-consuming, complex, highly subjective, and individual — everything the system is designed against.

What appears to happen in reality when an organization or individual clinician becomes “trauma-informed” is that old formulas simply get re-mixed with all the trauma ingredients and check-boxes and with none of the actual meaning. It becomes yet another way to advance one’s career and feel good about oneself while pretty much doing nothing different. It’s once again about boxing-in human beings being human beings.

Of course, this is not universal — there are many dedicated genuine trauma-informed programs and workers out there that do help many. This article is not about them. But if you’re uncomfortable reading this or find yourself feeling defensive, it might be about you.

The following is a glimpse into the numerous ways in which mainstream services and trauma specialists within this mainstream are perpetuating harm while patting themselves on the back for being so progressive and aware.

Ignores invisible “trauma”

Perhaps one of the more problematic ways that studies of “trauma” have impacted larger society is the implicit message that if an experience is not considered traumatic by the DSM, then it isn’t “bad enough” to cause a person to suffer intensely and greatly.

The DSM specifically describes trauma as either directly experiencing or witnessing some life-threatening event, such as violence, war, or sexual assault.

Witnessing or experiencing literal threats of death is horrible. But what is considered to be life-threatening to a two-year-old is very different than to a 22-year-old. And what threatens our psyches on an existential level is not always tangible or easily identifiable.

What overwhelms the body’s capacity to cope or what leaves a person in a chronic stress state may not be an overt event like assault.

Take ostracism, for example. Being ignored, disliked, and left out, no matter how subtle, can be a death sentence for some. It can be more painful and more damaging than physical bullying or abuse. Yet, in the world of the DSM and mental health professionals, it barely counts at all. It’s just not bad enough.

Smoking cigarettes is vastly different than taking a gun to my head. But both are likely to kill me at some point.

In the 1960s and 70s, family-systems-oriented therapists seemed to grasp a pretty good understanding of the toxic and insidious effects of covert interpersonal dynamics, such as gaslighting, double-binds, and scapegoating. It was understood that psychological dysfunction tended to exist within the complex family or social system rather than within any one individual, even if one individual might take on the symptoms, so to speak, for the whole.

This complexity and holistic view has been lost in the age of diagnosis and individual disease, even within family therapy. Because none of these destructive dynamics count as trauma and, certainly, are nearly impossible to measure or capture on a questionnaire, they somehow become irrelevant or triggers of underlying disease.

The mental health and trauma fields have come to a place where, essentially, if something cannot be easily identifiable and measurable, it apparently doesn’t matter.

Questionnaires and manualized treatments commodify life experience

Just because something cannot be boiled down to a simplistic question and measured on a 5-point Likert scale does not mean that it doesn’t count.

No one can truly capture experiences of chronic oppression, microaggressions, or the struggle of injustice with an arbitrary rating scale. Not everything can be quantified. This doesn’t mean that it doesn’t exist or profoundly affect those who experience such adversities.

What ends up happening is that if something cannot be conveniently measured and statistically manipulated, it’s either seen as somehow inferior to “real science” or is ignored altogether.

Qualitative research, which is based on the subjective and attempts to capture nuanced narratives, is predictably criticized by those who believe themselves to be serious scientists. In theory, quantitative research is supposed to be objective, unbiased, demonstrating new discoveries rather than common sense, reliable or consistent across studies and investigators, formalized, generalizable, and valid.

This is what social sciences value — predictability,lack of complexity, lack of subjectivity or emotion, and robotic-like formulas.

Yet, consider that the simple use of different statistical procedures can determine vastly different results using the same data. Or that millions of dollars are spent on brain research so that we can understand totally groundbreaking, non-common sense findings such as that sadness is associated with areas of the brain associated with emotions (and not even all the time!). Think about how researchers tend to find support for their particular affiliation (pharmaceutical, theoretical, etc.) more often than not, or that negative findings are almost never published. Do we really need 100s of studies to tell us that when bad stuff happens, it affects us and can drive us mad?

It’s fun to play with numbers and prove ourselves right. Who doesn’t like to be right? It also is super good for job security. But, it isn’t science. And it isn’t helpful.

Quite the opposite. It threatens to take a person’s subjective and very personal life narrative and shove it into a formulaic box that is then said to somehow lead to an explanation for why they suffer. Oh, you say that you never felt understood within your family? Like you were bad or not good enough for most of your life? You felt like no matter how hard you tried, nothing ever worked to help you get ahead or find validation and connection with others? Well, none of these things are on my validated trauma questionnaire nor is it included in the ACE’s scale. So nothing has ever happened to you. Sorry. You just have a chemical imbalance and are in need of expert treatment for your genetic mental illness.

Dictates understandable vs. not-understandable ways of reacting to stress

Even if a person is lucky enough to have their life experiences recognized and validated, there still is the problem of what is acceptable in response to such experiences. If a person can articulate his or her fear as directly related to the identifiable event that a mental health professional deems bad enough to warrant a distressed response, then it might be considered understandable. If the fear becomes diffuse or symbolized, or does not directly link to some overt event, now the person is paranoid or delusional.

If someone holds their pain and cries out in ways that disturb others, the person is almost guaranteed to be diagnosed with a non-trauma-related disorder that insinuates internal defect. If the person screams too loud or makes others feel their pain, their personality is said to be disordered. What does this even mean?!

This is preposterous. It is not science.

Diagnoses are almost entirely based on how any given individual clinician understands the person in front of them. One of the defining differences, for instance, between a dissociative disorder and psychosis is the story one puts to internal experiences.

If one feels that some “not-me” forces are controlling the mind or body and attributes this to “alters” or other people living in the body, well this is understandable and said to be dissociation. If the clinician believes that dissociative disorders don’t exist, then the person is told they’re making it up or just seeking attention.

Alternatively, if, instead, this possessive experience is attributed to aliens beaming radioactive light waves into the brain (which one might argue is more plausible), now the person has a genetic brain disease called schizophrenia that requires toxic drugs for life.

Basically, if a person is in extreme distress and seeks help from a mental health professional, the odds of getting understanding and trauma-informed care are vastly enhanced if you can articulate your experience and pain in a way that the professional understands, is not disturbed by, and can fit into a checkbox or validated scale.

Trauma theories have largely become just another disease model

There are many things that are helpful for understanding the correlates of what’s happening in the brain with sometimes confusing behaviors or feelings. When a person is in a freeze state, for example, the brain literally goes offline. Aside from basic functions for sustaining life, the brain is playing dead. Trying to talk to a person or forcing such a person to talk back when in such a state is a futile effort akin to making rain return to its cloud. Non-verbal techniques are prudent in this instance — getting angry and further pathologizing and blaming the patient for being difficult, of course, are much more common.

For sure, there are distinct brain changes that appear to be associated with child abuse, chronic stress, and other forms of adversity. The hippocampus tends to shrink, executive functioning is altered, the ways in which emotions are processed are different, and ventricles tend to be enlarged. BUT, this DOES NOT equal dysfunction or disease!

The brain is an amazing organ that adapts to its environment. One study that actually looked at cognitive differences from the perspective of adaptation showed how a group that had experienced trauma had difficulty with inhibition (i.e., they were “impulsive”). Yet, on the other hand, they were also better at quickly switching tasks and working in uncertain and stressful situations. These are people who might make excellent cops, paramedics, ER doctors, or soldiers. At the same time, they might make terrible librarians.

All we hear about, however, is how trauma damages the brain and impairs the victim.

And, of course, that a victim is a victim. Experiencing trauma and living with pain and suffering does not absolve a person of responsibility for his or her behaviors. Every perpetrator was once a victim. Too often, however, responsibility is conflated with blame, in that if a person is held responsible for his or her behaviors that person is somehow being blamed or is bad.

Victims are good. Perpetrators are bad. People who have experienced trauma are one or the other. Everything is simple.

Worse, there rarely is discussion of how the brain actually heals and can adapt to new, safer, calmer environments over time and with a healthy support system. It may get harder to overcome early experiences the older one gets and the more added layers of pain and adversity are added over the years, but the possibility for healing is always there.

Healing, though, just might mean something different to the person suffering than the professional needing to fix someone or feel good about his or herself for being a helper and getting rid of symptoms and disease like a real doctor.

Many things have been shown to alter the brain’s function and structure: yoga, meditation, relationship, therapy, aerobic exercise, nutrition, and more. And, for most of these, no mental health professional is needed.

Trauma can be incredibly damaging, toxic, and difficult to overcome. But it is not a disease nor is it a life sentence.

Modern Missionaries: Intervening where you are not needed or wanted

Mental health professionals love to tell the world how they should or should not behave, what are and are not acceptable behaviors, beliefs, and emotions, and how drugs and therapy are needed in almost any given situation. But what they love even more is showing how helpful and needed they are.

In the early 20th Century, Christian missionaries turned their efforts to sub-Saharan Africa. No doubt that they were benevolent in their efforts — believing wholly in the power of the gospel and the goodness of the words of Jesus, surely they wanted to give to others by sharing their knowledge and beliefs in far off lands. The outcome of these efforts, however, led to the eradication of centuries-old African customs and the eventual implementation of apartheid.

Similarly, it has now been widely recognized that when mental health professionals go into other cultures, especially after a natural disaster or other major tragic social event, they have made things worse. The idea that someone needs to “process” the traumatic event by specific trauma-informed therapy guidelines with a professional has led to prolonged suffering and worse long-term outcomes than those who were just left alone.

The book Crazy Like Us: The Globalization of the American Psyche, by Ethan Watters, describes how the exportation of the American mental health industry has led to the loss of local customs and alternative ways of understanding and coping with human suffering. And some of those cultures were better off before our psychiatric missionaries intruded on their society.

In the end, any ideology risks becoming polemic and authoritarian; psychiatry has already crossed that line. When business and career interests bias those with a strong identity of being the “good guy” or “helper,” then any suggestion that they are not needed or are doing harm goes unheard and dismissed. Such individuals have incredible difficulty holding anger, acknowledging when they are wrong, saying “I’m sorry,” or, better, “I don’t know.”

In the process, the helper risks becoming the destroyer.

It is time we started embracing diversity, difference, complexity, and humility. Mental health professionals would do well to consider that we are a tiny speck among the history of healers, believers, story-tellers, philosophers, charlatans, snake oil salesman, lovers, judges, and ideologists. No checklist or questionnaire will ever change that.


  1. Thanks Noel. I find this a nefarious tactic and almost perp like. Use something legitimate but abscound with the money and goods.
    I refused to look at the latest DSM when given a chance. In the other ones there was a axis about stress and life events. It was there but never ever used.
    Now folks see trauma as a profit engine.
    BTW folks should read up on the Sound if Music family. There were issues like in all families and one member was ill used by the MH system.
    I am still waiting for the use of the system to be shown to be used by corrupt other systems. Andrew Greeley had a thinly disguised mystery novel where a priest who had uncovered church malifiesence was remanded to a Psych. Unit.
    The system needs an entire inside out reform.

    • The musical Sweeny Todd has the corrupt judge who rapes the barber’s wife, then sends her to the loony bin so he can have her daughter for his own. Then when the daughter matures, he throws her in the loony bin too when she rebuffs his advances and tries to escape his confines.







    but, back to the article…

  3. i find it…difficult, to on the one hand acknowledge that there are intelligent, potentially kind and truly “helpful” people in the “helping professions…”

    but the guild as a whole is geared towards human destruction and profit optimization. maybe its because ive seen what the “caring” professionals are really like, when the insurance dries up or one asks too many questions…

    im not interested, no no no. people need people. i now have people who care in my life, not agents of the state pretending to be friends for profit and power.

  4. I’m in the mood again for a few couplets from John Lennon (from “Working Class Hero”), with a shout out to Lavender Sage. Hope Yoko doesn’t sue. 🙂

    “As soon as you’re born they make you feel small
    by giving you no time instead of it all
    ’till the pain is so big you feel nothing at all

    They hurt you at home and they hit you in school
    they hate you if you’re clever and they despise the fool
    ’till you’re so fucking crazy you can’t follow their rules”

  5. Meanwhile, biological psychiatry is growing desperate. Or so it seems.

    Russian biological psychiatrists are now trying to identify the specific body smell of the people “diagnosed” (read: labelled) with “schizophrenia” (read: anything that some psychiatrist decides as worth labelling, from altered state of consciousness to social deviance to political radicalism to intellectual heterodoxy to actual encounter with something paranormal). And this is not a joke… well, apparently (when I first saw the article, however, my first thought was something like: “Oh, some April 1st texts are getting published really late nowadays”).

    The article is in Russian… yet, I think, it is possible to use Google Translate (or some similar program) to get more-or-less adequate English translation:

    Well, seeing that psychiatrists featured in the article insist that chemical (particularly dopamine and serotonin) imbalance is “known for a long time” for “playing an important role in the mental illness formation”, one can quickly understand what to expect from their statements (and how dubious – at best – the validity of such statements is). Especially that it is simultaneously acknowledged in the article that no identifiable biological difference between the supposedly “normal” persons and labelled “schizophrenics” was ever found. How these two mutually exclusive statements can be held together, logically, is for anyone to guess. Yet I have always noted that the logic is not the strong side of the social organisations based on violent, oppressive power – coercive (read: violent) psychiatry included.

      • In Russia, the “chemical imbalance” claim is not yet relegated to the realm of mythology, but is still promoted as the great triumph of medical science by mainstream psychiatrists.

        I suspect this is because the criticism of psychiatry is totally marginal and thus almost publicly invisible in Russia. In my country, psychiatrists’ nonsensical claims almost always remain unchallenged, and that’s why they can persist even in the mistakes that have already been rejected (and now shamefully denied) by their Western colleagues.

        • Oh, we all wish it were relegated to the realm of mythology over here. Unfortunately, though the “thought leaders” have had to disclaim this notion, it is still very much alive in the trenches and is regularly used by doctors to manipulate their patients into taking the drugs. I think probably the majority of doctors actually believe it themselves and are pretty impervious to even their own leadership telling them otherwise.

          Sounds like things in Russia are pretty grim, though. I wish you good fortune in turning that around!

  6. Hi Noel,

    Your Article is very interesting and requires lots of attention.

    I meet my demons every morning when I wake up and providing I don’t get into a preoccupation with them, they don’t stay for too long.

    I think my demons don’t really belong to me, they are more general demons that managed to find a way in.

    I find it amazing that the “West” tried to export Mental Illness to Japan. As I believe all Mental Health solutions can be found in Buddhism.

  7. thank you. I think about this stuff all the time as well. The trauma-informed hip therapists who think they’re so cool and who are still totally supporting the status-quo and thus hurting a fair number of those they claim to serve. thank you for continuing to raise awareness. (anyone can take a weekend certification and call themselves trauma-specialists now too…it’s dangerous and misleading at best)

  8. Psychiatry lost its mind decades ago. Now it is addicted to the biological model to help explain all human distress. Like all addictions psychiatry and other mental health professionals avoid the immense pain of true engagement with another. All the psychiatric drugs, all the alphabet soup of “trauma informed manualized therapy” approaches, all the pseudo science are the professionals avoiding the exquisite discomfort of being with someone persistently over time in their distress, in their world, in their suffering. without knowing what particularly “to do” at any given moment.

    Thanks Noel for consistently raising these issues. There are those who will continue to pursue this art of engaging others to co-create safe spaces for healing and collaborative growth to occur. Your voice and teaching will provide support to those seeking this healing path.



      Professionals are too shallow to be highly psychological themselves, they can’t even imagine themselves in psychological archetype beyond egoic control. That is because, apollonians, egoic psychopats are extremely shallow. But they do not know about that, they think that psychological blindness or shallowness is a form of courage or strength, and that psychological man is weak, and they are not… What a crazy disdain for human psyche.
      When ego is in apollonian archetype, we think that we have control over psyche, when ego is beyond apollonian archetype, control belongs to psyche itself, and then, we are called mentally ill (and then we are dehumanised, not undestood). This is strategy of denial, of rational or theological denial. Professionalls are pretending that people have control, when they have not, when they are beyond archetype of control.

      Apollonian archetype gives your ego easiness and control, the rest of psyche demands COURAGE and HUMILITY.

      We need phenomenological awarness of what is psyche. For authoritarians psyche begins and ends in apollonian ego archetype. Where is the rest, death, psychological suffering, and so on? Is psychology only for stupid brainless happy cowards, while human suffering, death is in the theological coffin or in rational trash can, together with psychological man?

      WHERE IS THE PSYCHOLOGICAL REALITY? PSYCHO LOGICAL, not rational, not theological – mythical, beyond ego control? Apollonian, material fundamentalists have destroyed phenomenology of the psyche. For economy, for politics. For money.

      James Hillman – Re -visioning psychology.

  9. Thank you for your community service and for this blog. My only disagreement pertains to confusion with your term “madness.”


    I thought that “trauma-informed” care was about understanding how traumas cause mental distress (natural emotional suffering or coping styles deemed disabling) rather than about a “context of suffering” within a “mental state” of “madness.” How does a “mental state” of “madness” differ from other concepts of “mental disorders?”

    • I don’t object to being called crazy, mad, or whatever as long as it’s understood that this is a colloquialism, or even a slur; it’s when a term such as “mad” is used to denote an actual condition or “disorder,” rather than as one of infinite colorful adjectives that might be used to describe someone or their behavior. When people “identify” as “mad” and talk about “mad pride” I blanch; this is an internalization of a destructive label, period. It does not refer to an oppressed sub-species of humans. One should resist such labeling, not “take pride” in it.

      • Most terms in the lexicon dealing with psychiatric conditions are variants, in the etymological sense, of a way of calling an individual “sick”, possessing “ill health”, and, in that fashion, seeing ‘disturbed’ as ‘diseased’. Madness, on the hand, having been coined prior to the development of the medical model, originally meant changed. I don’t have a problem with that definition in particular. I do though have an argument with efforts to change people back into those people their community, friends, and relatives, etc., were more familiar with through drugs, electric shocks, and other destructive tortures. Mad, in this instance, is a way of responding with a measure of pride. Sorry, folks, but your changeling is here to stay.

        Oh, what a boring world we’d have if everybody were the same! I see Mad Pride as a reason to celebrate our differences, and thus, a cause célèbre. You’ve got little reason to conceal your difference. I’d say, when you can flout it, and flout it without being locked up for doing so.

  10. I was a little nuts. I went to a shrink who drove me loonier than Minnesota in the spring with his quack remedies he knew nothing about.

    The same drugs that drove me crazy kept me in a low grade state of madness for 25 years.

    I left the MI System, tapered off my crazy making drugs and am struggling to make a place for myself in the real world. I’m a Survivor. No longer crazy despite the system’s best efforts to keep me that way.

    Wrestling with anger, shame, guilt, and bitterness. As Noel points out it’s my fault too. If I hadn’t been such a thin-skinned wimp I never would have seen that shrink. I see my wasted life as a sort of punishment for failure to forgive promptly enough and not being sweet enough to fit in. That’s why my siblings never went nuts. No skin; no spine. Serves me right.

    • Rachel , I always am interested in your thoughts. Yeah I know we were duped big time. And I totally understand your self loathing. Been there done that. Depends on the day, depends what triggers I am forced to endure. Drive past the hospital ect ect ect and just that could drive folks into trauma.
      12 step programs deal with your feelings. Just lie say your an addict and leave it at that or do CODA.
      Stick with the old folks they know their stuff and yes they know exactly how you feel. Our issue is we were totally no responsible – we were just seeking help- not a crime. Bessel van der Klerk has states church sex abuse victims have an extreme self loathing – kind of the same dynamic.
      NB Noel – Writing is good but engage and do. Talk is worthless without action.

      • I keep praying the Serenity Prayer. If we refuse to take responsibility for our own actions we become passive and lazy. But if we assume responsibility for others (esp. adults) we can enable abuse or become manipulative and emotionally abusive ourselves.

        A lot of women who join NAMI honestly want to help their adult kids. They think “meds” will solve everything and they sometimes make the kid quiet. Couple the drugs with coercion–constant nags and put downs that are the emotional equivalent of water boarding.

        Then, ten or twenty years later the “kid” is still unemployed, can barely make a sandwich without help, has doubled in weight, has more health problems than the parents, and lives in their basement unable to keep their room clean thanks to the funky cocktail. And they are often weirder than ever. (The shrink blames the progression of alleged disease.)

        Sad story. Hard on everybody. The mom only thought she was helping. Now the “kid” is hopelessly stunted and can never adult. Nobody is happy–not even Mama!

        {Those last 3 paragraphs are an example of how assuming responsibilities for other people can spoil lives.}

  11. Thank you Noel for another informative and validating blog. I have your recent book and it’s excellent.
    I hope every book, blog, and story keeps moving the needle forward to expose the harm, cruelty and injustices going on in mental health care and bring justice and change. We can have somewhat differing interpretations or meanings for various terms but what is most important is the mission and the message. When I first came across MIA I was not sure if “mad” meant ‘angry’ or ‘mental/emotional suffering’, or a combination, but I quickly realized what the message and the mission was.

  12. If I understand correctly, trauma informed care doesn’t mean that you’re doing anything for the trauma survivor. It is raising the consciousness of the staff so that they don’t do things that continue to traumatize trauma survivors. It isn’t the actual doing of trauma work to help people transcend the terrible things that they’ve experienced. As Noel mentioned, trauma work is long and difficult, something that the system doesn’t want to indulge in. So, institutions can proudly call themselves trauma informed but this doesn’t mean that they’re doing trauma work with people to help them resolve their issues. Granted, trying to not re-traumatize people is important but that’s only the beginning of the real work. Most institutions are not going to do that.

  13. Sadly, even the “International Society for the Study of Trauma and Dissociation” (ISSTD) is rather uniformed when it comes to trauma work. They have a long list of guidelines for working with such survivors, and my wife and I have essentially done the opposite of most of what they suggest with better results…

  14. It is about time some one who is good with words can start to talk about some of the trauma created by? through? with? “trauma informed care” . So far all “trauma informed care” has done for me, is to allow county mental health official personnel to be more abusive to me after they have checked off all their “trauma informed care” boxes. “Trauma informed care” so far has been used to minimize and deny my intentional, beginning pre-birth, extreme, intense, long term, systematic, live long trauma.







  15. Thank you, Noel. I think you’ve clearly described situations common in our society, and pointed out the damage we’ve exported around the world. Your excellent book also demonstrated your awareness of research and its limitations. I hope that readers of MIA and beyond will attend to your clear integrity and willingness to face hostility from all sides. Cultural humility and openness to learning are ways of being and interacting that we all need, and unfortunately not often practiced.