So much has written about post traumatic stress disorder and complex PTSD. But not enough has been written about CTSD- Continuing Traumatic Stress (Disorder). For many people throughout the world, trauma is not in the past tense, but is an ongoing unfolding experience. Many of the symptoms are the same, but it becomes extremely challenging to heal and soothe the nervous system because the threat of continued harm is very real.
Refugees and undocumented immigrants, those in poverty, houseless, fighting oppression, racism and social injustice, as well as those experiencing ongoing abuse all fit this bill.
The term is not part of the psychiatric diagnostic manual (DSM) but has its origins in 1980’s South Africa under apartheid. Therapists working there saw how challenging it was to help South African blacks living under a system where they experienced ongoing fear of violence and victimization.
The road through continued traumatic stress is to understand that intertwining ecological, humanitarian and social justice crises are touching all of us at some level. These crises are breaking down the essential core resiliency in individuals and communities. Our mental health and addiction treatment services are ill equipped to treat these forms of understandable communal suffering.
Illnesses such as depression, anxiety, addiction and even schizophrenia are not always discrete disorders passed out in some form of genetic lottery. They are often the symptomatic end result of human communities in deep imbalance- with each other and the land itself. And these downstream communal symptoms of trauma and mental illness are not so easily solved by prozac or a few sessions of cognitive behavioral therapy. They are signals of distress calling out for systemic root changes.
I’d like to say there is a therapeutic prescription for this- but these are systemic problems that are not easily solved by talk therapy, medication, and stress reduction techniques. In this context, healing is not seen as a distant goal but instead as small acts of daily resistance, a way of surviving and working through oppression and the challenges of the modern experience.
But deeper, it is often about the process of storytelling, weaving a narrative that is different from the dominant story of the importance of profit, career, stock markets and economic growth. This narrative comes from the ancestors and from the land itself; stories of reconnection, realignment and relationship with the natural world and ancient traditional ways.
We as therapists and mental health professionals need to honor these stories and often our own role in perpetuating forms of colonization that harm our “clients”. That means that our solutions for distress are often not adequate- and sometimes perpetuate harm. Simply offering psychiatric medications to individuals who are in daily struggle and danger from oppression not only may be counterproductive, but can lead to side effects that perpetuate trauma by the dominant society. Antidepressants that cause libido loss, or anxiolytics that lead to horrific withdrawal effects, opioids that lead to addiction- are ways that we may perpetuate ongoing trauma.
In therapy, those who focus strictly on diagnoses such as major depression or generalized anxiety disorder- and call them chemical imbalances- without acknowledging the underlying perils of living in this world as a black, indigenous or person of color- also do a disservice to those individuals. Furthermore, offering superficial skills (breathwork, mindfulness) while not understanding and addressing the deeper layers of how colonization has caused the underlying distress- can also perpetuate ongoing trauma.
Reclaiming the Old Ways: Voices of Resilience
Cultures throughout the world have unique languages and tools around how to help people who are suffering. We are in the process of the “Americanization of Mental Illness” in which the language of psychiatric diagnoses, medication and therapeutic interventions is supplanting traditional ways of understanding suffering. This is in itself a form of colonization as traditional views of health and healing are disregarded- or worse- deemed unscientific superstition.
When we view oppressed people’s struggles through the lens of medicine and therapeutic intervention, we ignore the myriad ways that traditional communities have already established to work through continuing trauma. Those include:
Community Reliance. Gaining supports in one’s own community, engaging in activities and events that celebrate community resiliency is key. I think of the “Canoe Journeys” that happen here in the NorthWest, where numerous tribes gather to paddle traditional canoes through waterways- as a way of reconnecting to lineage as well as gaining intertribal exchange and support. Therapeutically this can also mean working with elders and members of one’s own community for help in healing.
“Every piece of the cedar tree is used, from carving a canoe, to utensils, to basket weaving and clothing…nothing is wasted. Every part has a responsibility. That’s what we want to use for bringing together our community, and particularly the community healing – to find a way for our people to belong and be part of participating in helping to get ready and the planning.”- Raymond McCloud, Puyallup Tribe on the Canoe Journey.
Reconnecting to Land of Origin. For many people displacement from one’s land of origin- oftento an urban environment- can lead to feelings of alienation and disconnection. Connection to land, culture, spirituality, food systems and language were all deeply damaged by colonization. Reconnecting to those roots can be key to building resilience.
“So, our biggest lesson is to understand that we need to take the time to work with the land we come from, and not just have dominance over it. That’s the big picture of why I do what I do. It really is about healing historical trauma, empowering people to feel comfortable in their own identity and helping people have the resources to walk in a modern world – with their ancestors beside them, helping them to make good decisions towards their health. What we see, time and time again, is that when native people are rekindled with their food cultures, they feel better. These people are reminded of who they are and where they come from, and these memories can also restore the land.” Native nutrition educator Valerie Segrest
Traditional Healing. From drumming, singing, chanting, sweats, prayer and fasting, there are a number of ways that can help an individual process and release trauma and regain resilience.
“The traditional Native view of health and spirituality is intertwined,” he explained. “Spirit, mind, and body are all one – you can’t parcel one out from the other – so spirituality is a huge component of healing and one not often included in western medicine, although there have been a few studies on the positive effects of prayer.” Native Veteran Greg Urquhart
Plant Based Healing. Traditional cultures have all relied in part on plants for nourishment, strengthening and helping with anxiety, shock and grief. From the food sovereignty movement to the use of local herbs for healing, plant based therapies have long been intertwined with traditional ways of gaining resilience and healing.
Those days together were an embodied prayer to all those ancestors we descend from, an honoring song and a love poem for all the sacred foods and seeds and cultural memory they have passed down through the ages to feed us. It is in gatherings such as these that we feed those sacred hungers of our ancestors, those who perhaps we caught in the tumult of the generational change that was brought on by colonialism, acculturation and displacement. In our time together, we fed those hungers and stoked the appetites of a whole new generation of Native people who wish to nourish themselves from the foods and flavors that fed their ancestors. Rowen White, Mohawk activist for seed sovereignty
Resistance to Dominator Culture/Social Justice Activism. As long as there is oppression, there will be suffering. Part of the work of working through ongoing trauma involves activism and standing up to that oppression. From Amazonian tribes protecting their local lands from logging to Native Americans protecting waterways from being despoiled by oil at Standing Rock, activism is a conduit for building resiliency and addressing there wounds that are leading to ongoing distress.
We are not myths of the past, ruins in the jungle, or zoos. We are people and we want to be respected, not to be victims of intolerance and racism.” Rigoberto Manchu, Guatemalan activist
In indigenous communities, continuing traumatic stress is part of the fabric of many communities. The long term effects of colonization and oppression have led to high rates of addiction, depression and suicide. Simple solutions of more addiction services or mental health treatment misses the larger point that colonization, the loss of land rights, forced boarding schools and religious conversion along with suppression of traditional ways of living have led to underlying suffering.
Continuing Traumatic Stress Disorder is a term that couches the effects of colonization and oppression in a psychiatric term. But it allows us to understand that for much of the world, distress and suffering is not primarily due to endogenous mental illness- but is simply due to the myriad ill effects of colonization and modernity. Healing is not a straight line that simply requires therapeutic and medical interventions. Healing is often a path of reclaiming, building resilience and standing up to the dominant forces that have been causing the suffering.