Some forty years ago, at a time when I was studying the topic of Christian healing, a group of doctors came together to form the British Holistic Medical Association (BHMA). Some of the things that these doctors were saying caught my attention, not least because they made a space for a spiritual dimension in their understanding of the healing process. It is useful to recall some of the principles of holistic medicine as presented in 1984. They have a certain resonance today as we find that there is a current concern for another, not dissimilar, holistic impulse. Today doctors and members of the caring professions are being urged to become ‘trauma informed’. In summary they are, like the doctors of the 80s, being encouraged to see illness in the human body or mind, not as the breakdown of a faulty machine, but as failures in the wider social or psychological environment to which the individual is exposed. These mental or physical illnesses are to be looked at as possibly signalling evidence of past trauma. If such is found, it will necessitate a somewhat different approach in respect of the treatment offered as well as the ongoing care of the patient. It will always be necessary to be alert and sensitive to the implications of this wider context of illness and distress and take steps to use this awareness to better serve the needs of those seeking help.
The first edition of the 1984 BHMA journal set out the principles of holism as they apply to medicine. Some of these are directly relevant to the topic of trauma which we are considering in this piece. I want to list some of the key ideas of holistic medicine. In these two parallel but related sets of ideas, the holistic and the trauma informed approaches, doctors and professional carers of all kinds are being invited to extend their horizons to incorporate fresh and broader insights about the nature of illness. In the 80s, classical medical practice was being taken to task by holistic practitioners for seeing illness in purely material terms and failing to understand the social and spiritual aspects of dis-ease. In a similar way trauma informed care urges those looking after people who may have been affected by trauma, to be alert to all the ways that a life-changing event may have affected a patient. To be trauma informed is thus to be able to practise your caring skills from the background of a particular manifestation of holistic thinking – one that understands the wide-ranging effect of trauma on people.
The first principles of the original 1984 statement about the then new approach in applying holism to medicine, are those that point out the error involved in breaking up the human personality into fragmented parts. This principle has also to be strongly affirmed as we seek to attend to the needs of people who have encountered an abusive or traumatising event. Trauma is a holistic event in the sense that it has the capacity to damage the personality at more than one level. To pretend or assume that people can easily walk away unscathed from catastrophic episodes which they have experienced, is a betrayal of care and imagination of enormous gravity.
This point is made well in the first statement made by the 1984 holistic doctors. Healing and harm both inevitably operate at more than one level.
The human organism is a multi-dimensional being, possessing body mind and spirit, all inextricably connected, each part affecting the whole and the whole being greater than the sum of the parts.
Damage to relationships is also a matter of great importance. The betrayal of human trust that occurs in many traumatic events needs to be responded to with considerable care
There is an interconnectedness between human beings and their environment which includes other human beings. This interconnectedness acts as a force on the functioning of the individual isolated human being.
Further holistic medicine principles focus on the one mediating wholeness. A particular emphasis is made that the ‘healer’ should not only have healing skill but also be an individual practising self-insight. The reference to alternative medical treatments like acupuncture may not appeal to many medically trained people today, but this was a common feature at the time.
One of the primary tasks of someone entrusted to heal, be he Dr, priest or acupuncturist, is to encourage the self innate capacity for healing of the individual industries.
To enable him to accomplish his task effectively, the healer needs to be aware of his own multidimensional levels of existence and have some expertise and ability in achieving a state of balance and state of harmony within himself – ‘Physician heal thyself’.
Clearly, the 1980s were not embarrassed by the use of the ‘he’ pronoun when talking about a healing practitioner. But the important point we take away from these insights is the gentle urging that doctors and other medical carers should break away from any narrow frames of reference. For the 1980s conventionally trained doctor (arguably still true today), the temptation was to treat patients as living machines which operated according to mechanical laws. Social and spiritual issues were thought to be outside the disease process. In the 2020s, with the advent of trauma informed thinking, there is a movement to ensure that there should be a better understanding of the effects of trauma on those forced to endure the burden of experiencing various forms of distress. The question that doctors and carers need to ask of their clients is not ‘how are you?’ but ‘what has happened to you?’ The asking of this question articulates the expectation that uncovering trauma of some kind is likely to be a regular part of helping someone who comes for help with some form of mental or physical affliction.
What exactly are we talking about in using this expression? Trauma informed approaches are not just applicable to the practice of medicine. They are relevant in all places where there are people who have experienced serious ill-usage at the hands of others during their lives. That perhaps applies to most of the population. But we need in our review of this new strand of holistic caring, some definition of the word trauma. One definition given by the Substance Abuse and Mental-Health Services in 2014, says this: ‘Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life-threatening and that has lasting adverse effects of the individual’s functioning and mental, physical, social, emotional, or spiritual well-being’. This definition will cover many of our survivor population. The trauma for them is, as we have attested many times, not just as the result of the original harmful event but is aggravated on many occasions by the sloppy and inadequate care received later.
Providing a caring and an appropriate response to a person who has experienced trauma is extremely important and requires sensitivity and skill. The trauma informed literature suggests a number of principles or forms of help that are needed to provide effective help for trauma victims. Many of us reading this will be thinking about church survivors and the variety of needs they have. But, whatever the context of the trauma, the same principles will apply when supporting anyone who has been through such an experience which resembles that described in the definition in the previous paragraph.
The first principle is the importance of giving anyone who has been through traumatic experience a place of safety. The place of safety may be found in a carefully prepared physical space backed up by a personal trusted relationship. Such elements will provide a supportive and nurturing environment for a survivor – a place of physical, emotional and psychological safety. The Church seems to be remarkably inept in this area. We hear stories about victim/survivors having to go to the home of a bishop or even return to the place where they experienced the original trauma. From a trauma informed approach, such inattention to a survivor’s need to feel safe is insensitive and unacceptable. The task of providing such emotional and psychological safety does require considerable imagination and insight, something that the safeguarding church experts often seem to lack.
A further example of trauma-informed practice is that a survivor needs to be helped to make choices and be given goals to aim for. The trauma may have removed a sense of agency and it is the task of trauma-informed support to help give back self-determination and power to the one who has suffered. As part of rebuilding a sense of self, the interaction with the helper will demand that latter has considerable skill and patience. If anyone is to help the trauma survivor, there needs to be a commitment to the long haul. Such care and support is expensive both in terms of financial as well as institutional resources.
Trauma informed therapy may originally be indebted to the insights of medical practitioners working with holistic principles. But, at another level, it represents a dedication to a culture of humane care. In the Church it behoves all of us who encounter the survivors of bullying and mistreatment of various kinds to be alert to the likely trauma burdens they carry. When we are able more easily to intuit their needs, we will first not fall into the trap of saying the wrong thing or offering inappropriate help and support.
Trauma is being actively utilised across the worldwide church as a method of gaining mastery over its peoples. I refer of course to some of the Fletcher and Smyth beatings scandals, but also to the almost routine bullying of people not toeing the line, such as Martyn Percy’s experience in Oxford.
A simple first step in improving the trauma-informed environment would therefore be to stop such ongoing use. Christians are hurting each other on purpose. Enough. Let’s remove trauma from the lexicon of management tools.
We each are born with a certain, but variable level of resilience to blows, be they physical slaps or emotional abuse. Below this we spring back largely unaffected. But breach our limits of elasticity, and the stretch or change is permanent and often irreversible. Severe trauma is designed to break people. Most of us will eventually break under sufficient pressure.
Limited recovery may be impossible. Even Jesus couldn’t withstand crucifixion, but despite God raising Him from the dead, the scars of the nails remained.
It’s valuable to get this subject aired regularly, because only in doing so will we keep attention on the amount of traumatising still being done.
Those of us who have experienced a measure of recovery will understand the complexity of its processes. Some things help and some things hinder. We all adjust differently.
One of the hardest things to accept can be our personal responsibility to own our own healing. Others can help, some can make things worse, but we must do what we can with what we’ve got. For some they are too brutalised to survive. It’s a tragedy, particularly in the church of all places. For those fortunate enough to make it beyond this points, and can glimpse a spark of hope, there are many things to study and embrace to help ourselves.
I completely agree with your post Stephen and the comment made by Steve Lewis yet when I read it I felt uncomfortable. Taking time to examine that feeling I realise that words like holistic and trauma informed have, for me, become modern day counterparts of the terms ‘healing and wholeness’ which was so widely used and abused in the 1980’s. I can imagine Mary and David Pytches reading your post and avidly agreeing yet how they interpreted being holistic and trauma informed was incredibly damaging for many survivors including me.
GP’s do not really like to be trauma informed because being so is far more expensive than giving someone a pill. They may offer a course of CBT which to my mind could equate to the damage done by the Toronto Blessing/Vineyard brigade. A quick fix with no real professional curiosity.
Being holistic and trauma informed does not balance out the power dynamic there will still be an imbalance that can be abused.
Just one point, accupuncture is often used today, GP’s will refer patients for it particularly in end of life care or chronic pain management.
When I left hospital medicine in the ’80s, I had the sense that we weren’t helping people very much. I’d been trained to think of people holistically, but practice seemed much more mechanistic. Returning myself as an in- and out patient in more recent years, there seems even more focus on specific symptoms or signs, and even less view of the whole patient. Try actually seeing your GP! At medical school, you’d be failed for not physically examining a patient. Of course I understand the impositions of covid, and its aftermath, but increased medical distancing appears to have set in permanently.
I was consequently drawn into the Christian healing ministry as my desire was to help people more holistically, including some specific spiritual practices. But I feel over the years that this potentially noble ministry has become commoditised.
Seen as an essential adjunct to successful church life, the bums-on-seats brigade have “monetised” healing ministry with various “manuals-of-ministry” available to ensure results. The pressure to announce those results mounts, to keep the faith stoked amongst the audience. This is easier in a big space. Amongst 2,000 people it would be surprising NOT to find someone here whose back isn’t feeling better. I don’t want to be cynical, because I do believe that Christ wants us to find wholeness and health in our lives.
However it is straightforward for manipulative leaders to prey on the vulnerable and sick amongst us, and offer unrealistic promises of healing, and then blame the victims for not having enough faith, further compounding their distress.
This is particularly so with mental dis-ease, where the level of ministry team expertise is inevitably low. I have first hand experience of knowing the leader’s statement “this is a safe space” to be completely wrong. Breaching of boundaries can be trauma.
There is so much in this post – and in the replies – which resonates with my beliefs and experiences. I experienced a particularly traumatic period of my life some years ago because of abusive and manipulative leadership in a church I attended. Yet, so many years later, much of my anger feels directed at the wider church institutions which have given me, I think, very little in the way of help or understanding. Although ministers and laity are well-intentioned, they have very little training – if any – in how to recognise and deal with trauma. I have, therefore experienced re-traumatising events at the hands of people in the church, and I think people believe that because the event is in the past, I only need to go through some cognitive process to achieve healing. Part of this is, I believe, to do with evangelicalism’s heavy bias towards a cognitive/intellectual approach to spirituality.
There is, furthermore, little understanding of the power dynamics involved in being a church leader and I very rarely feel entirely safe or able to let down my guard with church leaders. It’s not that I haven’t had positive experiences at church since I was in an abusive church environment, but there seems very little understanding of how to help someone.
Simon R I am interested in the point where you say that evangelicalism has a ‘heavy bias towards a cognitive /intellectual approach to spirituality.’ Is this your own thought or is there a resource that you could point us to? I agree with the point by the way, but do not know how to go further with it. Any leads?
Hi. It has come from a lot of reflection and discussion with friends. In terms of sources, There is a very good chapter in The Twilight of Atheism by Alister McGrath about the relationship between protestantism and atheism. It’s chapter 8, Disconnection From the Sacred. Ironically, as much as I like Alister McGrath, I felt he fell at this very hurdle when I heard him speak on C S Lewis. Hope that helps.
I agree with Simon R that a heavily cerebral approach to spirituality is common among evangelicals – particularly conservative evangelicals. I think it’s less true of charismatic evangelicals, who can sometimes overdo emotionalism.
Iwerne and its network is notably cerebral – hence its distrust of charismatics and the intuitive and sensory sides of faith. A Iwerne friend of mine once observed that ‘it’s a pity Taize aren’t Christians’! My father said he was a Calvinist because it was ‘the most intellectually consistent’ form of Christianity.
As for resources, David Watson’s autobiography ‘You Are My God’ gives some interesting background, though it’s an old book now. I can think of other books and resources, but I’m out of the loop now and don’t know of anything published in the last few years. Possibly Rachel Held Evans or Barbara Taylor Brown?
Trish used the expression ‘A quick fix with no real professional curiosity.’ I do think this neatly describes the bias against considering things more deeply and carefully. Jonathan Fletcher, in the book “Dear Friends” refers to psychobabble. To me, this was a typically dismissive attitude to close examination of what’s going on deep within us. [apologies, I can’t find the page reference] amongst evangelicals. I grew up with this. “Snap out of it!” Was the standard exhortation for mental distress. Basically you weren’t cognitively allowed to be unhappy because of the joy we must all have from what Christ did for us. Our wounds were negated, or in modern speak – gaslighted.
I don’t think you’ll find the above evangelical approach codified into writing, but many of us will recognise the cultures of intellectualism we survived (or not). Feelings you don’t like, you are encouraged to overcome with positive thought control. This leads to repression of so much, which then returns outside our awareness with destructive results.
Intellectualism isn’t the same as intelligence. I’ve met many bright people who live in a more wholesome way. Conservative evangelicalism is about squeezing everything into a couple of neat boxes, with no grey areas allowed.
In Charismatic evangelicalism, there is a strong tendency to dismiss the depths of the psyche and replace it with an oversimplified sort of demonology. The person doing the prayer ministry just makes up what spirit they think you’ve got and prays it out. If you don’t “let it go”, you’re the one at fault and must repent, otherwise known as blame-the-victim.
I recall one mass intervention to try and get a wounded church to move on from a particularly shoddy vicar who’d upset many people. This essentially was another cognitive manipulation. You leave everything at the foot of the cross and then leave it there, don’t you. Variations on this involve writing all your grievances on post-it notes and at some stage setting fire to them.
I’m certainly not decrying all cognitive behavioural techniques. Of course they can be effective with some and when carried out with professional expertise.
For a church that keeps its distance from much of depth psychology, there’s a remarkable amount of psychological manipulation going on. For me, the test is: am I being asked to engage in mental gymnastics about any particular area? If yes, hold at arm’s length or avoid.
Hi. yes, I agree with you. The approaches seem to fall in either one of two camps: the neat, nicely boxed up approach of Conservative evangelicalism or the the oversimplified approach of the Charismatic movements. Both seem to result in blaming-the-victim: either they’re not doing things properly, not thinking things properly, or they’re not willing to engage in a particular formula of prayer.
It strikes me, furthermore, that both these leave the institution free from scrutiny as well: If it’s the victim’s responsibility, then we can ignore the wider issues in the organisation!
A classic text for this approach is ‘Competent to Counsel’, by Jay E. Adams. It was first published in 1970 but (I’m dismayed to see) is still in print. Here’s part of the publisher’s blurb:
‘A classic in the field of Christian counseling, Competent to Counsel is one of the first works to fully articulate a vision of “nouthetic” counseling-a strictly biblical approach to behavioral counseling and therapy.
Dr. Jay Adams defends the idea that the Bible itself, as God’s Word, provides all the principles needed for understanding and engaging in holistic counseling. Using biblically directed discussion, nouthetic counseling works by means of the Holy Spirit to bring about change-both immediate and long-term-in the personality and behavior of the counselee.’
I got rid of my copy years ago!
As a retired GP, who trained in the 1970s, I agree with Steve Lewis that we were taught to frame our patients’ presentations to doctors and the health care system in bio-psycho-social terms and also to reflect on our own feelings and reactions in clinical and relational encounters. The latter was informed by psychodynamic ideas developed by the psychotherapist Michael Balint and others. In very simplistic terms – if the patient made you feel sad then they might well be depressed and if they made you feel angry then they might well feel that as well! What about if you started to really be fond of them….?
I continued to teach these approaches to my GP trainees but gradually over the years these ideas seemed to fade; and turned to more biomedical and their associated managerial models, without doubt, engendered by NHS imposed demands to follow guidelines and protocols when dealing with patients, their symptoms and “issues”.
Trish is also right that if a GP recognises vulnerability, it is “more expensive than giving someone a pill” The expense being as much for the GP as a person, as it is for the NHS.
I think it is widely recognised that “carers”, can frequently and unknowingly be meeting their own needs rather than those of their patients, clients or parishioners etc. This is often seen as benign but clearly can be far from this, even in plain sight.
I would suggest we all defend against what is painful and difficult, be this by a conservative evangelical cognitive stance, a charismatic emotional one or “just” by walking by or turning the blind eye?
I have two links for readers of this blog to consider.
The first written for psychiatrists is both approachable and very helpful in setting out the rationale for Trauma Informed Practice and approaches that can be taken to promote this approach. (It can be downloaded as a .pdf)
I also read it as an analogy for the best and worst of The Church and perhaps a model for reform.
https://www.cambridge.org/core/journals/bjpsych-advances/article/paradigm-shift-relationships-in-traumainformed-mental-health-services/B364B885715D321AF76C932F6B9D7BD0#
The second link is to a document written by a Public Health expert in the wake of Covid.
It contains advice about what to do and what not to do, that would be helpful for any caring organisation but the focus is on Churches and their response to collective and individual trauma. It has many links to practical matters; however I found the links to the ‘theology of trauma’ thought provoking.
https://www.cbcew.org.uk/wp-content/uploads/sites/3/2022/02/resilience-trauma-pastoral-recovery.pdf
Thanks Chris for your comments and these resources. For anyone wondering how much to dip into these or whether they may be overwhelming in volume or content, I’d skip to appendix 3 of the second document link, about what NOT to do. Right on the money.