This year our guest speaker was Ruta Mazelis. Ruta is a popular speaker and trainer who presents nationally on behalf of Sidran on issues surrounding self-inflicted violence, trauma, and trauma informed care. She
consults to SAMHSA's Center for Mental Health Services on topics related to
trauma, including trauma-informed care, co-occurring disorders,
re-traumatization in systems of care, self-injury, and criminal-justice
involved survivors. She provided extensive technical assistance to the SAMHSA
Women, Co-occurring Disorders and Violence Study, served as a program manager
for the National Center for Trauma Informed Care, and is currently on the board
of the National Trauma Consortium. Ms. Mazelis, herself a trauma survivor, has
worked as a substance abuse and mental health care provider in inpatient and
outpatient settings. She is the editor of The
Cutting Edge newsletter which she founded in 1990, and edits the
web site, healingselfinjury.org, and she has published numerous books.
Ruta immediately sensed the skill and knowledge in the room, and realized that she did not have to teach this audience the basics about trauma. Instead, she used her personal experience to instruct us about the realities of being a trauma survivor who relies on self-inflicted violence to deal with unbearable pain.I hope to write more about this training in a later blog. In this post I would like to convey some points that Ruta emphasized: The first is that self injury is not a distinct and uniquely horrible or dangerous symptom. It is just one more way people have found to deal with the unbearable pain that has been part of their lives. She emphasized that we all self harm, and that for all of us it is a method of coping with pain. It is adaptive, as are addiction, aggression, eating disorders, smoking, running away, sleeping all the time. It is actually not the most dangerous thing that many trauma survivors do. The long term harm to the body is considerably less than say alcoholism. Or smoking. It is not illegal, it can be kept hidden, and it does not hurt others. Ruta told us that she has learned from her newsletter that self-inflicted violence is part of the lives of people of all ages, sexes, socio-economic groups, professions, and statuses. She has known many treatment professionals who use this technique to manage their lives.
I was once again struck by the ways that the pressure to achieve change can so often interfere with change. Self harm is adaptive. The trauma survivor will stop doing it when they no longer need it. Therefore, if we immediately jump to methods to eliminate the self harm we are not respecting the survivor’s experience. If we start talking about replacement behaviors (writing on one’s self with red pen), it may seem naïve or insensitive to the client. If writing with red pen would accomplish what I need, I would have done that long ago. It may seem disrespectful: I am not interested in how you came to do this or what it means, I just want you to stop. Ruta said repeatedly that most trauma survivors stop self inflicted violence when they work on the trauma, are no longer in desperate pain, and do not need it any more.This is such a hard stance to maintain with all the pressures surrounding us, both from our colleagues, from those outside our agencies who monitor our performance, sometimes from the client’s family, and certainly from inside ourselves. It is extraordinarily difficult to stay with such a painful symptom.
So all we have to do is work on the trauma. What exactly does that mean? And particularly what does it mean for those of our children (most) who are far from being ready to talk about the events in their lives? As Ruta presented it, it does not just mean teaching coping skills. It means interacting with the child at every possible moment from the understanding that their behavior comes from fear, shame and despair and is adaptive. If a treater expresses that conviction repeatedly the client may gradually question their own self blame. It means creating a safe enough space that the client can relax, play and sleep. It means engaging in rhythmic rewarding activities with engaged adults to begin rebuilding the brain and reshaping early templates of relationships. Most of all it means love and compassion, for the client, ourselves and each other.So that’s all we have to do. And gradually the self inflicted violence will fade, along with the other extreme symptoms, as the client moves forward to a life worth living.
Ruta was intense, real, passionate, and at times uncomfortable. Just what we all need to counteract all the push towards shorter, more practical, symptom reduction quick fixes. Thank you Ruta for a reminder of the profound depth of the work we do.