Now more than ever we seem to understand on an intimate, bodily level that our health is not separate from the health of the people who surround us. The inescapability of our interconnectedness has been made painfully obvious by the pandemic, though it is a reality our institutions continue to struggle to tackle head on. Stories of praise for ‘healthcare heroes’ circulate at the same time that first responders denounce the lack of access to personal protective equipment (PPE). Community demands to cancel rent proliferate amid corporate bailouts. Calls for accessible testing grow louder while oppressed communities continue to experience alarmingly higher rates of infection.
As we confront our systems’ shortcomings and contradictions, public opinion is gradually shifting toward a more sophisticated understanding of vulnerability. COVID-19 is helping us understand that exposure to a virus is not the only health hazard we face––so are poverty, isolation, food insecurity, and other pervasive forms of precariousness that have resulted from years of neoliberal governance. As the headlines demonstrate all too clearly, these days lack of access to secure housing, a living wage, and strong community ties can truly mean the difference between life and death.
Along with this growing realization, the novel coronavirus seems to have finally validated the importance of mental health. In the media, news articles and reports are beginning to expose the ways in which experiences of isolation, loneliness, skin hunger, anxiety, and depression are exacerbated by the pandemic and can, in turn, make us more vulnerable to disease. In a recent address, UN Secretary-General Antonio Guterres declared that “mental health services are an essential part of all government responses to COVID-19 [and] must be expanded and fully funded.”
These are encouraging shifts, but they do not go far enough. As governments are urged to ramp up their relief efforts, we are failing to see the bigger picture: that nested within the COVID-19 crisis is “a trauma pandemic in the making”.
For many, the coronavirus outbreak has been marked by unnerving marketplace shortages, unprecedented rates of unemployment, heightened socio-economic instability, and acute relational strain. While a handful of reports are beginning to address the wave of ‘vicarious trauma’ and PTSD facing first responders, these experiences make it clear that nurses and doctors won’t be the only ones requiring robust mental health support––all of us will. We must therefore act swiftly and comprehensively to address the myriad ways in which COVID-19 and trauma intersect and will continue to intersect long after the curve has been flattened.
Below I outline a handful of key reasons why we must invest in the promotion of trauma literacy and in the design of structural interventions that honour the tenets of trauma-informed care.
1. Trauma affects both mental and physical health
While many of us carry a mental picture of trauma as one of debilitating fear and heightened emotional distress, we seldom talk about trauma’s impact on the body. Studies show that in addition to significant psychological strain, traumatic stress gives rise to serious medical conditions that range from muscular pain to diabetes, heart disease, developmental impairment, immune dysfunction, and more (see, for example, the pioneering work of Drs. Nadine Burke-Harris, Bessel van der Kolk, and Peter Levine).
Despite a growing body of scientific evidence, this fact remains largely unacknowledged by our institutions, though it will pose a significant challenge to our healthcare system in the months and years to come. In order to be effective, our mental health interventions must address the bidirectional relationship between mind-body health and facilitate interventions that adequately support our biopsychosocial needs in both areas.
Take Action: When it comes to both COVID-19 and climate change, examples of meaningful biopsychosocial interventions are still limited. However, others working in related fields are providing promising models to lead the way. In Toronto, for example, Dr. Gary Bloch treats poverty, homelessness and other social diseases as part of his approach to healthcare. As he explains in a recent interview, “When you can’t afford decent food or shelter, it has a very direct impact on health”. In a similar vein, "your neighbourhood can also affect your health, like having housing and supportive, safe communities." His intervention model acknowledges that, whatever the ailment at hand, dealing with individual factors alone will not be enough if systemic issues are not included in our understanding of health and wellbeing. Not doing so is to continue "looking at the wrong level" because, for many, "the underlying causes [of disease] are still inequality, racism, marginalization”.
2. Trauma is an ‘ecological’ issue
Because we do not exist in isolation from others, the experience of trauma is inherently a relational one. The impacts of trauma do not begin and end with single individuals but reverberate across the complex web of relationships that form the social ecosystem through which our lives unfold. As this academic study puts it, “for example, existing social services may become strained or ineffective, social support networks may be similarly stressed, and neighborhood, school, and work settings may become less effective in serving as buffers as employees and family members are absent or incapacitated.” Being able to rely on various forms of interpersonal and community bonds is precisely what helps people respond to, adapt, and integrate a traumatic experience.
If these bonds become strained or are not available––including in the form of lack of institutional acknowledgement or support––the experience of trauma can lead to disease as well as burnout, isolation, and social exclusion––understood not just in terms of social disconnection but of diminished participation in the economy. Financial insecurity can, in turn, ripple out to affect workplaces, households, and tax bases––affecting access to and delivery of social services, and placing additional strain on the very social networks we rely on for emotional and material support. For these and other reasons, we must challenge the traditional view of trauma as an individual medical diagnosis and recognize it for the ‘bioecological’ experience that it actually is.
Take Action: Rebecca Solnit’s excellent A Paradise Built in Hell remains one of the most compelling accounts of community organizing and solidarity in the aftermath of a disaster. With examples dating back to as early as 1906, Solnit documents the creative and altruistic ways in which communities hit by tragedy have been able to meet their needs in times of great uncertainty. Her recent article in The Guardian explores the rise of mutual aid groups and the many ways in which neighbourhood collectives have stepped up to help with anything from grocery shopping to childcare as a result of the systemic shortcomings that have exacerbated the impacts of COVID-19 on the ground. Guided by the principles of kinship, empathy, solidarity, and innovation, the mutual aid interventions she documents are rooted in the belief that tragedy can rekindle relationship, and that resilience must be fueled by joy and connection in order to be meaningful.
