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A PERSONAL JOURNEY OF MY HERO MY BROTHER

By Linda Obago-Nicolar

Pte San Ghi Wi

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Definitions

Trauma: A person who has experienced, witnessed, or was confronted

with an event or events that involved actual or threatened death or seri-

ous injury, or a threat to the physical well-being of self or others.

Resiliency: Recovering readily, as from adversity or illness. Horrific

events characterized by good outcomes in spite of serious threats to ad-

aptation or development.

Recovery: People can successfully endure severe psychiatric disability

and go on the live full and productive lives.

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TYPES OF TRAUMA

Acute Trauma: results from exposure to a single overwhelming event/

experience (car accident, single event of abuse or assault, sudden loss or

witnessing violence)

Repetitive Trauma: result from exposure to multiple, chronic and/or

prolonged overwhelming traumatic events (receiving regular treatment

for an illness-dialysis-cancer)

Complex Trauma: results from multiple chronic and prolonged over-

whelming traumatic events/experiences which are compromising and

most often within the context of a interpersonal relationship (family vio-

lence to)

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TYPES OF TRAUMA—cont.

Developmental Trauma: results from early onset exposure to ongoing

or repetitive trauma (as infant, children or youth) includes neglect,

abandonment, physical abuse or assault, sexual abuse or assault, emo-

tional abuse witnessing violence or death, and/or coercion or betrayal.

This often occurs within the child’s care giving system and interferes

with healthy attachment and development.

Vicarious Trauma: creates a change in the service provider resulting

from empathetic engagement with a clients/patients traumatic back-

ground. It occurs when an individual who was not an immediate wit-

ness to the trauma absorbs and Integrates disturbing aspects of the trau-

matic experience into his/her own functioning.

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TYPES OF TRAUMA—cont.

Historical and/or Intergenerational Trauma: emotional and

psychological trauma/wounding that can affect cultural

groups, communities and/or generations. Examples of this

types of trauma includes racism, colonization, loss of culture,

forcible removal from family/community, slavery, genocide

and war. Coping and adaptation patterns developed in re-

sponse to trauma can be passed through generations.

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COMPARISON AND EXAMPLE OF HISTORICAL TRAUMA AND CURRENT TRAUMA ADAPATION—TRIBAL PERSPECTIVE We are taught that when a loved one begins their journey to the ancestral land, it is our way to mourn for one year. Not to sing, dance, enjoy life’s beauty or be happy—to suffer the emptiness of the loss out of respect for the joy brought by that life—a “blackness of the heart.” It is that “blackness of the heart” (camp raids, massacres, rape, forced removal, separation of children/parents, pov-erty, alcoholism, suicide) that has been around us for hun-dreds of years. During that time the heartbeat of our people became weak and our life style changed/adapted to a shock-ing devastating degree.

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COMPARISON AND EXAMPLE OF HISTORICAL TRAUMA AND

CURRENT TRAUMA ADAPTATION—TRIBAL PERSPECTIVE

At present, there is a four day mourning ceremony/ritual ob-

served, by some. In some ceremonies, family members still

cut their hair as in ehanna. Some families carry their loved

ones spirit for a year—Keeping of the Soul.

It use to be that a Memorial Feed and Give Away was held

after one year of passing. Now some families have the Give

Away on the day of the funeral. It use to be that only in the

winter time, did you say the name of a loved one who began

their journey. ADAPTATION

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ONGOING COLLECTIVE, MULTIPLE LOSSES AND TRAUMA EXPERIENCE Generational parental trauma traced back to legacy of negative

boarding school experiences. “Lost Generation” Constant trauma exposure related to deaths from alcohol, sui-

cides, heart disease, diabetes, cancer, etc. Surviving family members include individuals who are descend-

ants of massive tribal trauma (massacres, abusive boarding school placement)

Current and lifespan trauma superimposed on a collective mas-sive. (Missing and Murdered Indigenous Women—MMIW),

Standing Rock DAPL, KXL. American Indians have the highest military enlistment rate

than any other racial or ethnic group– extends traumatic expo-sure.

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HISTORICAL TRAUMA RESPONSE CHARACTERSTICS Anger Survivor guilt Low self-esteem PTSD systems Depression Emotional numbing Fixation to trauma Compensatory fantasies Victim Identity Death identity Suicidal ideation Intense fear Preoccupation with trauma Dissociation Similarities with Child of Survivor Complex (Holocaust) Self-destructive behavior, substance abuse, etc.

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CASE EXAMPLE

SCENARIO: A male comes into an IHS facility for health care is-

sues. Patient presents as stressed, loud, critical of the intake pro-

cess, paces, forceful deliberate actions, tells staff he will only speak

to “the doctor.” Staff, afraid, explains the intake process and the

need to get some information first. He is reluctant to share symp-

toms and medical history. He seems to be fairly smart. He also

said, “he can’t get to the VA” and “no one really understands.”

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CASE EXAMPLE

Staff Scenario: Staff shares her personal concern with her super-

visor about the patients behavior and that the other patients

seem to feel intimidated and nervous by his actions. And could the

patient just be seen without doing the paperwork.

What would you do as the Supervisor? Put yourself in the shoes

of each person.

What are you visualizing? What are you thinking?

What is the best way to support the staff person and get infor-

mation from the patient.

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CASE EXAMPLE—BEING TRAUMA INFORMED

STAFF

The supervisor is aware that the receptionist (mother of two) is a survi-

vor of domestic violence, granddaughter of the boarding school era and

the patient may have “triggered” past feelings of fear.

With this information and the supervisor’s awareness of trauma informed

care, he recognizes that the receptionist is “triggered” because of her per-

sonal history and the supervisor understands that staff also need emotional

support doing their jobs.

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CASE EXAMPLE—BEING TRAUMA INFORMED

PATIENT

The supervisor then talks with the patient, realizes that the patient’s grandparents may be from the boarding school era, he mentions his family members who served in the military, an understanding visits occurs, a rapport is established, the patient relaxes. The supervisor arranges for the patient to see the on call therapist, immediately. The patient served in the Army, did two tours in Vietnam, was wounded

(received The Purple Heart medal). Was a proud descendent of Inkpa Duta

Divorced, with a daughter and son—felt the war was the cause.

Suffered from PTSD.

Prior to enlisting - Patient was an artist with Art Exhibits in well known Mu-

seums

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UNDERSTANDING TRAUMATIZED PATIENTS

AND STAFF PATIENT: The need for control was related to PTSD STAFF: If staff do not understand PTSD symptoms it is easier to get trig gered—to feel frustrated and to experience some of the same symptoms as the patient. PATIENT: Getting triggered STAFF: Trauma triggers—secondary and vicarious trauma and compassion fatigue. PATIENT: Change in environment can be disruptive. The need for control may cause the patient to be demanding, upset with schedule changes or changes in the environment—so he felt out of control in combat situations and the feeling of controlling the appointments diminished some of the anxiety. Staff: Change may be ok to staff, if the change is an improvement. When some people feel helpless, out of control, scared—they lash out to ap-pear stronger and reduce their sense of fear and weakness.

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The Patient was my Brother

He was my protector, my teacher

Before the war his art was done in

beautiful ancestrial colors of life—

after the war the “blackness of heart”

were of the colors used to the end.

My brother passed from complications of exposure to Agent

Orange.

But it will be Winter soon and I will finally get to speak his

name again.