Realize, Recognize, Respond: The Building of Trauma-Informed Care in Medicine

Abstract

In December 2019, Western University delivered its first lecture on trauma-informed care (TIC) to its medical students. TIC is a universal treatment framework that involves realizing, recognizing, and responding to the effects of emotional trauma. The model shifts the question from “what is wrong with you?” to “what has happened to you?” This change in approach has only recently gained traction among medical professionals, perhaps because until recently, post-traumatic stress disorder (PTSD) was predominantly understood within the context of military trauma while much less was known about the pervasiveness of trauma within the civilian domain. Consequently, historians have largely focused on the medical community’s understanding of psychological trauma in the wake of the Vietnam War. Indeed, combat-related psychiatric research helped shape early ideas of trauma, but there existed concurrent driving forces that have been mostly overlooked. Knowledge of a more complete historical narrative of the civil origins of TIC may serve as a powerful tool to create genuine empathy towards patients with past trauma. Drawing on journal articles, newspaper archives, and physician questionnaires from the early 1970s to the present, this paper demonstrates the significant contributions made by the women’s movement in forming the official diagnosis of PTSD, in dismantling taboos surrounding domestic violence, and in initiating the move toward TIC. This paper concludes with a discussion of the important role that TIC training in medical school curriculums may hold, followed by an analysis of barriers to the implementation of TIC within clinical practice, and finally, suggested future directions.