- Patients begin life with normal potentials for growth and development, given certain constitutional and genetic predispositions, and then become traumatized. "Posttraumatic stress reactions are essentially the reactions of normal people to abnormal stress"
- When people are traumatized in early life, the effects of trauma frequently interfere with normal physical, psychological, social, and moral development.
- Trauma has biological, psychological, social, and moral effects that spread horizontally and vertically, across and down through the generations.
- Many symptoms and syndromes are manifestations of adaptations, originally useful as coping skills that have now become maladaptive or less adaptive than originally intended.
- Many victims of trauma suffer chronic post-traumatic stress disorder and may manifest any combination of the symptoms of PTSD.
- Victims of trauma can become trapped in time, their inner experience fragmented. They are caught in the repetitive re-experiencing of the trauma, which has been dissociated and remains un-integrated into their overall functioning.
- Dissociation and repression are core defenses against overwhelming affect and are present, to a varying extent, in all survivors of trauma.
- Although the human capacity for fantasy elaboration and imaginative creation are well-established, memories of traumatic experiences must be assumed to have at least some basis in reality.
- Stressful events are more seriously traumatic when there is an accompanying helplessness and lack of control.
- Traumatic experience and disrupted attachments combine to produce defects in the regulation and modulation of affect, of emotional experience. Human beings require other human beings to respond to their emotions and to help contain feelings that are overwhelming.
- People who are repeatedly traumatized may develop "learned helplessness" a condition that has serious biochemical implications.
- Trauma survivors often discover that various addictive behaviors restore at least a temporary sense of control over intrusive phenomena.
- Survivors may also become addicted to their own stress responses and as a result compulsively expose themselves to high levels of stress and further traumatization.
- Many trauma survivors develop secondary psychiatric symptomatology and do not connect their symptoms with previous trauma. They become guilt-ridden, depressed, and exhibit low self-esteem and feelings of hopelessness and helplessness.
- Trauma victims often have difficulty managing aggression. Many survivors identify with the aggressor and become victimizers themselves. A vicious cycle of transgenerational victimization often ensues.
- The more severe the stressor, the greater the likelihood of post-traumatic pathology. The same is true the more prolonged the exposure to the stressor, the earlier the age, the more impaired the social support system, and the greater the degree of exposure to or involvement in previous trauma.
- Attachment is a basic human need from cradle to grave. Enhanced attachment to abusing objects is seen in all studied species, including humans.
- Childhood abuse often leads to disrupted attachment behavior, inability to modulate arousal and aggression toward self and others, impaired cognitive functioning, and impaired capacity to form stable relationships.
- Although it may be a lifelong process, recovery from traumatic experience is possible. Over the course of recovery, survivors may temporarily need safe retreats within which important therapeutic goals can be formulated and treatment can be organized.
- We are all interconnected and interdependent, for good or for ill. Safety must be constantly created and maintained by everyone in the community as a shared responsibility. The whole is greater than the sum of the parts.
Bloom, S. L. (1994). The Sanctuary Model: Developing Generic Inpatient Programs for the Treatment of Psychological Trauma. Handbook of Post-Traumatic Therapy, A Practical Guide to Intervention, Treatment, and Research. M. B. Williams and J. F. Sommer, Greenwood Publishing: 474-491.
Using these basic assumptions that first published in 1994, Dr. Lyndra Bills implemented what was developing as the Sanctuary Model, in a state hospital program that was astonishingly violent. The articles about this experience can be found here:
Bills, L., & Bloom, S. (2000). Trying out Sanctuary the hard way. Therapeutic Communities: The International Journal for Therapeutic and Supportive Organizations, 21(2 (Special issue)), 119-134.
Bills, L. J., & Bloom, S. L. (1998). From Chaos to Sanctuary: Trauma-Based Treatment for Women in a State Hospital Systems. In B. L. Levin, A. K. Blanch, & A. Jennings (Eds.), Women's Health Services: A Public Health Perspective. Thousand Oaks, CA: Sage Publications.