Approaching Mental Health Care with a Trauma-Informed Perspective

My father was a psychiatrist in the 1960s, ‘70s and ‘80s. Like many mental health practitioners of his time, he tended to define people by their supposed pathologies: “This one is a depressive,” or “That one is borderline,” and even “Oh, she’s got a paranoid personality.”

Thankfully, mental health awareness has progressed significantly since then. With anxiety and depression reaching epidemic levels, the movement to understand and prioritize mental health is gaining momentum, and people everywhere are embracing their diagnoses. The knowledge that they’re living with a health condition like “generalized anxiety disorder” or “major depressive disorder” helps them feel less ashamed of — and less isolated in — their experience. Changing attitudes have also made strides toward destigmatizing treatment like therapy and medication.

However, the current conversation about anxiety and depression is lacking a vital dimension: emotional awareness. We are now learning that many instances of anxiety and depression are actually symptoms of buried core emotions and unmet core needs. These types of symptoms — and the use of ineffective treatments to address them — could be prevented with more education surrounding emotions and trauma.

What Are Emotions?

Emotions are biological: they live in the body as much as the brain, and they evolved to perform essential functions in our lives. We believe there to be seven innate or “core” emotions that are hard-wired in our nervous systems: anger, sadness, fear, joy, disgust, excitement and sexual excitement. These emotions have a lifespan; when we allow ourselves to feel them (not necessarily acting on them, but allowing the emotions to express themselves), they move through the body and mind and naturally recede like a wave.

Then there are the “inhibitory” emotions: anxiety, guilt and shame. These emotions are designed to block core emotions when core emotions come into conflict with what pleases others (like our parents, peers and partners). For example, Lauren, a 40-year-old mother of a three-year-old named Betsy, grew up in a home with lots of violence. As a result, Lauren grew to fear the core emotion of anger, and she learned to shut down her own anger as well as Betsy’s, as it was too threatening for her to tolerate. When Betsy started to express anger at a toy being taken away, for example, Lauren yelled at her: “DON’T EVER TALK TO MOMMY THAT WAY!!” This sudden explosion scared Betsy. As time passed and no room was ever made for Betsy to safely experience her anger, or have it validated by her parents, Betsy’s mind and body learned to suppress anger using muscular contraction and holding her breath. Now instead of feeling anger, Betsy experiences anxiety.

Another reason we block core emotions with inhibitory emotions is to prevent us from being overwhelmed or “dysregulated.” When core emotions become too intense, we can shut them down using anxiety, guilt, and/or shame. For example, Tom was taught by his father that “crying and expressing sadness is for weaklings.” Now as a grown man, he feels ashamed every time he feels sad. Feeling shame for his true and natural sadness has contributed to his depression.

Because most people don’t know about core and inhibitory emotions, they may feel they are “genetically defective” or “damaged goods.” However, symptoms of anxiety and depression caused by avoided and buried core emotions can be healed with therapy and even eased by simply understanding how emotions work in the mind and body. The issue is that relatively few psychiatrists are taught about the science of emotions in medical school, so they risk misdiagnosing their patients and allowing the root cause of symptoms — the blocked emotions — to go unaddressed.

What Is Trauma?

Renowned psychologist Diana Fosha teaches that trauma and psychopathology is caused by experiencing overwhelming emotions in the face of unwanted, utter loneliness. Using this definition, it becomes clear that trauma is a universal human experience. How many of us have had to face our feelings alone for fear of judgment, abandonment or retaliation?

Trauma often happens in families and relationships when there’s emotional neglect or abuse. But trauma isn’t limited to what happens in families and relationships: we live in a society and a world filled with violence, stress and injustice.

Compounding our distress is the fact that parents and schools have, for the most part, not been given the proper tools to address this subject — and they are often unequipped when it comes to emotional health. As a result, they are not prepared to help children process overwhelming emotions — which is vital for raising calm, confident kids in the context of a chaotic, traumatic world.

Additionally, parents who don’t know how to deal with their own strong emotions are unlikely to be capable of helping their children deal with their feelings. Even the most well-intentioned parents can shut down their children’s emotions, and many schools lack the resources they need to help students thrive emotionally.

Thus, many children grow up feeling isolated and ashamed of their own emotions. Being shamed and left alone with emotions makes burying them the main strategy to deal with them. With little help for our growing anxieties, we are often left with simmering traumatic stress, which we numb with defensive behaviors, growing further addicted, distracted and disconnected. Perhaps we develop a destructive relationship with food, alcohol or drugs. Perhaps we isolate or lash out.

Healing entails processing these emotions, allowing our nervous systems to come back into balance and calm.

AEDP and the Change Triangle Tool for Emotional Health

After receiving my degree in social work, I trained in a healing-oriented, trauma-informed method called accelerated experiential dynamic psychotherapy (AEDP). In AEDP, symptoms are the starting points to discover the underlying core emotions and needs so we can name them, validate them, honor them and move through them to greater peace and calm.

The goal of this process is to move from our defenses, through our inhibitory emotions, to reach our blocked core emotions that are causing the symptoms. Once the blocked emotions are named and validated, people experience enormous amounts of relief, ultimately feeling more confident, calm and connected with their authentic selves. The Change Triangle is a handy map to understand how to move from disconnected depressed states through our core emotions to a more balanced state between our thoughts and emotions.

Reforming Our System

Emotional awareness is the key to well-being, and moving through our inhibitory emotions is a tool that we all need — not just psychiatrists and psychologists.

I believe that school health classes should include emotions education in their curricula, and teachers and guidance counselors should receive an emotions education in their own training. Parenting books should include this information as well to help parents learn to be emotionally available, neither threatened by nor frightened of their children’s emotions. On the contrary, they would learn to listen to their children’s feelings with interest but not react, modeling for their children how to validate and be with their emotions.

In this ideal world, adults are also better equipped to deal with stress and conflict in their own lives. Whether we are angry, sad, afraid or joyful, those emotions would be named, validated and supported. And we would all learn about triggers — those events that evoke intense emotional experiences. We would rest assured that life triggers strong emotions, and that that is completely natural and normal. It’s the knowledge, tools and practice we’d have that would enable us to respond to triggers in constructive ways.

A society with a strong foundation in emotional awareness is a society with high rates of physical and mental well-being. It’s a society that prioritizes authentic connection and collaborative community, because it understands what it truly means to be human.

Hilary Jacobs Hendel is author of the international award-winning book, “It’s Not Always Depression: Working the Change Triangle to Listen to the Body, Discover Core Emotions, and Connect to Your Authentic Self” (Random House). She received her B.A. in biochemistry from Wesleyan University and an MSW from Fordham University. She is a certified psychoanalyst and AEDP psychotherapist and supervisor. She has published articles in The New York Times, Time, NBC Think, FOX News and Oprah, and her blog is read worldwide. You can find free resources and curricula on emotions and the Change Triangle tool for emotional health at hilaryjacobshendel.com and follow her work on Facebook, Twitter, Instagram and YouTube.