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The Myth of Trauma-Informed Care

Happiness and success depend on a lot more than just absence of trauma.

Wikimedia Commons
Source: Wikimedia Commons

On Sunday, March 11, 2018, 60 Minutes featured a report by Oprah Winfrey on trauma-informed care, which she called “a revolutionary approach that’s spreading across the nation.” Working on the story was “life changing” for her. On 60 Minutes Overtime, she gushed, “I can say that of all the stories I’ve ever done in my life, and all the experiences I’ve ever had, and people I’ve interviewed, this story has had more impact on me than practically anything I’ve ever done.” That’s pretty strong stuff from someone who has virtually made a career out of finding inspiration in life. What exactly has she found?

Oprah was praising something called trauma-informed care. A central premise of trauma-informed care is to assume that when individuals experience psychological trauma in childhood, this can cause permanent, or nearly permanent, changes in the wiring of their brain. It is the revolutionary message that Dr. Bruce Perry, the childhood trauma expert that Oprah interviewed, has been promoting in his books and lectures for nearly twenty-five years. These alleged changes in wiring are not good. Examples of the outcomes of childhood trauma that were cited included the cycle of poverty, the cycle of joblessness, homelessness, and incarceration.

I’m an expert on childhood trauma. I’ve spent twenty-three years doing clinical and research work with youths with posttraumatic stress disorder (PTSD), with over fifty scientific publications on the topic, and published many of the groundbreaking research studies in this area. In my judgment, childhood trauma is not the cause of all those other massive life problems such as poverty, joblessness, homelessness, and incarceration. In my book on childhood trauma that is coming out next month, They’ll Never Be The Same, I devote a chapter to the neurobiology of trauma. While many experts and reporters have fallen into the narrative fallacy trap and believe that trauma permanently damages the brain and thereby alters personalities, the modern scientific data directly contradict that narrative.

For folks who want to do something about the cycles of poverty and violence, it is tempting to believe the narrative fallacy of trauma-informed care. It’s not every day that you get the chance to mold young children’s brains, which is the extraordinary claim being made in the 60 Minutes story. I have been involved in the assessment or treatment of over 500 trauma-exposed youths in New Orleans, and I probably have experience with more trauma-exposed preschool children than any expert in the world. I do not believe that early childhood trauma has steered these youths down the paths of joblessness, homelessness, or incarceration.

It is important to talk about trauma and to get treatment for PTSD. But trauma is only one component of why many individuals struggle. Trauma does not happen at random. Individuals with trauma often have lots of other life adversities and disadvantages that cluster together for nonrandom reasons. I believe it’s counterproductive to create false narratives that if we were only asking the right questions and if only victims had nurturing relationships, then they could change their lives that simply.

I commend Oprah and the 60 Minutes team because greater recognition of the impact of trauma is a step forward. The main impact of trauma is the development of PTSD, a chronic and often disabling psychological condition. In my book, I describe how researchers have found that PTSD is extremely difficult to diagnose. Even expert clinicians appear to miss the diagnosis about 90 percent of the time. If Oprah can bring more attention to the recognition of the impact of trauma, that seems an unqualified good thing, but, unfortunately, I would not hold your breath for the revolution.