THREAD
Inspired by @DrDaniJackson, I'm thinking about the limitations of trauma-informed care. Its core is thinking "what happened to you?" instead of "what's wrong with you?" I was energized by it when I first learned about it in residency because it focused on toxic stress BUT

it falls short by concentrating within the context of a system. It does not explicitly seek to dismantle the structures causing toxic stress. The antidote to ACEs became resilience. We celebrated the fact that there's a way to mediate the harm without asking why should we need it

People experiencing institutionalized trauma are expected to demonstrate resilience & grit while those w fewer barriers to thriving don't have to. It becomes a nuanced form of the "boot straps" logic because those who don't succeed can be seen as not "strong" enough to overcome.

“Surviving life’s hardest blows should not be celebrated — or expected. Recovery and reconciliation require reparations and resources. To expect resilience without justice is simply to indifferently accept the status quo.” -Dr. Mona Hanna-Attisha https://www.nytimes.com/2020/05/12/opinion/flint-inequality-race-coronavirus.html?action=click&module=Opinion&pgtype=Homepage

Her piece also quotes @hazimhardeman a 2019 Rhodes Scholar who grew up in public housing in North Philly: "Don’t be happy for me that I overcame these barriers. Be mad as hell that they exist in the first place.”

The social work field has a name for this: radical social work. Here's the description from @radical_worker "it aims to improve people's lives not only by helping individuals and families but also by striving for structural change. It challenges the culture and status quo...

and aims to change systems of oppression through advocacy, community organizing, and direct action. It also seeks to empower individuals to participate in creating social change."

What would a similar movement in medicine be called? How would it be described?

Despite my understanding of systemic oppression, I still held onto the limiting paradigm of trauma-informed care (which medicine as a whole hasn't even caught up to). Liberating people comes from dismantling oppressive structures, not building resilience.

I hope this distinction helps others as it has helped me. It also reaffirms our essential role in advocacy and community organizing as healthcare professionals. Personally, it reminds me why my work with patients is enjoyable, but not complete. And so we keep doing the work!
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