So for me, "trauma-informed" means getting past "what's wrong with you" --but not to "what happened to you", because maybe it'll never be any of my business what happened. /1

Trauma-informed = recognizing that some people have been made to feel powerless and are wary about bad things being done to them. And that means it's our job to help people find their power (+ be honest + transparent + predictable about where and why we will exercise ours)./2

I want to understand the state of post-traumatic existence as a problem not simply of fear--or as a form of "anxiety disorder"--but also as a problem of how to relate to power. This moves "trauma-informed" from a project of elaborate niceness, to more transformative practice. /3

The problem with seeing PTSD simply as a disorder is that then it remains our patients' problem. For people with chronic trauma that is created by or interwoven with inequity, injustice, and oppression--i.e., most people with chronic trauma--the trauma is all of our problem. /4

Not only is it all of our problem, but we can see that when we enact systems of power--and what is medicine if not a system of power?--we are almost _inherently_ traumatizing, if we understand trauma as a problem of power. A problem of having one's power taken away./5

This reminds us that being "trauma-informed" means not going to "what happened to _you_", but "how do _I_ re-enact traumatizing relationships" as the key challenge to practice, and a standard that we (or at least I) fail to accomplish on a regular basis. /6

"Trauma-informed" can become yet another humanistic badge we wear to congratulate ourselves for what good people we are, when in fact it should be a regular challenge to ourselves about how we enact damage just by ... being us. By being doctors. By holding power. /7

This paradox--power being traumatizing but people needing our power--is not easily resolved, and so should never be viewed as a problem that we solve only with furrowed-brow lists of clinic guidelines (though that's a start). Indeed it requires a process of re-imagining power. /8

I feel that I am only in the beginning of this process, but I am sure of one thing: any process that mainly serves to simply divide up providers as "meets standards" or "needs improvement" avoids any talk of systemic change or self-interrogation by people who "meet standards"./9

Therefore being "trauma-informed" can only be viewed as a stopgap measure; a minimum; part of a path that we are all still trying to define; but never an end destination. /fin