Last week I finished teaching a trauma course for students pursuing their graduate degree in social work. More than any other time in the 30 years I’ve been teaching has it been more difficult to balance what has been happening in the world with what I am teaching in the classroom. I’ve wondered if it’s because the class I teach is a trauma class, but then I remind myself that never before in the history of my teaching has so much worldwide pain been so accessible to all of us. And then I think of the reason I chose to be a social worker. I don’t wish to surround myself with pain, but then again, there is a certain opportunity that comes with being present to our own, and to another’s, pain.

I was talking with a colleague a few weeks ago about a variation of this idea. We began to talk about compassion fatigue and vicarious traumatization; what happens to us as helpers as a result of the work we do and being present to others’ pain and trauma. More specifically, we were talking about how much time so many of us spend talking about the toll our work takes on us, and so much less time talking about the privilege of being with another’s pain; the trust and vulnerability that accompanies our willingness to share our most painful moments with another person.

Yes, it is difficult and challenging. Still, when someone feels safe enough to let us in to historical or intergenerational pain, the pain that accompanies single or multiple event trauma, or the pain that comes with histories of neglect, we have an opportunity to be a witness; to affirm and validate the effects of suffering, and to support an acceptance that does not come from giving in but rather from acknowledgment.

Being a Witness

I’ve been seeing Julie for over five years. She originally came to see me because of a history of childhood sexual abuse by male relatives. She also had a desire to understand the impact of that abuse, especially as it related to her adult involvement with men who were often neglectful and abusive. In her first session, she told me she had been in therapy at other times in her life and while she found it helpful, she often found herself entertaining her therapist rather than looking more deeply at her history.

“I’m really funny,” she quipped one day. “I can make people laugh, taking the focus off myself pretty easily.” She went on to tell me that being the funny one in her family had been a survival strategy that she learned early on. If she could entertain her family members and make them laugh, she could hide. Although that may sound paradoxical, it was through her humor that her pain became less visible.

Over time, I learned more about Julie’s experiences of neglect in her family and also how that neglect made her more vulnerable to the sexual abuse that occurred. The distrust Julie had for men had a clear origin and the more we explored her history, the more Julie came to understand as an adult how abusive relationships with men were “comfortable;” not because they felt good or even safe, but because they felt predicable and familiar.

As a result of often painful conversations and realizations, Julie became less of an entertainer and more of a witness to her own pain. Through being seen by me and, in turn, seeing herself, she began to require more from the men in her life. She was better able to state her needs, and better able to hear the needs of her partners. She was developing more reciprocal and emotionally satisfying relationships.

At the same time we were doing this work, Julie often spoke of her dog, Maddie, who she had adopted while in an abusive relationship. Maddie became another witness to Julie’s pain; her companion through the years and through several difficult relationships. And of course, as Julie aged and moved through the years, so did her dear friend, Maddie.

One weekend I received an email from Julie telling me Maddie’s health had significantly worsened; that she could no longer walk and had stopped eating.   This was a moment Julie had dreaded, though she felt the decision was clear: it was time to let Maddie go. “She took a turn for the worse,” Julie wrote in an email to me. “I think tomorrow will be her last day. I was wondering if she could come to my appointment with me tomorrow?”

When I opened my office door the following day, I saw Julie waiting for me. At her feet was Maddie. They both looked up at me, Maddie with her graying muzzle, soft brown eyes, and a subtle but definite wisdom about her upcoming journey. Julie lifted Maddie and helped her into my office.   There, for a good while, the three of us sat quietly. I reached down and stroked Maddie’s head. The sadness was unmistakable. Yet at the same time, there was a sense of awe and privilege to be in the presence of impending loss and transformation.

And More to See

As that day progressed, I allowed myself to think about the people who choose to share the most intimate parts of their lives with me. I don’t often look at my schedule in a cumulative way, but I decided to create the space to look more closely at a few of the people with whom I would be spending time that week:

Dan: a 55 year old man who has had HIV for close to 25 years. We speak of his on-going and complicated health concerns, the friends he lost in the early 1990’s, his estrangement from his family, and his struggle with depression; each day making the choice to participate in his life.

Andrea: a 28 year old woman who grew up in a home in which there was domestic violence. Eventually, her father left but offered no financial support to her mother. Her childhood was spent moving frequently, sometimes being evicted from her home and often not knowing where she would live from one moment to the next. She never felt safe in her life and now works with children who have lived in homes where there has been intimate partner violence.

Lance: a 65 year old man who continues to have images of his sister’s death related to a farming accident when he was five years old. There was no one there when it happened except him and he sat with her for hours until his father arrived. To this day, he is drawn to those who are sick and wounded, and he continues to try to “save” them as a way to compensate for not saving his sister.

Facing the Perils and Joys of Humanity

As I continued to look at my schedule for the remainder of the week, and to think about the people with whom I would be meeting, I could feel my breath catch and the heaviness in my chest. At one point in my life, I realized, I would have felt overwhelmed by the amount of trauma and pain we all experience. And I would have wondered how I can keep doing the work I am doing.

I’m not going to say that I still don’t have days like this. But more than that, I am increasingly aware of the realities of the world in which we live---perhaps more now than ever. And I am aware of the incredible honor it is to be trusted with stories of pain and suffering; that pain and suffering are an inevitable part of the human condition. But so is the strength and unflagging energy we expend each day, facing the perils and the joys of humanity.

The same colleague I mentioned earlier, was telling me about an article she read in The New England Journal of Medicine written by a pediatric oncologist. In the article, he discusses people’s reactions to his work, and frequent comments like:

“That must be such difficult work.”

“I could never do what you do.”

“How do you do it?”

“That’s so sad.”

The doctor who wrote the article discussed the value of the work that he does. Almost more than the medical/physical work, he talks about the psychological support he offers, most of which takes the form of being with his young patients and their parents as they struggle with both emotional and physical pain. And he writes of the privilege of such work.

Just yesterday as I was finishing this post, I received a voicemail from a client I haven’t seen in close to five years. “Hello old friend,” he said. “I feel like I could use your guidance. Could we set some time to talk in the near future? I could really use that safe space to be vulnerable once again.”

Is there a greater privilege than to be the person to receive such a message?

“So why is it any worse for me than for anyone else to stand in consideration of the world’s unfairness? Yes, I’m reminded of it daily, but is it really any comfort to forget? Is forgetting even possible? Indeed, I’ve come to believe that it’s psychologically and spiritually damaging for a person not to be forcibly reminded of all the suffering in the world…

When we embrace as essential the psychosocial support that some might see as an added or even an unbearable burden, it really does feel like a privilege…even on the days when there is no lessening of…pain or curing of… ills….And then aren’t we the lucky ones, we who are always generating awkwardness and bringing people down at cocktail parties, we …or anybody whose profession puts us in the way of other people’s pain?  

—Chris Adrian, MD, The New England Journal of Medicine, December 2012.