When I came back to New Orleans after Katrina, I said I was going to stay about 2 years, get a division of post-disaster emotional-resilience rolling, get some people in place and then go back to my psychiatric career. I think what has kept me here 11 years beyond the initial 2, is that I felt that we really needed people in the spaces where young people were suffering who really felt their suffering, and who would fight for them and advocate for them.
Over the years after the Hurricane I noticed that very few people were thinking that there could be some trauma-based needs in young people. There have been a lot of experiences where you thought we were making movement and taking steps forward to address youth trauma, but until recently the whole city didn’t see this as an issue that we need to address. We have to keep in the work consistently and, ultimately, keep the children at the center of the work – the children who don’t have voices, the children who don’t know that the reason they are disregulated and they’re behaving in inappropriate ways, it’s because they are suffering emotional pain.
I began my psychiatric career with a lot of training in adolescent psychiatry during my residency in San Francisco – many, many years ago. I consulted to a group home back in the days when young people who had mental health problems could have community-based residential services. I have run in-patient units with young people. I’ve seen young people in outpatient care. I’ve run systems that take care of young people. I’ve seen them in talk therapy and in support groups to help them manage the stress that they’re feeling. I’ve also consulted with schools about young people that are having problems managing their mental healthcare and taught courses on stress and stress management. I’ve worked with teachers to help them be better able to identify when young people are showing mental signs of distress. So, over my career, I guess you could say that my focus has been youth and adolescence.
What I’ve seen over my life course is the shift in the realities for young people. They have to deal with so much more trauma than I did, and even my children did. There was a kind of innocence and a sense of protection at home, in the community, or in school. Things are very, very different for young people now. They grow up in homes where there’s a lot of interpersonal violence as well as a lot of intimate partner violence. In communities where they’re exposed to a lot of traumatic events such as witnessing or knowing about a lot of people around them being killed – friends, family members. And some are in schools where they don’t particularly feel safe. So, I feel that the burden of trauma is much higher in this generation of young people than ever before and what it does is disregulates their physiology and impacts their behaviors, but they don’t know that’s what’s going on.
Part of what saddens me about that is that they don’t have that young sense of freedom or the expectation that they can be the best that they could ever imagine themselves to be. I look back at my own time growing up in Jamaica, that sense of freedom that I had. I didn’t know that at the time of course, but growing up in that environment, I was allowed the freedom of thinking that I could accomplish anything that I wanted to if I studied hard enough. Back in high school in Jamaica, I used to think that I was brilliant! I thought I knew everything. Of course I learned in college I didn’t know as much as I thought I did, but I was so intellectually arrogant – which I think is good. When I see young people in urban schools, very few of them have that sense of “I am so brilliant; I can achieve.” This is my revolution – is having young people feel that they have this freedom. I want all young people, in particular, African-American youth, to feel they have the capacity to be the best they can be in life.
What we’re seeing in the schools now is that young people are experiencing trauma at disproportionate levels than previously, or are living in communities where there’s a lack of psychological safety and there’s no way for them to know that this is what they’re suffering from. Without a trauma-informed approach we’re going to lose a lot of our young people. We’re going to lose a lot of their wisdom, their potential brilliance, and we’re going to instead feed the criminal justice – or criminal injustice – system (because that’s what many young people experience). If the systems are not trauma-informed, their disregulated behaviors are treated as criminal instead of standing as evidence of some emotional or mental health disruption.
When we look at the impact of trauma on kids, the good news is that it’s treatable and we can actually change the conditions for young people and the ways they cope biologically or psychologically with therapy. There are therapists, evidence-based therapists, that work. The good news is that if we screen young people and identify trauma, we can treat it. The even better news is that for young people, sometimes if you have environments that are loving and supportive, like recreational outlets, or if you have opportunities for mentorship and for them to be around adults that are caring and supportive, in particular in the school systems, then you can mitigate trauma or you can even begin to treat some of the symptoms.