Honoring Survivors

“Trauma ruptures relationships,” Dr. Leigh Kimberg explained in her Keynote Address at the 18th Annual UCSF Interpersonal Violence Prevention Conference on Oct. 27. Beginning in 2000, the IPV Prevention Conference offers its attendees a brief but deeply affecting education how violence impacts everyone around us.

The conference explored violence broadly: domestic, firearm, sexual, and even state violence. Violence no longer lives in shadows — it dominates the news and public discourse.

Dr. Kimberg stepped in last minute when the original keynote speaker was unable to attend. She did not hesitate to prime all those in attendance for the key themes of the day: structural violence, vicarious resilience, and honoring survivors.

Following the keynote was a panel discussing structural violence — how societal structures allow for and perpetuate violence and harmful norms. Racism, sexism, ableism, and all the other -isms are so ingrained in our culture that they have become normalized. We are learning to recognize these -isms, which underlie individual acts of interpersonal violence and trauma.

Dr. Aisha Mays, Medical Director of the Roots Community Health Center Dream Youth Clinic, spoke about how preconceived notions of formerly incarcerated individuals prevents them from having stable lives and thus stable health. Patty Berne, co-founder of the disability justice organization Sins Invalid, spoke to the medical establishment’s “unconscious desire to eliminate [disabled] bodies.”

Chris Ahlbach, a UCSF MS3, explored how racism and poverty support gentrification and the San Francisco housing crisis. And Orchid Pusey, who directs the Asian Women’s Shelter, spoke of the multifaceted and often invisible nature of domestic violence. Regarding how structural violence breeds individual acts, Pusey said it best: “You don’t even have to do anything, the structure will do it for you.”

When the structures or societal norms themselves cannot be trusted, survivors of violence feel unsure where to turn. Relationships are severed by lack of trust. Support networks seem unreachable.

So how do we overcome structural violence? It would have been easy for the conference to simply demonstrate the innumerable ways violence permeates our society, but they deftly turned to one possible solution: vicarious resilience.
Throughout the conference, Dr. Kimberg and other speakers demonstrated this tool by ensuring that we stayed grounded. We literally planted our feet on the ground.

We breathed deeply. Sometimes exercises like these seem facetious, but here it created a warm, supportive space.

The conference educated us even in these moments of silence by encouraging us to be present with others fighting the same fight. Vicarious resilience is just that — resilience that develops from seeing someone who has survived trauma work to overcome it.

Providers often speak as if the field of medicine provides a one way emotional service, care delivered to the patient for nothing (besides money) in return. But vicarious resilience changes this framework.

Observing survivors, and possibly even helping to care for them, becomes a two-way street in which both parties develop strength. If trauma destroys relationships, then trauma informed care infused with vicarious resilience bolsters them. And to bolster a relationship, both sides — survivor and ally, patient and provider — must take comfort in the other.
During the provider training session, Dr. Kimberg provided the medicine and dentistry students with specific skills of how to practice trauma informed care: care that gives control and power to the patient. This type of care involves not just physical safety but emotional and psychological as well.

Medical providers yearn to solve their patient’s problems, but when it comes to trauma, solving the problem is something we cannot do. And forcing patients to disclose what they have survived is tantamount to harm in and of itself. Instead, trauma informed care involves acknowledging that patients have survived many experiences in their lives, and that we are here to listen to them about all such experiences — good or bad.

Be open about interpersonal violence, but do not accuse or assume. Offer specific resources regarding interpersonal violence to all patients where you have concerns, and build partnerships. Partnerships are key to mending broken relationships.

Perhaps the greatest gift the conference provided was its conclusion. A panel of survivors discussed their individual experiences and how they persevered. It gave attendees the opportunity to experience vicarious resilience.

It is easy to read news of violence or to discuss it in classes. Hearing it directly is something that I doubt any of us attendees will forget. Each of us came away with some resilience developed not from just our own experiences of overcoming violence, but also from that of others.

Now we just have to carry it forward.