Can you hear me?

As a survivor of child sex abuse working to further trauma-informed approaches in mental health, when I stand in a room before expectant eyes and share my lived experience, I often wonder: “Can you hear me?” “Are you able to take this in?”. And I fear that if you can, will what I have to say send you reeling? I feel a responsibility not to traumatize my audience (Chouliara et al., 2009; Nen et al., 2011). But equally, I speak because I hope that you, the listener, will take action to improve the experiences of trauma survivors in mental health services. In this editorial, I explore the relationality of giving and receiving survivor testimony in the context of increasing demands for trauma to be approached in new ways within mental health settings (Sweeney & Taggart, 2018), and draw attention to places where this relationality can be fragile.

What stands between us, speaker and listener, and a successful encounter? Might very natural self-protection mechanisms arise in the listener in response to traumatic material, closing down conversations (Isobel & Angus-Leppan, 2018; Sage et al., 2018)? Might that come at a cost to me where I experience this turning away as yet another rejection of my disclosure, or a refusal to believe me?

I begin by considering what survivors are offering. As Trauma Informed Approaches have nested into the National Health Service (Sweeney et al., 2016), trauma survivors are employed and consulted as ‘Experts by Experience’. As such we are a symbol of the human imperative to survive, a sign that for many, life can get better even after the most harrowing of experiences (Salgado et al., 2010). An Expert by Experience is a beacon of recovery, hope and healing, demonstrating that it is possible to bring about better futures for marginalized peoples. This is achieved by offering for example, a ‘worms-eye-view’ of mental health services, and how they can be re-shaped to better meet the needs of traumatized people.

Experts by Experience also inform and engage in research through co-production (Rose, 2008) and Patient and Public Involvement (PPI). Including and partnering with survivors ensures research is more appropriate and relevant to service users’ experiences. Evidence suggests that survivor-interviewers engage research participants in trusting relationships through shared histories, generating rich and honest data (Matheson & Weightman, 2020). Experts by Experience also contribute to the education of mental health practitioners, for instance through facilitating a hands-on, ‘trial run’ of interacting with a survivor (Happell et al., 2021). In my own role as a Trauma-Informed approaches trainer, I have been able to address concerns that have been lingering for some listeners for many years: one non-traumatized participant, on hearing me speak of my experience of vanishing into the silence of the freeze response, felt freed from years of guilt for her inability to assert her voice in situations of relational high-pressure.

In roles such as these, the survivor has become a person of ‘esteemed victimhood’ (Daniel Taggart, personal communication). The vesting of worth, and the respect placed in Experts by Experience, levels power relations and can play a part in recovery because it reverses the dominant role of the abuser in relational violence (Hagan & Smail, 1997). So it is not just for the benefit of services that survivors take this role.

But we cannot underestimate the cost to the Expert by Experience, because while it is work, it does not come from a place of professional identity. When we speak, we do so from our survivor identity. Abuse, of all types, shapes survivor’s identities (Herman, 1992), if I stay in my professional role of researcher or Mindfulness Based Cognitive Therapy teacher (other roles I occupy), I hive off part of my experience and hide it behind the excellent façade that I used for years before I reached sufficient self-acceptance to speak openly about my childhood.

Even now, it is not easy to reveal parts of my experience, and parts of me. My overriding fear when speaking to mental health professionals is that every sentence I utter is being used to diagnose a disorder for me, such as PTSD (Post Traumatic Stress Disorder) or BPD (Borderline Personality Disorder). The listener has this power over who I am seen to be.

This distancing creates a split, an ‘othering’, between me and my listener. Am I seen as broken or ‘disordered’? The listener considering himself ‘ordered’, rational, sane. Is this fear a fault line only in me? I suggest it could also be a self-protection mechanism by the listener. The othering of experience to stay secure in their own identity. For if the listener stays firmly behind their professional identity, distanced from the speaker, there is an imbalance of power. And here, again, we are in the territory of the original abuse. An equitable relationship relies on a mutuality of power.

What can stop this split between us? I have had to work hard to become resilient (enough) to ride out the listener’s view of me. But I would suggest that the listener also has work to do.

What makes it possible for some listeners to stay engaged with distressing and traumatic material, while others cannot?

The first answer may be found in the limbic system’s ability to override the executive function of rational engagement. Humans have phylogenetically evolved a ‘threat-detection system’ which is driven by the imperative to survive. If traumatic narratives are too distressing – even though the listener may be consciously willing to engage – their more powerful limbic system may sound sirens of alarm. This means that if the narratives being heard are experienced as a threat (e.g. “this might happen to me/my loved ones”), an autonomic response is triggered, the well-known Fight-Flight-Freeze system. Consequently, the listener’s withdrawal might involve physical distancing, or wandering attention or the psychological distancing when I am ‘othered’ by diagnosis, all forms of ‘Flight’. Alternatively, the listener’s limbic system may respond with ‘Fight’ to end the threat-response, meaning that the listener may challenge the validity of the survivor’s narrative. These may be the relational moments a survivor experiences as rejection.

All of these distancing actions are unconscious forms of self-defense. Understandable. Forgivable perhaps. Beyond conscious control. But they have implications for the relationality between survivor and listener. Turning again to neurobiology, polyvagal theory (Porges, 2001) suggests that the capacity to stay safe while listening to traumatic material requires the ability to ‘read’ the micro-adjustments in the facial expressions and prosody of voice of the other person. When a narrative of abuse is told both listener and speaker are engaged in a detailed reading of the threat or engagement arising in the other, as each person’s neural system adjusts and readjusts accordingly to come closer or more distanced (Dana, 2018). To engage fully in this relationship, the listener must be equipped to hear without experiencing the narrative as a threat.

However, if the listener continues to hear without falling into Fight or Flight, and experiences the narrative (consciously or subconsciously) as an overwhelming threat, they may experience vicarious trauma. This can be defined as a threat which cannot be escaped through limbic fight or flight, tripping the parasympathetic branch of the dorsal vagus into its last line of defense: traumatic collapse (Porges, 2009). This is hugely damaging to the listener, and beyond any reasonable job description.

For the benefit, then, of both listener and speaker it falls to the listener to develop their own resilience, and their capacity to stay engaged. Failure to do so risks their own well-being but also risks damaging the relationship and therefore the possibilities for involvement, co-production and change.

Listeners might look for examples of building relational resilience to certain forms of therapeutic interventions where the therapist willingly cross-examines their own narratives and subconscious fears in service of creating the safe, boundaried, and stable space to receive the pain of the client. Then, the burnished listener and raw client join together as an alliance focussed on the process of recovery (Martin et al., 2000) creating an opportunity for the pair to engage at relational depth (Cooper, 2017). Organisations, and institutions, within which these encounters unfold must play their part in supporting such endeavours.

The failure to respond appropriately to survivor testimony is creating a growing dissatisfaction among many survivor researchers and within the Mad Studies communities. This dissatisfaction is founded on consultations and involvement that result in inaction (Beresford, 2021), language and knowledge becoming co-opted (Penney & Prescott, 2016) and peer supporters remaining unpaid, with a lower standing than their titled and role-holding colleagues (Voronka, 2019).

Beresford is emphatic in the need for survivors to be supported to enable their contributions (Beresford, 2021). When speaking from one’s identity, without the protection of job title, professional body, peer support or supervision, a survivor is exposed and vulnerable to retraumatization, which may be sanitized and justified by services who dismiss it as an inevitable part of working with the traumatized.

If lived experience testimonies are not acted upon, no wonder survivors feel ignored and disrespected once more: they are being. This is a repeat of the original abuse but now hidden behind a façade of listening. The speaker-listener relationship risks destruction where ripples of dissatisfaction become a soliton wave. This dissatisfaction is bringing forth survivor-led organizations such as ‘Liberation’ (Disabled People Against Cuts, 2020).

When survivors offer testimony, qualities and actions of the listener are demanded. This moment of exchange feels fragile. It is, I believe, an opportunity which might be lost if it is not fully understood. Recognizing how the moment of exchange came to be may extend its tenure. Recognizing it is worth may protect it from too easily slipping away un-heeded. Because this is not the first time society has been listening only to fall back into a willful blindness. The history of trauma is one of waves of engagement and distancing (Andreasen, 2010), an “episodic amnesia” Herman (1992, p. 7). Inertia and defeat by the ferocity of trauma against the human systems of defense can be overcome if those with lived experience and those wishing to support them can stay attuned to each other and themselves in service of the shared aim to improve services.

Disclosure statement

No potential conflict of interest was reported by the authors.