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1) Narrow Definitions of Trauma

Restricted definitions of trauma and PTSD, as put forth by the DSM and practiced in clinical settings, emphasizes the individualization of trauma and oversimplifies “the complex and multifaceted ways in which individuals and communities experience traumatic events” (Goodman, 2015, p.60). Furthermore, this Eurocentric definition established by Western scientific research ignores centuries of community-based understandings of trauma. 
“This exemplifies a colonial or Western/Eurocentric framework that focuses on the individual as a way to deflect attention from systemic factors”(Goodman, 2015, p. 60).
Burstow (2003) suggests we think of trauma, not a disorder, but as “a reaction to a kind of wound” caused by a profoundly injurious situation or event, occurring in a “world in which people are routinely wounded”  (p. 1302). A trauma diagnosis is most often applied to individuals, but it is imperative to note that not it is not only individuals who can experience trauma. Community theorists recognize that entire communities “as an integral whole is traumatized” (Burstow, 2003, p. 1297). Trauma should also be understood as transgenerational or intergenerational, meaning that the impacts of traumatization felt by one individual can be passed onto the next generation. It can be passed on in this way by “virtue of belonging to a specific social group” or family (Burstow, 2003, p. 1297). The definitions provided by the DSM do not account for the way in which trauma can result from systemic oppression, such as ongoing racism, and be passed on as collective, historical (Goodman, 2015.) or vicarious trauma.

2) Diagnosing Trauma

Another critique of TIAs prevalent in the literature is in the way that individual trauma is diagnosed by a professional, demonstrating the “power of psychiatry” (Burstow, # p.). Many trauma-focused facilities are diagnostic which implies that reactions are "seen as an intrinsic character flaw” and are therefore pathologized (Goodman, 2015, p. 59). Indeed, Burstow (2003) argues that the mental disorder is brought on not by the trauma itself, but by the professional who applies the diagnosis as mediated by the DSM.  Through both definition and diagnosis there is an inherent individualization of trauma; in this way TIAs fail to address or advocate to change the systemic injustices and daily oppressions that increase one’s susceptibility to trauma (such as racism, and colonialism) (Goodman, 2015).

3) Evidence-Based Formula

The causes and conditions of trauma, as well as the embodied impacts of trauma have been heavily researched and documented within clinical settings. In fact, there are “numerous scholarly publications and intervention programs on traumatology (the study and treatment of trauma)” (Goodman, 2015, p. 56).  This work has pushed TIAs in the direction of  having more systematic and comprehensive models of practice. By understanding trauma in this way, the effects of traumatization have been reduced to an equation. Forms such as the DMS-5 PTSD Checklist claim to be a “psychometrically sound measure” and understood as “valid” “reliable” and “useful in quantifying PTSD symptom severity” (link to pdf). Burstow (2003) describes the way in which trauma is codified and measured by the DMS: 
Each of these criteria stipulates an attribute of trauma, then provides a list of included symptoms and identifies a precise number that must be met ( p. 1295)

In practice, these standardized forms can contribute to retraumatization. Herz and Johansson (2012) discuss the adversities that seem to follow the implementation of evidence-based practices: standardization, increase of manual-based social work, theoretical assumptions, and “neo-liberal individualization of ‘social problems’”( p. 529).

How can we integrate the critical approach of Mad Studies to address the identified gaps in TIAs?  

This is a difficult question, and one which cannot be simply answered on this webpage. This is a process that requires self-reflection in practice. However, as a starting point, we offer some initial thoughts for you to consider in your pursuit for a mad-infused TIA practice. 

We need to separate our understanding of trauma from the psychiatric narrative (Linklater, 2014). Very simply, trauma is “a person’s reaction to an injury” followed by an embodied response (Linklater, 2014, p. 22); it is not a diagnosed mental health disorder. It is, by no means, outside of the ‘normal’ experience of individuals and communities who are routinely affected by colonization, racism, discrimination, sexism, and the list goes on. This alludes to the critical importance of also adopting an anti-racist framework when practicing TIAs (Maiter, 2009).  “We can assume no absolute confidence in the homogeneity of people” (Faulkner, 2017), however, we do not need a trauma diagnosis to approach each service user with the intention of building a safe, transparent and collaborative environment of working relationship. 

We need to recognize that the ways in which the biomedical model, and the systems that support it (officially mandated helping institutions), are inherently oppressive. Burstow (2003) declares that “trauma is systematically produced by” these institutions, especially those operated by the state, and “must be understood as central players in the traumatizing of people and communities” ( p.1307).  Can we, as social workers continue our work in these institutions without reinstating harm to service users? Even as “critical” social workers? How can TIA principles claim to advocate for collaboration when operating within a model of psychiatry that “alienates people from their capacity to name, invalidates people’s conceptualizations, imposes a stigmatized identity on them, places them on paths not of their own choosing, deprives them of liberty, and imposes harmful treatments on them” (Burstow, 2003, p.1307)? Is it possible for effective collaboration to occur when working within these systems of care? For these and other reasons, TIAs need to align with the values of Mad Studies, and recenter experiential knowledge, and first-person narratives within academic and clinical dialogue about trauma.

By integrating principles of Mad Studies and other critical approaches into the practice of trauma-informed social work, we can address some of the inherent short-coming of TIAs. As Goodman (2015) identifies, TIAs offer major advancements in recognizing the underlying and complex impacts of a traumatic experience. However, in order to adopt a mad-infused practice we must analyze the disempowering, diagnostic implications of trauma assessment surveys as well as the officially mandated institutions that administer care.