Not the End of the Story: Building Empathy in Pursuit of a Culture of Health

"Doctors pulled the bullets out, patched me up and sent me back to the same neighborhood where I was shot. No one hugged me. No one counseled me. No one told me that I would be okay." If that emergency room treating Senghur had been trauma-informed, could he have been provided with the attention he may have needed and not have perpetuated the cycle of violence by eventually killing another man?
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"That wasn't the end of my story," says Shaka Senghur, a writer, a teacher, an MIT Media Fellow and an ex-convict. While his early life was defined by abuse, violence, incarceration and isolation, Senghur has undergone a transformation. He believes others can do the same if we provide them with the empathy and comprehensive services they need.

Earlier this year, the Robert Wood Johnson Foundation announced our new focus on building a Culture of Health, working to create a society where getting healthy and staying healthy is a fundamental and guiding social value that helps define American culture. We envision a society in which promoting health -- whatever your ethnic, socioeconomic, geographic or racial circumstance -- is as important as treating illness.

Empathy may not be an intuitive aspect of a Culture of Health but, in fact, it is integral. We must all believe we have a shared stake in being healthy and in meeting people where they are with the help that they need to thrive. People who lack empathy make decisions that not only hurt themselves, but also can hurt others around them.

At the Foundation, we believe we will not be able to achieve our vision of a Culture of Health if we don't simultaneously work toward eliminating the culture of violence and trauma that defines the lives of too many Americans, including too many of our children. Once again, empathy is imperative to achieving this goal. For some people who are exposed to violence or experience other forms of trauma early in their lives, it can have a lasting impact on their ability to empathize with others. This seeming "lack of empathy" can be a survival strategy. For example, Senghur speaks about the abuse and neglect he experienced as a child and about his own experience as a shooting victim, which left him paranoid and willing to adopt the credo that "it's better to be the shooter than the person getting shot."

My colleagues and I at the Foundation are trying to grow in our understanding of what is needed to prevent violence, and also what can be done to mitigate the impact of exposure to trauma and violence when it does occur. As my colleague Jane Lowe has said, trauma "does not need to be determinative of [a child's] life path; building resilience is a solution." At this stage, we believe that strengthening families will be key to our strategy, including ensuring that systems and services are poised to help families overcome the trauma they may encounter.

This approach includes exploring how we can support systems and services -- schools, communities, child services and clinical settings -- to be more "trauma-informed." Being trauma-informed means being able to understand, recognize and respond to the effects of trauma on a person, family and/or community. It means considering the whole picture -- versus a single situation or symptom -- in our approach to care and development. Senghur describes being cared for in the emergency room after being shot, "Doctors pulled the bullets out, patched me up and sent me back to the same neighborhood where I was shot. No one hugged me. No one counseled me. No one told me that I would be okay." While it may sound too simple, if that emergency room treating Senghur had been trauma-informed, if Senghur had been treated with empathy as well as with stitches, could he have been provided with the comprehensive services and attention he may have needed such that he might not have perpetuated the cycle of violence by eventually killing another man?

There are multiple challenges to providing trauma-informed health care. For example, it is one thing to screen for trauma, but something else entirely to be able to provide the services that are needed in response. Who will be held accountable? What training do they need to do so and who will provide that training? Considering the complexities of our health care payment systems, how will payment be handled? How can trauma-informed care be effectively integrated into existing systems? How could it contribute to dismantling unnecessary siloes? There are even questions of design. How can we design spaces or interventions that are trauma informed, that contribute to building resilience and do not expose children to trauma all over again? And how will we know that what we are doing is working? What types of evaluation and measurement will need to be developed? These are just some of the questions that need to be answered and which we are engaging others -- like you -- to help us to answer while asking you to help us identify additional gaps in our collective knowledge.

Fortunately, Shaka Senghur's story did not end when he shot and killed a man and was sent to prison. After growing up in a culture of violence, he is now dedicated to changing the system, doing his part to build a Culture of Health. It's stories like Senghur's that help build our own empathy. When we see people doing harmful things to their children or perpetrating violence against others, a good question to ask is "what is their story?" And not "I wonder what is wrong with them." It is possible they were hurt too. Unfortunately, what often seems like capricious harmful behavior is a normal reaction to an abnormal situation.

We need to allow children to be more than their experiences. Regardless of what has happened to any of us in our past, there is potential for so much more.

Help the Robert Wood Johnson Foundation to think about how it can promote the health and wellbeing of families with young children. Share your ideas with us.

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