A Commentary on Damaged, The Book

I marked up my copy of the book Damaged: Child Trauma, Adult Illness, and the Need for a Health Care Revolution so badly that I had no idea how I was going to write this essay. Part of me wants to say: Just go buy it. Post-it flagged pages are a sign that this is a significant book, one that I’m going to return to again and again.

I know one of the authors, Dr. Robert Maunder. He generously hosted me at Mount Sinai Hospital in Toronto when I gave a talk about my own book in early 2020. This essay is not an objective review, but it is a commentary on what I thought and felt as I read Damaged.

Psychiatrists Robert Maunder and Jon Hunter have written a book rooted in stories: the story of Dr. Maunder (let’s call him Bob) and his time with Isaac, a patient in his psychiatry practice. Another thread is about Bob and Jon’s relationship as colleagues. And we are given a peek at snippets of Bob’s relationship with himself as he reflects on his work with Isaac and other patients.

There is content about sexual abuse and family estrangement in Damaged, and I’m adding my own trigger warning for you. However, my discomfort was a reminder to me to pause and ask myself why I felt uncomfortable, for I will forever be a work in progress. I hope this won’t deter you from reading it, especially if you are a health professional.

It was impossible for me to read this book and not think about my time in therapy and my relationship with my own therapist. In fact, reading Damaged was like being in a six-hour therapy session. This isn’t a warning; it is a fact. This is not light reading, but important work is always hard and never easy. Damaged is a well-crafted book, but if you read it closely – and you should – you will see yourself reflected in the words, as a patient or a health care professional (or both). Sometimes these reflections aren’t pretty to see.

If you aren’t happy with the state of health care right now, Damaged offers practical tips to begin a care revolution. But before meaningful change happens, we all must be challenged in the stories we tell ourselves, and this book is written to challenge you to think about the 'difficult patient' in a whole new way.

I’m glad Damaged is called Damaged, not Broken. When I first started therapy after my cancer diagnosis four years ago, I insisted for months that I was a broken person. My therapist would gently redirect me and tell me that what I was experiencing was not evidence of my broken-ness, but that my despair was perfectly normal. Damaged normalizes having Adverse Childhood Experiences (ACEs). One out of every three human beings experiences ACEs (which include things like physical, emotional or sexual abuse, neglect or household dysfunction). Many people carry ACEs right into the health care world.

Maunder and Hunter’s main take-away is a plea for health professionals to ask patients about ACEs. Here is a quick 7 minute video from the authors about how to ask about Adverse Childhood Experiences. Before you say, “It can’t be done. I don’t have time,” you must read this book. An entire chapter called the Care Revolution is devoted to the “We don’t have time,” argument. Every time I speak about kindness to health care audiences, I also get told that “We don’t have time.”

If you care about having a trusting relationship with patients, you make the time for the important stuff; you don’t take the time.

I’m not here to convince you that Adverse Childhood Experiences affect us patients when we show up at health care settings (but they do). If you are sceptical, Damaged might just change your mind. Maunder and Hunter’s book is both well-referenced for those who like the data and woven with stories for right-brained readers like me. They demonstrate the importance of relationships by telling stories about relationships. An added bonus is content written by Heather Tuba about being the partner of someone who has experienced trauma. Her words give a family-centred perspective to the book.

If a physician asked me if I had any ACEs I wanted to share with them (and nobody ever has asked), I’d say: I grew up in an unkind household, so I really need kindness when I’m feeling small and vulnerable. I’d offer that 20 second glimpse and that’s all the time it would take. I’d then know that the doctor cared about me beyond my diagnosis because they asked me about myself. They would have insight about what’s important to me in health care. It would serve as the foundation for our relationship. As Maunder and Hunter say, patients are sometimes scared and feel unsafe in health care situations because they remind us of traumas in our past – and in the moment, we might not even know what we are remembering.

The authors remind us that it is hard for health care professionals to face suffering they can’t fix, but conversations about suffering serves as the foundation our shared humanity is built upon.

My greatest take-away from Damaged is the need to move beyond us and them, beyond professional and patient, to lead with empathy instead of problem-solving. That’s where Health Care Revolution promised in the subtitle resides – not in efficiency, or data or science, but in the place where people come together to demonstrate that they care deeply about each other.

Read this book if you long for a different health care world, whether you are a professional or patient. The practical tips shared to spark the revolution (and I’m cheering loudly here) include acknowledging power imbalances, recognizing healing comes through relationships and creating emotionally safe places for patients. All interactions with patients should be therapeutic ones – you don’t have to be a psychiatrist or mental health professional to offer that. As Maunder and Hunter say, “…the fundamental problem is not stubbornness or hostility…it is fear.” Help us be less afraid and maybe you will be less afraid too.

Lord knows this pandemic has shown us that every single one of us is damaged in some way. We all need some healing right now.

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