Vaccine Hesitancy = Unresolved Trauma

Vaccine hesitancy = trauma response? Here's a piece from Mind Over Medicine author Dr. Lissa Rankin Why Vaccine Hesitancy Might Be A Trauma Symptom: A Request For Crowd Sourcing For A Biden Task Force Assessing Vaccine Hesitancy As A Trauma Symptom

I've been collaborating with Chris Rutgers at The Trauma Foundation for my non-profit Heal At Last to address the health equity issue regarding cutting edge trauma treatment and how to democratize, scale, and make good trauma care affordable and accessible. Chris reached out to tell me the great news that a representative from a Biden task force addressing vaccine hesitancy as a trauma response had reached out and asked for his help. We're both reaching out to some industry leaders to co-write a statement to submit to the Biden task force as a way to lend an empathic, trauma-informed approach to the problem of vaccine hesitancy, as a way to improve buy in and cooperation. I thought I'd start with a few ideas I have and also share some thoughts from other trauma experts I've consulted.

First, as a trauma-informed physician in frequent consultation with experts on the front lines of public health and Covid but also deeply involved in the field of traumatology, let me share a few thoughts of my own. I do think that vaccine hesitancy, distrust of medical science, and conspiratorial thinking in general can be both caused by and amplified by trauma. Vaccine hesitancy can also be based on some very real and legitimate fears, traumas, and reasons to distrust institutions, so it's not easy to peel cause and effect apart, but let’s take a stab at it.

Let's start by naming some likely COLLECTIVE trauma responses that might be at play in vaccine hesitancy.

1. MEDICAL SYSTEM TRAUMA: Even if someone has not had any personal trauma as a patient in the US health care system, we've all been denied good medical care coverage in the US and made to feel like health care is not a right we’re all entitled to but a privilege enjoyed by only a few. Many privileged people pay a fortune for insurance that doesn't protect them well enough, and many go uninsured, untreated or declare bankruptcy because of how mistreated we’ve been related to the privatized medical system. Most of us have also witnessed loved ones get mistreated by doctors, hospitals, and broken, dysfunctional systems. Given that preventable medical error was the #3 cause of death in the US until Covid, people have good reason to be hesitant and mistrustful of the medical system in general. This is perhaps why the alternative medicine industry is a multi-billion dollar industry. Many who have medical system trauma swing so far to the opposite side that they don’t trust medical science at all and would rather die than see a doctor (or get a vaccine, for that matter.)

2. PHARMACEUTICAL INDUSTRY TRAUMA: The corruption inside Big Pharma is no joke, and the American people know it. Until there is less corruption in this for-profit industry that gives lip service to patient wellbeing but ultimately is legally bound to protect investor interests as their #1 priority, you can't expect automatic consumer trust. Especially when the government seems to protect privatized pharmaceutical industry interests above the interests of individuals who are harmed by medications or vaccinations, it’s no wonder people are scared. Many who are vaccine hesitant believe that their children were vaccine injured and then feel ignored, dismissed, or diminished by both the pharmaceutical industry and the medical system, which inflames their activism rather than helping them deal with the trauma of raising a child with a disability, whether or not that disability was the result of a vaccine injury. The fact that pharmaceutical companies are exempt from liability and backed by government funding further fuels this distrust that vaccine makers are not held accountable financially for any harm they may cause, all while they’re safe to profit from the vulnerability of the sick, the suffering, the young, and the elderly.

Many also remember countless times that drugs were rushed through FDA approval or given emergency authorization only to later be recalled or pulled from the market because of dangerous or even lethal side effects only found many months or years later. Some lost loves ones because of these medication side effects. Others got sick or disabled from drugs that came to market and were later pulled, like thalidomide. One common argument of the vaccine hesitant is that the vaccines haven't been around long and they're in a "wait and see" mode, scanning to see if potential side effects, like clotting disorders or myocarditis, might be more risky than the risks of those same conditions as side effects of Covid (so far, they're not, but there could be others we have yet to determine with our long, slow science.)

3. GOVERNMENT TRAUMA: After being consistently lied to by politicians (after 9/11 and the Afghanistan war, during four whole years of being lied to by Trump, and after countless politicians, including Obama, have made campaign promises they never kept), how can we expect people to trust the government? When the US government that lets billionaires double their wealth in a pandemic while countless others live in poverty, in a country with no nationalized health care coverage, where even a Capitol Insurrection doesn't lead to sending a President to jail, how can we expect people to just trust the CDC, who absolutely failed to put into practice the kind of rapid testing and contract tracing we should have put in place before lockdown ever ended, as was done in many countries with more trustworthy governments than ours?

4. RELIGIOUS TRAUMA: Many people were traumatized by complying with religious institutions that harmed them (pedophile priests, being shamed or abused for being non-compliant with religious leaders or nuns in Catholic schools, religious or New Age cult survivors, colonizers who committed genocide in the name of religion, witch hunt executions, etc). Such institutional abuse can make people generally mistrustful of all institutions.

5. RACIAL TRAUMA: Given that oppressed and marginalized people have been unethically and inhumanly scientifically experimented on historically in atrocities like the Holocaust or in the horrors of Tuskegee, it’s no wonder that Black and Indigenous People of Color (BIPOC) might be wary of complying with vaccine recommendations. This ties into our distrust of government. This country’s origin stories were a lie told to many in history books. We’re waking up to the reality that this country exists due to mass genocide, and for 400 years we advanced and enjoyed prosperity on the backs of slaves. We are waking up to the BIG LIE. The entire country is in PTSD. We don’t know who to trust, so this affects vaccine hesitancy.

6. INTERNET ECHO CHAMBER & ALGORITHM TRAUMA: As documentaries like The Social Dilemma reveal, our generation is influenced by a collective trauma never before seen at this scale- the trauma of the echo chamber and profit driven internet algorhythms. These reality distortions and the intense polarizations that arise in their midst are a difficult and painful collective trauma for everyone involved.

7. JOURNALISM & MEDIA TRAUMA: We have been so misled by some news sources that have strayed so far from the ethics of good journalism that it's no wonder people on both sides of many politicized divides cry "We can't trust the mainstream media." This mistrust of journalists, reporters, and televised news understandably makes it difficult to spread truth, facts, and reputable science.

8. RUGGED INDIVIDUALISM TRAUMA: In a country founded upon the noble ideals of the rugged individualist, the notion of sacrificing any of your individual freedom in order to help and protect the most vulnerable people in your community is anathema to many. It's a culture traumatized by a lopsided preference for narcissistic self-interest and self-improvement. Self self self. Any sort of self sacrifice in order to support others gets lost on a large swath of our society.

Next, let's unpack some PERSONAL traumas that might impact vaccine hesitancy.

1. PERSONAL MEDICAL TRAUMA: It is often traumatic to be a patient at the mercy of the conventional medical system, not just because it's traumatic to get sick and need medical care, but because the system is populated by traumatized doctors, nurses, and hospital staff who further traumatize patients because of their own burn out, compassion fatigue, overburdened patient load, insensitivity to the vulnerability and needs of patients, takeover by electronic medical records, disruption of the healer-patient relationship, and now understandable rage aimed at the unvaccinated who still come to hospitals begging for medical care when they get sick, putting vaccinated health care workers at risk of breakthrough Delta infections. Part of this personal medical trauma might be injection trauma. When children and adults undergo the pain and fear of multiple injections, and especially if people become sick and undergo many injections, as with chemotherapy or another life-threatening illness. All that injection trauma can add up and make people irrationally fearful of needles.

Personally, I've been part of the medical system as a doctor and witnessed and experienced first hand the trauma of being a patient. The one time I was ever a hospital patient after getting a C-section, I checked myself out of the hospital Against Medical Advice (AMA) because of absolutely malpractice levels of mistreatment. And I was a privileged doctor with good insurance in my own hospital! This threat is real, and almost every American I know has both benefited from and been harmed by doctors and the US health care system. So no wonder people are hesitant. Very rarely does a patient get the chance to get cutting edge treatment for the trauma of being a patient, so this trauma compounds over the years.

2. THE TRAUMA OF RAISING A DISABLED CHILD: Children get vaccines very young and some young children develop certain disabilities. While vaccine science has proven that the individual and public health benefits of childhood vaccination far outweigh the small risks, there are still risks and some people do become personally injured by vaccines. From the point of view of parents of young children who get disagnosedcwith a disability, It can be shocking and destabilizing to have to come to terms with the responsibilities, loss of freedom, and emotions of raising a disabled child, so even if the disability has nothing to do with vaccine injury, it’s understandable that some traumatized individuals might look for a scapegoat- the vaccine and doctors and Big Pharma- to blame for their child’s disability. It’s so much easier to believe, even if it’s not true, “The vaccine caused this disability” than to accept the uncertain ambiguity of “We don’t know why this happened and there’s nothing we can do about it.”

To add a level of nuance, one disabled reader added, on behalf of disabled or neurodiverent people, "You ignore the fact that parents don't have to be traumatized or devastated by raising a disabled child in the first place. Vaccines aren't the real scapegoat, as you suggest. Disabled people themselves are the scapegoats. If ableism didn't exist, then anti-vaxx conspiracy theories that use us as scapegoats never would've arisen either.

So I would add ableism and stigma as a reason that people fear the medical establishment. There is no reason to normalize a disabled person's mere existence as something devastating or traumatizing to their parent. It really doesn't help us disabled people engender trust in the medical establishment when you, as a representative of medical professionals, broadcast that it's ok for people to view our existence as a devastating trauma."

3. DEVELOPMENTAL TRAUMA AROUND AUTHORITY, AUTONOMY & TRUST

According to Margaret Mahler's stages of childhood development, children are supposed to be enmeshed with their mother during the first year of life in a healthy symbiosis, but by the second year of life, they're supposed to start the separation-individuation stage, when they begin testing their limits, asserting their autonomy, rebelling against the enmeshment with the mother, and individuating.

As all parents know, the first stage of "practicing," as the toddler practices saying NO and rebelling, is risky. The toddler thinks he's limitless, invulnerable, and can behave in reckless ways that get him hurt. If parents are too overprotective and don't let him rebel and individuate, that child may grow into a meek, timid, blindly compliant adult unwilling to take healthy risks or challenge authority, even if authority figures are asking them to do something that might harm themselves or others. He might also rebel in the future if he was overprotected as a young child. If parents are underprotective and don't set limits and teach the child that they're not superhuman and invulnerable, he may grow into a reflexively rebellious adult who thinks rules and boundaries don't apply to him.

Blind compliance is a trauma symptom that can lead people to comply with rules, guidelines, and authority figures, whether they are harmful or helpful to themselves or others. Blind compliance may have led otherwise good-hearted people to blindly comply with killing Jews under Hitler’s authority, colonizing and killing the Indigenous, committing mass genocide in Rwanda, or enforcing Apartheid in South Africa. Thank God some people were able to see that these authority figures and rules were dehumanizing and immoral violations of human rights. People like Corrie Ten Boom and others who hid the Jews to save their lives rebelled against, rather than complying with, a dangerous authority figure, which is a brave and healthy form of rebellion. Blind compliance also grooms people to tolerate abuse, since they don’t rebel against mistreatment when they should or use their power as an activist to speak out against injustice- to themselves or others.

Blind rebellion is also a trauma symptom that can lead to reflexively rebelling against ALL rules, guidelines, and authority figures, whether they’re harmful or helpful. People who blindly rebel often feel entitled to freedoms they’re not entitled to, which leads them to engage in behaviors they’re not actually free to engage in. This can lead to criminal behavior, as when a guy at prom feels entitled to have sex with his prom date, and when she says no, he rebels against her boundary and rapes her. He felt free to have sex with her, but he’s not free. His act of “freedom” is illegal and can (and should) land him in jail if she presses charges and he is found guilty. People who reflexively rebel often get very triggered by any boundary, such as the requirement to wear a mask inside during a pandemic or the request of a potential sexual partner to wear a condom. As a trauma symptom, they see themselves as above the law and entitled to just do whatever they please, even if it might harm someone else. This kind of anti-social behavior is why we have laws, so we can enforce legal consequences if someone feels entitled to be free to do something they’re not actually free to do, like drive under the influence or initiate a physically violent act against someone else.

Healthy people who are less traumatized neither blindly comply nor blindly rebel. They are able to assess rules, guidelines, and figures of authority case by case, to decide whether they trust the authority figure and agree with the rules, even if they may not like them. Overall, it’s safest and healthiest to neither reflexively comply nor blindly rebel, but to use our mental, intuitive, emotional, and somatic intelligences and discernment to make wise decisions about how to deal with authority, rules, and guidelines.

Most people with developmental trauma and boundary wounding in childhood are neither blindly compliant nor reflexively rebellious; they are a combination of compliance and rebellion. For example, if a child is enmeshed with a mother who doesn’t let them individuate (the Autonomy Survival Style in the NeuroAffective Relational Model of trauma healing), then he will often grow up outwardly compliant- a “good boy.” But secretly and privately, he may rebel and behave like a “bad boy,” someone prone to lying, manipulating and gaslighting. The Autonomy Survival Style flavor of trauma survivor may tell his wife he’s monogamous but then he’ll cheat and feel secretly entitled and even proud of his ability to get away with the rebellion while not losing the favor of the attachment figure. At some point, when these trauma survivors get busted for their lies, they may develop a "fuck it" mentality and become outwardly rebellious, perceiving any boundary as an attempt to limit his freedom and control him. But really, it’s because he never got his childhood birthright- the ability to exercise his autonomy in pro-social ways. So now he has to defend his autonomy in anti-social ways- like by not cooperating with vaccination and blaming those who try to enforce public health guidelines as “taking away his freedoms.” To the developmentally traumatized, this feels like a mortal threat to their sovereignty. And it’s not rational- because it’s emotional. No amount of science or data or emotional coercion is going to make them not rebel, unless they get treatment for these traumas, which is not feasible at the level of public health.

If the need for AUTONOMY is not met, the following traits commonly develop as a trauma symptom:

-ambivalent, paralyzed by their internal contradictions

-often complain of being stuck or in a morass

-fear of losing their independence when they become intimate

-choose to please others over themselves and then feel resentful

-will-based, stubborn identity based on efforting

-fear of their own spontaneous expression

-fear of being rejected or attacked if they are openly oppositional

-global fear of guilt, inappropriately apologetic

-superficially easy to please

-covertly feeling spite, negativity, and anger

-passive aggressive, self-assertion and access to healthy aggression is limited

-secretive about their pleasures for fear that they will be taken away

-feel their only choices are to submit to authority or rebel against it

-strong fear of humiliation

-often complain of being “stuck”

-forceful in defending others but not themselves

-will avoid or distance themselves from a situation rather than confront it

-projection of authority onto others

-believe that others have an agenda for them; imagine it even when not true

-want to know what is expected of them so they can do the opposite

-pressure themselves constantly while imagining the pressure as coming from the outside

-continual self-judgment and self-criticism

-confuse their unwillingness to stand up for themselves with flexibility

-use the pressure of waiting until the last minute before a deadline as a motivating force to break through their paralysis in order to complete tasks about which they’re ambivalent

Those whose autonomy needs don’t get met often have shame-based identifications: angry, resentful of authority, rebellious, enjoys disappointing others. They also may have pride-based identifications: nice, sweet, compliant, good boy/girl, fear of disappointing others.

If a child grows up unable to trust that his parents will not manipulate, coerce, gaslight, abuse, or exploit him, he may grow up with the Trust Survival Style from NARM, which makes him mistrustful of authority and may cause him to override feelings of powerlessness by developing narcissistic qualities that cause him to overpower others and feel entitled to mistreat others or betray their trust. Children need to be able to trust that love is unconditional and that they are free to become themselves. If children cannot trust their caregivers to let them become their own person, they struggle with the ability to trust others, foreclosing trust and healthy independence, giving up their authenticity in order to be who the parents want them to be (best friend, straight A student, gifted musician, sports star, good little Christian child, etc.) These children are rewarded for selling out and they feel pressured to fulfill their parents desires, not their own. Trusting and depending on others becomes conflated with being used and betrayed (as they were used and betrayed by their parents.) As adults they expect betrayal and may betray first. They seek power and control and prioritize “getting to the top.” At the healthy end of the spectrum, they can become visionaries and empire builders. On the unhealthy end, they can be ruthless, manipulative, and self-absorbed, doing whatever it takes to win at all costs. If the AUTONOMY survival style and the TRUST survival style get mixed together, we see many trauma responses commonly displayed among the willfully unvaccinated.

If the need for TRUST is not met, children grow into adults that often display the following trauma symptoms:

-underlying feelings of impotence and powerlessness

-fear of failure

-feeling of emptiness for always playing a role

-displacing of blame; always make it someone else’s fault

-not being able to depend on others, they feel alone

-projective identification making others feel small, weak, stupid or helpless

-inflated self-image

-always needing to be “one up”

-always wanting to be the best, the winner

-empire builders; when healthy, they can be visionaries

-deny the reality of their bodily experience

-act “as if”

-appearance of commitment to others, but in reality self-serving

-good at reading other people, particularly their weaknesses

-become anxious when they cannot avoid or deny

-when the idealized self image fails, they may become self destructive, prone to substance abuse or other high risk behaviors

-paranoia: life is a jungle- survival of the fittest

-turn the tables: “I have lived with fear; now I’ll make you afraid,” “I don’t get ulcers; I give ulcers,” “I’ll never be betrayed again- I’m the betrayer”

Those whose trust needs don’t get met have shame-based identifications: small, powerless, used, betrayed. They also may have pride-based identifications: strong and in control, successful, larger than life, user/betrayer.

Of course, we can't paint all public health rebellion with one enormous psychoanalytic brush, but I do find it helpful to try to apply the question Bruce Perry and Oprah Winfrey ask. Instead of "What's wrong with you?" we can ask "What happened to you?" and try to both hold people accountable for the consequences of their actions (which included dealing with the justifiable anger the vaccinated may feel towards the willfully unvaccinated, who are ruining things for everyone), but also while extending compassion to the willfully unvaccinated, resisting the shadow temptation to dehumanize or exile anyone from the whole of humanity.

POLYVAGAL THEORY

From the lens of scientists and therapists with an understanding of Stephen Porges's "polyvagal theory," those with any of the previous traumas, but especially those with developmental trauma, often live with perpetually dysregulated nervous systems, firing threat responses even in the presence of safety. Those with traumatized systems often develop faulty "neuroception," the ability to accurately distinguish threat from safety. Their nervous system often get it backwards: the perceive safety when there is danger and they perceive danger when it is safe.

There's also the understanding that "state creates story." In other words, if the Autonomic Nervous System is firing threat responses, then the mind will make up a story- even a conspiratorial one based on lies and misinformation- to try to create a story that is congruent with the threatened state of the nervous system. This lies at the root of many delusions and paranoid psychotic states. The story is inaccurate, but the threat in the nervous system feels so real because of a dysregulated, chronically threatened nervous system. From the polyvagal theory, trauma-informed lens, many conspiracy theories, including the conspiracy to harm people with vaccines, makes sense, even if it's not true.

RICHARD SCHWARTZ, PHD: An Internal Family Systems (IFS) Lens

I asked family therapist, author of No Bad Parts, and founder of IFS Dick Schwartz, PhD, what he thought about the subject of the Biden task force. He said, “I think it’s very complex because there are so many groups, each with different reasons to be anti-vax and with different parts structures and sets of burdened beliefs. Certainly, lack of trust in government or in traditional medicine is a common theme across them, but each has different reasons for their lack of trust, whether it's Tuskegee, yoga philosophy, distorted Christianity, the growing gap between rich and poor, lack of meaningful work for the poor and middle class, condescension from liberals, blind allegiance to Trump and Fox News, etc.

My limited experience with such people is that what they have in common is fearful exiles that fuel the parts that don’t trust and are frozen in scenes in the past when they felt powerless and betrayed. What would help? The way I approach distrusting protector parts in general is to lead with empathy— “I get that you have reasons to not trust”— lack of coercion— “You don’t have to”— and then become a hope merchant— “If you did, then (present the data.). Too often

vaccinated people are demeaning toward those parts, which only makes them stronger.”

Regarding the IFS model, August Mohr points out that "Different "family" roles for internal parts can be extended up the hierarchy: interacting parts of a person, small groups and families of people, neighborhoods within a community, even different towns can be assigned their roles, from success to troublemaker, holder of that which the others deny. Among states and countries too, there are traumatized countries that have been assigned their roles within the international family/community. Florida currently holds a scapegoat role, and having been assigned it, they will play it out hard. Does living in an overtly traumatized country make it easier to recognize the external forces that are traumatizing you? Why is the schizophrenia recovery rate so much higher in third-world countries?"

LAURENCE HELLER, PHD: A NeuroAffective Relational Model Lens

I asked Laurence Heller, PhD, author of Healing Developmental Trauma and founder of the NeuroAffective Relational Model (NARM) trauma healing method to chime in. Larry said, “I agree with Dick’s comments that the reasons for people's reluctance are differing and complex. Hesitancy is coming from both sides of the political spectrum. I agree with your observations, Lissa, about the themes of the two NARM survival styles (Autonomy Survival Style and Trust Survival Style) coming in to play. I see individuals at both ends of the spectrum struggling with significant anxiety. We know that people whose anxiety level is high are not available for objective information. I agree with Dick Schwartz that empathy is the most helpful response. People need to feel that individuals in authority are actually listening to their concerns. Shaming, lecturing, and pressuring in this kind of context never seem to work.

On a practical level, these hesitant folks are much more likely to listen to individuals from their own communities who have changed their minds for whatever reason. As reluctant individuals are really being listened to and as they talk with people from their own community who are now on board, hopefully their anxiety will diminish enough to open to more objective information. Although I tend to be generally optimistic, I believe that there are some individuals on both ends of the spectrum who will never change their minds. Alternatively, there is a substantial group of people who are currently skeptical but if addressed with empathy and real concern, will come around.”

GABOR MATE, MD: A Compassionate Inquiry Lens

I asked family practice doctor and bestselling author whose work is featured in The Wisdom of Trauma documentary Gabor Mate, MD his opinion about vaccine hesitancy as a trauma response. He said, “I have a somewhat different language for this reflexive oppositionality, ‘counterwill,’ a concept of a brilliant developmental psychologist friend of mine, Gordon Neufeld, as fully explained in two of my books. I imagine it’s close to Dick’s IFS Model and Larry’s NARM models.

It’s the automatic drive of an immature creature to resist any sense of coercion, which begins with the reactive “NO! of the two-year-old. In traumatized and developmentally arrested people, it’s gets stuck there.

There is also at play a significant drive to deny reality. To quote from my book-in-progress The Myth of Normal, ‘The denial of plain reality has roots in early wounding: when the truth is too awful to bear, better to pretend it does not exist,’ writes the psychologist Michael Milburn. ‘As children, we learn in our families to deny reality, to repress feelings, and to construct imaginary worlds. As adults, we deny aspects of contemporary reality that remind us of the emotional pain we suffered in childhood: the rage, the helplessness, and the sadness.’

It is also a fact that in this culture (which just expended 2 trillion dollars and many thousands of lives on a war based on total lies, for example), many have an ingrained suspicion of authority which, in traumatized people would be exaggerated beyond reasonable.”

JEFFREY REDIGER, MD, MDIV, Harvard Medical School Faculty Psychiatrist, Head of Maclean Hospital, Author of CURED

"So much pain and trauma exist in the world, and surely that colors how people - all of us - experience and perceive so many things, including vaccines and how they are viewed in our preferred communities. Speaking personally, and suspecting that I'm not alone in this, I struggle with trust for the institutions you mention as well, and in addition, with the institutions associated with media and social media, and how we all interact with those.

Histories of personal acute trauma and developmental trauma create a lack of trust, a diminished awareness of one's value, and a perception that one may be alone in a friendless universe. Any and all of these can be activated or increased by institutions or individuals that seem to act in accordance with any interests other than the welfare of all citizens, or one's preferred community. All people want to feel seen. When factors intervene in such a way to contradict that, individual trauma can be extended, sometimes exponentially. It can become not just personal, but "the way the universe is," which of course unleashes more fear, rage, and the need to find someone to blame or scapegoat. This conceivably affects the vaccine discussion on both left and right with dynamics that are both similar and different.

In regards to the medical system and pharmaceutical companies, I've developed deep opinions over time about the ways in which the trifecta of industry, academia, and government interact to create a science and sets of recommendations that are more influenced by business interests than I would wish. I both value science and wish for more attention to its biases, underlying values, and unspoken or unexamined assumptions. No science is value-free or as objective as we pretend. When this trust is broken over and over, we struggle with where, when, and how much to trust. Some of us will sit with the ambivalence and see value to competing arguments on different sides. Some will just walk away, vulnerable to taking a partial truth as the whole truth, and I can understand how this could occur. Lots could be said about how personal and collective trauma histories and memories can intersect with this and vaccine hesitancy and you say it well.

I also struggle with the conflicts that leave many ambivalent about the apparent drift of many democracies towards what could perhaps more fairly be called oligarchies, plutocracies, or kleptocracies. I suspect many of us are vulnerable to bringing our own developmental or other kinds of traumas to bear on the experience that our votes and actions really don't matter as much as the influence of a wealthy or privileged few, who with their money can gain the ear and influence of political leaders that the average citizen cannot. We are in the early stages of adapting democracy to the needs of the internet age and, at this time, our institutions of democracy are proving inadequate to an age where people expect immediacy, transparency, and input. If we cannot evolve our institutions for this new age, if "democracy" is really only increasingly in name only and if the alternative is either this or perceived rescue by a charismatic political populist who seems to put words to their anger and felt disenfranchisement and then took that disenfranchisement to another level - well, some hope for better results from the latter. I'm sure that the guttural raging of an authoritarian populist - "the parent who finally cares" - who promises to fix the corrupt system and return the nation to the "world as it used to be" feels like a promise too hard to give up, no matter all evidence to the contrary. Lots of trauma related to why one would choose such a savior.

Your discussion of boundaries as they relate to individual and communal needs and interests is excellent, Lissa. Thank you for your hard work on this."

VICKI ROBINSON, Developmental Trauma Therapist

Personally, almost all of my clients with developmental trauma are hypervigilant about masks and vaccines to the extreme end of safety. Possibly this is the common denominator between the hypervigilant and hyper-fearful of the vaccine; the survival threat seems so great that having a more pragmatic/meet-the moment approach is simply not on the table. Meeting the moment and taking a pragmatic and realistic approach to current facts is a luxury of a balanced nervous system. Allowing people safe venues to address their fears; and, as per Peter Levine’s Somatic Experiencing approach, taking a deeper dive into where these deep-held fears are living somatically, could be useful. For instance, a discussion group that only functions on the belief that rational discourse ‘wins the day’ tends to fail when individuals are unable to come out of their extreme states of fear, anger, anxiety, and dissociation.

Taking people into a deeper dive into "OK, fear of the vaccine means losing freedom..say more about that? What is the felt sense of losing freedom? What is the body’s reactivity?" Loss of freedom leads to fear, anger, complex emotions. Having skilled individuals holding the container of these challenging emotions and sensations could get deeper to the root of what is really going on. For instance, following this line of tracking: 'I don't want to lose freedom'...which could lead to disagreeing with closest cohorts could lead to anger (I don't like what is happening) disagreement, and an invitation to say more. "I fear..." the unknown, being injected with a poison, suffering, being alone and ostracized, losing my house, my job, my family. I am afraid of dying." Uncovering these layers somatically vs. staying in the pre-frontal cortex could begin to call out these common human concerns that can be addressed with a little more parasympathetic, a little less sympathetic nervous system activation and more rational discourse."

JAJA CHEN, Licensed Clinical Social Worker-Supervisor (LCSW-S) and Certified EMDR Therapist/Approved Consultant who specializes in trauma, particularly interpersonal, developmental, racial, birth, and perinatal trauma.

"I agree that many individuals who are vaccine hesitant have experienced medical trauma of some sort - whether personally, a child, or a family member. I have found that many have also had previous histories of childhood neglect and/or abuse, particularly generational, developmental, or physical, spiritual or emotional trauma from family and/or institutions. From an EMDR therapy perspective and Dan Siegel's Window of Tolerance work (which correlates and overlaps with Vagus Nerve theory), when individuals have experienced trauma and it is not integrated, individuals may have the past & present ongoing negative belief that "I am unsafe", "I am out of control," "I am in danger," "I am helpless, "I am trapped," or the collective "we are unsafe" or "we don't matter" (for example due to racial trauma).

The unresolved trauma moves them above or below their Window of Tolerance and leads to an overactivated or under activated nervous system. This is what can then lead to the fueling of ongoing behaviors and responses we see in those who are vaccine hesitant. I would say the flip side occurs as well for those who identify strongly as "pro-vaccine" and who are holding very little space, empathy, or desire to understand why some are vaccine hesitant.

Dan Siegel's Window of Tolerance discussed how when we are in our window, we are most at ease, calm, clear, and connected within ourself and with others. This is the space we need to be in our nervous system to hold space for empathy and dialogue. And to proceed in decision-making with discernment. Positive beliefs (which have connections with being in integration & connected with all parts & your core Self from an IFS perspective), from an EMDR Therapy perspective in the window would be, "I (or we) matter," "I am doing the best I can with what I have," "My emotions matter," "My voice matters," "I am learning and growing," "I am not alone."

I believe that even within your window, there may still be individuals who are vaccine hesitant or who end up deciding to get the vaccine, even with their hesitancies.

Some individuals may also have already gotten and fully recovered from COVID-19 and may be vaccine hesitant due to now having natural immunity and not knowing why they should get the vaccine. Or determining they do not need it. This may be less related to trauma and more connected to the individualism vs collective mentalities in the American culture, meaning that recovered individuals who are not getting vaccinated may be focusing on their individual experience with COVID as opposed to the global and ongoing collective impacts of the pandemic. I've observed this with more young people who are able-bodied and who had mild symptoms to COVID and thus now "do not see the point" in getting vaccinated.

I also have seen this response in individuals who had mild experiences with COVID (who identify as "crunchy" and believe fully in functional medicine or holistic health and the power of their immune system responses.) I do believe part of these responses, alongside individualistic culture, may also be due to financial, health, and age-related privilege.

Here are some responses I have observed when individuals are out of their window:

ABOVE THE WINDOW responses (sympathetic)

-Anger toward or protesting against COVID-19 policies (flip side is immense anger toward those who are vaccine hesitant and having zero-tolerance for why people may be)

-Anxiety regarding safety and well-being and how to protect themselves or family

-Arguments and debates on social media and/or in person regarding their views

-Feelings of self-righteousness or indignation toward those who are "pushing" agendas (or not listening to policies - for those who are "pro-vaccine")

-Shaming words/ behaviors toward those who believe otherwise

-Immense confirmation bias and resharing/ commenting via articles on social media and perspectives only from their own side and not considering other perspectives, thoughts, or experiences and potentially even discrediting or dismissing these other perspectives without curious exploration

-Distrust of institutions, organizations, or individuals who may "be on the other side."

-Above the window responses can also include panic attacks, difficulties sleeping, racing thoughts, and other anxiety-related experiences

BELOW THE WINDOW responses -(dorsal vagal/parasympathetic)

-Feelings of numbness, helplessness, shame & guilt, depression, potentially to the point of self-harm or suicidal ideation

-Use of substances or other numbing strategies to cope

-Dissociative responses

-Chronic fatigue & burnout

-Hopelessness leading to resignation and indifference toward the pandemic and how to proceed

-Fear and powerlessness regarding how to best support or help family/ themselves

-Indecision regarding how to proceed and feelings of confusion & "being stuck" on what to decide

IN OUR WINDOW - when we are within our window, I have observed the following in many:

-Being willing to consider different perspectives and thoughts, curiosity toward people who think differently than you

-Even if one is STILL vaccine hesitant (ex. perhaps due to child having an actual vaccine injury), I've seen an openness to considering other ways to protect their community through wearing of masks, encouraging those who can get vaccinated to do so, self monitoring of symptoms, distancing, etc.

-Empathy toward "both aisles/sides;" an acknowledgement and compassion - as opposed to judgment & shaming -toward individuals who are vaccine hesitant and/or pro-vaccines (which leads to deeper dialogue and empathy)

-Courage within to get vaccinated - if one is able to depending on their situation - despite initial fears and hesitancy; I believe these individuals are some of the bravest heroes of the pandemic and we must speak into and acknowledge these steps individuals have taken to get here as a nation and as leaders while also not shaming those who are immunocompromised and/or unable to get vaccinated due to previous vaccine injuries, side effects, and/or other health concerns

-Clarity regarding how to proceed and how to support family and self with the steps one is able to control and proceed in

-Boundary setting surrounding how to engage in conversation surrounding this topic, how to speak to individuals who think differently, focus in on showing up day to day with what one can control

-An integrative perspective that examines both sides - balancing the best of both Western and alternative medicine approaches when it comes to prevention & treatment"

Anyone else have a point of view or a statement to add? If so, please include your credentials!