In 2022, the U.S. Surgeon General issued a report about workplace mental health and wellbeing. Many of you will not be surprised to learn that in a survey of 1,500 U.S. adult workers across for profit, non-profit and government sectors, 76% of respondents reported at least one symptom of a mental health condition, and 84% reported at least one workplace factor that had a negative impact on their mental health (Office of the U.S. Surgeon General, 2022). This means that in every mental health, healthcare and social service setting, clinicians must deal with the effects of workplace stress on their clients, while they are also trying to manage similar problems themselves. Not surprisingly, the report cites research suggesting there are five workplace attributes most predictive of whether workers refer to their organization’s culture as “toxic”: disrespect, non inclusivity, and unethical, cutthroat or abusive behavior (Sull et al., 2022).
In caregiving environments, these toxic factors have been accumulating and spreading like a contagious moral virus for decades. Indeed, my colleague and I wrote a whole book about it that was published thirteen years ago, and for the most part, nothing has significantly changed for the better (Bloom & Farragher, 2010). As service delivery has been seized by the mandates of capitalism, not by the ethics of caregiving, it is individual caregivers and their patients who have borne the burden of unrealistic economic demands that make high quality service delivery difficult or impossible (Christiansen, 2017; Porter, 2013).
The universality of these problems determines this to be not a health, psychiatric or psychological problem, but another public health epidemic. Then, when we broaden the notion of caregiving to encompass our care for the planet and all life on Earth, the threat to the overall wellbeing of the environment takes on even more meaning and relevance. The Gaia hypothesis, named after the ancient Greek goddess of Earth, posits that Earth and its biological systems behave as a huge single living entity. This entity has closely controlled self-regulatory negative feedback loops that keep the conditions on the planet within boundaries that are favorable to life (Midgley & Lovelock, 2007).
These conditions have been deteriorating for decades, and without radical change, the environment for future children may be so toxic as to be unsurvivable. This is a difficult reality to face, but we all live in cultures that are “traumatogenic,” that create, participate in, and permit the creation of trauma. A traumatogenic culture produces trauma‐organized individuals, families, organizations, communities, and governments that become stuck in time, repetitively adapting to circumstances and events that have already happened, but not responding well to the present and creating a predictable, but highly problematic future. I have defined a trauma‐organized system as one that is fundamentally and unconsciously organized around the impact of chronic and toxic stress, even when this undermines the essential mission of the system (Bloom, 2012). The more people there are in an environment with unrecognized, untreated, chronic, or continuous exposure to the stressful conditions that have been and continue to be a fundamental part of our environments, the more likely that parallel processes of dysfunction will occur and affect everyone, top to bottom.
Most clinicians reading this column will be familiar with the concept of a “paradigm shift,” having already experienced such a shift in reorienting your practice around the issues of trauma and adversity. Paradigms are the source of systems, so a paradigm shift means transformation, revolution, or metamorphosis. A paradigm represents society’s deepest set of beliefs about how the world works (Kuhn, 1970). Scientific paradigms, like trauma theory and the adverse childhood experiences research, change mental models, which represent the basic understanding we have about the rules for how the world works. As a result of changes in our mental models, we then experience changes in attitudes and ultimately changes in the way we behave. In the world of mental health services, these changes are still evolving. In an organization, for a paradigm shift to occur, everyone needs to change by acquiring knowledge and skills that lead to changes in attitudes, practice and policies.
If we are to address the reality of the multiple ways caregiving has been depreciated, and our cultures have become toxic, we need a new mental model for thinking about our sociopolitical and economic systems and their component parts, as biological systems. That means sacrificing our current thinking about them as machines, a paradigm inherited from the last Industrial Revolution. Instead, we must develop an understanding that every corporation, each workplace, regardless of how small, and every person that works for the organization is a living being with all the basic characteristics and requirements of life. We need to think of our workplaces and all our emergent systems as “biocratic.”
The word “biocratic” was first used in the 1930s by Dr. Walter B. Cannon, a famous Harvard physiologist who had already named the “fight-flight” response and had defined the internal physiological balancing act that keeps us all alive: homeostasis. He used the word “biocracy” to describe the relationship between the physical body and the social body, emphasizing the vital importance of democracy. He understood that our socially constructed systems are alive, just as the human body is alive. In 1936, he wrote, “It seems to me that quite possibly there are general principles of organization that may be quite as true of the body politic as they are of the body biologic.” Then in 1940, he became President of the American Association for the Advancement of Science, and in his presidential address, he asserted that the most efficient and stable human society would be a “biocracy in which the myriad of differentiated cells would be organized into functional organs all cooperating in a dynamic democracy in which any form of dictatorship would lead to degeneration and death” (p.1) (Laurence, 1940).
For several thousand years, humanity has been laboring under anti-democratic, top-down organizational structures that are taken as the norm. Since the second half of the 20th century, we have also been laboring under the delusional notion that the “market” will take care of all our problems, including climate change (Orestes & Conway, 2023). Unfortunately, this neoliberal market fundamentalism stands a very good chance of destroying all of us. As a result, there are few truly biocratic workplaces, and therefore most people have little to no experience with practicing democratically, and none approaching their organizations as living systems.
Such a change requires the development of new skills that can serve as an antidote to the almost universal adaptations that humanity has made to thousands of years of relentless exposure to adversity and to trauma. Learning to participate in the workplace environment requires an ability to process complex information along with active listening to others as key leadership skills. Conflicts inevitably emerge that require the capacity to manage emotions and control impulses that disrupt the group process. Working in participatory environments requires shared decision making and problem-solving. That means people must substitute words and reasoning for action. All of this necessitates workers with sophisticated social skills that include the capacity for trustworthy behavior and negotiation, combined with a willingness to compromise and make concessions that promote collective action.
Unfortunately, few people have grown up in democratic families or schools, much less workplaces so all of this may be foreign to them, and even frightening. Creating more biocratic workplaces will depend upon trustworthy supervision, coaching and leadership. One of the pioneers of social, organizational and applied psychology, Kurt Lewin, pointed out long ago that, “Only through practical experience can one learn that peculiar democratic combination of conduct which includes responsibility toward the group, ability to recognize differences of opinion without considering the other person a criminal, and readiness to accept criticism in a matter-of-fact way while offering criticism with sensitivity for the other person’s feeling” (p.52)(Lewin, 1951).
Biocratic organizations are living systems that model themselves after the human body, and that may guide us in formulating strategies that support organizational health instead of tolerating dysfunction. In service of this possibility, my colleagues and I have created a new online organizational approach, only recently released during the COVID pandemic, that we call Creating Presence to assist whole organizations in making the paradigm shift to becoming trauma-informed, healthier, biocratic organizations (Bloom, 2023). The organizing framework builds on the scientifically grounded and extensive knowledge about trauma and adversity that I now call “The Science of Suffering.” The overarching purpose in Creating Presence is to provide the knowledge base and skill development for collective change starting at the organizational level, and gradually impacting every member of the organizational culture through the acquisition of knowledge and experience. It also builds on the landmark work of organizational development theorists, Peter Senge and his colleagues, who laid out a roadmap for the future workplace as Learning Organizations, before the knowledge we now have about the effects of adversity and trauma were widely recognized.
We use the word P.R.E.S.E.N.C.E. as an acronym for interlinked trauma-informed concepts and values that are meant to consistently inform and anchor all personal, interpersonal and organizational processes: P = PARTNERSHIP AND POWER – Promoting shared decision-making; R = REVERENCE AND RESTORATION – Promoting respect and healing from the past; E = EMOTIONAL WISDOM AND EMPATHY – Promoting deep understanding and compassion; S = SAFETY AND SOCIAL RESPONSIBILITY – Promoting safety, self-awareness and teamwork; E = EMBODIMENT AND ENACTMENT – Promoting insight and empowered behavior; N = NATURE AND NURTURE – Promoting proactive rather than reactive behavior; C = CULTURE AND COMPLEXITY - Promoting diversity and avoiding oversimplification; E = EMERGENCE AND EVOLUTION – Promoting healthy growth rather than repetition.
We have also created an instrument to measure change, OPTIC: Organizational Presence of Trauma-Informed Change, that is administered during the assessment period, and at intervals along the way. In the implementation process of Adoption, Installation, Initial Implementation and Full Operation, each value is actualized through the acquisition of individual and organizational knowledge, practices and skills that are tailored to specific needs of the organization, and the role of the individual within the organization, and lasts for at least eighteen months so that the learning can begin becoming deeply embedded in workplace practice without significantly interfering with workplace function, and because it is more than just “training” – it is about redevelopment (Brownson et al., 2017). By the end of the process, we expect that the organization will have decided on policy changes that need to be implemented to make the change permanent. The process is too new for anything, anecdotal and qualitative data so far, but the results are promising.
About the Author
Dr. Sandra L. Bloom is a Board-Certified psychiatrist, and Associate Professor, Health Management and Policy at the Dornsife School of Public Health, Drexel University. Dr. Bloom is recognized nationally and internationally as the founder of the Sanctuary Model and is the Past President of the International Society for Traumatic Stress Studies. For more information, please see: www.creatingpresence.net and www.sandrabloom.com.
References
Bloom, S. L. (2012). Trauma-Organized Systems. In C. R. Figley (Ed.), Encyclopedia of Trauma (pp. 741-743). Sage.
Bloom, S. L. (2023). A Biocratic Paradigm: Exploring the Complexity of Trauma-Informed Leadership and Creating Presence&trade. Behavioral Sciences, 13(5), 355. https://www.mdpi.com/2076-328X/13/5/355
Bloom, S. L., & Farragher, B. (2010). Destroying sanctuary: The crisis in human service delivery systems. Oxford University Press.
Brownson, R. C., Colditz, G. A., & Proctor, E. K. (2017). Dissemination and Implementation Research in Health : Translating Science to Practice (Edition 2). Oxford University Press. https://doi.org/10.1093/oso/9780190683214.001.0001
Christiansen, I. (2017). Commodification of healthcare and its consequences. World Review of Political Economy, 8(1), 82-103. http://ezproxy2.library.drexel.edu/login?url=https://www.proquest.com/scholarly-journals/commodification-healthcare-consequences/docview/1907287204/se-2?accountid=10559
Kuhn, T. (1970). The Structure of Scientific Revolutions, 2nd ed. University of Chicago Press.
Laurence, C. (1940, December 28). Human body held best "democracy"; A Society Modeled After Its Organization Urged by Dr. Cannon Before Scientists. New York Times.
Lewin, K. (1951). Field Theory in Social Science: Selected Theoretical Papers. Harper & Brothers.
Midgley, M., & Lovelock, J. (2007). Earthy Realism: The Meaning of Gaia. Andrews UK Ltd.
Office of the U.S. Surgeon General. (2022). The U.S. Surgeon General’s Framework for Workplace Mental Health & Well-Being.
Orestes, N., & Conway, E. M. (2023). The Big Myth: How American Business Taught Us to Loathe Government and Love the Free Market. Bloomsbury.
Porter, S. (2013). Capitalism, the state and health care in the age of austerity: a Marxist analysis. Nursing Philosophy, 14(1), 5-16. https://doi.org/https://doi.org/10.1111/j.1466-769X.2012.00556.x
Sull, D., Sull, C., Cipolli, W., & Brighenti, C. (2022). Why Every Leader Needs to Worry About Toxic Culture. MIT Sloan Management Review, 63(3), 1-8. http://ezproxy2.library.drexel.edu/login?url=https://www.proquest.com/scholarly-journals/why-every-leader-needs-worry-about-toxic-culture/docview/2655624549/se-2?accountid=10559