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Psychiatry Professor Hadar Lubin: Healing through homecoming

Yale Medicine Magazine, 2018 - Spring


In retrospect, it seems logical that Hadar Lubin, MD, assistant clinical professor of psychiatry at Yale School of Medicine and co-director of the Post Traumatic Stress Center (PTSC), would end up treating trauma. Conflict was an inescapable part of daily life, a direct part of almost every Israeli’s experience in the 1960s and 70s, as Israel fought for its existence against repeated invasions. A heavy psychological toll was an inevitable byproduct. Emotional suffering from its fallout wasn’t.

Lubin began her psychiatric residency at the West Haven Veterans Affairs Medical Center in 1989. Owing partly to West Haven’s strong ties with Yale’s Department of Psychiatry, its VA was tapped as one of the Veterans Affairs’ National Centers for Post-Traumatic Stress Disorder (PTSD). The American Psychiatric Association had recognized the diagnosis in 1980, following studies of the impact of “combat trauma” on Vietnam War veterans. In 1992, Lubin was appointed medical director of the Specialized PTSD Inpatient Unit at the VA, and from 1994 to 1997 she served as its chief.

“Within the first few weeks of working there, I knew that psychological trauma was to be my career passion,” Lubin said. She served in the Israel Defense Forces as an intelligence officer, but was not directly involved in combat. She believes that her family’s experiences and resiliency provided “a protective shield that buffered the effects of that trauma.” These early experiences deepened her later understanding of the role of an individual’s social environment in “mediating the impact of toxic stress.”

It was at the VA that Lubin met David Read Johnson, PhD, a psychologist and drama therapist who was then chief of the inpatient unit. With colleagues, they published studies of their work with Vietnam War veterans, including one identifying “homecoming stress” as the most significant predictor of the development of PTSD symptomatology.

“Our work at the VA greatly influenced the orientation of the Center,” Lubin said, contributing an understanding of the importance of integrating clients back into their communities. “The consequences of trauma interfere with one’s ability to feel affiliated, to feel a sense of connection.”

“And the avoidance is so intense that one isolates and eventually pushes people away,” she added.

Although some are veterans, the majority of the Center’s more than 250 clients seek treatment for what Lubin calls “civilian trauma” or “familial trauma.” This condition includes a range of incidents including early childhood trauma, sexual abuse, and domestic violence. Though every person’s experience of trauma is unique, there are similarities that are useful for clients and therapists to consider.

As trauma therapists, Lubin said, “we are not passive. We directly and actively engage with the clients and their traumatic narratives.” In addition to individual work, the Center also offers the Women’s Trauma Program, a Transitioning to Adulthood Group Program, and Trauma-Centered Family Therapy. It also runs trauma-based public health intervention programs in elementary and high schools.

The Post Traumatic Stress Center is in a converted firehouse (itself a piece of New Haven history). It doesn’t feel like a clinic—more like the office of a sculptor or artist than a clinic. A spiral staircase where the firepole used to be leads to the Remnant Wall, a display of items symbolizing trauma that clients have “shed.” Presented behind a transparent panel, the objects have been brought into the open to be confronted directly. The Center also maintains a collection of “Breaking the Silence” books—bound volumes of trauma and healing testimonies donated to the center by some clients for public display.

“Encouraging clients to share their traumatic stories lifts their burden and sense of isolation. They learn that although therapy is confidential, the traumatic events are not, as they reflect on the deeds of the perpetrators,” Lubin said. “We tell our clients the secrecy that comes with trauma protects the perpetrator, not them.”

Lubin believes that healing is a process. Clients are encouraged to mark key moments in their progress; they will celebrate milestones with symbolic enactments of transformation. These therapeutic ceremonies are informed by the Center’s staff’s understanding of trauma and its aftermath in a way that will highlight the progress that was made. A therapeutic ceremony may feature artwork or poetry that symbolizes strides made in the therapy. It may be a ritual as simple as a walk across a room into the embrace of family and friends, to underscore the importance of connecting to their social network.

Building on their work on the homecoming experience of Vietnam War veterans, Lubin and Johnson found that for civilians, what’s key is how the disclosure of trauma is received. “With a civilian trauma,” Lubin said, “there is no homecoming. The trauma is at home—hence the ceremonies, to heal the individual and the community.”

“Testimony is observed in a semipublic setting because the role of the witness is so central to the healing. In fact,” she explained, “we tell our staff and clients—and I stand by it completely—that trauma occurs alone, but healing can only occur in a social context. You cannot heal by yourself.”