“In the midst of a crisis there can be silver linings from which we can learn to do better moving forward,” said Lynn Black, MD, MPH, an attending physician at Massachusetts General Hospital (MGH), chief medical officer for the National Disaster Medical System’s Trauma and Critical Care Team, and an asylum evaluator for Physicians for Human Rights.
Last spring she helped quickly set up MGH’s outpatient Respiratory Illness COVID-19 clinics, which were fully approved and seeing patients within a few weeks. This accomplishment took tremendous teamwork and would ordinarily take years to operationalize.
In the spirit of moving forward during these challenging times, she and about 30 to 50 other Harvard faculty, researchers, and staff recently participated in a workshop training series entitled “Collective Healing Begins with Me: How to Respond in a Time of Crisis,” sponsored by the Harvard Longwood Campus Office of Employee Development and Wellness.
Held in late July and early August, this three-part workshop was taught virtually by Thomas Hübl, an author and facilitator who is known for his international work on collective trauma. For the past 18 years, he’s been teaching people how to understand and integrate both the subtle and more acute forms of trauma that impact societies. For example, he has facilitated healing from the intergenerational effects of the Holocaust among thousands of Germans and Israelis. Hübl worked as a paramedic in Austria during the 1990s and attended medical school at the University of Vienna for four years before embarking on a career path that would support health through mindfulness, relational awareness, and other practices.
“Recent events with COVID and racism have caused fractures in the global fabric, and are stressors for many of us,” he said. “It’s difficult, but if we can learn from them, it’s a chance to grow.”
To fully participate and meet the challenges, Hübl suggested that each participant reflect on what is happening inside themselves. He invited participants to first, learn to self-regulate when stress builds. To do this, he recommended a practice of aligning body, mind, emotions to become aware of any imbalances or incongruities.
Often, he said, in our professional lives, our minds dominate, and our emotions recede. Becoming more aligned with all of one’s senses can then lead to a “felt connection, which is like a strong internet connection” in our interactions. Together, these steps become the basis for building trust, cohesion, and resilience on a team or on a collective level, he said.
Throughout the series, Hübl guided participants through a self-reflection process to become aware of how collective trauma influences each of our lives, from intergenerational traumas to our early developmental experiences. “In the country in which each of us grew up, there’s a framework of collective traumatization that is expressed around us. How did I internalize this in my upbringing?” he asked us.
He encouraged participants to examine these origins of potential trauma to understand why some parts of ourselves feel numb and overwhelmed by the challenges around us. Becoming aware of these aspects of ourselves and healing in relation to others is key to unlocking the hold trauma can have on our lives, collectively and individually, he stressed.
“In the country in which each of us grew up, there’s a framework of collective traumatization that is expressed around us. How did I internalize this in my upbringing?”
In his book “Healing Collective Trauma: A Process for Integrating our Intergenerational and Cultural Wounds” which will be published in November, Hübl discusses the process he has been refining over nearly two decades around integrating collective trauma. “Nearly every effect of trauma, whether individual or collective, can be understood as an intelligent evolutionary response: as both an impulse of survival and an opportunity for conscious integration,” he writes.
Hübl has been offering talks and workshops at Harvard Medical School since December 2019 when he spoke at the Talk@12 with Bala Subramamiam, MD, director of the Center for Anesthesia Research Excellence at Beth Israel Deaconess Medical Center, who researches the pre- and post-operative effects of meditation on patients.
“Nearly every effect of trauma, whether individual or collective, can be understood as an intelligent evolutionary response: as both an impulse of survival and an opportunity for conscious integration.”
By incorporating this level of awareness and these practices into our patient care, office culture, and communities, we begin to create the collectives we envision as we lead by example, while taking responsibility for our personal stress levels.
“Authentic and aware leadership creates safety and permits deeper coherence to arise.” said Hübl, whose steady gaze and kindness even comes through Zoom. “When these things are present, it doesn’t take long before a sense of trust and curiosity unfolds throughout the space. I believe leadership is a synchronous function of both competence and awareness of the team members.”
These are the stories of four people who participated in all three sessions of Hübl’s workshop, how they contemplate applying what they learned to their work—on the COVID frontlines globally, in clinical and translational research, medical/graduate education, to transforming primary care—and to their personal efforts to relieve stress amid these turbulent times.
“I’m always on the lookout for a new lens on connection, resilience, and how we manage trauma, which is why I found Thomas’s work so meaningful,” said Black, whose work addresses the resilience of responders and survivors after disasters and the impact of sexual violence. She’s been on the ground with disaster response teams in Liberia during the Ebola virus outbreak and in Haiti after an earthquake and Hurricane Matthew, for example.
“One of the things that’s always been important to me with team building is that my colleagues feel safe and cared for,” she said. “When you feel safe, you communicate better, and you can work better together.”
Her personal stress came from long days in the COVID clinic as well as a deep sense of responsibility while assisting with preparation for COVID-19 at a major hospital in Haiti and educational programs for community health workers in African nations.
She worries about her daughter who’s in her third year of an emergency medicine residency in Florida and her son and daughter-in-law in Colorado. She doesn’t know when she’ll see them again. “We can’t control what’s happening around us, but we can work on knowing ourselves better so we can have meaningful connections and move through what we can’t control,” she said.
She has started to meditate daily and is now up to 15 minutes. “Even if you take two minutes to re-calm your brain, I’ve found it’s incredibly helpful.”
“We can’t control what’s happening around us, but we can work on knowing ourselves better so we can have meaningful connections and move through what we can’t control.”
Not quite sure what the workshop was really about when she signed up, Lindsay Hunt, MEd, said, “I was immediately drawn into the content in a way that surprised me. It really resonated with me.” She wasn’t sure about the meaning and implications of collective trauma, but soon connected with the idea of how trauma is passed on through families and generations. It made her reflect more deeply on her own family history.
As director of health systems transformation at the Harvard Medical School Center for Primary Care, Hunt has been gearing up to launch a Practice Optimization Sprint, a ten-week improvement program focused on reopening and redesigning primary care practices safely during this time of COVID. She and her team are involving a range of expert faculty from across the country, including the perspective of a mother of a medically-complex child.
The team is working with more than 30 primary care practices to share ideas around new telehealth workflows, strategies to handle the increase in health-related social needs, and thinking more broadly about their community, as in, “who’s coming in the office and who isn’t, and how do you reach the folks who aren’t.”
“There are many challenges facing primary care right now, but it is also an exciting time for innovation and redesign,” she said.
Hunt is thinking about how some of what she learned from Hübl might amplify their discussions around leadership training and resilience in the primary care workforce. Her group’s Medical Director Leadership Institute, next offered in January 2021, devotes its first month to self-reflection on leadership and authenticity.
At home, she’s the parent presiding over the partly-virtual third and fifth grade education of her two daughters. “There are some days when I find myself not breathing well, so many things are pulling on my attention and it’s difficult to slow down,” she admits. “The workshop reminded me of the value of making time for mindfulness.”
She’s found solace in the garden, by taking walks, and reading (she heartily recommends Vanishing Half by Brit Bennett). At the beginning of the quarantine, her family began raising seven chicks, three of which have survived. She’s still waiting on the eggs.
Compassion for Yourself
Adama Sesay, PhD, was part of a multidisciplinary, multi-institutional team that in the early months of the pandemic quickly came up with a global solution for the shortage of nasal swabs to test for COVID-19—a nasopharangeal swab that can be quickly and inexpensively produced.
Sesay is lead senior staff engineer at the Harvard Wyss Institute for Biologically Inspired Engineering and has a background in diagnostics and microsystems. Her Biosensors and Diagnostics team is also still at work on alternative serological diagnostic tests for COVID-19.
In the midst of their feverish race to help society fill these critical needs, her mother and sister, who live in London where she was raised, both contracted COVID. “It was touch and go for awhile with my mother, but she pulled through,” she said. “My daughter is living with them while going to college and had to take care of them both. It was all a big worry.”
As a Black woman who’s married to a white Englishman, the current race issues in this country have generated many family discussions. Her parents originally lived in New York City, where she was born, and were involved in the Civil Rights movement in the 1960s.
“Growing up In London has some parallels, but not the same as the racial tensions with police now happening here,” said Sesay, who came to the U.S. to the Wyss Institute in March 2019. “It’s been a bit of culture shock and has brought up lots of issues for us on how to deal with it.”
One helpful perspective she found in the workshop “is to remember to have compassion, particularly for yourself, before you can help others,” she said. “Otherwise you’ll be running on empty.”
There are many distractions in her life, but especially since taking the workshop, she said she tries to take time in the morning to reflect and be present in the moment. When times get stressful, she’s trying to stop herself from overthinking.
“Rather than get myself all wound up, I’ve been better able to just deal with the situation at hand,” she said.
Opportunity for Healing
Amy Cohen, director of administration of the Harvard/MIT MD-PhD program, said she was attracted to the workshop because “the concept resonated with me in terms of seeing how our past challenges in life play out in the work environment, especially as we’re all dealing collectively with a global pandemic and navigating social unrest.”
The workshop helped her better understand her own anxiety and avoidance of conflicts, she said, and how she might mitigate that in working with others, all the while recognizing that others bring their own past experiences to interactions. The concept of collective healing reminded her of her background in Al-Anon, a 12-step program for people concerned about loved ones with a drinking problem.
“People attend Al-Anon because they want to help or fix somebody else, but what you really need to do is work on yourself, the part you can control,” she explained.
She and several of the students in the MD-PhD program have lost family to COVID-19. When her 97-year-old grandmother died, her family wasn’t able to be together or hug one another. Her silver lining was a beautiful video her cousins put together to honor her grandmother’s life, shown at a Zoom event joined by family from different time zones around the world.
Cohen volunteered at the end of the Hübl workshops to host the first of a series of practice groups for faculty and staff across Harvard who wanted to continue the conversation about applying the tools they learned to life and work.
She found hopefulness in Hübl’s guidance. “Not only that we can move through these crises, but in fact they can be opportunities for healing,” she said.