Professor E. Alison Holman is a leader in the field of collective trauma. Her studies of collective trauma following catastrophic events speak directly to policy makers in state and national legislatures. Her current work – a multi-disciplinary study for which she is in the process of seeking funding – focuses on the compound physical and mental effects of climate-induced catastrophe on a vulnerable county in California.
Holman was one of the very first faculty members employed by UCI’s Program in Nursing Science – the degree program from which the UCI Sue & Bill Gross School of Nursing originated. As such, her work has helped shape a curriculum that reflects the school’s deep concern for health equity and community care.
She began teaching her graduate course on Compassionate Care for Underserved Populations more than 10 years ago. In 2017, she incorporated “a section on climate change and its impact and who it affects most,” because “after Hurricane Harvey, it became obvious that the communities hardest hit were the poorest people in Texas.”
This theme is the natural continuation of a body of published work that meticulously builds evidence around Holman’s lifelong question: “How do people cope with all this trauma?”
Her own nursing career began in a pediatric ICU, where she encountered on a daily basis the impact of children’s health emergencies on the wider family unit. It got her thinking about the group implications of traumatic experience – and how to deal with it.
“From my perspective, we had to take care of the family,” she explains. “We had to think about the psychological processes going on in the family’s minds. When her kid’s in the ICU, yes, Mom’s anxious! And we know that anxiety is the most contagious emotion – that’s a well-known psychological fact. You have a kid with asthma in the ICU who is finally stable, it’s taken several hours to reach this point, then the anxious mom comes in and soon the kid is wheezing again. Bottom line is if you don’t pay attention to the family, you can’t fix the kid. The other nurses called me the psych nurse of the unit – because I always wanted to address the mental health aspect of being in an ICU.”
It became my mission to
E. Alison Holman
understand how people
deal with the overwhelming
trauma in their lives.
Frequently, however, it was the source of children’s injuries that made Holman feel frustratingly powerless to provide help that would make a lasting difference. Daily, she encountered families living with complex layers of difficulty and danger, in the middle of which was a child in crisis. These issues were outside the scope of an ICU nurse, and Holman felt that she needed to do more.
“So many of my colleagues just didn’t address the severity of trauma that families were experiencing,” she says.
She decided to leave ICU nursing to investigate the underlying issues that underserved communities face, what this means for their health, and whether at least some of the traumatic impact on them could be prevented.
“It became my mission,” she recalls, “to understand how people deal with the overwhelming, sometimes cascading traumas in their lives. It remains my passion to this day.”
She is currently part of a multidisciplinary research team seeking to analyze the aftereffects of devastating wildfires on communities in a Californian county that “has an eight-year lower life expectancy than the state of California overall. These communities have a very high rate of mental health problems: suicides, suicide attempts.”
The entire United States pacific coast is at increased and increasing risk of wildfires, with homes in Lake County, California rated the highest risk in the state.
She further explains: “We’re working with engineers who study community infrastructure and its impact on the quality of the water, soil, and air – so we can look at the combined effects of physical toxicity with the mental health toxicity of being ignored or abandoned for years. I’m interested in understanding how the psychological process impacts the physical health of this community.”
The territory is reminiscent of her very first work as a graduate: on leaving the ICU, she studied two California communities that lost more than 300 homes to wildfires in 1993. “California’s wildfires are increasingly climate related,” she reflects, “although climate was not my reasoning then. I was interested in perceptions of trauma – what we then called ‘community-based trauma.’”
In her current study, the impact of climate change on human health is very much a specific focus: “What we’ve seen over the course of the past 20 years is an acceleration in the rate of exposure to major collective events. The curve is going up. After a wildfire the soil’s bad, the lake has been poisoned by toxic run-off – communities depend on that water for various functions – and then you get fire after fire. We’re going to model the accelerating pace of exposure. We’re looking to examine predictors of mental and physical health outcomes in this county.”
Holman speaks with the authority of a researcher whose National Science Foundation-funded work with long-term colleague Roxane Cohen Silver is regularly shared with policy makers in Washington, D.C. For three decades, the research duo has ensured that all their studies involve representative samples of the American population, so that their results can be generalized with the necessary degree of confidence to argue for policy and law.
It’s work that is now informed by years of research in the field of collective trauma, beginning in 2001 with a study of the traumatic impact of the terrorist atrocities of 9/11.
Holman was on holiday in Nigeria, “not watching TV for a couple of weeks,” when the September 11 attacks took place. The impact of discovering, via satellite media coverage at a friend’s home, what was going on in her home country that very day, had an enormous effect on her. “First thing, I didn’t believe it. I was massively affected. I couldn’t sleep for several nights. That was the moment I realized that this is a national collective trauma, and I had to do a study on it.”
The studies that she carried out with Silver on 9/11 and, subsequently, the Boston Marathon bombing (2013) and natural disasters such as Hurricanes Irma and Harvey (2017), amassed evidence about the role of media imagery in accentuating and perpetuating
collective trauma.
She explains: “Extensive media exposure sensitizes people, not desensitizes them. It’s since 9/11 that social media outlets have blossomed. In the aftermath of the Boston Marathon bombing, exposure to bloody images from the bombing site increased the distress of those who saw them – and the more media people consumed, the more distressed they became. Those images can light up the part of the brain associated with PTSD. As people become more distressed, they become more attached to reporting of the event, and media outlets roll the worst, most eye-crashing pictures as they tell the story. It’s a negative cycle. And when you’re watching it in the media, you’re powerless to stop it…unless you turn it off.”
The distress caused by exposure to adverse circumstances that are out of your control is an enduring theme in Holman’s narrative. This distress is particularly severe when it is categorized as “moral distress”: where a person can see the (morally) right thing to do yet sees that it is not being done, while they themselves lack means to, or are prevented from, doing it.
Despite this inability to affect events being central to the kind of trauma she studies, Holman is averse to describing those affected as “powerless.” Her line of inquiry has been driven by an archetypal nurse’s mission to follow the imperative to help others and, crucially, to help others help themselves.
“They’re not powerless,” she says. “It’s that they can see what’s wrong, and it’s just so hard to believe that no one is doing anything about it.”
Dealing with compound trauma and its aftereffects can still be hard for her, too, she acknowledges. But these days, her own distress is somewhat ameliorated by a sense of having helped.
“Being able to share my findings with policy makers helps. Being able to hopefully have that influence on how people address the problems – that makes a difference to me. And teaching about compassion. That’s my biggest bridge to my students – to help them learn ways to work with people in underserved areas – you have to learn how to talk to people! Show respect and understanding. That takes a true compassionate stance.”
Holman is not backing off her mission any time soon. If anyone has the power to reduce trauma by reducing the causes of trauma, she implies, then why would they not use that power? In her new study on the compound results of climate change-related disaster, she knows she is investigating the biggest potential cause of trauma in our times.
“Human-caused harm often leads to a stronger [trauma] response than natural hazards,” she says. “And climate change is creating a much thinner line between the two. The traumatic effects are increased because we see people and government agencies not doing anything about it, and we want them to.”
