You Cannot Be Trauma-Informed and Still Diagnose and Medicate People.

Dr Jess argues that the faux trauma-informed movement is still pro-psychiatry - and still pathologises victims of abuse and trauma.

‘Trauma-informed’ has become a buzzword. I warned that it would, years ago.

It was so obvious. Now even the APA are trying to revive the DSM by claiming that they have ‘discovered’ that many mental disorders are actually linked to… trauma.

Wow. Round of applause.

Even they are jumping on the trauma-informed bandwagon.

And that’s why I need to write this out for you all - as a warning.

It is everywhere. Police forces are trauma-informed. Charities are trauma-informed. Therapists are trauma-informed. Entire health systems now claim to be trauma-informed. Prisons claim to be trauma-informed. The language has spread rapidly, almost unquestioned, and with it has come an assumption that something meaningful has changed.

But let’s be honest, it hasn’t.

Women are still being pathologised. Victims are still being diagnosed. Survivors are still being medicated. People disclosing abuse are still being funnelled into psychiatric frameworks that locate the problem within them rather than in what was done to them. The systems themselves remain largely intact. Only the vocabulary has shifted.

So I want to make a very clear argument: you cannot be trauma-informed if you are not anti-pathology. The two positions are fundamentally and theoretically incompatible.

What we are seeing is not a trauma-informed revolution. Getting CPTSD recognised is not a trauma-informed revolution, ladies. It is the addition of yet another mental disorder to diagnose you with. The D on the end stands for disorder, don’t you ever forget that.

What we are witnessing is the absorption of trauma into existing systems that have no intention of transforming themselves. The language of trauma has been adopted, but the underlying assumptions about human distress, disorder, and treatment have not been challenged. Instead, trauma has been layered over the top of psychiatric models as a kind of explanatory add-on, a way of softening the edges without altering the core.

This creates an illusion of progress. Services now talk about trauma. They may ask about it, acknowledge it, even validate it in passing. A practitioner might say that a person’s behaviour is linked to trauma, or that their experiences have had an understandable impact. But what follows is often entirely predictable. The same person is assessed, diagnosed, labelled, referred, and frequently medicated. The endpoint remains unchanged.

This is not trauma-informed practice. It is psychiatry with better public relations.

The contradiction at the centre of this model is stark. You cannot simultaneously claim that what happened to someone matters and their trauma responses are valid, and then proceed to define their responses as evidence that something is wrong with them. Yet this is exactly what is happening across services every day. A woman discloses domestic abuse and is told her distress is understandable. Her trauma is acknowledged, sometimes even emphasised as part of a trauma-informed approach. And then she is diagnosed with a disorder, or referred into mental health services, or offered medication as a solution.

What has actually been achieved in that moment? The abuse has been named, but its impact has still been relocated inside her as pathology and mental illness. This is not validation. It is simply a more palatable form of the same old logic. The focus shifts, almost imperceptibly, from what was done to her to what is now wrong with her.

Many so-called trauma-informed services have, in effect, created a softer pipeline into psychiatry. Controversial, I know. But someone had to say it.

Instead of dismissing victims outright, they acknowledge trauma, validate distress briefly, translate that distress into symptoms, and then route the individual into diagnosis, therapy, or medication. It feels kinder. It sounds more progressive. But the outcome is the same. The individual becomes the site of the problem, and once that happens, the original trauma is deprioritised.

We are no longer dealing with your abuse. We are dealing with your mental health condition.

This becomes particularly concerning in services designed to support women and girls subjected to violence and abuse. These spaces are often explicitly branded as trauma-informed, which implies safety from judgement, blame, and pathologisation. Women enter these services expecting to be understood in context, to have their experiences recognised without being reduced to diagnoses. And yet many of these same services continue to rely on psychiatric frameworks to interpret women’s responses, encourage or facilitate diagnoses, and refer women into mental health systems as a routine pathway.

The result is a profound contradiction. Women seek refuge from systems that have historically misunderstood and pathologised them, only to be gently guided back into those same systems under the banner of trauma-informed care. This is not simply ineffective. It is misleading. It creates a false sense of safety in which the language suggests liberation from pathologisation, while the practice reproduces it.

The same pattern can be seen in policing. Forces now describe themselves as trauma-informed, and officers are increasingly trained to understand trauma and its impact on behaviour. This is often presented as a significant cultural shift. But in practice, victims are still referred into mental health services, their credibility is still subtly assessed through psychological frameworks, and their distress is still interpreted as instability, vulnerability, or risk. Psychiatry remains the underlying lens through which victims are understood, even when trauma language is layered on top.

I write and deliver the anti-pathology training across police forces, and I often see ‘trauma-informed training’ that came before me, and it is littered with mental disorders, pathologising language and a total misunderstanding of trauma.

Don’t even get me started on the bullshit about victims’ brains going ‘offline’ and perpetrators being ‘wired up differently’ that I have to delete out of training packages every week.

So again, we are left with the same question: what has actually changed?

If trauma-informed practice is to mean anything at all, it must begin with a fundamental shift in how we understand human responses to harm. There is nothing inherently wrong with a person who has been traumatised. Their responses are not symptoms of disorder. They are human, adaptive, meaningful responses to what has happened to them. They make sense in context.

The moment we introduce diagnosis, disorder, or pathology into that framework, we alter the entire focus. Attention moves away from the abuse, the perpetrator, and the context, and onto the individual’s functioning, symptoms, and treatment. That shift is not neutral. It reflects a deeply embedded ideological position about where problems are located and how they should be addressed. And it directly undermines the very foundation of trauma-informed work.

This is why the idea that we can be both trauma-informed and pro-pathology is so problematic. These positions cannot coexist without contradiction. You cannot claim to centre trauma while simultaneously reframing trauma responses as indicators of disorder. You cannot validate someone’s experience while diagnosing their reaction to it as dysfunctional. At some point, the tension between these positions becomes impossible to ignore.

That point is now.

We need to be far more honest about this as a sector. If trauma-informed practice is to be more than a superficial rebranding exercise, it must involve a rejection of the pathologisation of trauma. It requires us to move away from diagnostic frameworks as the default response to human distress and to stop routing victims into systems that fundamentally misunderstand their experiences. It demands a complete reframing of distress as meaningful rather than disordered.

Anything less than that is not transformation. It is adaptation. Or manipulation.

And right now, much of what is being presented as trauma-informed practice is simply the adaptation of existing systems to new language. The structures remain the same. The outcomes remain the same. Only the way we talk about them has changed.

If your practice still locates the problem inside the traumatised person, you are not trauma-informed. If you diagnose your clients, you are not trauma-informed. If you push medication, you are not trauma-informed. If you convince women to go to hospital or doctors when they are traumatised, you are not trauma-informed. You have just learned new words to describe the same old ideas.

I am throwing down the gauntlet.

Are you with me?