BOOK REVIEW Creating Sanctuary - Toward the Evolution of Sane Societies by Sandra Bloom

Creating Sanctuary  - Toward the Evolution of Sane Societies  by Sandra Bloom  1997, Routledge Publishing

Creating Sanctuary is an excellent book to have on the shelf at any program providing support to victims of complex trauma.  Sandra Bloom’s book is over ten years old but I found it to be a refreshing look at trauma and how organizations can build and sustain a sanctuary for victims. 

According to her biography on the Drexel University website, Dr. Sandra L. Bloom is a Board-Certified psychiatrist, graduate of Temple University School of Medicine and recently was awarded the Temple University School of Medicine Alumni Achievement Award. In addition to her faculty position at the School of Public Health at Drexel, she is President of CommunityWorks, an organizational consulting firm committed to the development of nonviolent environments. Dr. Bloom currently serves as Distinguished Fellow of the Andrus Children’s Center in Yonkers, NY.
From 1980-2001, Dr. Bloom served as Founder and Executive Director of the Sanctuary programs (see link at left), inpatient psychiatric programs for the treatment of trauma-related emotional disorders. n partnership with Andrus Children’s Center, Dr. Bloom has established a training institute, the Sanctuary Leadership Development Institute, to train a wide variety of programs in the Sanctuary Model®. The Sanctuary Model® is now being applied in residential treatment programs for children, domestic violence shelters, group homes, homeless shelters and is being used in other settings as a method of organizational development.
Dr. Bloom is a Past-President of the International Society for Traumatic Stress Studies and in addition to being the author of Creating Sanctuary: Toward the Evolution of Sane Societies and she is co-author of Bearing Witness: Violence and Collective Responsibility.

This highly readable book is broken down into five sections.  Section one is a comprehensive view of trauma theory that reviews the research done by a number of experts in the field of trauma and neuroscience.  She includes the physical, cognitive, emotional, social, and behavioral responses and discusses the innate need for the survivor to make meaning out of the trauma that has occurred.  By telling the stories of trauma survivors, Dr. Bloom demonstrates how a victim’s life can become completely organized around trauma in their thoughts, feelings, behavior and meaning making.  Section Two responds to the question “if traumatic experience is so damaging, and human history has been so traumatic, how have we survived and thrived?” by explaining how our attachments to each other and our social groups that follow us from cradle to grave help survivors heal from trauma.  Section Three discusses the social in psychiatry and how some treatment milieus and concepts have not served trauma survivors well.  Dr. Bloom speaks to the impact that feminist theory has had on psychiatry and how it facilitated a shift to a more relational and empowerment based model of meeting the needs of trauma survivors.

In sections four and five, Dr. Bloom takes the reader beyond the usual scope of trauma as an interpersonal issue that is healed within one to one relationships and encourages us to examine reconstruction society as a whole within a sanctuary model.  She lists shared assumptions that encourage the reader to look beyond diagnosing and treating to engaging in the creation of healing sanctuaries.  This includes assessing burnout, vicarious trauma, and practices within the organization that may limit the abilities of advocates and others in providing support.  

The last section, “Toward the Evolution of Sane Societies”, documents the significant trauma that occurs within society as a whole and addresses how the world at large contributes to trauma.  This book was written well before September 11, 2001 and it would be interesting to have an update in regards to Dr. Bloom sees the terrorism and the responses of our government as contributing to the traumatization of individuals and societies. According to Dr. Bloom, the globalization of trauma and the effects on individuals needs to be addressed beyond the scope of individual organizations.  It requires social changes, changes in the way we do business, changes in the classroom, recognizing justice as a force for healing trauma, creating an emotionally literate population, and being willing to bear witness and move beyond just being a bystander.

The depth of this book in addressing the issue of trauma can at times be overwhelming and challenging.  However, Dr. Bloom does an excellent job of outlining the issues surrounding traumatized societies and addressing it by creating a model for sanctuary in our organizations, social service agencies, and political institutions.

This book is being added to the NHCADSV library and is also available on Amazon.com or through your local bookseller.

Using Right Brain Activity to Build Resilience and Assist Recovery from Trauma

I went to a conference this past week and was reading Sandra Bloom’s book, Creating Sanctuary – Toward the Evolution of Sane Societies, on the plane and became a little discouraged as I was reading her chapter on Trauma Theory. I was particularly impacted by the following paragraph on pages 28 and 29:


“Evidence also exists that the massive secretion of neurohormones at the time of the trauma may deeply imprint the traumatic memory (Van der Kolk 1994, 1996c). The neuroscientist Le Doux (1992) has termed this ‘emotional memory.’ In studying the influence of fear in particular, he has shown that emotional memory appears to be permanent and quite difficult, if not impossible, to eliminate although it can be suppressed by higher centers in the brain (Le Doux 1992; 1994). This ‘engraving’ of trauma has been noted by many researchers studying various survivors (Van der Kolk 1994; Van der Kolt and Van der Hart 19931).”

This imprinting of the traumatic memory and the flooding of chemicals into the amygdale (doing center of the brain) appears to make it almost impossible for a survivor of trauma to be able regulate their emotions and they will continue to respond to life events and relationships as if the trauma is ongoing. If this is so, how can advocates possibly hope to be able to work with and assist survivors in making positive changes in their life?

Fortunately, the Self and Family Conference provided some answers so that I was able to return feeling less discouraged and more empowered.


Using Right Brain Activity

There were a number of speakers, including Stephanie Covington, Judy Crane of the Refuge, and Cardwell Nuckols who spoke on using right brain activities to calm down the spin cycle of the amygdale, move away from the constant interpretive cycle of the left brain, and empower the survivor by engaging them in activities in which they can gain some competence and make meaning out of their experience.

The left brain is responsible for trying to make sense of the world and the perception of self. For trauma survivors, trying to make sense out of trauma can keep them in a cycle of constantly responding to the world as if the trauma is ongoing. By engaging in right brain activities, i.e. art work (collages, painting, drawing), music (drumming, dancing), exercise (yoga, Tai Chi or Qi Gong) and writing (poetry and short stories), a person is able to engage the brain in other activities that generate competency, slow down the left brain activity that keeps them in constant hyperarousal.

Judy Crane of the Refuge (see links to the left) gave a couple of dramatic examples. She told the story of a woman who had been severely sexually abused by her grandmother when she was three years old. This woman was given the materials and support to create a figure out of soda cans and Marlboro cigarette packs (her grandmother smoked Marlboros and drank a lot of diet coke). The woman put pieces of paper in the cans that described how she felt. She was given permission to show her work and then she used Judy’s golf cart to flatten the cans. The work that went into the can sculpture enabled her to be able to create, move out of the left brain, and feel empowered.


Another client of Judy’s was using self cutting as a coping mechanism. She was given red and black paint and was encouraged to use this as a way to focus her pain rather than causing self injury as the self harm was disrupting to the other inpatients. Within a few weeks, the client had gone from cutting herself to creating significant art that showed her progression from hurting to healing.

There is a lot of research out there about the calming effects of yoga, Tai Chi, and even aromatherapy. I was also given information on Soul Collages (see link to the left) and integrative medicine (I hope to expand on this in the future).


The Healing Relationship

There is more and more evidence in the mental health field that the primary catalyst for healing in trauma survivors has little to do with the mode of treatment. It is the “therapeutic relationship.” In domestic violence and sexual assault work we can refer to it as the “healing relationship.” Being as genuine, empathic, and knowledgeable of the impact of trauma on survivors as we can, we can assist them in beginning the road to recovery. This is difficult to do in situations when the survivor is still being impacted by the activities of the abuser, but can open the gateway to slowing down the hyper activity in the left brain and increases their sense of safety and trust in the advocate.

Another note: Anyone Can Provide Trauma Informed Services

Stephanie Covington, PhD. was quick to discuss how any provider can be trauma informed. In addition to speaking around the country about her programs for women, trauma and recovery, she also has talked to other providers about how to be trauma informed. She has even met with her dentist’s office to discuss how they can be more trauma informed i.e. explaining to the patient in advance each move and being responsive to how the weight of the apron worn during x-rays could be triggering. The dental office changed their procedures to be more trauma informed and uses these procedures for everyone so there is no need to question patients about their trauma history.



The conference was very informative and I hope to write more over the next few weeks about what I learned from experts in the areas of trauma, substance abuse, and mental health.