When “Patient and Family Relations” Becomes Part of the Harm

The original harm was devastating. What happened afterward taught me just as much about the system.

After the psychiatric abuse, I contacted the hospital so-called Patient and Family Relations Department. I expected a process that was interested in understanding what had happened, looking at where things went wrong, and preventing it from happening again.

Instead, I found a protracted, painful, do-everything-you-can-to-make-the-person-shut-up-and-go-away experience. I have a stack of letters from that department, mostly stonewalling and word salad.

They wondered why I kept coming back. Most people gave up after a few tries. I hung in there probably longer than anybody ever had. Part of the reason was because I wanted to see what the system would actually do. Not just for me, but for anybody who reported serious harm. I took notes on every interaction and saw the patterns.

It took eighteen months just to get a meeting. And the meeting wasn’t even with the psychologist whose actions had caused the harm. Instead, it was with two physicians from the same satellite facility. It seemed like they hadn’t been briefed in advance. Their faces wore matching “thrown under the bus” expressions, with eyes like silver dollars.

Oddly enough, their surprise turned out to be the best part of the whole process. Unlike the Patient and Family Relations personnel, their responses weren’t scripted for legal security. They were genuinely shocked and upset by what I described had happened to me in that facility.

I felt bad for them because it appeared they had walked into a booby trap. Knowing that made me even more determined to treat them with respect. I didn’t go off on them. They weren’t responsible for any of my problems.

I brought with me a list of intervention points that had been missed. Any one of them could have prevented the manufactured mental health crisis I experienced after being given a pharmaceutical “remedy” for the distress that came from a lifetime of abuse. As we went through the list, they became increasingly engaged. They were impressed with what I had put together and asked if they could keep it.

From an Interpersonal Neurobiology perspective, people make sense of their experiences through relationships. Institutions do the same. When a system responds to reports of harm with delay, deflection, bureaucratic language, and endless process instead of curiosity and accountability, it teaches everyone inside it how not to respond. The complaint process stops being a path toward repair and becomes another layer of the injury.

I wonder where those two doctors are today. My guess is they’re long gone from that hospital. It is hard to imagine they could go through that process and go back to business as usual. Who would want to stay in a place that treated patients that way? And who would want to practice medicine in a system that treats its own doctors that way, too?

Unfortunately, the psychiatric abuse was just the beginning for me. The non-consensual gynecological surgery–medicalized genital mutilation–was even worse. I didn’t turn to Patient and Family Relations for help. I knew from prior experience that it’s the soft end of the hospital’s legal department. Its goal is not helping distressed patients and families, but containing their distress, extinguishing their expression of it, and protecting the institution’s fiduciary, reputational, and administrative interests.

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The Problem With Functional Medicine

Functional medicine presents itself as a more complete approach to health, but, like mainstream medical treatments, it focuses on individual physiology and treats the body as the primary site of explanation and intervention. Distress is framed as the result of internal imbalance, measurable through lab values and addressed through protocols, supplements, and lifestyle prescriptions. This determines what is seen and what is ignored.

Functional medicine consistently underaddresses the role of relationships and social conditions in shaping health over time. Human regulation is affected by ongoing interaction with caregivers, partners, institutions, and communities. Early relational harm, chronic insecurity, social exclusion, housing instability, and institutional abandonment leave lasting physiological effects. Functional medicine tends to compress all of this into the category of stress, which reduces complex lived conditions into a background variable rather than a primary driver.

The neurobiological dimension is also treated narrowly. Functional medicine often measures downstream correlates such as hormones, inflammatory markers, or neurotransmitter byproducts. These can describe a state but they do not explain how that state developed or how it is maintained through daily interaction with the environment. Regulation is treated as chemistry rather than as an ongoing process created by safety, predictability, and connection. As a result, cause is often misattributed. Effects of chronic relational strain or systemic precarity are reframed as internal dysfunction requiring individual correction.

This approach aligns well with a market-driven healthcare environment. Expansive lab panels, repeated testing, and long-term supplement regimens are costly and usually paid out of pocket. Promises of personalized answers and root causes appeal to people who have been dismissed or underserved elsewhere. The structure rewards certainty and intervention even when the evidence is thin. When improvement does not occur, responsibility quietly shifts back to the individual for not following the protocol closely enough or for having a body that is too complex.

Another problem is that functional medicine relies on continuity and resources that many people do not have. Trauma, poverty, and housing insecurity disrupt continuity. When care models require consistent attendance, sustained purchasing power, and stable life conditions, they systematically exclude the people most affected by chronic stress and relational harm. The model then interprets dropout or nonresponse as individual noncompliance rather than as a predictable outcome of structural strain.

Functional medicine is not entirely without value. Some practitioners are careful and restrained, and some physiological issues do benefit from closer attention to diet, inflammation, or metabolic health. The problem is that biology is treated as separable from relationship and context. Health is produced through interaction over time, not solely through internal adjustment.

When relational conditions are ignored, care is incomplete. When neurobiology is reduced to lab values, regulation is misunderstood. When social systems are left out of the analysis, individuals are left holding responsibility for conditions they did not create. That is the core limitation of functional medicine. It promises a whole-person approach while leaving out the conditions that make whole-person health possible.

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What Every Sex Abuse Story Has in Common: The Patterns That Protect Predators

Here is a very short list of the most common denominators in sex abuse and trafficking stories, grounded in lived experience, trauma research, and systemic patterns:

1. Power imbalance. The abuser holds more social, economic, institutional, or physical power than the victim.

2. Grooming and manipulation. Trust is slowly gained and boundaries are broken down over time.

3. Silencing systems. Institutions (families, churches, schools, hospitals, justice systems) protect perpetrators and disbelieve or punish victims.

4. Victim isolation.The survivor is made to feel alone, ashamed, or responsible, which keeps them from seeking help.

5. Repeated betrayal.The most lasting damage often comes from those who failed to intervene, covered it up, or blamed the victim.

We have to talk about this. It’s the only way it stops. Abuse thrives in silence, and every time we speak up, we break a piece of the pattern. Because it is a pattern, predictable, repeated, and protected. Jeffrey Epstein, Robert Hadden, Earl Bradley, Larry Nassar, and George Tyndall all operated for years inside respected institutions. They were surrounded by people who looked the other way, made excuses, or actively covered for them. This isn’t about isolated monsters. It’s about systems that enable abuse, discredit survivors, and protect power. Until we name the pattern it will keep repeating. And until we are willing to listen, believe, and hold those systems accountable, more lives will be shattered. Speaking is an act of courage and a necessary disruption.

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Gynecology’s Outrageously Dirty Secret:  Medicalized Female Genital Mutilation

“Gynecology’s Outrageously Dirty Secret: Medicalized Female Genital Mutilation,” watercolors, ink, psychiatric hospital pencil. 12×9

Modern gynecology grew from violent roots. J. Marion Sims, celebrated by some as the “father of gynecology,” performed repeated surgeries on enslaved Black women in the 1840s without anesthesia or consent. He justified it by falsely claiming they didn’t feel pain like white women. He operated on women, over and over–including 30 surgeries in four years on one named Anarcha–to develop techniques he would later use on white patients, with anesthesia. His work is foundational to a field built on exploitation.

From there, gynecology evolved within a broader system that medicalized and pathologized women’s bodies–especially Black, brown, and poor women–often without addressing consent, autonomy, or justice.

That legacy persists today in deeply disturbing ways. One example is the widespread practice of non-consensual pelvic exams performed on unconscious women during unrelated surgeries, often by medical students. These violations have been documented for decades. Only recently have some states passed laws to outlaw them. That these laws are even needed says everything. But gynecologists often perpetrate far worse violations.

Brooke Shields revealed that her doctor performed a non-consensual “vaginal rejuvenation” procedure, tightening her vaginal opening without asking her, then boasted about it. It’s not an isolated incident. Many women still undergo non-consensual procedures, especially under anesthesia.

Today’s gynecology still carries echoes of its abusive roots, especially the way power is often wielded over patients, sometimes with coerced or no consent. Non-consensual surgeries, like the so-called “husband stitch,” where a doctor adds extra sutures to a woman’s perineum after childbirth to increase vaginal tightness for the satisfaction of a male partner, are reportedly still performed. Many women aren’t asked or even told, only discover it later, often after enduring chronic pain, sexual dysfunction, or shame they were told was “normal.”

A Durham University article states that, “The husband-stitch appropriately fits into the WHO’s definitions of FGM [Female Genital Mutilation]. Since both practices include stitching female genitalia without women’s consent for non-medical reasons, they are abusive practices. This means that like FGM the husband-stitch is a human rights violation of bodily integrity, which is the right to have one’s body not touched or interfered with without one’s consent. This includes any forceful breaking or alteration of an individual’s body.”

No clinical, large-scale statistical studies exist that measure the exact frequency of the “husband stitch”. Because the procedure is medically unendorsed, unscientific, and constitutes severe malpractice, doctors who perform it do not document it in medical records or report it to databases.

A University of Miami, Miller School of Medicine study reports that “This procedure has serious negative health consequences, including dyspareunia and vaginal prolapse. There is a lack of treatment options for health consequences resulting from the Husband Stitch. The women expressed social isolation, and while they have not been diagnosed with mental health disorders, expressions of shame and helplessness are DSM-5-TR criteria for depressive disorders and post-traumatic stress disorders, raising concern for mental health consequences that may result from the ‘Husband Stitch.’”

Yet, the mainstream culture seems to be unconcerned. Brooke Shields’ story hardly raised eyebrows over how common this is as a systemic failure to treat women as full, autonomous human beings. Instead, media focus was overwhelmingly on the sensationalism of the individual act as it pertained to a famous personality, as Shields had expected.

A comprehensive global meta-analysis published in the Journal of International Gynecology and Obstetrics established that the global prevalence of obstetric violence sits at about 55%, with non-consented medical care being the single most common violation at 33%. In addition, cross-sectional data collected by advocacy groups like the Birth Trauma Association found that 40% of women reported undergoing physical procedures during labor—ranging from membrane ruptures to vaginal tearing repairs—without providers seeking or obtaining their explicit consent. 

Some women report that their doctor installed pelvic mesh implants without consent. “Many women harmed by mesh have been forced to live with a constant reminder of this lack of consent and abuse of trust, as they deal with significant health problems and difficulties in accessing mesh removal.”

A common gynecological procedure is the perineorrhaphy, in which the doctor cuts away some of the perineum and tightens the underlying pelvic floor muscles with stitches. A survey of gynecologists showed that in 35% of perineorrhaphy cases the practitioner made the decision in the operating room, without necessarily obtaining specific consent. Deep tissue healing, nerve regeneration, and scar tissue maturation in the perineum frequently take 6 months or longer. Because the perineum is a highly sensitive, high-pressure area that moves every time one sits, walks, or goes to the bathroom, long-term discomfort is very common. Gynecologists’ decisions to perform the procedure is based on their “belief” that it helps, but “there is a lack of evidence to support whether this operation benefits patients by measures of improved quality of life, sexual function, or decreased prolapse recurrence.”

Also disturbing, women are often gaslit about their pain after non-consensual gynecological surgery. They’re told it’s in their head, that postpartum sex is supposed to hurt, or that it’s just part of being female. These practices, amplified by posts and testimonies across platforms like Reddit, indicate a pattern of ongoing obstetric and gynecological violence, particularly against women of color, disabled women, and others in vulnerable positions.

The normalization of these abuses extends beyond the doctor-patient relationship in traditional clinics; it is deeply embedded in carceral settings where bodily autonomy is stripped entirely. This is perhaps most starkly illustrated by the 2020 allegations regarding the Irwin County Detention Center (ICDC) in Georgia. There, more than 40 women detained by U.S. Immigration and Customs Enforcement (ICE) accused a gynecologist of performing invasive, unnecessary procedures, including hysterectomies, without their explicit or informed consent. These acts echo the darkest chapters of American history, including eugenics-era forced sterilizations, and demonstrate how vulnerability–whether based on disability, immigration status, or poverty–is weaponized by a system that treats marginalized bodies as disposable assets for institutional control.

The system still treats many women, especially those most marginalized, as if their bodies exist for practice, control, or someone else’s benefit. It’s not medicine if it’s done without consent. It’s sexualized violence, and often, Female Genital Mutilation. And it’s still happening. Because institutions and organizations permit it.

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Trauma in a White Coat: Why Survivors Are Blamed and Predators Protected

The most dangerous predator is not the stranger in a dark alley, but the familiar one in a white coat, protected by institutional walls, bureaucratic scripts, and a system trained to look the other way. Medical institutions, licensing boards, and state legal systems have built layers of insulation around healthcare practitioners who cause deep, life-altering harm. They treat those harmed as too emotional, too sensitive, or even mentally unstable. This isn’t medicine. This is sanctioned abuse. 

At the core, this is a nervous system issue. When someone undergoes a traumatic medical violation, the brain and body respond with all the alarms of survival: freeze, shut down, or fight to be heard. But survivors are met not with care or co-regulation, but with cold process, scripted statements, and defensiveness. This is a personal betrayal and a systemic rupture.

Through Interpersonal Neurobiology, we know that healing requires safety, attunement, and accurate mirroring. Institutions designed to protect predators do the opposite. They gaslight, dismiss, and shame. They violate again, with legal language instead of pills or surgical tools.

We are told to be rational. To file complaints. To trust the system. But the system operates from a state of emotional disconnection and moral disengagement. It is, in effect, psychopathic: lacking empathy, incapable of repair, and fully invested in preserving its image and authority. It uses cold tone, rigid protocol, and power asymmetries to protect itself, while dysregulating and destroying the nervous systems of those who dare to speak out.

Predators thrive in this environment because the institution does not feel. It calculates to protect the white coat, not the human being whose body was violated. And when survivors are angry, protest, or write letters naming the harm, that becomes the problem. Not the abuse. Not the lifelong trauma. But the survivor’s tone.

This inversion of harm and accountability smashes people. The original assault was too much, and then we face the impossible task of being expected to heal in a world that stands against healing, because it insists nothing wrong ever happened. It punishes the truth-teller, while wrapping the perpetrator in prestige, credentials, and legal armor.

There is nothing healthy about this. There is nothing regulated or relational. This is not how healing happens. It is how trauma metastasizes, generation after generation.

If we want to build a truly healthy system, we must name what this is. And we must stop pretending that a medical culture built on dissociation and denial can offer safety to anyone.

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“You Can’t Count on Anything”: The Birthday Dinner I Never Forgot

On my twenty-fifth birthday, my father took me out to dinner, just the two of us. That had never happened before.

He insisted I order the Oysters Rockefeller. I had never had them. They were incredible. I remember sitting there feeling like a princess. For that one evening, I believed I was being seen, chosen, celebrated.

Toward the end of the meal, he handed me a birthday card. Every birthday and Christmas for years, my siblings and I had each received a check for one hundred dollars. It was predictable. That year was different. Inside the card was a check for fifty dollars. My brother had told him I was struggling financially and that I was counting on that birthday money to help me get through the month. My father knew that. He looked at me and said, “You can’t count on anything.”

People sometimes hear a story like this and think the injury was about fifty dollars. It wasn’t. If he had simply decided to give me fifty dollars that year, it would have been disappointing. Instead, he first created an experience of feeling special. He took me somewhere nice. He encouraged me to order something I never would have ordered for myself. He created a sense of caring. Then, when I was open to receive it, he took away the ground beneath me. That is a very different relational experience. It was premeditated abuse, a classic control tactic called the Idealize, Devalue, Discard Cycle. It is often used by people with strong narcissistic traits, or by individuals setting up an emotional or financial scam.

Our brains constantly learn what relationships mean through repeated experiences. We do not just remember events. We learn patterns. If care is consistently followed by humiliation, the body begins to associate the two..If generosity is followed by punishment, generosity no longer feels entirely safe. If someone repeatedly creates hope only to remove it, hope itself can begin to carry uncertainty. These are the patterns my father repeated throughout my life.

This is one reason developmental trauma is often misunderstood. People focus on the individual events while missing the sequence.

The nervous system always asks, “What usually happens next?” In healthy relationships, comfort is followed by more comfort. Repair is followed by trust. Celebration strengthens connection.

In unhealthy relationships, comfort may become the setup for humiliation. Kindness may become the doorway to control. Safety disappears just when it seemed possible. Over time, the body learns that opening to connection carries risk. That does not stay confined to the original relationship. It can affect how we experience friendships, intimate relationships, healthcare, workplaces, and communities. Someone offers kindness, and another part of us waits for the other shoe to drop because that happened before. Again and again. This is not pessimism. It is learning.

The encouraging part is that learning is not finished. Just as repeated experiences taught those expectations, repeated experiences of consistency, honesty, and respect can slowly reshape them. Our brains continue learning from lived experience throughout our lives.

The birthday dinner has stayed with me for decades, not because of the restaurant or the money, but because it revealed a relational pattern that had been there all along. The lesson my father wanted me to learn was that I shouldn’t count on anything.

The lesson I have spent the rest of my life learning is that some people actually can be counted on, that those relationships change us in ways every bit as real as the harmful ones did, and that at that dinner, my father showed me exactly who he was.

 

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“Isn’t That How It Works?”

One of my doctors was telling me about his path into medicine. He attended a highly prestigious private school. He went on to say that there, he met a mentor who connected him with someone at Georgetown University. That relationship helped open the door to medical school. Then he said, “Isn’t that how it works?”

He wasn’t being insensitive or boasting, only describing the world as he has experienced it. But standing there with him, I was struck by how different our worlds have been.

I was the second unwanted girl in my family. The boys received the resources. My sister and I experienced childhood sexual abuse. We were told we didn’t need college educations because we could marry men who would take care of us. Our brothers, we were told, needed an education because they would have families to support. (One of them never had children, although both my sister and I did, and eventually became single parents.)

The family system was organized so the resources flowed toward them. Opportunity accumulated around them. My sister and I learned that our futures mattered less. That is also “how it works.”

Today, my doctor visits art exhibitions in famous museums around the world. I spend my time asking for injections that reduce my pain enough that I can keep trying to build an income while recovering from a lifetime of abuse, including by men whose own positions were shaped by privilege and power. These are not simply different life choices, but different developmental environments.

From the perspective of Interpersonal Neurobiology, relationships and environments shape development. They shape expectations, confidence, opportunity, health, education, and the social networks that become available over time. Every relationship either expands or constrains what becomes possible next.

When someone grows up surrounded by mentors, educational opportunities, financial stability, and people who know people, those advantages can become invisible. They feel normal. It becomes easy to assume everyone has similar access if they simply work hard enough.

That is one way privilege maintains itself. Not necessarily through arrogance or bad intentions, but through limited awareness of experiences outside one’s own.

When I heard, “Isn’t that how it works?” I was reminded that many people have never had to imagine what life looks like when there is no mentor, private school education, or introductions. When there is no family encouraging your education, no financial safety net, and no one opening doors.

Some people inherit relationships that create opportunities. Others inherit relationships that create obstacles and setbacks. Neither group builds their understanding of the world in isolation. We all make sense of reality from the environments that raised us. If we never examine those environments, we can mistake our own experience as universal. Then it’s easy to believe that others, who haven’t fared so well, simply “made bad choices.”

Understanding that difference does not assign blame. It reveals more of the picture. Because “how it works” depends a great deal on where you were when your life began.

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“How Would You Like to Proceed?”: The Role of Agency in Safe Medicine

A recent visit to my dermatologist inspired me to write about the relationship between safety and agency.

We’d already had four appointments before this visit. She always asked permission before touching me. Every time, she explained what she was doing and asked what I wanted to do. She has shown me again and again that she’s safe. She hasn’t ruptured the connection. She’s conscientious and understanding, and even remembers the Patel Pause because she put a pop-up in my chart.

I had asked for a pop-up about my needs as a trauma survivor on my chart at ChristianaCare, but the Patient and Family Relations department representative told me they couldn’t do that. She told me that instead I should carry an explanatory piece of paper in my pocket at all times and hand it to practitioners, including in the ER. As if anyone in the ER is going to stop and read something a patient hands them.

My dermatologist’s approach builds support into the encounter. The hospital’s solution places the burden of sufficient care on the patient.

At my last dermatology appointment, I needed to have some spots checked in a part of my body that nobody has seen in a very long time. Even after four positive experiences with her, I was anxious about the exam. That was natural and normal due to the location and my history.

Because I understand that speaking aloud about our internal state helps us regulate, and so does sharing our difficulties, I said, “This is very difficult for me.”

My dermatologist nodded and asked, “How would you like to proceed?” That reinforced my agency, which helped me feel immediately ready to proceed.

Safety is not only a person who is kind or knowledgeable. Safety also depends on whether we have choice. Our bodies need to know: Can I say yes? Can I say no? Can I slow this down? Can I ask questions? Can I change my mind? Will my boundaries be respected?

Our nervous system is constantly assessing not just whether we are in danger, but whether we have agency. When we have choice, when our boundaries are respected, and when we can influence what happens next, our body is more likely to settle. When choice is removed or ignored, our body is more likely to move into protection.

This is one reason healthcare can be so difficult for people with trauma histories, especially after experiences of medical betrayal. The problem is often framed as anxiety within the patient when it is frequently a sensible response to environments where agency has been repeatedly taken away.

Consent is not a signature on a form, but an ongoing process of collaboration. It sounds like, “Is it okay if I touch you here?” “Would you like more information first?” “Do you want to take a break?” “How would you like to proceed?”

These are simple questions, but they change the experience of care because care feels different when it happens with us instead of to us.

 

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Bystander Complicity: An IPNB View

From an Interpersonal Neurobiology (IPNB) perspective, the nervous system operates relationally, meaning that safety, trust, and connection are deeply shaped by social environments and relationships. Bystanders who witness abuse but fail to intervene may experience internal conflicts between their own safety and the moral imperative to act. Their nervous systems might prioritize self-preservation over the risk of confronting someone with more power, thus inhibiting action.

This dynamic can be explained through the lens of differentiation and integration:

Lack of Differentiation: Many bystanders fail to differentiate themselves from the social or power structures they are part of, such as the entertainment industry. Instead of acknowledging their own responsibility or agency, they become fused with the status quo. The inability to differentiate oneself from the corrupt system leads to passivity or compliance, as their actions are shaped by the norms of the group rather than individual moral integrity.

Impaired Integration: Integration involves linking differentiated parts—acknowledging both one’s individuality and the relational aspects of being part of a larger society. In the case of these bystanders, the failure to integrate their awareness of the abuse with the need for moral action leads to emotional dissonance. They may suppress their discomfort by rationalizing their silence or convincing themselves they have no choice but to remain passive. This lack of integration stifles any potential action to protect victims.

Fear and Immobilization: The nervous system’s response to danger, especially when the danger comes from a powerful individual or institution, often leads to immobilization. Bystanders may experience a fight-flight-freeze response, and in many cases, freeze becomes the default option. They may feel helpless to act against the influence of someone like Diddy, whose power could have social, financial, or personal consequences for them.

Compromised Agency: For those who are aware of the abuse but do nothing, their own agency becomes compromised by external pressures. They may feel trapped by a culture that rewards silence and punishes those who speak out. Their autonomy is overshadowed by the fear of social or professional repercussions, which ultimately reinforces the cycle of abuse.

Neurobiological Shame and Cognitive Dissonance: Over time, bystanders who remain silent may experience shame, as their inaction contradicts their internal moral values. This cognitive dissonance can create internal stress, leading to psychological and emotional consequences. However, to avoid facing this discomfort, many may engage in further denial, distancing themselves emotionally from the victims and reinforcing their complicity.

Relational Trauma: For the victims, the betrayal by these bystanders adds layers of relational trauma. It’s not just the abuse itself but the fact that others—who could have intervened—stood by and let it happen. This lack of support disrupts the victim’s sense of safety, belonging, and connection, deepening their trauma.

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Noticing Safety in the Small Moments We Overlook

Walking home from the community garden, I saw a young man coming toward me on my street. It was Independence Day weekend and there was a local event happening nearby, so there were more people around than usual, including people who don’t normally move through this area.

While we were still several yards away he asked, “Hi, how are you?” in a tone that rang with authenticity.

I said, “Fine thanks, and you?”

He said, “ I’m fine thank you.”

I asked, “Are you going to the festivities?”

He said, “Yes. It’s a really nice weekend.”

I said, “It is. Have a good time!”

He said, “Thank you. Enjoy your weekend!”

It was a brief, predictable, social interaction. Two people passing on the street, exchanging basic recognition and orientation. But my nervous system shifted. I felt a surge of activation, a kind of sudden relief that showed up so strongly it brought me to tears after he walked on.

The strong feeling was due to what the interaction represented in the context of the last eight years of my life, where so many relational experiences have involved threat, disruption, lack of protection, inconsistency, or being left to manage things alone.

From an Interpersonal Neurobiology (IPNB) lens, what happened in the street was simple and very important. The nervous system constantly recognizes cues of safety and cues of danger in relationship. It notes tone, timing, predictability, recognition, and whether another person responds in a way that is coherent and non-threatening.

In this case there was recognition and reciprocity. There was also no demand, intrusion, unpredictability, or evaluation. Just an ordinary human exchange. And because those kinds of exchanges have been limited and often overshadowed by more harmful relational experiences over time, my system did not treat it as “small.” It treated it as meaningful.

This is where a lot of cultural misunderstanding happens. We are taught to look for safety in large narratives: one safe person, one secure relationship, one stable place that will finally make everything okay. That story is everywhere. It is also incomplete.

I have learned that, as this moment made very clear, connection is often built in much smaller increments. It is built in everyday interactions that signal: you are seen, you are not in danger with me, you can move through this moment without having to defend yourself.

Those signals accumulate. They do not replace deeper relationships, but they create the conditions where deeper relationships become possible without overwhelming the system.

From an IPNB perspective, the concepts of titration and pendulation are important. The nervous system does not shift through force or insight alone. It shifts through small doses of experience that move between activation and settling, between contact and return, between engagement and rest. When the dose is too large, the system can be flooded. When it is too absent, it can stay isolated. The middle range allows change to integrate.

This does not only happen in rare moments. It can happen repeatedly if you are in environments where these kinds of exchanges are possible: walking where people are present, acknowledging others in passing, brief respectful contact, small mutual recognition. It can also happen online in conversation that feels coherent and non-threatening. The form is less important than the quality of the interaction.

The important part is learning to notice what your own system does with these moments. Some people feel nothing. Some people feel a small softening. Some people feel a wave of relief or grief or release. None of those responses are wrong. They are information about how much relational safety has been available and how the system has adapted to what it has had to work with.

And it is also important to go at nervous system speed. Not forcing more contact than your system can hold. Not interpreting activation as failure. Not assuming that bigger is better. The changes that last tend to come in small steps that can actually be integrated, repeated, and built on over time.

Like I did, you can use the principles of IPNB to guide you. These two Trauma Aware America articles are made to help:

“IPNB-Informed Recovery Plan for Stress or Trauma”

IPNB-Informed Recovery Plan for Stress or Trauma

“Cultivating Safe Relationships When You Have No Support”

Cultivating Safe Relationships When You Have No Support

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