What Trauma Makes Impossible

Guest post by Susan Ousterman

Note from Kathleen:

Every so often, I come across a piece of writing that says something so clearly I simply want to share it.

This guest essay is by my friend Susan Ousterman, founder of the Vilomah Foundation

https://www.vilomahfoundation.com/

an organization dedicated to supporting parents after the death of a child.

While Susan writes from the experience of losing her son, Tyler, her message reaches far beyond grief. She reminds us that trauma changes the brain, often impairing the very abilities we depend on to care for ourselves and make healthy decisions.

As I read her words, I couldn’t help but think about the families I meet every day. We often ask, “Why won’t they just...?” when perhaps the better question is, “What has this trauma made impossible today?”

I hope you’ll take a few minutes to read Susan’s essay. I think you’ll find it thoughtful, compassionate, and deeply relevant—not only to grief, but to how we understand addiction, recovery, and the people we love.

What Trauma Makes Impossible

Susan Ousterman

Today I left my doctor’s appointment with a prescription for metformin.

Apparently, I’m pre-diabetic.

The diagnosis didn’t surprise me. In many ways, it began six years ago, when my son Tyler died.

After he died, I could barely breathe, let alone care for myself. I remember asking my husband to remind me to brush my teeth and shower because I realized entire days were passing while I simply stared into space. I knew I was no longer capable of managing even the most basic parts of daily life.

Eating became a chore, and it has remained one ever since. I never regained an appetite. Cooking feels like climbing a mountain, and when I become absorbed in my work, I’ll often eat only when the discomfort becomes impossible to ignore. Instead of making a meal, I reach for whatever requires the least effort and provides the quickest relief, which is usually something sugary.

Six years later, my body has paid the price.

People often ask why someone continues doing something they know is harming them. Rarely is the answer that it feels good. More often, it’s because it feels like the only thing they have the capacity to do.

Trauma changes the brain. It doesn’t simply create sadness. When the nervous system experiences overwhelming threat or profound loss, it shifts resources toward immediate survival. The parts of the brain responsible for planning, organization, motivation, working memory, and future-oriented thinking become less efficient, making ordinary tasks feel impossibly difficult. Long-term health becomes secondary to making it through the next hour. Research has consistently shown that traumatic stress and profound grief can impair the very executive functions we rely on to care for ourselves.

That’s true whether someone reaches for cake, alcohol, opioids, work, gambling, shopping, or countless other ways of quieting unbearable pain.

The object isn’t the point.

The brain is.

Trauma doesn’t care whether relief comes from sugar, opioids, work, gambling, or something else. What matters is that relief is found.

This is why I’ve long seen parallels between profound grief and addiction. I’m not suggesting they are the same experience. They aren’t. But both can alter the brain in ways that temporarily diminish a person’s capacity to care for themselves. In both cases, people often become attached to whatever helps them survive unbearable pain, even when they know it carries a cost. And in both cases, we frequently expect them to recover using the very capacities trauma has impaired.

What’s striking to me isn’t how people cope after trauma.

It’s how the rest of us respond.

No one shamed me for surviving on sugar after my son died. No one told me to pull myself up by my bootstraps or that I simply needed to want it more.

People recognized that I was grieving, but very few people actually helped.

I don’t blame them.

They loved me. They cared about me. Many of them were grieving too or simply didn’t know what to do.

That’s why education matters.

When someone dies, we bring flowers, casseroles, and desserts. We say, “Call me if you need anything.”

Those gestures come from love.

But profound grief changes the way you move through the world. We assume that if someone needs help, they’ll ask. The truth is that many can’t.

If someone had asked me, “What do you need?” I wouldn’t have known how to answer. I wasn’t refusing help. I had lost the ability to identify it.

What I actually needed was someone to notice that I hadn’t eaten a real meal in days, that cake had quietly become a substitute for nourishment, and that I was disappearing into work because it was one of the only places my mind could temporarily escape the reality that my son was gone.

Then gently step in.

Put healthy food in front of me.

Not because I asked.

Because I couldn’t.

People living with a substance use disorder are often expected to organize their own recovery using the very abilities trauma has impaired. We expect them to schedule appointments, remember medications, navigate insurance, secure housing, find employment, rebuild relationships, prepare healthy meals, and make consistently healthy decisions.

Then we wonder why recovery is so difficult.

We call it personal responsibility.

But what does personal responsibility mean when trauma has temporarily taken away the very capacities required to exercise it?

We cannot expect people to heal while they’re hungry.

We cannot expect people to recover while they’re un-housed, shamed, isolated, or food insecure.

We often assume that love should be enough. We ask why someone won’t stop using substances for their children, why they won’t take better care of themselves for their spouse, or why a bereaved parent can’t simply focus on the family they still have. These questions begin with the assumption that the problem is motivation. Trauma suggests a different possibility: the problem may be capacity. Love and motivation can remain fully intact even as the abilities needed to translate them into consistent action are profoundly disrupted.

We cannot expect someone whose brain is consumed by trauma to independently build every support they need while blaming them when they cannot.

This isn’t an argument against personal responsibility.

It’s an argument for matching responsibility with capacity.

I also want to be clear about something else.

Nothing I am suggesting should be interpreted as support for involuntary treatment. Helping someone meet their basic needs is fundamentally different from taking away their autonomy. The goal should never be to replace a person’s agency. It should be to strengthen it until they can once again carry what trauma has made temporarily impossible.

Support doesn’t replace accountability.

It makes accountability possible.

The encouraging part is that capacity can return.

Brains heal.

People heal.

With safety, connection, nourishment, stable housing, meaningful relationships, and appropriate support, many of the abilities trauma temporarily impairs begin to come back. The goal of support isn’t to create dependence. It’s to help restore independence.

This is also where people with lived and living experience become indispensable.

Years after Tyler died, a close friend unexpectedly lost her husband.

I didn’t ask, “What do you need?”

I got on a plane.

I cooked meals for her family. I made sure there was food in the house. I was not uniquely compassionate; I had lived what she was living. I knew that deciding what to eat could feel impossible. I knew the questions she wouldn’t be able to answer.

That’s the power of lived and living experience.

It doesn’t just create empathy.

It creates practical wisdom.

This is why people with lived and living experience belong at every table where services and policies are designed.

Their expertise coupled with science that completes the holistic approach.

Science helps us understand how trauma affects the brain.

Lived experience teaches us what support actually looks like when those changes occur. It teaches us which abilities disappear first, what people stop noticing, and how to recognize when someone needs help before they’re able to ask for it.

Too often we focus on changing behavior because behavior is what we can see.

But it’s only after we understand what has been impaired by trauma that we can ask the question that follows:

How do we help restore ability while protecting the person’s dignity, autonomy, and right to make their own decisions?

To me, that’s what support looks like.

Not rescuing.

Not controlling.

One thing grief and substance use seem to share is this: everyone wants you to become someone different.

What you often need first is someone willing to love and accept where you are today while helping carry what you can no longer carry alone.

Ironically, that acceptance is often what creates the safety needed for change.

I didn’t need anyone to take away my pain.

They couldn’t.

Whether someone is surviving on cake after losing a child or using substances to survive unbearable circumstances, healing begins with being seen.

Maybe we’ve been asking the wrong question.

Instead of asking why someone won’t change, perhaps we should first ask:

What has this trauma made impossible today?

That question won’t solve every problem.

But it changes where we begin.

It moves us away from judgment and toward understanding.

Away from assumptions and toward curiosity.

Away from asking people in survival mode to tell us exactly what they need and toward learning to recognize what trauma has made impossible for them to do alone.

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