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Endemic to the Gulf Coast, tropical storms, floods, and hurricanes cause vast devastation and expense, but in our times are rarely fatal. Even so, on Galveston Island we remember the Great Storm of 1900 which took 10,000 lives. Still, given the miracle of modern weather forecasting, we would be embarrassed even to conceptualize our paltry storms as trauma. Among ourselves, however, we share storm stories habitually and might concede that these visitations constitute perhaps, at worst, a Stage Zero level of trauma.
This zero level of chronic and recurrent impingement has perhaps nourished my interest in defining Stage Zero trauma therapy. Classically, trauma therapy is divided into three stages: In stage one, we try to establish safety and symptom control; stage two involves processing traumatic memories to construct a coherent narrative; and in stage three, we try to repair developmental deficits so the patient can create a meaningful life in the here and now (Herman, 1992). I have added the concept of Stage Zero interventions (Nykiel, Baldessarini, Bower, Goodwin, & Salvatore, 2008) to describe the pretreatment preparatory work that is sometimes needed before more structured therapy can begin, and which also may be required later if recurrent traumatic events and regressions supervene. Stage Zero interventions overlap with the simple helping that first responders and volunteers undertake at disaster sites: transport to safety and attention to basic needs (water, food, sleep, breathing, thermoregulation, shelter, emergency medical care, and locating and contacting loved ones). At Stage Zero, the aim is to be there, accessible and attentive, but not diagnosing or treating in our usual technical sense; and mostly trying, as Hippocrates taught us, not to make things worse, not to distract from the immediate project, which is to survive.
Why call it humble? Because it draws more upon our personal values (perhaps on our true selves) than on professional skills