When I was sixteen, YouTube outed me. My mom walked into my bedroom one day and hit me with a question that stopped my heart:
“Are you gay?”
She told me that she and my younger brother had used my computer to visit YouTube and saw videos. She wanted to know where the videos came from. She wanted to know if I was gay.
I’d feared this moment for so long, and I wasn’t ready.
A truck with several confederate flags near my childhood home in Horse Shoe, North Carolina.
I grew up in a Southern Appalachian town called Horse Shoe, where I drove past Confederate flags every day on my way to school. I spent most of my early teens trying to “pray the gay away” in earnest. Driven by fear and self-loathing, I repressed any emotion or expression which could’ve brought on the wrath of a high school boy or the scorn of an adult.
As a teenager, the internet was my solace. I didn’t know any queer people in my 600-person school, and I had no adults in my life who were outwardly LGBT+. In the physical world I was closeted and stoic. In the digital world, I found people like me, and it made me feel less alone.
I knew these worlds needed to stay separate. There were real, physical risks if my parents discovered my online activity: they might kick me out, or send me to conversion therapy, or worse. I diligently scrubbed my browsing history, used alternate email addresses, and waited until late at night—when my parents were more likely to be asleep—to watch vlogs and chat.
But it only takes one slip-up. I hadn’t thought about the YouTube recommendations.
A church in Horse Shoe proclaims, “OBEDIENCE IS BETTER”.
I’d planned to come out to my parents eventually. I just didn’t want to do it then, in that way. I wanted to do it on my own terms.
When my mom asked if I was gay, I faced a choice. I could deny it, which might keep me safe for awhile. Or I could tell the truth and pay the price.
Through tears, I told the truth.
Two years ago, I joined Cityblock. Alongside psychiatrists, social workers, and other specialists, I work to provide care to people with complex health needs.
An undercurrent of trauma runs through the populations we serve. To counter this we practice trauma-informed care. Trauma-informed care is a framework for minimizing harm through understanding trauma and its effects and proactively working to prevent re-traumatization.
Rather than asking, “what is wrong with you?” a trauma-informed approach asks, “what has happened to you?”
As I learned about trauma-informed care I began to wonder, what would technology look like if it recognized trauma as a force in all our lives?
Over the past six months, I’ve interviewed care teams at Cityblock to understand how they confront trauma. They’ve shared tips on technique and language, and shared stories. Together we’ve explored how we might design technology from a trauma-informed lens.
Trauma-informed design is the practice of building systems which reduce harm and foster healing
There are six principles for a trauma-informed approach:
- Safety
- Trustworthiness and Transparency
- Peer Support
- Collaboration and Mutuality
- Empowerment, Voice, and Choice
- Cultural, Historical, and Gender Issues
These principles were developed by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the American Psychiatric Association to address in-person care, but we can adapt them to a digital context.
Before that, however, it’s important to talk about what trauma is and how it affects the brain.
Trauma is an experience that overwhelms someone’s ability to cope
Trauma can occur as a result of violence, sexual abuse, physical abuse, loss, terrorism, natural disaster, and other emotionally harmful experiences. It may be a single moment, or a pattern of events spread out over months, years, or generations. It affects anyone.
Trauma affects the way that you view the world and the way that you view yourself. Rob Jordan, Behavioral Health Specialist at Cityblock
Trauma exists as an embodied, measurable force. It rewires neural pathways. It manifests through avoidance, nightmares, flashbacks, anxiety, dissociation, hypervigilance, and intrusive memories.
Tech can frustrate stressed-out brains
Imagine this:
- Someone presents you with new information. You register what you’ve been told, but before long, you can’t remember what it was. Was it important?
- Images, words, shapes, and motion don’t always appear “present”. They’re somehow detached from reality. You struggle to recall them.
- It’s hard to categorize objects. What goes where?
- When filling out a form or something that requires accuracy, you often make errors and don’t spot them until you’re told.
- Staying focused is a challenge. You often feel unmotivated to start and complete tasks. Small distractions can wreck your concentration.
- Tiny things can provoke strong anger or fear or make you unable to move. Later, you may tell yourself that your response wasn’t rational, but this doesn’t prevent it from happening again.
This is life for many people with a history of trauma, and it presents serious obstacles to everyday use of technology.
Minor frustrations for non-traumatized brains may present serious obstacles for traumatized ones.
This happens because extreme stress changes the brain’s structure. It decreases the volume of the anterior cingulate cortex — which deals with attention, error detection, and motivation — and the volume of the hippocampus, which helps encode verbal declarative memory.
On the left: a healthy brain shows most activity (red and white) in the cerebellum. On the right: A PTSD brain shows changes to the anterior cingulate cortex, the amygdala, and the hippocampus. Source.
In addition, the amygdala — the brain’s fear response center—becomes overactive, making higher-level thinking much more difficult.
These changes to the brain are visible in people with PTSD, but PTSD is only one subset of trauma, which affects the brain, body, and spirit in many ways.
Trauma-informed design is accessible design
The physical world can inform our approach to designing digital spaces. In the 1960s, 70s, and 80s, people who use wheelchairs waged a campaign to require cities to build curb cuts—the ramp connecting sidewalks to street-level. Without them, the six-inch drop made cities unnavigable.
The Americans with Disabilities Act was passed in 1990, making accessibility a requirement for all public spaces. It wasn’t long before parents with strollers, postal workers with mail carts, and kids on bicycles realized how helpful curb cuts could be for them, too.
By prioritizing those with the greatest need, trauma-informed design improves life for everyone.
Six principles for trauma-informed design
We can get close to trauma-informed solutions by simply practicing “good design.” Many design patterns exist in direct response to the quirks and limitations of human cognition. Intuitive organization, familiar interaction patterns, intentional use of visual principles, and the ability to offload working memory all make people feel calmer and more in control.
Even small frustrations and cognitive burdens drain our ability to make informed, healthy choices.
“The least frustrating design,” says Rob, “is going to be trauma-informed.”
While researching, I asked friends and family to share moments when technology has hurt them and when it has helped. Their thoughts, anonymized, are quoted in each section below.
Safety
Dating apps automatically pulling info from Facebook has allowed people to find me on other platforms and say, hey, we didn’t match, but *hey*, I *really* liked you.
A band member I follow shared a brutal video on Instagram and I literally felt ill. Like visceral, horrible. I had to swipe up to get it out of my phone’s frame.
Noonlight and iPhone’s SOS feature give me peace of mind knowing I have a modern-day Life Alert built into the thing I carry around with me everywhere.
To help people with a history of trauma, “safety is the first priority,” says Loretta Staples, Behavioral Health Specialist at Cityblock. “Oftentimes, traumatized people do not feel safe in their own body. I try to create a holding environment, one where the person feels not smothered, but contained.”
She continues, “I never say, ‘this is a safe space.’ I don’t have the power to make that declaration.”
The systems that we design should counter abuse, permit making safe mistakes, promote privacy by default, and moderate content to prevent the spread of hate speech and disinformation.
Trustworthiness and transparency
I feel spied on. It’s weird if you show up to, say, a hotel, and the concierge knows all about your personal life. That’s what some products in tech feel like.
Whenever I search something on Google and then I see an ad for that on Instagram, I wonder, if they know that about me, what else do they know? It makes me feel vulnerable and exposed.
The Diagnostic and Statistical Manual of Mental Disorders mentions “a sense of foreshortened future” as a symptom of trauma. Trauma damages trust, and a lack of trust warps the experience of time itself, states a 2014 study. Survivors of trauma often strongly believe that bad things — like dying early, or suffering rejection — are sure to befall them.
“Trust has been violated with many individuals with a history of trauma,” says Rob.
Broken trust is difficult to rebuild. But we can work to promote trust by practicing transparency. Don’t exploit or manipulate people. Don’t ask for unnecessary information. Eliminate black boxes. And let people know ahead of time when you’re planning to roll out big changes.
Peer support
A trans friend reached out to me for help. They wanted me to report a pre-transition photo of them so it would be taken down quickly.
There are some small Discord servers I’m a part of that are cute and fun, despite all being strangers. Decentralized platforms allow for these subcultures [to form] that don’t have anywhere else to congregate.
If I’m using a piece of technology, peer support is about communicating and working together with people like me to understand and work through any problems I may encounter.
It’s important for tech systems to allow for public critique, emphasize shared humanity, and contextualize data to encourage informed reactions.
Collaboration and mutuality
[The Q&A platform] Stack Exchange has a meta discussion board where anyone can post feature requests and leave comments on announcements before a new release. Engaging the community really helps build a strong platform that everyone can help shape.
[3D creation tool] Blender is open source. The community is amazing, and enough people (and corporations) donate that they’re able to pay for full-time staff.
While the previous principle is about enabling people who use your technology to empathize and work together, collaboration and mutuality is about working as equals with the people you’re building for.
“People aren’t data sets,” notes Loretta. “People are highly-edited presentations of self.” And despite the language often used in tech, people aren’t “users”—people are people.
By collaborating with the people you build technology for, solutions improve. You use familiar language, avoid assumptions and judgement, weed out guilt and shame, and recognize that the things you want to do—as a designer, an engineer, or a product or business leader—are not always the things that others want or need.
Empowerment, voice, and choice
When I reactivated my Instagram after deactivating it several months ago, every person I ever tagged was re-notified, including my exes.
The ‘so-and-so viewed you’ notifications on LinkedIn don’t tell me much besides someone keeps obsessively looking at my page.
It’s really lovely to be able to say ‘I don’t want to interact with this person’ and make them (sort of) disappear through hiding/blocking them. [There are] lots of people from my childhood I want nothing to do with…
Trauma is often the result of being out of control in a situation. Thus, it’s critical to give people the power to change things—whether that means deleting their account, revoking consent, or adjusting what appears and what doesn’t.
Cultural, historical, and gender issues
Pregnancy apps are super normative and make a lot of assumptions. I don’t need to know that my baby is the size of an apple. I need to know where to find a midwife near me, or what to do when this part of my body hurts.
I’m very sensitive to weight loss-centered language with fitness or activity apps. I just want a numberless food tracker!
[Planned Parenthood’s period tracker] Spot On never assumes you identify as a woman, want to get pregnant, have tits, etc. A lot of period trackers make fertility their main focus, so Spot On was a relief.
People from different backgrounds go about the world differently. If people from different backgrounds aren’t a part of creating your technology, you’re going to miss things. You might miss an algorithm amplifying bias, or the impact of metrics on self-worth. Your language might unintentionally exclude certain people.
Charlotte observes, “everybody wants to be known, but nobody wants to be labeled.”
Putting theory into practice
Trauma-informed design is difficult work
It’s often easier, both technically and organizationally, to barrel forward with a new feature or product without implementing things like user settings, consent-based workflows, privacy safeguards, and algorithmic transparency.
Technologists have an enormous responsibility to create systems of interaction which respect individuals and promote healing.
When we move fast and break things, sometimes the things we break are humans. This work is difficult because it’s worthwhile.
Design is not enough
This isn’t a framework you can slap on at the end of the project and call yourself trauma-informed. You have to step back and look at the business model itself to ask whether it exploits or perpetuates harm to individuals, groups, or ecosystems. A business model which relies on selling user data is not safe or transparent, no matter how clean the interface is. A business model which exacerbates inequality will also exacerbate trauma.
Trauma-informed design requires asking questions and establishing a dialogue, not prescribing answers. If you’re used to moving quickly, adopting a trauma-informed approach will likely slow you down. This is good. It means you and your team are taking time to answer difficult questions about how your technology affects the well-being of others.
Through trauma-informed design, we can create a future where technology respects our attention. One that’s quietly supportive, not presumptive or over-helpful. One where we’re free to move between platforms without guilt. One where we know our data isn’t sold at our expense. Where we feel safe. Seen, but not watched.
“Mistakes will be made,” Charlotte says. “But it’s important for someone to believe they will be heard.” Keep feedback loops open, co-create meaning, and above all?
“Be more gentle.”
After I was outed, things got difficult for a while. I remember locking myself in my room and sobbing into a pillow and feeling deeply alone. I remember feeling exposed and unprepared.
Compared to other kids, I was lucky. I wasn’t kicked out of the house. I wasn’t taken out of school or sent to conversion therapy. Although this was before a marketing campaign would tell me so, it did get better.
My parents eventually came around. With my sister, my mom attended a protest against Amendment One in North Carolina. A year after coming out, my digital and physical worlds merged more fully: my parents got to meet my first boyfriend, who came to visit from South Carolina. We’d met on those message boards.
I doubt that the designers and engineers working on YouTube in the 2000s expected their recommendation algorithm to out a Southern teen. Yet it did.
What if those YouTube recommendations hadn’t been there? Would history have taken a different course? I can’t know for sure, but I do know that for everything I build now, I want my designs to be trauma-informed.
Special thanks to Ari Rosner, Blithe Parsons, Charlotte Christopher, Jon Marquez, Juliana Ekong, Lon Binder, Loretta Staples, Maria Boncyk, Neves Rodrigues, Owen Tran, Pooja Mehta, Rob Jordan, Taylor Maynard, Toyin Ajayi, and many other friends and colleagues who contributed to this article.