A paradox at the center of healing is that sometimes the way that survivors soothe their pain can also harm them.
For example, substance use provides an escape from pain, but can harm bodily systems like the liver, areas of life like relationships; and pose dangers like intoxicated driving and other risky behavior. Self-harm can offer a welcome release but hurts the body. And disordered eating provides a sense of control but could negatively impact the gastrointestinal tract and many spheres of life.
And yet, these strategies, while dangerous, have made many todays bearable and survivable for survivors and trans people, who have particularly high rates of engaging in dangerous coping tools because of their experiences of trauma, discrimination, and stigma.
Making it through the day is no small feat. Survival itself—including the messy, sometimes painful ways it happens—is worth honoring. Trans survivors of sexual and relationship violence have complex and imperfect lives, and so it makes sense that their coping tools are often also complex and imperfect.
An acceptance of this imperfection is one of the theoretical underpinnings behind harm reduction, a framework that can be defined as “an umbrella term for interventions aiming to reduce the problematic effects of behaviors. Most frequently associated with substance use, harm reduction also applies to any decisions that have negative consequences associated with them… At its core, harm reduction supports any steps in the right direction.”
PrEP is harm-reduction. Providing clean razors for cutting or non-suicidal self-injury is harm reduction. So is condom distribution. So are designated drivers. And so is needle exchange.
While so many interventions for people who are suffering focus on ending the risky behavior altogether (like how drug rehab programs have a goal of abstinence), harm reduction focuses on minimizing harm by making other changes. Harm reduction says: “don’t take away the messy ways that people stay alive. Instead make those messy strategies less dangerous.”
While harm reduction is a vision guiding big government and non-profit programs, we can also adopt harm reduction frameworks on a small scale, in our own lives and our approaches to ourselves.
Harm Reduction offers particular gifts to trans survivors.
One way some trauma survivors learn to cope with the pain of trauma is with “black and white thinking” or splitting. Abusers and others often vacillate between telling survivors they are all good and all bad, and so survivors internalize this polarized thinking. These black and white views of people and the world are damaging because they make it hard for trans survivors to accept their wholeness and complexity. Binary thinking also leaves little room for non-binary experiences of gender. So it can cloud and complicate the processes of healing and transitioning for trans survivors.
Harm reduction, in its embrace of gray complexity, can therefore be a powerful countervailing and healing force.
So what does harm reduction look like if we apply it through out our lives?
It means celebrating and embracing imperfection and half measures when they are progress over graver harm and deprivation.
-going to therapy late instead of not going
-making a safety plan for a dangerous relationship
-eating junk food instead of no food
-taking a “bird bath” instead of not bathing at all
-taking safety measures when drinking such as giving away your keys, drinking Gatorade, drinking at home, etc.
-cleaning just a little of the house, washing just a few of the many dishes in the sink
-checking in with a friend when having sex with a stranger or doing sex work to let them know where you’re going
-using PEP and PrEP
-binding or tucking for fewer hours a day, if you’re used to doing so for long hours
-engaging in less risky forms of self-harm or reaching out to friends to make sure you’re okay after self-harming
-working toward forms of work in the underground economy that are might be safer (such as stripping instead of street sex work)
-using opiates in front of friends and having naloxone in hand rather than using alone
-doing just a little exercise rather than none at all
Harm reduction allows us to see beyond the binaries of being good or bad and simply honor how we survive. It allows us to accept that even if we cannot make our lives perfect, we can make them safer. Part of healing is showing up for ourselves—loving ourselves—through that messy process.