How Stratifying Our Risk of Vulnerability Creates Disconnection.


Working in health care has taught me a lot about risk stratification. It has also highlighted how we use it in our daily lives to try and control our own risk of experiencing pain and vulnerability.

Working as a clinician, risk stratification can be an important concept or tool to assess overall chances of a patient developing certain diseases.  I can use that information to help guide me to understand and conceptualize disease prevention as well as chances of disease recurrence.

However, risk stratification can be a slippery slope because we as humans can't easily be put into a box or category.  We are so much more complex and dynamic than a set of statistics.  It does not serve people well to reduce them to a calculated risk assessment even in the clinical setting.

And certainly outside the clinical setting -- with human behavior and hearts, pretending we can stratify risk to avoid our own pain and loss is dangerous. Yet we do it all the time. I'm guilty of this on a regular basis.

We want to believe that we can strong arm our vulnerability into being predictable and preventable.

What does this mean? When trauma happens to other people, we try to create distance by assessing the cause to find something or someone to blame so that we can once again feel safe under our false illusions of control. We want to compensate for the sheer terror of the truth of our inherent human vulnerability.

This shows up every day.  A few examples of how risk stratification looks in our own lives:

Your daughter was just diagnosed with breast cancer? Was she late on getting her mammograms? Do you have a strong family history of breast cancer? (My daughter stays up to date on preventative care and we don't have a family history of breast cancer so that will never happen to her.)

You had a miscarriage? Oh, it must have been because you didn't take prenatal vitamins early enough or you must have done something wrong with your diet. I'm so sorry for your loss. (I follow all the up to date recommendations and get early access to health care so that will never happen to me.)

Your Dad died of lung cancer? Was he a smoker? I'm so sorry for your loss. (My Dad doesn't smoke so he'll never get lung cancer.)

Your friend died in a horrific car accident? He must not have been wearing his seat belt? So sorry for your loss. (I always wear my seat belt so I'll never die in that kind of accident.)

Your sister died of an overdose?  So sorry for your loss. (My sister doesn't have a drug problem and only drinks on the weekends so that will never happen to my family.)

Your partner came home and asked for a divorce? Did they have an affair? Were you having sex on a regular basis? So sorry your marriage is ending. (My partner and I are so solid even though we don't always agree--at least we have sex once a month and I know they would never cheat on me. We will never get a divorce.)

Your city just got hit with a natural disaster and thousands of people are without resources? I'll send $20 to the relief fund and get back to work. (My city is in a safe place where natural disasters don't happen.)

See what I mean here? Does this sound familiar?

When we see human suffering the discomfort of facing our own vulnerability feels so viscerally impossible to hold that we often immediately sort and stratify risk and compare it against our own experience.

We tell ourselves we aren't at risk because we have control over the "behavior" that causes vulnerability.

In trying to control our vulnerability we create an "otherness" and this othering is at the core of separation and disconnection between us. Being sure "other" is separate from you may work for a short time. It may help you feel safe for a moment.

Until it's your phone call from the doctor that the biopsy was malignant. Until your partner comes home and asks for a divorce.  Until your city gets hit with a hurricane or earthquake.

Trauma is not selective, my friends. Loss and grief, vulnerability and pain are equal opportunity human experiences.

And we need each other to get through them. We need to carry each other. One day it will inevitably be our turn to be carried.

If you've spent your time and energy engaging in risk stratification and creating a false sense of security by othering those who experience trauma, you are also othering yourself.  There is no place for belonging there. There is only fear, disconnect, shame and isolation.

When we make people wrong for the trauma they are experiencing, everyone loses.

No amount of risk stratification is going to change that we are all vulnerable.  That is the painful truth. It's also the beautiful truth.  Connection and resilience can be created when we sit with and embrace the painful and effervescent truth that we are vulnerable and human. Together.

So, let's all stop pretending that we are immune to grief, loss and trauma. Let's stop creating walls to "protect" ourselves and instead cultivate nourishment to help ourselves and each other together through the hard times. Let's learn how to feel the loss, grief and vulnerability and start learning how to support each other through it.  

Let's hold each other.

Let's belong to each other.

And, as I always say to my Love: Let's be human together.



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