In recent years, concepts of trauma-informed care have been taught and applied in many fields. To help guide this development and to prevent burnout in the care of our patients in psychiatry, I propose "the ring-shaped island model" which represents the state of silence and social/emotional isolation. The ring-shaped island is a donut-shaped island with an inner sea that symbolizes silence and the struggle people face when sharing traumatic experiences that are intense or stigmatized in their respective society. This model integrates various aspects of trauma by employing three metaphors: GRAVITY (symptoms/reactions in response to trauma), WIND (interpersonal conflicts and uncertainty), and WATER LEVEL (societal misinterpretation and nonacceptance). Using the framework of this model, the care for the disabled (including psychiatric care) is discussed. Many victims of the Sagamihara stabbings at "the Tsukui Yamayuri En" (a facility for severely intellectually disabled people) in 2016 had severe intellectual disabilities which led to the loss of their voices, sunk in the inner sea. Some of them suffered from severe behavioral disorders as well, but their care workers also had little opportunity to talk about their emotional burden and trauma in caregiving. As a comparison to this event, I analyze the care for the victims of sexual violence using the same model. The limited financial, human, and social resources are common in both instances and highly stigmatized in many societies. On both islands, the gravity is strong, the wind is everchanging, and the water level has always been high. Lastly, I propose some recommendations to reduce compassion fatigue and burnout for the care workers who are exposed to extensive emotional labor and trauma.
 Author's abstract