Letter from the editor
In this issue, I explore the topic of childhood trauma and its positive correlation with mental disorders. While this is not a topic directly relevant to mental health stigma, it is important because there is much evidence to suggest that childhood trauma can trigger mental disorders (Whitfield, 2010; Maté, 2000). In turn, mental disorders fuel stigma. Therefore it is more than plausible to suggest that childhood trauma leads to mental disorders which in turn increases the level of stigma in society.
Today there is a tendency to label mental health disorders and to rely, perhaps more than we should, on psychotropic medication to cure these disorders. Many commentators argue that psychotropic medication is not indicated in cases where PSTD is the problem and every effort should be made to use talk therapy or other natural intervention before doctors rush to the pad to prescribe (Whitfield, 2010; Corry and Tubridy, 2001; McKay and Zac, 2002). Medication is indeed useful in some circumstances but every effort should be made to establish if therapy alone can be enough. Alternatively, a combination of medication, therapy and the willingness of the sufferer to work towards recovery are ideal for chronic cases.
According to some commentators, clinical diagnosis exacerbates stigma (Corrigan et al., 2000; Weiner et al., 1988; Anderson, 1991; Kashima, 2000). Although diagnostics are developed by mental health professionals to better understand mental disorders, the result is that diagnostic classification exacerbates the problem of stigma. Sociologists define structural stigma as institutional efforts that unintentionally lead to discrimination (Hill, 1988; Wislon, 1990).
There is also evidence, from statistics, to suggest that childhood abuse affects a great number of our children. A survey from my personal longitudinal research of nine years has revealed that about 80% of sufferers, out of a sample of over 700 sufferers, have endured traumatic experiences during their childhoods. For example, many people who suffer with Borderline Personality Disorder (BPD) report to have had a history of abuse and neglect. Many studies support these claims (Klaft, 1990; Zanarini, 1988; Brown and Anderson, 1991; Herman, 1992; Quadrio, 2005); and that childhood trauma is a risk factors for a diagnosis of schizophrenia later in life (Janssen , Krabbendam , Bak , et al, 2001).
Some research indicates that childhood trauma can be a causal factor for the development of psychosis and schizophrenia (Read, van OS, Morris and Ross, 2005).
I have also argued in previous issues of this journal that mental health stigma is increasing in society despite great efforts to reduce it. For these reasons, it makes good sense to suggest that perhaps our efforts in Australia should be directed toward reducing childhood trauma, a topic that is much neglected by researchers and mental health.
My longitudinal study indicates that what triggers most mental disorders is childhood trauma. What has also become apparent from my research is that sufferers are almost always unaware of having experienced a childhood trauma until we start discussing past experiences. To give an example, this is what a sufferer wrote:
“I don’t think there is a cause for my depression and psychosis. I was sexually assaulted at 16 and my mother was an alcoholic, abusive and violent. But there does not seem to be any ongoing trauma from that.”
This was by no means an isolated incident. The majority of sufferers either block the traumatic events from consciousness or, alternatively, they are genuinely not aware because they are so sure that it is a biological illness as in brain disease. When I read the email and saw that there was sexual abuse, as well as violence and alcohol involved, I became suspicious so I asked a psychologist friend. This is what he wrote in an email:
“That kind of patter makes me strongly suspect repressed severe trauma. She should go to a good therapist and do age regression hypnosis. If there is trauma, and she recalls it, she can deal with it and get rid of the problem sometimes for life. It usually feels too scary to do. I say to my clients: there is a box there, and you are working hard to keep the lid on. But what’s in the box is not a monster. It’s the photograph or movie of the monster. A photograph or movie cannot hurt you, only remind you of your past hurt.”
One interesting fact that research tells us is that most homeless families are women and children escaping domestic violence, which is often sparked by excessive alcohol consumption and/or drug intake (Hansen, 2010). The Drug and Alcohol Services of South Australia (2010) reports that over 450 000 children, in South Australia alone, live in households where they are at risk of exposure to binge drinking by at least one adult. The Australian Bureau of Statistics (2004-2005) reports that one in eight adults (approximately 2.5 million people) drink at risky/high risk levels.
Currently, in Australia, 12,133 children under the age of 12 are homeless. In addition, almost 28,000 young people below 18 years of age are homeless and their past has often been a traumatic one.
There are 7,483 homeless families and every day, 2 out of 3 children who require immediate assistance are turned away. These figures are quite alarming if we consider that Australia has a population of just over 20,000,000 people. (Homeless Australia)
In Australia, we have the Department of Community Services (DOCS), a department that monitors the welfare of the children. The problem is that for some reason, DOCS is failing to protect all, and perhaps most, of our children. In the Sunday Telegraph, Jane Hansen wrote that:
“…a senior Community Services bureaucrat has claimed that caseworkers don’t visit extreme cases of abuse and neglect for fear they will be blamed for the deaths of children. The official, who has made the sickening allegations, has also handed over files detailing serious shortcomings within the department.” (Hansen, 2011)
From direct experience, as someone who has lived in a troubled government complex of houses, both my wife and I wrote numerous letters to ministers and government organizations before DOCS’ caseworkers came to see children who had been abused or exposed to domestic violence, fueled by alcohol and drugs. The caseworkers were unable to help the children, who continued to be exposed to violence and abuse for months after their visits.
The AIHW reported that in Australia, during 2009-10, there were 286,437 reports of suspected child abuse and neglect made to state and territory authorities (AIHW, 2010). We have to keep in mind that there are so many cases which are not reported for a variety of obvious reasons.
Traditionally, child protection data is considered to be a very conservative estimate of the occurrence of child maltreatment (Bromfield & Higgins, 2004). Child abuse and neglect often goes undetected because of the private nature of the crime, the difficulties children experience in disclosing and being believed, and lack of evidence for the crime (Irenyi, 2007).
Unfortunately, we are not able to get an accurate number of possible child abuse cases because, as a social worker commented during an interview with me, a more realistic figure may be that there are between 500,000 and 700,000 cases of child abuse each year. This social worker speculated that:
“thousands out there are terrified to pick up the phone. There have been hundreds of Social Workers who were ‘afraid’ to get involved because of threats of violence.”
There are many statistics which show that many Australian children are not well looked after by their parents or guardians. These statistics help in supporting the idea that mental illness and childhood trauma are strongly and positively correlated.
In recent years, many studies have attempted to demonstrate that symptoms of post traumatic stress disorder (PTSD) are not necessarily the result of traumatic experiences. Accordingly, commentators argue that these symptoms may have existed even in the absence of trauma. This kind of rhetoric is particularly helpful for those who consider mental illness to be a disease of the brain and therefore not always connected to environmental factors. One could say that pharmaceutical corporations would benefit from such ideas because if mental disorders is considered to be disease, then medication is the only thing that will help.
Fortunately, many studies disprove these false beliefs. There is a particular study on twins which may quiet doubts over the debate on PTSD and traumatic events link In this study of 103 pairs of identical twins, one twin had been exposed to combat in the Vietnam War, while the other had not. Pitman and colleagues from Harvard University and the US Department of Veteran Affairs found that men who had been at war had three-fold more symptoms than their brothers, as well as compared to the combat veterans without PTSD and their co-twins. This study tends to suggest that genetics or biology have little to do with PTSD and that there is a strong link between PTSD and experienced trauma. Research in the US (National Institute of Health, 2009) reveals that “a certain gene variation long thought to increase risk in conjunction with stressful life events actually may have no effect” (NIMH,2009). To the contrary, there is strong evidence from research that stressful life events are strongly associated with a person’s risk for major depression and psychosis.
There is plenty of evidence to support the idea that most mental disorders are triggered by childhood traumas and perhaps this is the direction that research should follow.
Unfortunately, not much research is done on childhood trauma, perhaps because it is such a sad topic. The researcher would have to come to the understanding that we, in our Western world, are damaging the minds of our children and that we are having a negative impact on their future in complex ways. Not many of us would like to admit this, for we like to think that the world is OK, that we have advanced technology, and that the future may be brighter and lead to improvements. In my opinion, we can no longer sustain such optimism, particularly in the face of the fact that our democratic system seems to be failing our children.
In this journal I try to explore these complex issues with the help of sufferers who have endured childhood traumas directly. I hope that our voice contributes to the understanding that PTSD is caused by traumatic life experiences and not by innate and biological factors alone. For all of these reasons that I have discussed in this letter, it would make much sense to move away from the idea of “mental illness” as disease and begin to research childhood traumas and traumatic experiences more generally.
I hope that this issues prompts mental health professional to pay more attention to childhood trauma and entertain the possibility that childhood trauma makes up the greatest percentage of mental ill health cases in our world today. It is clear that the important message of this particular issue is that if childhood trauma is indeed what causes most mental disorders in Australia, it would make sense to attempt to reduce childhood trauma because in so doing, we may well reduce mental illness and related mental health stigma.
Childhood traumas and psychological disorders. Alfredo Zotti 2011
It is the child who may have been sexually abused by a relative, or who may have been beaten by a violent mother or father (and who has a genetic predisposition) who will often develop chronic symptoms. In these cases, where the child is unable to defend or protest against the abusive or violent adult, the child will often suppress emotions and feelings which will cause trouble somewhere along their life.
If the child had the knowledge, will, and ability to speak they would say to the offending adult: “What are you doing? Aren’t you ashamed to treat a little child this way? What kind of gutless human being are you?” In reality the child cannot speak and he or she is forced to suppress the harsh reality falling helpless victim to the hands of the adults who should not be anywhere near the child.
Many would say that the world is not perfect and that many have had problems during their childhood years. Is this so? Or is this a cop out? Is it a way to avoid responsibility? Whose fault is it really if many of the world’s children are traumatized to such an extent that in later years they develop problems such as mental illness and substance abuse?
Whose fault is it if so many children are traumatized?
It is the fault of every single human being including me; of governments and of our perpetual ignorance. Through the wrong actions, while dealing with our children, we often generate mental disorders. But the problems do not stop here because after traumatizing our children we continue to traumatize them further throughout their lives.
When the troubled child grows we ensure that her or his mental health worsens. We have psychiatric medication for this, often considered to be the only solution that in reality only suppresses the problems and adds to the trauma. The other problem is stigma which in many cases becomes internalized.
Many readers may think that this is a very negative perspective from which to see the world? Maybe, at the end of this paper, my initial statements will seem less irrational and much closer to the truth. I begin to explain why I entertain these negative perspectives and what we could do to improve the situation.
Collective denial: what does research tells us?
That we are in denial about the problems that the children of the world face today is a fact. I am not talking about the children of third world countries but of first world countries for it is in the developed world that most children are traumatized.
Dr Felitti (2002), in his article “The Relationship Between Adverse Childhood Experiences and Adult Health: Turning Gold into Lead” informs us that the Adverse Childhood Experience Study (ACE) comprises 17,421 adult subjects who have worked in collaboration with Dr Alda at the Centre of Disease Control and Prevention (CDC). The study is based on the evaluation of social, psychological and biomedical factors. The findings have important social, medical and economic implications.
The study shows that adverse childhood experiences are both common and destructive. Because of this finding, as well as other research, childhood traumas are the most important determinant of health and well being of a Nation.
Unfortunately, a closer look at Nations of the world reveals that we have a serious problem in the sense that a great number of children are traumatized and often develop disorders such as ADD or ADHD, Depression and many other health problems. Usually we turn to psychiatric medication to solve these problems but is this the right thing to do?
If we look closer we often find traumatic experiences behind these problems that require a very different approach to psychiatric medication.
This is not the only study which links childhood problems to mental illness. For example Dr Whitfiled (2010) writes that:
“Today, in 2010, we have hundreds of published data based and peer reviewed reports conducted on well over 200,000 trauma survivors and their controls…Does childhood trauma cause mental illness?…the answer is yes.”
Today we are aware that childhood trauma causes mental illness. If this is so why are we not doing more to help our children? And why are we in denial about the fact that our tolerance of alcohol and drug dependent parents, along with the many sexual abuse cases, psychological abuse cases, and physical abuse cases, are the cause of the problem that today we call mental illness? Why are we not working towards reducing the traumatic experiences that often occurs because of parental ignorance or other factors which could be improved? What are we doing to help our children? Where should we start to improve the situation?
I will try to answer these difficult questions not only personally but also with the help of the subjects of both my personal longitudinal study and pilot study conducted over 9 years of constant email exchanges. I will start with Judy who kindly wrote, during our discussions on childhood trauma:
“Alfredo, I really do agree with you here and I have asked myself this same question many times – What do we do? It is so frustrating to see this cycle of child abuse go on, generation after generation. I think those of us who are dealing with our depression or whatever have been able to see where it came from and to try to heal ourselves and, hopefully, make sure we don’t keep passing this on. Those who hurt us were also hurt as children, I believe. But, there is still that stigma among many about mental illness, so nobody wants to talk about it or about their abusive childhoods, so people still remain ignorant about what effect it has.
I think most criminals have also most likely suffered some kind of abuse or mistreatment in their lives – I guess I would rather be depressed than be a murderer, but think of all the suffering we could avoid if we could stop the mistreatment of children. A lot of people don’t even recognize abuse when they see it, we’ve gotten so immune to it. They don’t realize that words CAN hurt us, a lot of times worse than any physical punishment. I know that as a child, I sometimes would wish my dad would just hit me and get it over with, rather than rant on and on about how stupid and disgusting I was, we all were.”
I think that Judy has made a good point in highlighting the problem of psychological abuse which, in my study, is very common amongst sufferers. Indeed my study shows that verbal abuse is the major cause of childhood trauma. In my email exchanges with psychologist Dr Bob Rich this is what he wrote when I told him that verbal abuse, in my personal research, is the major cause of childhood trauma:
“I agree, and this is in line with what I understand depression to be: a set of beliefs. Verbal abuse of a child by an adult is likely to give rise to self-damaging beliefs.”
Why do parents tell their children that they will never amount to much or that they are hopeless? Words do hurt sometimes more than physical punishment and if the psychological abuse is ongoing it is more than likely that the sensitive child will often develop a psychological disorder.
I have personally had this problem with my alcoholic father, and my wife had the same problem with her grandmother who brought her up because her mother died when she was 4 years of age. We were both psychologically abused and this was a very traumatic experience for us. Why does this happen?
This is what a sufferer writes:
“My guess as to why people psychologically abuse their children is that there could be several causes, but I think the biggest one might be that they were abused themselves, maybe even physically, and are enough aware that they don’t want to commit physical abuse, but somehow think the psychological abuse is not as bad and they use it when they feel powerless and need to feel like they’re in control. Being a parent myself, I know that even though they are little, they can run your life to the point of exhaustion, at which point you’re thinking more about your own pain rather than their overall, long-term welfare. I’ve always thought it would have helped a lot if my parents could have ever (a) acknowledged that what they did was wrong and (b) said they were sorry. Now, if that were to happen, I don’t even know how I’d react; it would almost be like too little too late. I feel like any normal parent-child relationship never really existed, so how could it ever return?
Sometimes, I think drinking might play a factor in abuse but from what I’ve seen and heard, it seems like most were abused themselves. It’s probably a sure bet that if they’ve used physical abuse that the psychological abuse has been part of it, as well. The problem with this is when we can’t acknowledge that we’ve been hurt and so it keeps getting re-played out in each generation – probably as far from mindfulness as you can get. It’s too bad that you can’t make people get a license to have children; there is more concern about letting people adopt animals than there is about having kids. I’ve kind of come to look at my own healing as a way of stopping abuse in my own family and maybe trying to heal the world, one family or child at a time.”
I do agree with what this person says in terms of there being several causes as to why parents and people are verbally abusive. The issues are indeed complex and in regard to these complexities this is what Nuyens (2010) writes:
“Verbal abuse is language that’s harmful to one’s spirit. As I listen to clients share this deep hurt, I realize that severe chronic stress has damaged both body and mind.”
How do we measure verbal abuse and when do we categorize it as abuse or not? Of course this is a complex issue and as a rule I would say that what is hurtful to a person, depending from the person sensitivity, should be considered as some sort of abuse within reason of course. For example below I include a mild case of verbal abuse that does not take away the fact that it is nevertheless painful to the person who writes:
“I have social anxiety. My father was always abusive and I feel that this is the source of my problems. I wish I could tell him but I know he wouldn’t understand”
It is difficult, in the case of this sufferer, to try to explain to her parents, particularly later in life when one is grown up, that their behavior is hurtful and that to engage in such behavior is verbal abuse. I would say that at this stage parents are unlikely to listen to what their sons or daughters have to say about it.
For this reason I feel that education is needed and indeed I once suggested on a website that parents, before they have their first child, and are able to keep it, should attend a course at the end of which they receive a kind of parenting license. To obtain this license one needs to pass a course where basic elements of child psychology are learned and where an examination of the knowledge learned is undertaken in order to obtain the license.
Regarding my suggestion about a license this sufferer writes:
“…these are all good ideas and I liked Alfredo’s about needing a license to have children – I’ve always thought that. How do you enforce something like that, though? It is ironic, we need a license to drive, to have a gun and all sorts of other things, but anyone can have a child. How do you regulate people’s reproductive capabilities? I know that have or had laws in China about only having one child and if you were pregnant again, you had to have an abortion (which I don’t believe in) or I’m not sure what other options there were.
I hate to see something like that happen, too. But a big campaign of some kind, maybe that could reach a lot of people.
One thing I notice is that it often seems people have children so that they have someone to love them unconditionally and someone to carry on the family “name.” The former is probably more prevalent among teenagers, but in that case, that’s a recipe for trouble because a child needs THEIR love more than vice-versa. Before you have children, you have NO idea how much work it is. Yes, there are joys and it is worth it, but some people are just not capable of the responsibility that is required, so then they take it out on the child because that’s how they saw their parents cope with stress.”
Verbal abuse, in the more extreme cases, can lead to physical abuse. Indeed much research shows that verbal and physical abuses are part of the bully’s repertoire. In regard to this Nuyens (2010) writes:
“I believe that verbal abuse is at the root of physical violence. When I worked as a school counselor, I saw how other children hurt others with their words. Often they thought it was humorous, and could not understand why the victim took it so seriously. I reminded children that if the other person isn’t laughing, it isn’t funny! Children learn to think it is permissible to cause other’s pain, and even become callous about others’ suffering. I believe that we must first rid our country of verbal violence if we are ever going to solve the problem of physical violence. The step between the two is slight.
Verbal abusers are dependent on the attention they get from their victims. It is their “fix.” Verbal abusers need a participant. It becomes a codependent situation. Clients have shared how they have tried to be “assertive” by being verbally abusive back to their partners. They may plead and cry to arouse sympathy, or even try to reason with them. Unfortunately, though these women were trying to protect themselves, it only made matters worse. This behavior actually rewards the abuser.”
Indeed as psychologist Nancy Nuyens argues the step between verbal and physical abuse is slight. In regard to this I have been exchanging emails with many sufferers who had abusive parents who engaged both in verbal and physical abuse. This kind of parental behavior is very detrimental to the child’s mental and physical health and can often result in trauma.
Children rely on their parents and/or caregivers and are the most dependent members of our society. They are also the most vulnerable and yet social regulations and the law, in many cases, is not enough to protect them from abuse. My personal research shows that sufferers who had endured both verbal and physical abuse during childhood where the ones more likely to develop serious psychological disorders such as psychosis, bipolar and schizophrenia.
Parents are often unaware of the damage that they are inflicting. Indeed they may believe, in some cases that their verbally aggressive behavior motivates children and encourages them to try harder in life (Solomon & Serres, 1999). When verbal and/or physical abuse occur frequently, or when the child’s emotional and mental resilience is exceeded, the children self-esteem and feeling of self-worth are damaged (Lyness, 2004). This has been the case for many sufferers of my personal study. In regard to this a sufferer writes:
“…Especially when I was younger, 12-15 years old, my father had a strange habit of punishment, being verbally and physically abusive, then ten or so minutes later he
would come into my room and tell me he loved me and give me some kind of compliment in an attempt to apologize and make me feel better. He was an alcoholic. The compliments and anything he said was impossible to believe.”
These mixed messages of being abusive and soon after become nice are very damaging to the child. In regard to this Thomas Harris, in his famous book “I am Ok, You’re Ok” (1970) argues that:
“Freida Fromm noted that a person who shows manic and depressive swings was, as a rule, brought up under the shadow of great inconsistency”
I find this to be very relevant to my experiences as a child with an alcoholic parent. For me it was the alcohol who made my father behave erratically and what Freida Fromm describes as the shadow of great inconsistencies is alcoholic and drug addicted behavior. At least this is true for most of the cases in my study where parents who showed inconsistent behavior had an alcohol or drug problem.
Why do parents verbally abuse their children? As Judy stated there are many reasons for this: some commentators argue that abusive parents feel inadequate and are often frightened by the task of having to be a model to their children. They often realize that they are neglecting their children but are unable to stop this. (Fontana 1973).
Other commentators argue that abusive parents are afraid that their children may not love them and in this sense are very insecure something that often signals that they have had abusive parents themselves. This insecurity often turns into unrealistic expectation where the parent begins to think and often believes that the child has the responsibility to look after them rather than the other way around. (Bowlby, 1988)
One of the most troublesome aspects of abusive behavior happens when the parent gets a chick out of abusing their child. This may sound strange but it is something that has happened to me. I could sense that my alcoholic father had made an art of abusing me verbally. In regard to this psychologist Nancy Nuyens writes:
“Verbal abusers are dependent on the attention they get from their victims. It is their “fix.” Verbal abusers need a participant. It becomes a codependent situation.”
Verbal and physical abuse is not just a family problem. It is a social problem. We have bullies who abuse people in society and children can also be victims of their peers who may abuse them. There is often a bully behind the verbal and physical abuse. But if this is so why have we been unable to protect people from bulling behavior? I think that there is a particularly damaging ideology at work here plus the fact that many people, even those educated, are often in denial about the true state of affairs. In regard to this again Nancy Nuyens writes:
“Children are not held responsible for the pain they inflict on brothers and sisters because it’s just “normal” sibling rivalry. If children can’t take the teasing, they are seen as wimps or sissies. Youngsters who are verbally abusive may even be admired because they come on witty and strong. Often these bullies instill fear. Confronting them is a frightening experience!”
We accept bullies in society and we often see them as desirable, being of strong character and being able to stand up on their own feet. But is this true? Probably not! Bullies are often very troubled people. In this paper I don’t have the space to enter into complex analysis of bulling behavior. It is clear that more research needs to be done in terms of bulling behavior and its effects on our children and society. In reality there is nothing to be admired about bullies and society should recognize that bulling behavior presents a serious problem which often leads to development of a psychiatric disorder.
I think it is more than relevant to introduce here a poem written by psychotherapist Dorothy Law Nolte from her book Children Learn What They Live (1988):
If children live with criticism, they learn to condemn.
If children live with hostility, they learn to fight.
If children live with fear, they learn to be apprehensive.
If children live with pity, they learn to feel sorry for themselves.
If children live with ridicule, they learn to feel shy.
If children live with jealousy, they learn to feel envy.
If children live with shame they learn to feel guilty
If children live with encouragement, they learn confidence.
If children live with tolerance, they learn patience.
If children live with praise, they learn appreciation.
If children live with acceptance, they learn to love.
If children live with approval, they learn to like themselves.
If children live with recognition, they learn it is good to have a goal.
If children live with sharing, they learn generosity.
If children live with honesty, they learn truthfulness.
If children live with fairness, they learn justice.
If children live with kindness and consideration, they learn respect.
If children live with security, they learn to have faith in themselves and in those about them.
If children live with friendliness, they learn the world is a nice place in which to live.
I now move to present some of the child sexually abused cases.
Sexual abuse, also known as molestation, happens when there is forcing of unwanted sexual behavior by one person upon another. The term also covers the behavior of an adult towards a child in order to stimulate the adult’s or child’s sexuality. It is called child sexual abuse when the person abused is younger than the age of consent.
Child sexual abuse has a very negative impact on the future of the child although the severity of the suffering and related symptoms may be a matter of personality, genetics, strengths and life circumstances as I have discussed in previous chapters.
It is important to be aware that the following mental problems can derive from child sexual abuse: self injury, suicidal ideations, sexual dysfunctions, chronic pain, addiction to drugs and alcohol, depression, post traumatic stress disorder, borderline personality disorder, schizophrenia, bipolar disorder, anxiety, and many other mental and physical problems. I say physical problems because it is well known that mental problems do lead to physical problems. In regard to this Dr Bob Rich writes:
“Most complaints people take to the doctor have a strong psychological component”
Going from personal experience and from the experience of other sufferers when I became depressed or anxious there are often physical symptoms related to these mental problems such as digestive problems, fatigue, headache, sleep disorders, sinus and allergy problems and so on. This means that it is difficult to separate the body from the mind.
In my personal research I have found that sufferers who were sexually abused while children have later developed bipolar, schizophrenia and often psychosis. Research shows that child abuse happens frequently in society. (Finkelhor, summer/fall 1994). This large percentage of the world’s population who experiences childhood trauma is probably enough to accommodate all cases of psychological disorders in our world and given that many people do not disclose their traumas, either because of privacy issues or because they dismiss the trauma from their conscious mind, we should entertain the possibility that the majority of what we call mental illness originates from childhood trauma.
Here is what a sufferer writes which I feel is a very descriptive account of her ordeal and suffering:
HELLO, MY NAME IS ROSE. I AM A SINGLE, ATTRACTIVE, 58 YEAR OLD WOMAN . WHEN WE READ ABOUT CHILDHOOD TRAUMA AND NEGLECT AND SUBSEQUENT MENTAL DISTRESS WE TEND TO THINK ABOUT POOR IMPOVERISHED, UNEDUCATED PEOPLE. I WISH TO SAY, THAT LIKE MYSELF, I HAVE MET MANY PEOPLE LIKE MYSELF WHO SUFFERED ‘LACE CURTAIN NEGLECT’ WHICH CAN BE HIDDEN TO A CERTAIN DEGREE, OR AT LEAST IGNORED, COVERED UP. MY MOTHER WAS A HIGHLY EDUCATED, BEAUTIFUL LOOKING WOMAN OF MANY TALENTS WHO TAUGHT MUSIC, MY FATHER CAME FROM A LARGE BUSINESS AND INFACT JUST TO GIVE YOU AN IDEA OF THE LACK OF CLASS DIVIDES IN CHILD NEGLECT/ABUSE, MY GREAT GRANDMOTHER WAS INFACT A TITLED LADY.
BYE BYE BABY BYE BYE !!
AT 5MONTHS JUST BEFORE CHRISTMAS, MY MOTHER TRAVELLED FROM LONDON VIA BOAT WITH ME, A TINY BABY IN A BASKET. SHE HAD AN OLDER DAUGHTER CHARLOTTE JUST 9 MONTHS APPROX OLDER THAN ME. SHE BROUGHT ME TO HER MOTHERS [MY GRANDMA] SAYING SHE WANTED TO LEAVE ME THERE AND GO BACK TO KENSINGTON TO SORT THINGS OUT WITH HER HUSBAND. WELL, SHE WENT BACK ONLY TO GO ON TO HAVE 9 MORE CHILDREN, 7 OF WHOM LIVED AND WERE LOVED BY MY MOTHER.
SOMETHING ISN’T RIGHT IT FEELS WRONG
AT 5 YEARS OF AGE, I HADN’T STARTED SCHOOL, BOTH MY GRANDPARENTS WERE ELDERLY, TOO OLD TO LOOK AFTER A YOUNG CHILD. I HAD BEEN WELL TAUGHT TO BE QUIET, CLOSE DOORS QUIETLY, NOT TO SING, TO BE QUIET, NOT DANCE AROUND. LOOKING BACK THERE WAS NO SENSE OF BEING A PERSON AND NO SENSE OF BOUNDARIES. SHUSH AND BE QUIET BECAME A MANTRA I LIVED BY. DURING THIS TIME, MY GRANDPA, WHO WAS NOT HAVING SEXUAL RELATIONS WITH HIS WIFE STARTED TO GIVE ME PONYRIDES ON IS KNEE, WITH MY LITTLE LEGS ASTRIDE. HE WOULD BUMP UP AND DOWN. AT THAT EARLY AGE , I FELT SOMETHING WASNT RIGHT. I COULD FEEL SOMETHING VERY HARD. I WAS AWARE THEN OF BEING PLEASURED BY A HAND. I CANNOT GO INTO DETAIL AS IT WOULD SEEM PONOGRAPHIC IN INTENSITY, BUT IT WAS DREADFULLY CONFUSING FOR ME. I COULDNOT UNDERSTAND THIS FEELING WELL UP IN ME. ALTHOUGH PLEASURABLE, IT DIDNT FEEL RIGHT. SO, I LEARNT TO SWITCH OFF PHYSICALLY. I LEARNT TO FEEL I WAS DIRTY, FILTHY, I BEGAN A SELF LOATHING AND IT WAS ABOUT THAT TIME THAT I BEGAND TO FEEL WHAT I NOW KNOW WAS DEPRESSION. IT IS INTERESTING TO NOTE – I ALSO DEVELOPED A DREADFUL PHOBIA OF SWALLOWING, I WAS AFRAID OF CHOKING. THE LOCAL GP ADVISED MY GRANDMA [WHOM AGAIN I CALLED MOTHER AND FATHER] TO LET ME STARVE AS IT WAS A GOOD SAUCE.] THIS WAS AN EXTREMELY SCARY PHOBIA AND I WAS ASHAMED OF IT TOO. I WOULD CHEW AND CHEW AND BECAME TERRIFIED OF SWALLOWING. I HAD ALSO COME TO DREAD BEDTIME FOR REASONS I NEED NOT GO INTO.
I STARTED HAVNG DREADFUL NIGHTMARES, NIGHT AFTER NIGHT, THE SAME ONE… ID BE UP A LONG LANE, I COULD HEAR A LORRY COMING UP THE LAND, VERY VERY SLOWLY THE CLOSER IT GOT TO THE TOP OF THE LAND, THE MORE PANICKY I BECAME. I WOULD WAKE UP IN A SHEER SWEAT. I WAS TIMID, HIGHLY ANXIOUS AND FELT A DEEP SENSE OF SELF LOATHING.”
This is a rare account of a sufferer’s experience because it is very rare for people to discuss these problems. I was fortunate that in my study I was able to establish a communication of trust where sufferers have been able to open up to me. I think that I do have an ability to get people to open up to me and to discuss intimate problems. I feel that this is a talent or a gift and it is important for a therapist or a helper like me to have this ability. I am also aware that people tend to loose inhibition when communicating online and especially in emails (Campbell, 2003)
It is rare for people who have experienced child sexual abuse of a serious nature to be able to recover from such experiences. This particular sufferer has been able to turn her life around because of receiving CBT and undergoing exposure therapy where she has been able to desensitize herself from her traumatic memories. She writes:
“As a child I believed that I was nothing and would never amount to anything. The men that my mother entertained touched me and hurt me and I believed that they did it because I deserved it, because I was a bad child. I only started to get better when I was 34 when I was asked what happened to me rather than what was wrong with me. Today I have conquered my bipolar caused by those traumatic experiences. In my case it was not genetic but traumatic.”
Trauma is very complex and how people become affected by trauma is something unique to their personality, character and genetic strengths. Trauma has negative impact on the future life of the child. In regard to this Read (2005) in a review of the study Childhood trauma, Psychosis and Schizophrenia writes that:
“Several psychological and biological mechanisms by which childhood trauma increases risk for psychosis merit attention. Integration of these different levels of analysis may stimulate a more genuinely integrated bio-psycho-social model of psychosis than currently prevails. Clinical implications include the need for staff training in asking about abuse and the need to offer appropriate psychosocial treatments to patients who have been abused or neglected as children. Prevention issues are also identified.”
There is a vast literature which can be used as evidence for the argument that childhood trauma is directly linked to the development of psychological disorders. In the late 60 the self help book of Dr Thomas Harris titled I am OK you’re OK (1969) became a best seller. Harris was a supporter of Transactional Analysis following the work of Eric Berne who proposed that there are three internalised positions in every individual which are the parent, the adult and the child. The phrase I am OK you’re OK is one of the four positions presented in the book. These are: I’m not OK you’re OK; I’m not OK you’re not OK; I’m OK you’re not OK; and finally I’m Ok you’re OK. The most common position is “I’m Not OK, You’re OK”.
As children we see that adults are large, strong and competent and that we are little, weak and often make mistakes, so we conclude “I’m Not OK, You’re OK”. Children who are abused may conclude “I’m OK, You’re Not OK” but as Harris states this is very rare and it may represents children who do not have a predisposition for the acquisition of psychological disorders. These are lucky children who may be able to pick up the pieces and move on. But many children will have a predisposition to acquire a form of psychological disorder and they will be not so lucky to escape the terrible symptoms. The following ideas expressed by this sufferer are particularly interesting:
“Hi Alfredo, Child abuse is at an all time high here in Ireland and indeed the UK. the amount of children who haven’t even grown up to suffer with mental disorder because of their violent [emotionally/physically] parents/carers is growing daily. Babies being beaten, shaken to death, Social workers afraid to stick their noses in too far when its obvious that Sexual abuse is taking place but afraid of losing their jobs Sorry! this has been shown to be true here where even a grandmother had phoned Social services to report her daughters drug taking and abuse of her granddaughter !
In Ireland, we’ve now made it against the law to slap a child. Has it worked? No. Each day I travel on the Light rail or bus, I still encounter it, hard slaps, slaps that are not in correlation to the crime. the other day I encountered a young woman, unhappy and looking tired and drawn scream at a young Toddler I’m leaving you here’ the child was absolutely beyond fear and then she went over and started hitting him,. What’s the answer? Children have always been treated as possessions. But, neglect is on the increase,, why? Depression is on the increase why? Animal cruelty is dreadful here too. As civilized people we’ve failed the children of thee world. Child labour is alive and well in south America, 3rd World, and the items manufactured, bought by the big Western businesses. It overwhelms me, Gun Crime is the norm here now in Dublin and sexual assaults are up, the reasons are so complicated, Society is breaking down.
I do all I can, I try and get legislation changed regarding puppy farms and Cruelty Acts because this is my Gift, with animals. I sign for changes regarding children and their protection, I don’t buy 3rd world produced items. I try to buy Fair Trade Teas , it starts with me, but it starts with Government. Have governments the will? The will to stop drilling for oil with subsequent damage to our Earth and Atmosphere – No, to stop chopping down rainforests [big money] that’s ruining climate and the lives of natives – No. Child Labour? No. 3rd World companies still have Medication sent to them that’s not passed in the West. Nestle back in the 80s were getting women in the 3rd world to stop breast feeding and buy their ‘Milk Formula’ which mixed with dirty water cost many thousands of lives. I could go on and on… i try and work with the man in the mirror, I try and do something, to cheer up somebody’s life everyday, to help in some way. This isn’t enough I know, Alfredo, I don’t have an answer and sorry this is so long.”
The problems that Rose describes above are common to all first world countries. Dr Gabor Mate’ (2010) argues that we’ve created a world addicted to shopping, work, drugs and sex and that post-industrial capitalism has completely destroyed the conditions required for healthy childhood development.
Dr. Maté is the bestselling author of four books: When the Body Says No: Understanding the Stress-Disease Connection; Scattered: How Attention Deficit Disorder Originates and What You Can Do about It; and, with Dr. Gordon Neufeld, Hold on to Your Kids: Why Parents Need to Matter More than Peers; his latest is called In the Realm of Hungry Ghosts: Close Encounters with Addiction.
Dr. Maté is staff physician at the Portland Hotel in Vancouver, Canada. Portland Hotel is a residence and harm reduction facility and is situated in a neighborhood with one the densest concentrations of drug addicts in North America. The Portland Hotel hosts the only legal injection site in North America, a center that has come under fire from Canada’s Conservative government. He writes:
“The hardcore drug addicts that I treat are, without exception, people who have had extraordinarily difficult lives. And the commonality is childhood abuse. In other words, these people all enter life under extremely adverse circumstances. Not only did they not get what they need for healthy development, they actually got negative circumstances of neglect. I don’t have a single female patient in the Downtown Eastside who wasn’t sexually abused, for example, as were many of the men, or abused, neglected and abandoned serially, over and over again.”
(Mate’, December 26, 2010)
Reading Gabor Mate’ makes me wonder how we can, in the face of child abuse, treat the problem that we call mental illness as if it was somehow a biological problem to be treated with medication. The idea brings shivers to my spine because I cannot help but wonder how many will never get the help that they need and deserve after so much suffering.
We know that most sufferers live in denial hiding their trauma from their conscious mind; and we know that therapists, doctors and psychiatrist often prescribe psychiatric drugs without exploring other options first. In regard to this Dr Whitfield (2010) writes:
“ …Yet when people take psychiatric drugs, they almost always do so without realizing that the drugs ‘work’ by disrupting brain function, that the drugs cause withdrawal effects, and that they frequently result in dangerous and destructive mental reactions and behaviors…The intake clinician usually does not carefully look for the three common causes of these symptoms – a recent significant loss, a history of repeated trauma/PTSD and alcohol or other drug dependence. Instead, after a brief (influenced by health insurance or government treatment time limitations) and a cursory evaluation (influenced by the clinician’s training and skills), and usually with no physical or laboratory examination, a psychiatric diagnosis is made. This diagnosis may be in error, such as “depression”, an “anxiety disorder”, “bipolar disorder”, “ADHD”, a “psychosis”, or the like. After all the DSM is more a political document than a scientific one. Decisions regarding inclusion or exclusion of disorder are made by majority vote rather than by indisputable scientific data.”
Once a diagnosis is made, as Dr Whitfield argues, a psychiatric medication is usually prescribed. As I have discussed in previous chapters in cases where the problem is traumatic and sufferers are experiencing symptoms of PTSD psychiatric medication can at best mask the problems for a while. CBT and particularly exposure therapy is the only intervention that can get to the root of the problem.
If medication is taken for a long period of time then problems are likely to surface while the source of the problem becomes more difficult to identify.
Dr Whitfiled argues that anti depressants and anti psychotic drugs can be agents of trauma. In his research he names this phenomena Drug Stress Trauma Syndrome or DSTS. He describes the problem as follow:
“Sooner or later, the patient either stops taking the drug or forgets to take the drug, and for most psychiatric drugs, one of the most common toxic effects begins to occur-drug withdrawal symptoms. If the withdrawal symptoms are bothersome enough, the patient usually contact their prescribing clinicians or physicians who should – but usually do not – recognize them as being in drug withdrawal. Instead, they tend to misinterpret the symptoms as a re-emergence or worsening of the patient’s original possible misdiagnosis’ symptoms or signs. With this misinterpretation, or second misdiagnosis, they commonly then prescribe a higher drug dose- or a different or stronger drug. They usually give the patient no education or insight on withdrawal symptoms, and again, no serious yet appropriate psychotherapy or counseling.
The now vicious cycle continues. Over time, the patient may become progressively more dysfunctional in their personal life…As part of the DSTS, they often become physically ill, with one or more rushed and expensive emergency department visits, medical or psychiatric hospitalization, violence, arrests, family dysfunction, relationship breakups, increasing medica costs and mounting debts. Eventually, similar to people with advanced alcohol or drug dependence, they may hit rock “bottom”
What Dr Whitfiled describes above is his idea of DSTS. It is most likely that the patient never needed a psychiatric drug in the first place and could have done well with therapy as it is usually the case. Yet our first course of actions is to prescribe psychiatric drugs causing trauma to sufferers who become even more traumatized than they were and who often miss the chance to help themselves through therapy.
Why does this happen? I think that this is not only due to the mass promotions of multinational pharmaceutical companies, already cashing huge amounts of money, in search of ever increasing profits; but also due to our collective denial where we have somehow dismissed the reality of childhood trauma and convinced ourselves that this is a biological problem that has no known origins and therefore no one is responsible.
I think that this denial is dangerous. We must bring the problem to the conscious mind and realize that only by treating the problem can we truly help sufferers. And the problem can best be treated by therapy.
In addition, it is when we recognize the problems that we are often able to provide support and create adequate social structures to combat stigma and prejudice.
Childhood traumas remain the major cause of psychological disorders in our society. Depression, Bipolar, Anxiety and Schizophrenia often rise from both traumas and a genetic predisposition.
In our world, were alcohol and drugs are freely available and where parents often lack the skills to be adequate parents, children’ futures are left to fate. There is a clear correlation between alcohol, drugs and the development of psychological disorders.
If the children are lucky they may not have a genetic predisposition in which case, even if they are abused or mistreated, they won’t develop symptoms and will be able to pick up the pieces and move on. But those who do have a predisposition to acquire psychological disorders, if exposed to trauma, will develop symptoms.
My personal research clearly demonstrates to me that the majority of psychological disorder cases are due to traumatic childhood experiences and we can easily say about 80% of all sufferers. Both my friend psychologist Bob Rich and my psychiatrist Dr David Butler, who practice daily, agree that childhood traumas makes the largest portion of all psychological disorders in the world today.
It is clear that we are dealing with suppressed emotions and feelings and that medication can block the symptoms or reduce them but, in the long run, symptoms are likely to surface once again unless these suppressions are released through talk therapy.
A stigma free social environment can provide adequate support. For example, the many hours that I spent on Mental Health websites have provided a stigma free environment which has helped me tremendously and from which much of this book has been inspired. I would say that if governments were able to reduce alcohol consumption and drug intake many psychological disorders in the world would be reduced.
We need to educate parents about how delicate children are and how their childhood days can affect the rest of their lives.
When children develop mental problems we usually take them to a specialist who often prescribes psychiatric medication. Many psychiatrist, psychologists and health professional recognize that psychiatric medication is not indicated in the majority of cases and that we need to tackle the problem using therapy. I feel that the major problem that explain why some people dislike therapy or claim that therapy does not work for them is due to ideology and denial of the true problems. To remain in denial, however, is not compatible with a progressive social world.
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Towards a Unified Theory of Anguish (TAUTOA)
alfredo zotti 2011Introduction The principal aim of this study is to determine the validity of the idea that what we loosely call “mental illness”, or more technically psychiatric disorder, is nothing more than a kind of human suffering best described as mental anguish.