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All posts for the month January, 2012

We have all encountered children who are defiant, belligerent, overly aggressive, unwilling to share, and difficult to manage because they don’t appear to have developed a capacity to reflect, empathically on the emotional state of another. Conversely we have encountered the fearful, withdrawing child. The child who doesn’t want to go out to play where there might be strangers, or other children that they do not know. These children might shrink away from new, novel experiences and lack a sense of adventure. They might be overly compliant.

That children are adversely impacted by bad parental behavior is not a revelation, but psychology and psychiatry are beginning to increasingly understand that these behaviors, at opposite extremes on a spectrum, are predicted by particular negative environmental influences, acting on the child’s brain, in the period from birth through early childhood. Why does this kind of child differ from the child who has compassion and empathy for other children and adults; a child with a strong  sense of adventure?

In the late 1990’s the HMO, Kaiser-Permanente, developed a structured study looking at Adverse Childhood Experiences (ACEs).  They found that children, in the first years of life, exposed to neglect, abuse, or family dysfunction will generally grow up with a host of maladaptive behaviors. If caregivers expose the child to total neglect, or erratic unpredictable attention, physical abuse, sexual abuse, emotional abuse, family alcohol or drug abuse, domestic violence such as one parent battering the other, or mental illness, such as depression, bipolar behavior, anxiety, psychosis and other unpredictable destabilizing behaviors, the child adjusts to life in a way far different from other children. They grow up with a greater propensity towards suicide attempts, drug and alcohol abuse, sexual promiscuity and sexually transmitted disease (STDs), domestic violence, cigarette smoking, and eating disorders (van der Kolk, 2005, p. 401). They also seem at higher risk for auto-immune disorders (e.g. Fibromyalgia in adult women), cardiac disease, stroke, liver disease, diabetes, cancer, and other medical issues.

Trauma researchers are recognizing that a child’s early exposure to terrorizing behavior, from parents or others who are responsible for their care, causes a kind of conditioning in the brain, that is similar to what is called Post Traumatic Stress Disorder (PTSD), but with many more complex developmental features.

A typical example of an individual suffering from PTSD would be a combat veteran returning from a war. In the war with the insurgents of Iraq, waged by the United States and its allies from 2003-2012, combat veterans were constantly exposed to garbage cans and other objects on the side of the roads, which were rigged by insurgents as Improvised Explosive Devices (IEDs), detonated by contact or remotely. Many soldiers were killed or maimed by these IEDs in Iraq and other wars. The veteran returning to civilian life, often had (and has) the three characteristics of PTSD described by Harvard trauma expert, Dr. Judith Herman (Herman, 1997). These are:

  • Hypervigilence – a tendency to be constantly and anxiously watching for situations where the terrorizing event could happen again. (e.g. The soldier does not go near garbage cans, in his small rural town, because he feels that they could explode, like they did in Iraq!).
  • Flashback – Sounds, visual impressions, night-time dreaming, and unpredictable events triggering the feeling that the terror is happening again; feeling like it is once again brought into the present (e.g. Noises that sound like gunfire).
  • Life constriction – I am not going to go to places or get involved in situations or events that could remind me of the terrorizing event, where I know I would be triggered (e.g. Not wanting to go onto busy city streets).

The child, exposed to seeing Mom being beat up by Dad, or having a parent or family member violating them sexually, or erratic unpredictable anger that results in their physical abuse, or seeing a parent gone (dissociated) in a depressive state, or an intoxicated state which feels like an unpredictable neglect, is terrorized by the experience. Like the veteran she is conditioned to want to avoid the behavior, with hypervigilence, flashback, and avoidance, but is powerless to do anything. Instead the child’s brain learns to promote a dissociation in her that causes  her to act out in a controlling, bullying, lying, or aggressive way with no empathic attunement to the other (trying to control or fight before she gets hurt), or to withdraw into a shell, paranoid and fearful (trying to fly or escape before she gets hurt).

This childhood trauma is part of a general class called complex trauma. Dr. Bessel van der Kolk, one of the world’s leading trauma experts (van der Kolk, 2005), has suggested that, with children, this phenomenon be called, Developmental Trauma Disorder (DTD), which allows the clinician to have one focus (rather than weeding through a variety of disconnected diagnoses like ADHD, or Depression, or Oppositional-Defiant).

Julian Ford (Ford, 2009, p. 32) says that when a child is exposed  to complex trauma:

in infancy and early childhood, there is a shift from a brain (and body) focused on learning to a brain (and body) focused on survival. The learning brain is engaged in exploration (i.e., the acquisition of new knowledge and neuronal/synaptic connections) driven and reinforced by a search for an optimal balance between novelty and familiarity. The survival brain seeks to anticipate, prevent, or protect against the damage caused by potential or actual dangers, driven by a search to identify threats, and an attempt to mobilize and conserve bodily resources in the service of this vigilance and to the defensive adjustments that maintain bodily functioning. The learning brain and the survival brain are the same brain, with the same capability and core processes (i.e. neural networks and pathways), but their orientations to the environment and their utilization of core processes are critically different. The survival brain relies on rapid automatic processes that involve primitive portions of the brain (e.g., brainstem, midbrain, parts of the limbic system, such as the amygdala-fight or flight), while largely bypassing areas of the brain involved in more complex adaptations to the environment (learning brain, e.g., anterior  cingulate, insula, prefrontal cortex, other parts of the limbic system, such as the hippocampus…).

Also, neurobiologists (cf. Siegel, 2008), state that that memories of terror go into an area of brain memory called intrinsic (or raw) memory where they are cordoned off, so to speak, from autobiographic memory. That is, these memories are too much, too difficult to integrate, so they are not remembered unless something in the current environment triggers them, abruptly, and then they come flooding out in a raw autonomous way, often with a lot of negative affect or emotion (the person is uncontrollably upset, like the soldier who feared the sight of a garbage can in his town). Regular memories are stored in extrinsic memory where they are remembered, in an integrated way, where the memory is associated with the emotional response(tolerable at the time), autobiographically, and the person learns from the experience (Siegel, 2008).

Putting this information together we can begin to understand that the child, terrorized by relational and physical interactions from infancy through childhood, such that they have more of a survival brain than a learning brain, would be constantly hypervigilant about reliving terrorizing experiences, trying to avoid flooding emotion, and would try to keep things under control by acting out aggressively to control their experience in a dissociated way, or in a fearful paranoia, by withdrawing into a shell.

We can understand why social interactions with other children and adults is so difficult, exacerbated by the school experience, which forces social interaction, and in addition structures learning, which the child, in their survival mode, is ill equipped to experience. Hypervigilent about the next thing that could go wrong, they want to dissociate; they want to be aggressive or withdrawn, and in fact their attention is often scattered and unfocused, which may, in the end, be the explanation for what we know as Attention Deficit Hyperactivity Disorder (ADHD)!

When the child reaches adolescence, he or she is exposed to even more creative avenues of dissociation, including drug and alcohol abuse, and sexual promiscuity. These activities, tragically, are experienced as relief. Also, as they pull away from family towards peers, their aggressive or withdrawal behaviors are accentuated as they find peers to act out their behaviors. A teen who has been a bully child, may solidify as an aggressive abuser in peer relationships. A withdrawing teen might unconsciously gravitate towards a “strong” peer who is actually controlling and abusive, or get together with like-minded peers in a cohort that emphasizes withdrawal.

What to do therapeutically?

I work with kids with these problems every day in my experience as a mental health counselor, working with children and adolescents in a community mental health clinic, associated with a K-12 school system. A typical scenario, for a troubled child, would be that they were exposed to horrible terrors until the age of, say, 6 years, with a biological family that engaged in so many transgressions, that Child Protective Services was summoned, and the child is taken from the parents, and moved to the Foster care system, or was adopted.

The new parents are taught, primarily in the Behavioral psychology paradigm, to build up a structure for the child that promotes house rules, predictable and expected behaviors, enforces boundaries, and works to gently help the child realize that they do not need to act out, lie, steal, manipulate, be a bully or fearfully withdraw from life’s events.  They can survive in a family with loving care, with consistent expectations about rules and responsibilities, and still get what they need.

In addition to this, there is the issue of Attachment bond. In the terrorizing family environment, the child generally does not really attach to the caregiver in the way that John Bowlby described as Secure Attachment (Bowlby, 1988), the kind of attachment that promotes loving consistent caregiving, and the learning brain described by Ford above. This child does not trust or attach to the new parent, because they have already developed the survival brain, and this tends to promote the feeling that anyone will be a terrorizing perpetrator, no matter how well-intentioned.

So in addition to teaching the behavioral structure to the new parents to help the child feel safety and trust in the new environment, the therapist also wants to bring the new parents into the session, to promote bonding between the new parent and the child. This involves developing a gentle reflection on bad memories, and how they are no longer going to happen because they now have these new parents, dedicated to helping them be loved and safe at all times.

With teens, as they build their identities, you find their strengths (creative not maladaptive strengths), what they really might love, if they were not so busy covering up their post-traumatic fears. You try to help them understand their development from childhood, how it got off course with their reflexive responses to trauma in early childhood. What their true Self might be if they can free themselves from the false Self that developed because of the trauma. You get into their darkness, and show you get it, but model a better way if you can!

All of this sometimes works, or sadly sometimes does not. A lot depends on how early you acquire the child in counseling and how dedicated the parents are to reducing and eliminating unpredictable, terrorizing or neglectful behaviors. With teens, its how much they look to you as a positive role model; how well you connect. You come a long ways by being ruthlessly true and authentic with them.

————–

References:

ACES study, http://www.cdc.gov/ace/index.htm, Center for Disease Control and Prevention (orig. study: Kaiser-Permanente, Inc.)

Bowlby, J. (1988) “A secure base”, Basic Books, New York.

Herman, J. (1997) “Trauma and recovery”, Basic Books, New York.

Ford, J.D., (2009) “Neurobiological and developmental research”, p. 32, In “Treating Complex Traumatic Stress Disorders”, The Guilford Press, New York.

Siegel, D. (May 1, 2008) “The neurobiology of we”: How relationships, the mind, and the brain interact to shape who we are”, Audiobook, Sounds True, Inc.

van der Kolk, B. (2005) “Developmental trauma disorder: towards a rational diagnosis for children with complex trauma histories”, Psychiatric Annals; 35, 5; Psychology Module pg. 401.

 

Healing Fiction - James Hillman [Book Cover]I recently listened to a Podcast of an interview by the anthropologist, Jeremy Narby (KUOW.ORG, 2012). Jeremy was studying for his PhD at Stanford in the 1980’s, and lived with the Ashaninca Indians of the rainforests of Peru. The Shaman there, coaxed him to drink the hallucinogenic Ayahuasca tea, so that he could participate or enter into their experience. You can listen to his experience (if the link above persists) or read his book The Cosmic Serpent (Narby, 1998) where he reflects on what it all meant to him.

Jeremy went to Peru ‘as a marxist anthropologist, a materialist scientist’, interested in recording, objectively, the experiences of the indigenous people there. He describes himself as ‘Agnostic to belief’ (2012). After ingesting the tea, he was ‘confronted by two massive serpents who helped him understand how small and insignificant he was in the total scheme of the things’ (2012). He was transported ‘out of his body, many miles above the earth, then the Ayahuasquero (Shaman singing or chanting the song underlying his experience), brought him down to his body, where he saw 100,000 images, including the many veins of his hand, and how these corresponded with the veins of a leaf.’ (2012). Jeremy reflected that ‘these images were of nothing that he had seen before…not images repressed into his subconscious'(2012). They seem to have been images and communications with ‘spirits’ independent of his life memory system.

In his seminal work, Healing Fiction (1983, pp 78-81), James Hillman describes the process of Active Imagination, which I believe, as an experience, could be similar to what Jeremy Narby experienced with the Shaman of Peru, although Hillman might take exception with the drug induced state of experience (1983, p. 79).

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James Hillman

I have been a psychotherapist for 6 years now, working in a community mental health, with a small private practice. I work with children, teens, single adults, couples and families, and I do that while complying with the clinical focus, or ‘evidenced based’ methods, mandated by government and third-party reimbursers…family systems, cognitive-behavioral methods, the neurobiology of trauma and it’s aftermath, along with developmental considerations. These all have their place in my work, as I seek to ease the suffering of people cut-off from a comfortable connection with life.

Hillman though, has always beckoned with is maverick, literary, imaginal, and mythopoetic approach. Along with Freud and C.G. Jung, and all those that have followed in the traditions of psychoanalysis, and Jungian analysis, Hillman has helped me navigate the deeper world of the Unconscious, the place of art, dreams, and imagination.

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