Sunday, 24 June 2012

The Long and Arduous Road toward Trauma Awareness

Near the close of the 19th century, Sigmund Freud began documenting memories of childhood sexual abuse in many of his patients.  He wrote three papers on how these sometimes repressed memories resulted in “hysterical symptoms” or “obsessional neurosis”. This discovery could have launched the study and treatment of Post Traumatic Stress nearly a hundred years before it finally came to the notice of psychologists and therapists.  But that was not to be.

Why Freud’s early discoveries and theories were suppressed is one of the deep dark legends of the mental health field.  The parents of Freud’s patients who disclosed child sexual abuse at the hands of their parents and other family members, were Freud’s peers and patrons.  As soon as Freud began to speak publicly of the devastating and long lasting effects that sexual abuse had on their children, those peers and patrons convinced Freud that to continue in this manner could destroy his career.  So Freud took the expedient course to save his career and reversed his stand on this “hysteria”.

To place himself in good standing in his community, Freud  reversed his position by labeling these child sexual abuse victims as false accusers and claimed that memories of incestuous experiences were remnants of childhood desires to be sexually seduced by their parents.  He created the “Oedipus complex” to explain this phenomenon [other practitioners used Oedipus for males and created the title “Electra complex” for females] So in effect, Freud and his followers blamed the victim.  And because children are quick to learn, a shroud of silence descended over the topic of child sexual abuse that continues to silence many victims to this day.

Since that time, generations of therapists were taught that children were “resilient” that no matter what we did to them, they would “bounce back”.  And the ones who didn’t “bounce back” – well, they arrived at their addictions, anxiety, depression, aggression, self-injury, or suicide, through other flaws in their character.

Even when Post Traumatic Stress Disorder was added to the Diagnostic and Statistical Manual of Mental Disorders in 1980, one main criteria for the diagnosis was that the victim’s life had to have been in danger.  It is only recently that clinicians have recognized that if it “feels” like your life is in danger, then it was in danger.  The emotional part of our brain [the limbic system] that keeps us safe and organizes our memories, isn’t capable of reason.  The amygdala – the almond sized guardian of our safety in the core of our brain cannot tell the difference between a real or imagined danger, nor a current traumatic experience or a memory of a traumatic experience in the form of a nightmare or a flashback.

In my practice and my years working with at-risk and high-risk youth I have come upon so many children and youth who were medicated for multiple diagnoses; ADHD - Attention Deficit Hyperactivity Disorder, RAD - Reactive Attachment Disorder, ODD - Oppositional Defiance Disorder, OCD - Obsessive Compulsive Disorder, MDD Major Depressive Disorder, and other clinical “alphabet” disorders.  But what my colleagues and I found over and over, was that under all of these sets of symptoms, lay unresolved childhood trauma.  Once we understood that trauma was the wellspring of the behaviours we saw in these children and adolescents, it all began to make sense.

ADHD – The child can’t focus.  How can they focus when all they can think about is the memories of their abuse?  How can they focus when they are living in a dangerous and threatening world?

RAD – How can a child form healthy attachments to adults when it was an adult who hurt them in the first place?

ODD – Can you blame a child for opposing the will of adults when the last time they submitted to that will they were sexually or physically abused?

OCD – Of course they obsess over rituals, they are desperate to have some form of control over their lives.

MDD - Who wouldn’t be depressed by the memory of abuse?

And what we found was, if we looked past the multiple diagnoses and treated the Post Traumatic Stress, the symptoms of all those disorders faded or vanished completely.

Thankfully, we are now moving away from the old model of multiple diagnosis and prescription drugs to treat symptoms alone and are looking deeper to explore and treat the underlying trauma.  Therapists have known this for years and now small pockets of the medical community is finally joining us in that movement toward mental health through the use of fMRI [Functional Magnetic Resonance Imaging] to see inside the brains of patients in order to tailor therapeutic approaches to treat the lingering effects of trauma. Once we see how deeply rooted the trauma is within the brain, we can provide a therapy that begins where the patient is at.

Aaron D. McClelland, RPCc

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