School is out and I am finally able to relax and spend time…well, reading and preparing for next year. I am also doing other things but I am happy to have the time to reflect and plan for the coming year. I am continuing to read The Body Keeps the Score which I discussed in this post. Recently I have been reading about the effects of trauma on the body and a person’s health. Van Der Kolk points out that many patients will receive different diagnoses that are often unrelented in the course of any psychiatric treatment.
“If their doctors focus on their mood swings, they will be identified as bipolar and prescribed lithium or valproate. If the professionals are most impressed with their despair, they will be told they are suffering from major depression and given antidepressants. If the doctors focus on their restlessness and lack of attention, they may be categorized as ADHD and treated with Ritalin or other stimulants. And if the clinic staff happens to take a trauma history, and the patient actually volunteers the relevant information, he or she might receive the diagnosis of PTSD. None of these diagnoses will be completely off the mark, and none of them will begin to meaningfully describe who these patients are and what they suffer from.” (P138)
Later Van Der Kolk discusses a study he was in charge of comparing the problems of different groups of traumatized individuals. They interviewed 525 individuals at five sites around the country looking to see if particular populations suffered from different constellations of problems. The individuals were divided into a group who had histories of childhood physical or sexual abuse by caregivers, recent victims of domestic violence and people who had recently experienced a natural disaster. What they found were that there were clear differences among the groups.
“The adults who had been abused as children often had trouble concentrating, complained of always being on edge, and were filled with self-loathing. They had enormous trouble negotiating intimate relationships, often veering from indiscriminate, high-risk, and unsatisfying sexual involvements to total sexual shutdown. They also had large gaps in their memories, often engaged in self-destructive behaviors, and had a host of medical problems. These symptoms were relatively rare in the survivors of natural disasters.” (P145)
At the time of this study the team took the results and voted to include a new trauma diagnosis for victims of interpersonal trauma in the upcoming DSM-IV to be released in May of 1994. When the DSM-IV came out they were surprised to see that the diagnosis had been left out. It has not been included yet. As Van Der Kolk states, “Not having a diagnosis now confronts therapists with a serious dilemma: How do we treat people who are coping with the fall-out of abuse, betrayal and abandonment when we are forced to diagnose them with depression, panic disorder, bipolar illness, or borderline personality, which do not really address what they are coping with?” (P145)
Van Der Kolk is discussing diagnoses in adulthood. I find it interesting that so many of my students are being diagnosed with similar disorders and being medicated at 6 and 7 years old when what we are observing of their behaviors may be attributable to the trauma they have or are experiencing. Further ahead in the book I know that Van Der Kolk is going to discuss paths to recovery but I am wondering how valuable what he shares will be to my work with young children. From what I have read so far it seems that the majority of his work has been focused on adults and the effects of trauma in adulthood.
Regardless, I find this research fascinating. I think of families I have worked with and the layers of health issues that are embedded in so many members of those families. Trauma does not end with one person. Often it is generational. And within families health issues can be identified as genetic when many family members experience similar health problems. In 1990 the CDC encouraged Vincent Felitti, the chief of Kaiser Permanente’s Department of Preventive Medicine in San Diego to begin a study looking at the connections between health problems and adverse childhood experiences. This study resulted in the Adverse Childhood Experiences (ACE study). Scores on the ACE study predicted a list of high-risk behaviors including smoking, obesity, unintended pregnancies, multiple sexual partners, and sexually transmitted diseases. But it is the toll of major health problems that may be the most interesting: “Those with an ACE score of six or above had a 15 percent or greater chance than those with an ACE score of zero of currently suffering from any of the ten leading causes of death in the United States, including chronic obstructive pulmonary disease (COPD), ischemic heart disease, and liver disease. They were twice as likely to suffer from cancer and four times as likely to to have emphysema. The ongoing stress on the body keeps taking its toll”. (P149)
Maybe some of the disease we see in people is NOT genetic. Maybe a reason it can look genetic is that siblings who experience similar trauma in their childhood have a higher chance of getting similar diseases. And why might those siblings parents or children suffer similar health issues? Well, according to the research traumatic life experiences during childhood and adolescence are far more common than expected and adverse experiences are interrelated. “People typically don’t grow up in a household where one brother is in prison but everything else is fine. They don’t live in families where their mother is regularly beaten but life is otherwise hunky-dory. Incidents of abuse are never stand-alone events. And for each additional adverse experience reported, the toll in later damage increases.” (P147)
By focusing on health issues and approaching a person as having a disease are we missing out on treating the actual roots of these diseases and in turn finding ourselves unable to help a person recover? In our society we focus so much on pills, surgeries, shots, diets…but what if we need to go deeper? Obviously not all who suffer from these diseases experienced childhood trauma but obviously many have. Yes, we need to treat the disease but by ignoring the roots it’s like pruning a bush you wish would go away. It will not stop growing until you deal with its roots.