What if ACEs (Adverse Childhood Events) Were the Basis of Mental Health Treatment? 

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What would happen if the mental health system fully recognized the pervasive and profound impacts of trauma on their clients?  How might a deeper appreciation of the multi-faceted sequelae of childhood maltreatment and toxic stressors reshape mental health services?  While the implementation of trauma-informed care in mental health programs has made significant inroads, the dominant bio-reductionist model continues to constrain and undermine progress.

As readers of this website well know, the seminal ACE study (Felliti & Anda) continues to enhance our understanding of the correlations between childhood trauma and both psychological distress, as well as physical illness.  These correlations are striking in their dose-dependent nature – the higher the ACE score, the greater the probability of being diagnosed with a wide spectrum of mental health disorders, including depression, anxiety and psychosis.  The ACE studies give credence to the straightforward proposition that when bad things happen to us at vulnerable ages, physical sickness and extreme distress is frequently the result.  In addition, people exposed to high ACEs commonly adopt a host of risky behaviors such as substance abuse, overeating, and unprotected sex in an attempt to cope with their overwhelming experiences.

Acknowledging ACEs and implementing a trauma-informed perspective threatens to blow up the fictitious diagnostic boxes that mental health systems currently employ to categorize human suffering.  The DSM’s nosological approach focuses on describing the disparate surface symptoms of distress (depression, anxiety, psychosis) while ignoring their known etiology in childhood adversities.  By disease-ifying distress, the DSM pathologizes adaptive, normal responses to abnormal experiences.

Take, for example, the diagnosis of Intermittent Explosive Disorder. A child is labeled with this when it is noted that from time to time, for unknown reasons,  s/he becomes enraged and verbally abusive, destroys property, or hurts others.  The DSM naively names these de-contextualized behaviors as a disorder, and dismissively overlooks the role of chronic, unpredictable toxic stressors that are frequently playing out in the traumatized childs’ life.  It is akin to diagnosing someone who has a urinary tract infection (UTI) with a fever disorder (FD), co-morbid low back pain disease (cm-LBPD), and frequent urination illness (FUI).   ACEs can be likened to an infection that manifests itself in myriad ways in survivor’s bodies and minds.  Etiology matters.

When people become overwhelmed with an unrelenting sense of fear, emotional dysregulation, and alienation brought on by cumulative traumatic exposures they often seek help from mental health programs.   The help seekers’ signs and symptoms will be duly documented, and myopic diagnoses assigned.  Bessel van der Kolk observes in his recent book, The Body Keeps the Score, that a “mislabeled person will be a mistreated person.”  Van der Kolk adds that mental health providers frequently focus treatment on the traumatized person’s solutions rather than their underlying problems.

Due to the deeply ingrained medical model, we heavily medicate problems: we saturation-bomb them with neuroleptics.  A pill for every ill; and if one does not work – another is added.  When traumatized people do not respond well, we call them “treatment-resistant” and “non-compliant.”  Psychiatry’s magic bullets, aimed at mythical chemical imbalances, can offer temporary relief and tamp down some distressing symptoms – but they cannot heal the wounds inflicted by ACEs.  Not all traumatized people develop mental health problems, and not all mental health problems are readily attributable to trauma; but most are, according to ACEs research.

If the impact of ACEs was fully recognized, help-seekers could be invited into an ongoing exploration of what’s happened to them, rather than a code-ification of what’s wrong with them.  Baffling and troubling behaviors could be seen as the ingenious survival strategies they often represent.  A traumatized person can begin to make meaning out of realizing there are comprehensible reasons for their seemingly incomprehensible feelings of despair, inability to relax and feel joy, and distrust of others.  Understanding that one’s behaviors makes sense in the context of ACEs, rather than seen as some random neuronal static, or discombobulated dopamine receptors, can be as life-changing as it is challenging.  Recovery will require hard work and active participation by the traumatized person and their support system, but healing can and does happen, whereas  passively taking pills will not overcome these barriers to health and well-being.

Not only can an in-depth understanding of the effects of ACEs better support trauma survivors’ recovery, it can also increase providers’ empathy towards help seekers. (Lebowitz 2014) Mental health professionals express more empathy towards people when they hear a story, rather than a diagnosis accompanied by tales of life-long brain diseases.  Recent studies point out the failure of ongoing efforts to dispel stigma by promoting the notion that mental illnesses are diseases like any other (Read 2007).  In addition to the lack of supporting evidence for this trope, actual evidence shows that stigma reduction campaigns using this message may actually increase stigma.  Apparently sharing one’s experiences of being subjected to heart-breaking parental abuse, unpredictable episodes of terror, or feeling unloved, engenders more empathy and emotional support than being told that a person has a defective brain.

What if ACEs were the basis of mental health treatment?  Perhaps there would be more compassion from mental health professionals and from the public.  Most importantly, there would be more compassion by traumatized people toward themselves.  Many returning war veterans receive well-deserved support, respect and admiration when seeking help for PTSD.   We will take a significant step forward in trauma informed care when we extend that same support and respect to the survivors of unseen wars at home.

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References:

Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) StudypastedGraphic.pngAmerican Journal of Preventive Medicine 1998; 14:245–258.

Kolk, B. (2014) The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma.

Lebowitz, M., & Ahn, W. (2014). Effects of biological explanations for mental disorders on clinicians’ empathy. Proceedings of the National Academy of Sciences Proc Natl Acad Sci USA, 17786-17790.

Read, J. (2007). Why promoting biological ideology increases prejudice against people labelled “schizophrenic.” Australian Psychologist, 118-128.

83 COMMENTS

  1. Great article. Perhaps also adverse events happening in adolescence and adulthood. Events, and how they impact and are experienced by the individual. If this was the basis of emotional and mental health care, I believe we would have a far more effective system of response. Dismantling current dominant misguided approaches would need to occur also.

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      • Well, it’s great but who will protect the abusers? And more importantly what if the abusers are the very people who are supposed to “treat” you?
        It’s kind of funny (in a sad way) to watch psych professionals writhe and ramble when someone as much as suggests that tehir awesome “treatments” traumatize people. Good luck getting a psychiatrist to apologize to his/her victims or even stopping the ongoing abuse.
        The primary reason why mental illness is not linked to trauma and experience of abuse of various nature is because psychiatry is not there to serve the victims – it’s there to silence them, control them and cover up for the crimes that were committed against them. And many trauma surviviors recognize it – I’ve just watched and interview with one, who was sexually abused as a kid:
        https://www.youtube.com/watch?v=4wmIQbB3iu0
        (listen especially from 27′).

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        • You are absolutely correct.

          Almost everyone I deal with on a daily basis in the state hospital where I work as a peer worker was abused, either physically, sexually, or emotionally, as a child or teenager. And yet, the one thing that is NEVER addressed in their so-called “treatment” (which is nothing but drug cocktails that numb and zombify the person) is the abuse and the resulting trauma that is the basic cause of most of the issues that people are locked up for. Absolutely NOTHING is done and the psychiatrists don’t even want to talk about or address the abuse and trauma.

          As a society we do not want to address this issue at all, for very many reasons. I’ve been lecturing and making presentations for a year now about the ACE Study and it’s importance as the nation’s number one public health issue. Out of 12 presentations only three people out of all the ones I’ve addressed had even vaguely heard of the study. And it’s very interesting to me that when I gave the presentation for clinical staff only two psychiatrists out of the thirteen who work where I do even bothered to show up. A few social workers came and the two psychiatrists came and that was it out of a staff that numbers in the hundreds. Very telling.

          It’s the largest public health study ever done in the history of this country and no one knows about it. Our society doesn’t want to know about it, plain and simple. People refuse to admit that this is done to children all the time every day of the year. People choose to be blind and deaf to this greatest of problems.

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          • The fact the psychiatric industry is profiting off of covering up child abuse is also the “dirty little secret of the two original educated professions,” according to an ethical pastor of mine. The religions, and their hospitals, have historically and still today, stand 100% in support of profiting off of coving up child abuse, by turning child abuse victims into “schizophrenics” (or any of the “psychotic” affiliated disorders) via the neuroleptics, antidepressants, benzo induced anticholinergic toxidrome induced drug combos.

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  2. Great article, Wayne. I love the vision. However, I am afraid I don’t see things going that way in the long run unless the institution of psychiatry is dethroned as the ultimate arbiter of what makes someone mentally ill or well.

    When I first got into the MH field (1896), the DSM-III was new and just starting to have an impact. At that time, everyone KNEW that mental health problems were caused by childhood trauma! Although too much blame was probably put on mothers and not enough on fathers, siblings, communities and societal institutions, it was generally accepted that we learned to be the way we were as a means of coping with our childhood environments at home. Carl Rogers was in the ascendancy, everyone was recommending using “I-statements” and having family councils at home and avoiding spanking and letting your kids feed when they wanted to and picking them up when they cried. Counseling and support groups expanded explosively at this time, as did grassroots political efforts to reduce social oppression, such as domestic abuse shelters and programs and volunteer community crisis lines.

    This changed primarily because of the DSM-III and psychiatry’s selling out to the pharmaceutical companies in the interests of increasing their market share. The narrative was changed because it didn’t fit with the needs of the new paradigm, namely that mental illness was in your brain and you needed drugs to fix it. The propaganda to that end was remarkable in both its volume and its effectiveness, and within a generation, it became an absolute taboo in the MH profession to attribute any responsibility to a parent for how his/her child turned out, and of course, social causes of mental illness were ridiculed into oblivion.

    With this amount of investment in their “model,” however fictional they may know it is, it is difficult to imagine the profession of psychiatry allowing this new (old) narrative, which, let’s be honest, is what most of us intuitively know is really the case without having to look at the ACEs study, to get more than minimal footing, because it will cost them buku bucks. And of course, Big Pharma would be even more upset if we started talking instead of prescribing, and maybe even curing people to the point they don’t need their “helpful” drugs any longer. I really wish that the facts so clearly demonstrated in the ACEs study were sufficient to convince Psychiatry to join the movement and to join reality, but unless the profit/loss balance sheet changes significantly, I see them as likely to fight any such efforts to the death.

    — Steve

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    • Thanks for weighing in, Steve. Much appreciated. I did say “what if”?, not what will be. (or what I hope) but I do believe that the pendulum is beginning to swing back towards understanding human beings in their environments? But agree with you that the huge profits to be made in current paradigm will slow the pendulum down.

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      • I do think it is swinging that way, and about time. I am just predicting that it’s going to take some serious force to keep it moving that way, because I think psychiatry as an institution (not talking about individual psychiatrists here) has been denying this fairly obvious truth ever since 1980, and is not likely to decide to change paths, and in fact will continue to actively oppose this kind of thinking. I sure hope this momentum continues, because I view it as a return to sanity!

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        • The tide is turning. Have faith, Steve.

          The old Jefferson Starship “Winds of Change” (1982) always makes me feel hopeful when I have my doubts.

          Robert Whitaker’s work as well as other authors featured here have contributed greatly to the paradigm shift, but so has the tireless work of many in the trauma field which has been fighting with the APA for the inclusion of the developmental diagnosis for many years.

          What the APA is just starting to recognize is that we are not going away any time soon, the resistance movement is building and gaining momentum. I see cracks in the mirror. I see a growing unease and reactivity on the part of the APA leadership especially those in high ranking university positions whose attempts at damage control are quite laughable. The fact that Dr. Jeffrey Lieberman blocks anyone who has anything critical to say about psychiatry or anything that suggests taking trauma seriously as a major public health issue that needs to be addressed will get the guy acting in a highly defensive and ‘reactive’ manner. The popularity of Dr. Richard Friedman’s recent disingenious article in the New York Times is a fine example of political spin doctor. “I love neuroscience, but it hasn’t resulted in any new treatments” LIE. “We need to put more money into psychotherapy research” – that was the red herring – that was the “tell”.

          Psychotherapy is not a cure or appropriate stand alone treatment for trauma. CBT & DBT have been researched to death. People have been drugged and CBT’d and we still don’t have less depressed people. Perhaps because what causes a great deal of pain and suffering can be traced back to their early childhood development (attachment).

          It’s also very difficult to get funding for any non pharmacutical drug that offers an alternative to psychiatric medications: somatically based interventions such as yoga, biofeedback, EMDR, herbal and holistic remedies are only a few of the healing modalities that come to mind that actually have shown efficacy with trauma but are not empirically validated. Hence, the insincerity of the comment made by Friedman that no advances in treatment have been made in neuroscience – the funding has not been there from the NIH the fund the research! Dr. Friedman does not mention the contributions that neuroscience has made in terms of our understanding of trauma. He’s not going to because it would mean that his ‘house of cards’ would collapse.

          So, I know that all of us together can make a change if we put up a united front and do not back down. Psychiatry’s influence is lessening as the “old white men” that make up most of the rank and file of the APA leadership are reaching retirement age. They have invested decades in an old paradigm of treating those with mental health conditions – they have invested their egos and careers – let them go down like a dying ship.

          Love the lyrics to the Jefferson Starship song. (I would highly recommend watching the original music video. It’s hillarious with old 80s hair and clothes). It has me feeling hopeful and upbeat every time I listen to the song.

          Winds of Change
          Walk softly through the desert sands
          Careful where you tread
          Underfoot are the visions lost
          Sleeping not yet dead

          Hang on – Winds starting to howl
          Hang on – The beast is on the prowl
          Hang on – Can you hear the strange cry?
          Winds of change are blowing by

          Mountains crumble and cities fall
          Don’t come to an end
          Just lie scattered on the desert floor
          Waiting for the wind

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      • You’re right, of course. Parents do the best they can, and blame isn’t really appropriate when someone is doing the best with the tools they have. But allowing parents to accept responsibility for their contributions to whatever issues are going on for kids allows them to address and change their own behavior in a way that can help. Instead, we are denying them their own power and claiming there is nothing they can do about it! I don’t see it as blame at all, I see it as empowerment for both kids and parents. Unfortunately, the NAMA/APA line has been the opposite – any suggestion that parents might be able to impact the situation is seen as “parent blaming” and is shamed out of existence. It’s actually a quite insidious way to take away parents’ control and responsibility for their offspring.

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        • Steve , yes to all your comments! The change that happened in the 1980’s was unbelievable. But so many people were unaware!
          I was involved in a whole separate psych program that worked on the basis of Selma Fraiberg’s work on mothers parenting infants. It was never blame or shame based just old fashioned trauma acknowledgement. This was a problem I always had with NAMI because they just didn’t get that guilt and blame weren’t needed to be part of the problem. It’s so generational. I still see it in my family and I am sure it’s from oppression that affected individual families which then in turn affected parenting which affected kids. Thanks for all your writing!

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        • I agree with these comments. I also think there is a growing consensus that drugging kids is not a healthy way to raise kids. The NAMI/APA Alliance is losing ground as a result of the backlash against drugging kids. ADD/ADHD and bipolar disorder in childhood populations are grossly overdiagnosed whether psychaitry wants to admit that or not. But parents are also frustrated by psychiatrists when drugs do not work or their kids are having problems in school and they don’t understand why. The legitimacy attention deficit disorder and conduct disorder (or intermittent explosive diorder) as diagnosis has been put into question since attachment issues has been identified as the source of the problem, not so much trauma per se. Dr. Bruce Perry’s The Neurosequential Model provides a way for clinicians to provide specific, individualized interventions based on a child’s stage of brain development. This kind of understanding of neuroscience also informs Dr. Dan Siegel’s work. He’s written a number of books on the subject as well as provided workshops and training for both parents and clinicans. His latest work emphasizes teaching healthy parenting skills. This work is becoming more mainstream as more social workers, teachers and therapist seek training and accepted as a preferable way of working with kids and families that sturggle with these issues. Thirdly, Dr. Margaret Blaustein at the Justice Resource Institute in Boston has developed the ARC (Attachment- Self Regulation-Competency) model that emphasizes education for caregivers, parent-child sessions, and parent workshops.

          Alternatives to medications such as introducing meditation and yoga in school settings, for example, providing biofeedback as an alternative to medications in clinical settings have been demonstrated to facilitate emotional regulation or the calming of the nervous system which is the primary issue with these kids.

          The key to success with these models requires not blaming or guilting parents. Rather the emphasis is on providing optimal emotional regulation through attentive, responsive and nurturing care from primary caregivers. Most parents want to do right by their kids. They just don’t always have the necessary skills. This is where education comes in as well as the acknowledgement that it “takes a village”. We will not raise healthy children if we do not invest in their care.

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          • Jennifer this is the first that I remember seeing you here. You’re thoughts are encouraging. What walk of life do you come from?. I work as a substitute teacher and youth worker.’My lived experience with diagnosis and hospitalization was 1989 and 1990-From what I gather, and Whitaker’s historical context provides a good back drop for what I personally experience, as well as a jump off point for discussion with my supervisor at the foster home. (this was a time when bio-psychiatry was really being driven home.-1989)I gave her the book. I also have been logging my concerns about the role of psychiatry in our residents lives.’I feel like that I have been taking a personal risk n doing so. The director of the agency was concerned that I wasn’t discussioning the issue directly with the residents-a valid concern and something I don’t do.

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          • “…the emphasis is on providing optimal emotional regulation through attentive, responsive and nurturing care from primary caregivers. Most parents want to do right by their kids. They just don’t always have the necessary skills. This is where education comes in as well as the acknowledgement that it “takes a village”. We will not raise healthy children if we do not invest in their care.”

            Jennifer:

            I could not agree more.

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          • Hi Chris,

            [Apology ahead of time: Don’t know if this comment will appear above or below yours..]

            I think there are reasons to be encouraged. The information is being disseminated slowly bit surely. More social workers, juvenile justice personnel, teachers, school counselors, social service providers and others who work with “at risk” children are starting to understand how trauma & attachment impact the behavior of children that they serve.

            I have a background in education. I was a public school teacher for a number of years. I am also a trauma survivor and I now spend a lot of my time reading and writing about complex trauma. Thanks for asking, Chris.

            Good luck with your work too.

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    • Wasn’t it also a fallout of the counter-revolution against the outbreak of freedom and creativity in the 60s? Too many wild women and blacks and natives and all the other weirdos running around – one has to rein them in, right?
      Psychiatry is only a piece of a bigger picture. We can’t build alternatives to the current model until we address the totality of the problem. Until then we’ll be only moving people between asylums and jails every couple of years.

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      • I agree – it all fit in very well with the Reagan Revolution and the “Me Generation” and the deifying of greed and rugged individualism and the de-contextualizing of poverty, racism, etc. And I also think things like support groups (non-professional people helping each other? Heresy!) were very threatening to the authorities. Psychiatry’s move was very coherent with larger society’s backlash against the rebelliousness of the 60s and early 70s. Which probably helped the selling of the “chemical imbalance” story – it’s a story the elite establishment also liked and related to, because it let them off the hook for the oppression they were creating and advocating for.

        —- Steve

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        • I agree with you, Steve. And I truly think the reality that the psychiatric industry functions as “social control,” under the guise of “medical care,” is a subject that needs to be admitted to and addressed, too.

          Anyone with a brain in his / her head should know that no one can help an abused child overcome the issues associated with child abuse by claiming all his problems are “delusions” or “psychoses,” and tranquilizing the child. The “antipsychotics don’t cure concerns of child abuse,” as an ethical oral surgeon finally stated to me.

          The bottom line is, however, covering up child abuse is a very profitable business (and benefits the paternalistic powers that be). Plus, the psychological / psychiatric industries have been in this business since at least Freud’s day, more likely since the witch hunters were forced out of it.

          An ethical pastor even confessed to me that the “dirty little secret of the two original educated professions” was that the psychiatrists have been covering up the “zipper troubles” of the clergy and the easily recognized medical mistakes of the mainstream medical community for decades, if not longer.

          And Read’s research does seem to imply it is possible, even likely, that the most common etiology of “schizophrenia” today is psychiatrists misdiagnosing ACEs and child abuse as “psychosis.”

          http://psychcentral.com/news/2006/06/13/child-abuse-can-cause-schizophrenia/18.html

          And since the gold standard treatment for “psychosis,” the neuroleptics, can cause the negative symptoms of “schizophrenia” via neuroleptic induced deficit syndrome. And the neuroleptics, antidepressants, and benzos used in high doses or combination can cause the positive symptoms of “schizophrenia” via anticholinergic toxidrome. It’s highly likely most “schizophrenia” (and, of course, “bipolar” and the other “psychotic” associated “mental illnesses”) are indeed completely iatrogenic.

          Thanks for writing the article, Wayne, it’s a topic you all know has been driving me nuts. And I’m quite certain we could actually de-stigmatize “mental illnesses,” IF we could end the psychiatric propaganda that “schizophrenics” are evil, dangerous criminals with “chemical imbalances” or “broken brains.” And educate our society to the reality that the medical evidence actually shows that most “schizophrenics” today are child abuse victims who had ACEs or symptoms of child abuse misdiagnosed, then they were massively tranquilized with drugs known to cause “psychosis,” and the other symptoms of “schizophrenia.”

          Oh, by the way, Steve, you look absolutely fabulous for a man who started his career in the MH field in 1896.

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  3. Thanks for the great article.
    I would imagine that if the crisis was viewed as underlying issues coming to a head, then the focus would involve dealing with these issues ; and most people would get better and return to life.

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  4. Hi Wayne

    Thank you for this thought provoking piece. I can’t help but imagine sometimes how different things may have been for me, if inpatient experience had focussed on these things rather than imposing the chemical imbalance dogma on me.

    It’s deeply concerning to me, when I see things like the Murphy Bill, and the corresponding testimony of Murphy and the other hacks such as Torrey, Lieberman etc harping on about “brain diseases” – I don’t understand why Anda/Felitti and Van Der Kolk etc are not also giving their views in these sort of forums…? The idea that an as-yet-to-be-proven “disease” model forms the foundation of lawmakers decision making, to further erode the human rights of people seen as “other” is so disturbing. These two conversations need to come together:
    1. On one hand is the ACE Study which actually has evidence showing a drastic correlation between “trauma”/adverse experience and mental illness such as depression and suicide attempts. Many of these adverse life experiences relate to the psychological impacts of violence; coercion; force and intimidation. One of the desired outcomes of the study is for the findings to influence policy and law-makers to take such data into account; and yet

    2. On the other hand there is a dialogue which has disease and pathology at its foundation, and despite not having produced evidence for any such pathology – is actively influencing law-makers to develop frameworks that revolve around imposing actual or implied violence; coercion; force and intimidation on the same people in (1) above.

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    • You’re very welcome, Anonime. You’ve nutshelled the disconnect very well. On the one hand, non-evidence based/dominant approach in mental health; OTOH evidence based alternatives that are barely mentioned in the national debate.
      The big difference = $

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    • Anonime,

      Your point about Dr. Felitti and Dr. van der Kolk lack of participation is well taken. There are several reason why I believe they do not engage in this kind of discussion. The most obvious reason is a conflict of interest given their professional positions. It’s a political tightrope.

      I will say the Dr. van der Kolk has been, and continues to be, an outspoken critic of psychiatry. He makes the case in the video: Psychiatry Must Stop Ignoring Trauma.

      http://bigthink.com/videos/psychiatrys-complex-relationship-with-trauma-with-bessel-van-der-kolk

      Also, he also shows his antipathies and sentiments known in a pitch for an alternative to psychaitric medications in the treatment of ADHD/ADD. He sees neuroscience has having a promising future in the treatment of trauma. If he’s correct we could conceivably see far fewer kids and adults taking stimulant medications as well as antidepressants and antipsychotics.

      Neurofeedback 2015 Research Funding Campaign
      https://vimeo.com/128399541

      The primary reason he needs to go around begging for money from the general public for neurofeedback research is because it’s not being funded by NIH and it’s not a psychiatric drug based treatment. It does not add money to the coffer of either Big Pharma or psychiatrists. Neurofeedback has already shown efficacy in ADD/ADHD and in helping those with trauma histories develop a greater capacity for emotional regulation. However, insurance reimbursement is not offered for non empircally based treatments, hence the need for published research studies.

      So while, Dr. Felitti and Dr. van der Kolk have not participated in this forum (and have no known affiliation with Mad in America, as far as I know), I think it’s safe to say that they share some of the same concerns as other authors and readers at this site. Dr. van der Kolk has spoken publically about his concerns about the current DSM and how it is being misappropriated, how people are being misdiagnosed and stigmatized (particularly borderline personality disorder which he believes is a attachment disorder). He has expressed his concerns regarding the overprescribing of psychiatric medication. He has offered his perspective regarding the close minded and short sighted perspective of many psychiatrists as well as the leadership of the APA in reference to his battle to get the developmental (complex) trauma diagnosis included in the DSM V. Both Felitti and van der Kolk have articulated the need for trauma informed care based upon solid research which they have conducted over the course of several years.

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      • Hi Jennifer

        Thanks for your note and the links.

        Sorry, didn’t express myself very clearly in my post – I know Van Der Kolk and co aren’t linked to MIA – my point was more why are they not also co-testifying to Congress when people like Torrey, Murray and Liberman are lying their little socks off?

        From an ethical standpoint, if they know the Emperor has no clothes, why are they not speaking out in the forums where they propose yet more erosion of our human rights?

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        • Hi Anonime,

          Well, I know that Dr. van der Kolk is not affiliated with MIA, and I think he should be. I honestly feel my own sense of frustration with some of the trauma “experts’ in the field because I think they have considerable credibility and influence.

          I cannot answer your question regarding his lack of participation in the hearings. This could be for any number of reasons.

          Maybe we could draft a letter and send it to all relevant parties and ask for their support. I have thought of doing the same thing. I think that survivors of childhood trauma, in particular, need to start organizing politically. Trauma informed care is a human rights issue. We have the right to ‘trauma informed care’ and the ignorance of psychiatrists or other doctors and mental health providers is not an excuse to deny appopriate services and treatment.

          I would be interested in talking with you or anyone else at MIA that is interested in starting such a grassroot organization or movement to support such a cause. I have been interested in starting a nonprofit dedicated for specifically this purpose. And it is not something I can build alone.

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          • Hi Jennifer,

            Thanks for responding.

            I do want to do something…earlier this year I wrote a book setting out *everything* – but in reality, people do not want to hear about this sort of stuff…

            I was reading an article by Jeffrey Liebermann in the NYT on the latest spate of shootings in the U.S. – and quell surprise his argument is that AOT frameworks need to be put more aggressively to use…it’s the most insidious scare-mongering…but most scary was the number of ‘comments’ to the article which cheered him on!

            It’s easy for the APA, Congress (e.g. Murphy & co) to dismiss people like ‘me’ – because who cares what some random
            “crazy woman” thinks, eh?

            If a letter goes out, it would be great coming from either MIA itself or Bob…as he’s not so easy to silence 🙂

            I just want someone with appropriate credibility and muscle to “call out” people like Congressman Murphy; to connect the dots and put these people in a room together once and for all. I’m happy to write it; I’m more than happy to append my personal history – but the sender needs to be someone with whom they will actually engage.

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    • I agree this is a great article. Just wanted to chime in, as someone currently doing a thesis pertaining to adulthood effects of childhood trauma, I can understand why Felitti/Anda and others aren’t speaking critically of psychiatry. For many outcomes, researchers are still at a point where they still may need to rely on psychiatry for their research efforts (e.g., get a heavily “exposed” trauma sample from a psychiatric clinic). You could critique this as not being a terribly generalizable sample, but sometimes it is what works out to being most feasible. My own dissertation is an example of this. Some of my data in fact come from the patients of psychiatrist who has gotten involved in a pharma funding scandal. Hence, you won’t see me using my real name here on MIA, and although I am currently recovering from an adulthood trauma and subsequent bad experience in psychiatry, it doesn’t help my cause of advancing ACE research to be openly critical.

      Although the ACE body of literature is getting rather big, keep in mind that not only are there some areas where holes exist, it is an exposure that is easy to be critical of because most ACE exposure are derived from retrospective self report. Hence , you will always have people reluctant to accept it because of things like recall bias, so there really does need to be a lot of ammunition. Though, I will say 17 years after the original Felitti article, public health is past the point where it needs to start really pushing ACE based interventions. I see some people doing this (e.g., Nadine Harris and others testing out the feasibility of using the ACE questionnaire to screen parents about their own histories in a pediatric clinic setting). In general, I think we need to reach a point where childhood maltreatment becomes a more open conversation, though this is going to take a lot of work. That is something I aim to do once I finish my own dissertation (and heal from my own traumas, though engagement in this field of work is something I find therapeutic).

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      • Thanks for your comments, firewoman. Your points about the chilling effect of continued reliance on Psychiatry for research funding make sense. When van der Kolk’s proposed diagnosis of Developmental Trauma Disorder was slapped down by the DSM committee for lack of evidence (despite substantial research backing, that exceeded most other diagnoses) you wonder what it will take to break through the wall of denial and self interest.
        You couldn’t be anymore spot on when you say – “we need to reach a point where childhood maltreatment becomes a more open conversation, though this is going to take a lot of work.” True that.

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        • Hi Wayne,

          What it requires is that trauma survivors start politically organizing. When the American Psychaitric Association denied Dr. van der Kolk’s submission to have developmental (complex) trauma included in the DSM 5, it was purely a political move. It was also a slap in the face to people like me who know damn well what we have suffered in our childhood and how it is connected to our mental health problems. I am the survivor of incest and rape as a child. I came close to death as well. I had to put these memories away to survive my childhood. But this does not want to be acknowledged by psychiatry. I was told, as many others are told, that their pain and misery, their depression or symptomatology is genetic in origin. I was misdiagnosed as bipolar and put on dangerous psychiatric drugs that ended up harming me and inevitably did nothing to faciliate my treatment or healing from complex trauma. The etiology of my pain (and others who have complex trauma histories) is not acknowledged, therefore, their legitimacy as an authority needs to be put into question. American Psychiatric Association is not only a drug pusher, it is an instrument of “denial”and “gaslighting” because it denies the reality and experiences of the patients that it proports to be providing care. The failure to include the development trauma diagnosis only results in more misdiagnosis, more mistreatment and distreatment and more money for Big Pharma.

          It requires ‘will’ on the part of individuals dedicated to seeing changes in the mental health system. We could take some clues from the AIDS movement. They were able to successful lobby for more research and funding devoted to providing treatment for AIDS. Why should treating complex trauma or complex PTSD be any different?

          The problem is that psychiatry is still calling the shots. This needs to change, now. And we need to stop waiting for Dr. van der Kolk to take a stance or to act. We need to act. As much as I appreciate Mad in America hosting this topic, “talk is cheap” – where is the will of anyone to actually change anything through mental health activism?

          More research money devoted to discovering new psychiatric drugs is not the solution to ‘curing’ complex trauma. [We know this already].

          – We need to push for more research dollars spent for treatments that have shown efficacy in helping those with complex trauma: EMDR, neurofeedback, integrative/naturopathic solutions that address the immune system & heal the body (vitamins, supplements, herbs). And then, insurance needs to start paying for these forms of treatment.

          – We need to hold social media platforms such as PsychCentral, Psychology Today and HealthyPlace accountable for the information they post related to complex trauma as well as ADHD, borderline and bipolar disorder. Bipolar propaganda on sites such as PsychCentral needs to be exposed for what it is. Many people rely on these social media sites to make informed decisions about their mental health. However, when the information is false and misleading, when the motive is to promote psychiatric medications, it has the potential to cause harm to those who could benefit from complex trauma treatment.

          – We need integrative treatment centers – “healing communities” where people can get psychoeducation, yoga, meditation classes, EMDR, neurofeedback under one roof.

          – We need to hold psychiatrists accountable for such things as being ethically responsible for helping people taper off of medications.

          – We need to expand outreach to hospitals and primary care physicians who still are largely ignorant about the needs of the trauma survivor population. There needs to be some accountability there too. Too many people (including myself) have been retraumatized by doctors and in hopsitals by insensitive healthcare professionals who should know better, but who do not.

          – I’d also like to see some kind of voucher system set up through employers or insurance so that people can elect for themselves how they would choose to use their medical benefits. I’d much rather have benefits/subsidies for neurofeedback treatment or to see my naturopath rather than a Rx benefit package.

          I am confident changes can be made. It does require the organization of the major stakeholders (which includes trauma survivors, mental health providers – clinical psychologists, therapists, trauma reseachers, social service providers) to form a united front. Efforts made by groups that support ACE/Trauma Informed Practices being adopted in schools and medical settings is a step in the right direction. And that’s only a start. There’s still much more work to do.

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          • To this list of good ideas, I would add that psychotherapy and peer support groups be added as areas of research to aggressively pursue / push for insurance coverage. (Re)ddeveloping loving human relationships and becoming able to trust and feel safe are the alpha and the omega of recovery from severe trauma.

            In my opinion, loving friendships / healing relationships (of which psychotherapy can potentially be one) are more important than things like EMDR, neurofeedback, or vitamins/herbs… good human relationships are the most central foundation to a healthy sense of self in children or adults.

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          • Hi bpdtransformation,

            I completely agree with your sentiments. Your comments are thoughtful. I enjoy reading them.

            Trauma survivors live with considerable ‘relational deprivation’ from the get go (from childhood) often through their adult lives. Dr. Bruce Perry makes the point in relationship with traumatized children, and I think the same thing applies to adult trauma survivors. A weekly session with a trauma therapist, regardless of their skill level, does not make up for a lack of meaningful connections with others in our neighborhoods or communities. Relational deprivation is also a ‘killer’ or a destabilizing influence insofar as it begets more emotional dysregulation. I know I spent most of my time in isolation when I was experiencing complex PTSD. The sense of alienation , isolation and hopelessness , I think, explains part of the reason for the high suicide rate among borderlines or those with trauma histories. Rather than recognizing the legitimate need for love, nurturing, and compassion, the borderline often portrayed as someone merely “acting out”. This is not conducive to healing, and when you do not have a “village” or community to offer support, it requires using one’s inner resources and resiliency to pull oneself through. I also benefited from informal support via a social media forum – and that is a poor substitute for love, companionship, touch that comes in physical form. It was a common comment among the peers I connected with that we understood each others pain better than our therapists who were often unhelpful and invalidating. The power of peer support cannot be underestimated. There is much need to develop these services so that more people can benefit. The onus needs to be put on social institutions and local communities to take responsibility to care for people who have suffered abuse rather than to demonize and stigmatize.

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          • Thanks for your thoughts Jennifer. Sometimes in reading MIA I have the sense that vaguely defined forms of “treatment” for trauma like nutrition, herbs/vitamins, novel therapies like EMDR and biofeedback, etc. are overemphasized; to me these are no substitute for people’s core needs for love, understanding, emotional closeness, and safety…. which can only come from direct contact with other human beings. We should not be afraid to say that security, acceptance, love, and closeness are the best treatments for “mental illnesses”; they are not quantifiable, but they count for way more than medications or adjunct treatments like nutritional supplements.

            To use self psychological terms, people need mirroring and empathy more fundamentally than anything else. A child brought up in a lonely house with parents who neglect and abuse him, but who gets good nutrition and biofeedback is still not likely to feel very well. Whereas a kid raised with loving capable parents plus a typical American diet is likely to do better emotionally speaking.

            American society to me is strange in its avoidance of openly promoting intimacy/interpersonal closeness and its overemphasis on self-reliance and individual achievement. Speaking very generally and polemically, that is part of why proportionally very many American people are “sick” and unhappy, emotionally and spiritually speaking. I think a greater proportion of people in less advanced and more socialistic societies are often healthier emotionally speaking. In fact, well-being studies of northern European nations like Denmark/Sweden vs. the USA now strongly support that idea; their citizens are on average significantly happier than ours. Sad, that a country which prides itself on being exceptional, is really not so exceptional at all, or rather exceptional for some of the wrong reasons.

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          • (Not sure exactly where to post this re: bpdtransformation, B.A. August 30, 2015 at 6:58 pm, and 10:00 pm comments.)

            Yes, throughout my boyhood, I suffered continual emotional abuse from my extremely dysfunctional, “rageaholic” father. I now realize this has caused me to suffer life-long developmental/complex-PTSD.

            I was never provided with any of the appropriate, common sense treatments you suggest, such as psychotherapy, counseling, empathy, interpersonal and relationship skills, personal and social growth, nor simply just being pointed in the right directions.

            Most regrettably, the highly-regarded, experienced psychiatrist I saw for 20 years did virtually nothing for me listed in the proceeding paragraph. Instead, he ignored all my childhood traumas, but anesthetized, numbed, and zombified me with SSRI and benzo combinations for 18 years, finally finishing me off by adding a neuroleptic (for sleep) into the mix for and additional 2 years.

            The final result of my “psychiatric treatment” has been extremely disastrous for every aspect of my life.

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      • Hi firewoman

        Appreciate your point re: not biting the hand that feeds you…

        On the “holes” you point to e.g. that trauma relies on “self-reporting” and the assumption that the information is therefore unreliable…surely it’s no more or less reliable than the inherent self-reporting of the symptoms in a DSM checklist is it??? Where else does either camp get their data from – us!!

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        • Hi anonime,

          I definitely agree with your point about dsm validity being questionable considering that it is a form of self report. Keep in mind though, the dsm assessment is different vast majority of measures for childhood trauma, where, in the research setting at least, there is no sort of clinical interpretation involved at all. We just have people fill out the questionnaire, and add up the scores. I think the perception is that having someone else supposedly more objective involved makes it more “valid”. Which, when you think about it doesn’t really make sense, and if anything, we do know that people are far more likely to underreport rather than falsely report trauma. Any self reported questionnaire gets this criticism, although for some exposures like smoking, there are laboratory measures that can validate the exposure. Some people consider court validated abuse/CPS reports the true abuse gold standard because someone else is involved, but considering how little maltreatment is reported, this is rather ridiculous (you would have to use self report anyway to assess non reported abuse). My long winded point is that when an exposure measure is imperfect/bias prone, it is particularly important to have replication studies with a variety of populations.

          The other holes in the literature I was referring to largely deal with specific populations/outcomes. For the population I work with, there are reasons to believe they could actually be more vulnerable to the effects of abuse, but there is little previous work in this area. Which is important to know, from a public health pt of view

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  5. Wayne,
    Great article, I hope you will spread this research/viewpoint to as many colleagues as you can. Hopefully over periods of years, more and more young mental health workers will be exposed to these ideas about trauma and etiology in a meaningful way. Then hopefully they will gradually replace the outgoing blind men (mostly psychiatrists, some other allied mental health workers) who believe that mental illness labels work well without an in depth understanding of etiology.

    In this way a positive demographic shift might occur, as once happened with other contentious social/political issues in the United States, such as the right of women to vote, of black people to be equal citizens, of gay people to have equal rights and so on. Distress in adulthood being primarily understandable through the lens of what happened to people in the past should be another right.

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      • I’m living proof of the lie of psychiatry…. just sayin’….
        I’m this far down in the comment thread, but don’t see a better place to post this semi-non-sequitor comment….
        The DSM itself is mass, organized “blame-the-victim”….
        Even when any child abuse is “the parents fault”, we need to remember that almost without exception, parents were themselves abused in some way, as children…. More “blame-game”, which doesn’t work, and is irresponsible, besides. I’d be happier to see more mention of A.A., the 12 Steps-model recovery program, and the “Big Book” titled “Alcoholics Anonymous”. In working the 12 Steps, we learn that it is our *relationships* that are unhealthy, and that cause us such misery.
        It is by understanding these relationships that healing occurs. And the blame-game ends…. Also, I never would have believed it, when I was young. Usually girls, but boys, too, are sexually abused, then later, taken to quack shrinks, and “diagnosed” as “mental”, and *drugged*, all to cover up the abuse, and let the perpetrators go free. I now know of at least 3 such cases among my female friends. One woman’s abuser-father even became very active in the local NAMI chapter, further enhancing *his* credibility
        at *HER* expense…. Sure, sometimes, some people do better on some drugs, for some length of time. But, the current “bio-psych” approach is to dose as many drugs as possible, at the highest doses, for as long as possible.
        Life without parole…. Psychiatry is no more than 21st Century phrenology. Any and all so-called “mental illnesses” are in fact as real as presents from Santa Claus. I know. I received many presents from Santa Claus when I was a kid…. That’s how “real” psychiatry is. We need to throw psychiatry on the scrap-heap of history. It’s been a tool of violence, oppression, and worse, for decades. Besides, am I indeed the ONLY person to EVER wonder this: “How is it possible for ANYBODY to be correctly, (truly, accurately) convicted of murder, and not ALSO be “diagnosed” as being somehow “mentally Ill”? The ONLY possible, logical answer, is that to the pseudo-science of psychiatry, MURDER is NORMAL. You’ve never heard the psychs. claim otherwise, have you?…. I rest my case.
        Dr. Peter Breggin is one of the FEW “good psychs”.
        In closing, I’m sorry I can’t recall authors’ names, but “Repeat After Me”, and “For Your Own Good” are 2 books that ANY “mental patient” needs to read…. My HOLISTIC understanding of the sequelae of childhood traumas of all kinds has been the backbone of my recovery. I wasn’t as sick as I was *in**spite* of the psychs, no, I was as sick as I was BECAUSE of the psychs. That’s why it’s called “iatrogenic neurolepsis”. 100% of all drugged psych patients have it. Hey, even SOME heroin addicts *LIKE* heroin….From what I’ve read here by Wayne Munchel, there’s far too few of you, dude!….>grin<, aka: LOL……

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  6. “What if ACEs were the basis of mental health treatment? Perhaps there would be more compassion from mental health professionals and from the public. Most importantly, there would be more compassion by traumatized people toward themselves.”

    Self-compassion is vital to our well-being; otherwise, we are crunched by our own self-judgment and self-blame. But it falls to the wayside when people do not feel loved for who they are, at any given time during their process, unconditionally.

    From the ultra-violence happening now, my guess is that this lack of self-compassion is more common than not. Indeed, this would be beneficial to emphasize and re-learn–simply from knowing we’re all doing the best we can with what we know, learning and growing along the way (hopefully). That applies to everyone.

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    • Right.

      The behaviors and actions that many psychiatrists label as maladaptive are actually defense mechanisms and behaviors that people who’ve experienced significant trauma developed in order to survive in a world they experience as hostile and dangerous.

      As you said, people are just doing that best that they can based on their particular experiences growing up. The challenge is offering people the chance to discover new and perhaps better ways of doing things, realizing that they can learn and grow along the way.

      I have the feeling that traumatized people find it very difficult to believe that they can learn and grow and move forward in new ways. I think this is one of the areas that peers can be of tremendous help, as long as the peers realize that their particular way of learning to grow and move forward is not the end all and be all and the way that everyone else must grow.

      Our job is to offer the insight that people themselves can come up with these new ways of living and doing and learning and moving forward. They just need the support of others who believe in them enough to encourage them to try their own hand at creating new ways of living.

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      • I think the challenge for people who’ve experienced chronic trauma is feeling loved and respected. Also, inner peace is elusive in a traumatized state. Indeed, there are individual paths to achieving feelings of love, self-respect, and peace of mind. May we all find them for ourselves.

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        • I agree with this also.

          My experience with a close friend, who experienced terrible sexual abuse as a child all the way to the age of 13, is that this person doesn’t seem to believe that they are lovable and the person is shocked that anyone would even want to love them. I can’t say that this is true for every trauma survivor but it seems true for this friend. Love, respect, and peace are very elusive things for this person.

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        • I think we’re hitting on it, here. Agreed–for the most part we seem to be taught to be hard on ourselves, to punish ourselves for mistakes, and to be ashamed and humiliated if we march to the beat of our own drummer, rather than follow the mainstream; and to feel like a failure if we don’t measure up to the standards of the ‘norm,’ and instead have our own standards and priorities for ourselves, as individuals, each one of us unique and deserving.

          This, I believe, is what society teaches us, in lieu of self-respect and self-compassion. That’s inherently traumatic and would disturb anyone’s inner peace, until they get that it’s really their own live to live and their own person to be, regardless of what anyone tries to dictate to them. “The norm” is not necessarily sound and desirable to everyone, and there’s nothing at all wrong with that. In fact, it is the precursor to originality and creativity , two things we sorely need nowadays.

          And for social change to occur, dare to be different.

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          • Hi,
            My experience is that peer groups (or one to ones) are the best place to share private feelings. These feelings are often universal but suppressed (for survival) in normal life; and can be cringe inducing in a clinical setting.

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          • I agree, Fichara. NORMALIZATION of our feelings and experiences is primary to healing. Yet psychiatry does the opposite – it pathologizes normal reactions and makes people feel inadequate and embarrassed about their own at least semi-successful methods of coping with a less than optimum reality. Support groups are radical because the whole idea is to connect with other people who understand just how normal your reactions are. The support group movement was and is very threatening to the psychiatric establishment.

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          • I don’t know, people respond differently to different things, which is our individuality.

            When I was going through the ‘peer world,’ I found it to be yet another culture with norms, and anything deviant was stigmatized. I experienced it as an extension of the system, and it was hard to grow without eliciting resentment from others. I experienced tons of negative projections from some of the peers with whom I worked.

            This may not be true for everyone, but for me, it was most healing to get away from ALL groups with ‘norms’ and discover who I am, regardless of to whom I can relate in that moment. That took inward focus, witnessing myself aside from others. Comparing ourselves to others leads to distortions. The world is filled with resonance outside of established ‘groups.’

            “I am what I am and that’s what I am.” Popeye the Sailor Man.

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          • Alex, unfortunately the support group and mad pride movements have been coopted by the establishment. It doesn’t surprise me that peer services you encountered were “normed” just as the rest of the psych world is “normed.” I’m thinking more of things like the domestic abuse survivor groups or groups for spouses of soldiers in Iraq or other more free-floating groups that haven’t been coopted yet. Still you’re right, the same thing doesn’t work for everyone. It just seems to me that labeling your own reactions or coping measures designed to deal with a traumatic environment as “disabilities” or “disorders” is so automatically disempowering that almost anything you could do would be less harmful. A lot of people focus (properly) on the dangers of psychiatric drugs, but I find “diagnosis” to be the more insidious evil. Convincing people that they are abnormal and damaged is never a good way to promote healing!

            —- Steve

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          • “Convincing people they are abnormal and damaged is never a good way to promote healing.” So true, and this behavior is close to the definition of gaslighting.

            https://en.m.wikipedia.org/wiki/Gaslighting

            And basically this is what many, or most, of the bio-psychiatrists do, especially now that the DSM disorders have all been confessed to be scientifically “lacking in validity” disease entities.

            Although what they do is insidiously worse, the psychiatrists try to convince people they have “chemical imbalances” then give them drugs that actually create “chemical imbalances” in their brains. And the psych drugs do, in reality, create the very symptoms of the so called “mental illnesses” in at least a percentage of the population.

            Today’s bio psychiatric industry is really nothing more than an extremely insidious gaslighting industry. Although I do understand the medical industry and much of society, as a whole, has been deluded by the greed inspired fraud of today’s psycho / pharmacutical industries.

            But, it’s important to note that by definition, gaslighting is “mental abuse,” not “mental health care.”

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          • Steve, Fiachra, and SE, totally agreed that it is the diagnoses which amount to insidiously abusive, what I’d call social abuse, pure and simple. That gets a person good and stuck, until they shift their self-perception away from feeling like a ‘disordered person.’ That is an illusion, of course.

            And, indeed, the diagnoses seem to be designed–or at least how it is practiced now–as a way to deflect the cause of true mental distress, which to me is more social than anything. I think we drive each other crazy more often than not via guilting, shaming, double binding, gaslighting, etc, all forms of bullying, as an inherent dynamic of the system. That’s quite common, I think, including in family systems. The independent thinker is courageous and takes risks, here.

            This is why I think this insidious social abuse is often a carry over from childhood. We internalize it and it becomes ‘familiar’ so we operate this way until we awaken to ourselves. Hence, society the way it is.

            Groups mirror us which can be helpful if it is a healthy, grounded, and self-responsible group. But they do us great harm if it’s just a repeat of everyone’s toxic family dynamics.

            So I guess it’s a matter of discernment and boundaries, which are things we refine along our journey of personal growth.

            Plus, a group can be extremely beneficial initially, indeed, to normalize our experience and see that we are not alone. But the point is to grow and move on. Groups often seem stuck and its members become very attached to each other, which is what gets me weary. Those are more systems forming.

            As long as issues are being resolved and people are moving on, then I’d call it a safe group. But often, it’s just everyone continually rehashing their stories, with no change, keeping all that fear and rage alive, rather than moving past it as a way of healing. That’s when it gets really frustrating and feels stuck, and can be very toxic and counter-productive.

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          • Hi Alex,

            “…But often, it’s just everyone continually rehashing their stories, with no change, keeping all that fear and rage alive, rather than moving past it as a way of healing…”

            I think the whole idea has got to be that a person can recover completely – and I’ve seen full recovery happen lots of times. The bullsh**t I refer to in groups is mobile phone brand comparison.

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          • Hi Fiachra, unfortunately, there are a lot of people who believe they are stuck with the trauma for the rest of their lives, and, moreover, seem to feel that full on healing is simply a ‘myth,’ and won’t even consider that someone may have actually healed from these issues, and that they can, too. I found this to be the majority of people in these environments. That leads to a lot of stigma and discrimination, just as routine.

            I do not relate to these beliefs, and so I experienced a lot of resentment for coming off meds and healing as a result, then successfully establishing a business. Here in the USA, that response seems par for the course. I find people to be way more competitive rather than supportive. Don’t grow TOO much or your “friends” will hate you. Even though I offered my services and information at no charge, I could not avoid the resentment of others. It was quite oppressive.

            BUT, it motivated me to break free of all that and plant my own feet in the world my way. Out here in the world, outside of those ‘mental health’ walls, I feel supported for my efforts and achievements in the world, which I would expect from a healthy community, and which is what I always offer to others. Jealousy and resentment were palpable energies in the mental health world, which is terribly unsafe.

            I just find that entire culture to be toxic as all get out. I found it impossible to achieve clarity and self-actualization from within any part of the ‘mental health industrial complex.’ The world is our oyster if we believe in ourselves.

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          • Hi Alex,

            That’s the problem – non recovery is a very prompted viewpoint, but it’s not in any developing persons best interest.

            I know people with the most horrific life stories that have made full and enduring recovery
            (and helped others to do the same).

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        • [Not sure where to reply – sorry again if this gets posted in wrong place]

          Very interesting discussion, particular regarding ‘recovery’. I have a problem with the use of the word ‘recovery’, ‘post traumatic growth’, ‘resliency’ – all common complex trauma ‘speak’ that often says nothing much about the individual’s experience of complex trauma, but says more about the need to provide legitimacy to one’s perspective as the ‘expert’ or the one in the ‘know’. A lot of complex trauma articles and books homogenize the experience of complex trauma (i.e. – everyone follows a similar recovery path – all roads lead to nirvana or integration). People latch on to this work because they are often desperate for a solution to their pain and suffering. I’m not saying these works are without value, however, I think they are “oversold”. “Healing” (which I believe is a more honoring term for the process), in my experience, requires rejecting others definitions of what recovery should look like or what it should mean to me. I ulimtaely needed to reject the treatment and roadmap that was offered by therapist, and I needed to create my own.

          Moving beyond the experience of CPTSD or an identification with being a trauma survivor or a victim, is an individual process.

          I appreciate everyone’s comments here because it has prompted me to think more about these issues. I’d like to sit in a room with all of you and talk. I’m sure we could discuss this for hours!

          I like Alex’s comment:
          This is why I think this insidious social abuse is often a carry over from childhood. We internalize it and it becomes ‘familiar’ so we operate this way until we awaken to ourselves. Hence, society the way it is.

          Adult survivors of childhood trauma often get what they got as children – mistreatment, abuse, sense of alienation, a hostile world …
          The adult experiences often mirrors the childhood experience, but this mirroring cannot be explained away by merely attritbuting it to ‘repetition compulsion’ – that is, it is not only the choices the individual makes in relationships that causes the trauma survivor more pain and suffering as an adult, it’s the pathological elements of society that cause the distress. I think, this may be related to what Alex is alluding to in his comment? It is not so much that we are ‘sick’, it’s that we live in a ‘sick’ society that cannot provide the ‘holding’ that a trauma survivor requires as part of their healing.

          I’d also add that nature is kinder than most human beings. I think that is “undersold’. We are told that human connection is required in order to heal – however, that assumes that there are healthy people to bond with, and even within the mental health community, it’s difficult to find healthy people. Going off into the woods and hugging a tree can be more healing than hugging a person who cannot offer true empathy or compassion.

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          • Thanks, Jennifer, yes, you are reading me correctly. I do believe that we live in a sick society, and I actually mean that at this point with no judgment, truly, but more with concern, frustration, and puzzled over how to best encourage a shift here. It’s very challenging.

            AND, I’m a huge fan of nature and feel that it is our most healing support in life, always. That is non-judgment and non-analysis, pure freedom; simply being in the current always flowing and ever-creating. An excellent mirror for our true personal nature.

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          • And yes, while I don’t think anyone is ‘sick’ but more so, we have perhaps absorbed the ills of society at large, it seems that we can act as abusers or be victims, that seems to be the choice offered in society these days. That’s a fierce double bind which causes people to suffer at the hands of callous hearts and keeps social and class division alive and well.

            Where is it that we can live and let live, without taking on either one of these roles? That would be a desirable society. Not cold, it’s a good feeling to have the encouragement and support of a community, that would be mutual respect and kindness.

            When we find that neutral identity, then we can change our experience because we no longer identify with the original trauma(s).

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  7. And if treating adverse childhood experiences were also seen as key to reducing the recidivism rate of those incarcerated we all would be moving toward an America that embraces all. If there were an effective treatment program, not drugs, for those locked up, looking at trauma, many lives would be reclaimed.
    I spent years in state and VA mental hospitals before learning of trauma and getting real help. I have been around thousands of men who could have been reclaimed from their inner hell, but for the abusive lack of caring by states, and yes, the VA. Thorazine and Prolixin treatment were indicators of the lack of sanity of the system, not the “patient”.
    Hugh Massengill, Eugene

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  8. I wonder how a system which largely ignores trauma and too often traumatizes those who look to it for help can ever be responsive to ACEs. Can any amount of training for existing staff and practitioners result in change that is long overdue?

    The National Council is having a webinar on August 31, “‘Trauma-Informed Care Systems Implementation.” Is a webinar alone sufficient for any organization achieve a transformational paradigm shift? Is it even enough to provide the impetus for change? From the National Council’s announcement, “Participants will learn the principles of a trauma-informed care approach and the critical elements involved in implementing and leading this type of transformational change within an organization.”

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    • You are so right, Joe. The biggest problem with training people on TIC is that a practitioner really has to be willing to get in touch with his/her own traumatic past and be willing to feel that pain before they can really be present to do good trauma work with someone else. When it comes to “mental illness,” the diagnostic system makes it WAY to easy for practitioners to project their insecurities and pain onto the client and victimize them yet further. I don’t think any amount of training can make it less traumatic to have your emotional reactions to a difficult childhood relabeled as “bipolar disorder” and “treated” by suppressing those reactions. I believe most DSM “true believers” really NEED to believe in the DSM because it protects them from seeing that they’re not so very different from their clients. But in my experience, it is the very ability to find those similarities and to empathize with the client’s situation that leads to an understanding of how to help.

      TIC is wonderful, but without a total scrapping of the DSM, I don’t think the mental health world can really incorporate it, because it is totally counter to everything the current paradigm encourages clinicians to do to their clients.

      —- Steve

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      • Great points, Steve. Unfortunately, there are a lot of wounded healers working in the mental health field too, causing more harm than good. You cannot be present to others pain, if you cannot be present to your own. That’s Trauma 101 training for the therapist.

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    • Let’s start with the fact that no psychiatrist who uses force against his “patients” is ever going to admit that this can be traumatizing and make people worse rather than better. And even if that were the case it will be treated as not a big deal. I have challenged 2 psychiatrists on that personally and only heard denial, half-a** excuses (“sometimes it’s necessary”) and diversions (“I get a lot of letter from people who are grateful”). Are these are supposed to be people whom you are discussing your trauma with? It’s like telling a rape victim to go to her rapist for help. Laughable and pathetic.
      Btw, what people who were traumatized need the most is justice. Justice not only understood as punishment for perpetrators (though that would be very welcome) but primarily as recognition of their suffering and making sure that it never happens again – not to them not to anyone else.

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      • Hi B,

        I sympathize with your experience having been retraumatized and abused by psychiatrists in the past. I could have filed a lawsuit, that would have been stupid though since doctors have malpractice attorneys with deep financial pockets (typically win 9 out of 10 lawsuits). I could have filed a complaint with the Amercian Psychiatric Association which sole purpose is to protect ‘their own’. That would have got me nowhere fast. Only more pain, suffering and victimization during a period of time I was close to ending up in a psychiatric hospital. Believe me, I understand your pain.

        I’d just like to add that it’s interesting to observe who is choosing to respond to whom in these comments. It’s apparent that the divide still exists between those who treat are in the ‘know’, those with the PhDs and MFTs and MAs after their names and those who are trauma survivors need to be ‘informed’ by them. Titles and given one legitimacy in Mad in America forums. It also offers the possible benefit of making a name for oneself for the purposes of pubishing a book in the future.

        Trauma survivors want justice because they have been abused not only by their family of origin, but also by psychiatrists and mental health professional who like to leverage their credentials and professional experience to tell trauma survivors what trauma means and what treatment means because it’s clear we are too f’d up to figure that out on our own. I do not see forum as any different since their is a power differential that is subtly being played out in these exchanges. We survivors talk to each other. And the professionals talk to each other. Where is there a meeting of the two parties? Where is there an equal exchange of ideas or opinions? There isn’t. What does a trauma survivor have to add to the conversation, after all, it’s only their experience that is being talked about.

        Some people write articles, books and promote their professional services, and others sit in psychiatry offices on a weekly basis and receive abuse and inappropriate treatment which is an exploitation of the psychiatrist’s authority.

        When it comes to justice for trauma survivors, the professional ‘experts’ here are silent on the issue. Don’t expect them to activiely participate in changing the system or defending the rights of trauma survivors, they prefer intellectualizing and pontificating from the sidelines.

        Peace out, you all.

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        • Hi Jen – just noticed your post and wanted to respond. When people address themselves to specific others, as you (& others sometimes do) I’ve generally refrain from commenting, as I think I’m intruding.
          I believe that for trauma informed care to be effective, it can’t come from a “one up” experts w/ alphabet soups after their names. We’re all bozos on this bus – and as someone who struggles w/ my own ACE’s, prefer a side-by-side, transparent approach.
          For what it’s worth – my own experience w/ this site is that it is remarkably not dominated, or segregated by professional/survivor status. MiA has been a an incredibly educational forum for me because of that.

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    • Great questions, Joe. IMO Yes- training, coupled w/ bold, impassioned leadership that has drank the TIC kool-aid can bring significant change (not that common)

      But no, a webinar alone ain’t enough. For me, the key is the commitment of supervisors (mid-levels) to implement TIC, long after the trainings are over. Without them, very little progress.

      I have seen it happen, organizational alignment a must.

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      • I forgot to thank you Wayne for writing this piece. My son is into graphic novels and they seem to be very, very popular. A lot of the new ones out deal with ACE’s. However, many writers have drunk the kool-aid and accept the idea of medication even despite side effects.
        Who in this community can write a graphic novel similar to “Fun Home” that describes our viewpoint?
        Ideally you could have a therapist and a client novel inter woven together but still separate stories.
        Or you could go traditional and have PharmaBoy or PharmaGirl save the day from a word ruined by pharmaceuticals in the water and bloodsteams.
        Or how about a superhero that avenges ACE’s?
        Superman was written by two guys who were bullied at school. This could work.

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        • Loving it, Catnight! The ACE Avengers are born!
          In my trainings, I often make note of the ubiquity of childhood trauma narratives in the Super-Hero pantheon (Batman, Spiderman, X-Men etc…) – they derive their super strengths (post-traumatic growth) from their grievous wounds.

          Awesome idea.

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          • “…they derive their super strengths (post-traumatic growth) from their grievous wounds.”

            I really love this, Wayne. I’ve often thought what would be the indicators of childhood trauma having healed. Certainly seeing the meaning to our suffering (discovering our ‘super-powers,’ which I believe we all have somewhere in there which we can cultivate once we own them, as our inherent gifts) is a leap in the right direction. Catching up with ourselves as a result would be another part of the healing process, witnessing our own transformation, for which we all have the potential.

            Then, perhaps becoming comfortable with who we are in our new skin, leading to a new self-identity, not as one who has been traumatized, but as one who learned and grew from the trauma to discover their strength and power, as well as authority over their own lives.

            LOVE the phrase “post-traumatic growth!” I’d like to see this incorporated into the language of these discussions. I think it points in the right direction of complete healing from trauma.

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