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

Wayne Munchel
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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.

* * * * *

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.

  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

      • 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.

        • 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!

        • 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.

          • 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.

          • “…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.

          • 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.

    • 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.

      • 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

        • 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.

  3. 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.

    • 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.

      • 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?

        • 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.

          • 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.

    • 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).

      • 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!!

        • 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

  4. 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.

  5. “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.

    • 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.

      • 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.

        • 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.

  6. 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

  7. 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.”

    • 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

      • 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.

    • 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.

      • 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.