Death of a Thousand Cuts: Young People and Trauma
This blog was originally posted on Therapy Route
When we hear the word trauma we often think of a terrible life-threatening event – a car accident, natural disaster or an act of violence which changes us forever.
But psychological trauma needn’t be caused by a single event – it can be – and often is – the result of a cumulative process of traumatic interactions in childhood which can permanently change the brain and leave young people with a vulnerability to mental illness. As trauma theorist Bessel van der Kolk puts it: “Chronic trauma interferes with neurobiological development and the capacity to integrate sensory, emotional and cognitive information into a cohesive whole. Developmental trauma sets the stage for unfocused responses to subsequent stress leading to dramatic increases in the use of medical, correctional, social and mental health services.”
Trauma such as this (complex developmental trauma) occurs during particularly sensitive periods in a child’s development – usually from birth to 3 years. This is the period during which important regulatory functions are developed and brain structures, pathways and connections are formed or “turned off.” The important experience-dependent development which occurs at this early stage allows us to adapt to our social environment, helping us learn to regulate ourselves and recognise our own and others’ emotions. Although the brain does remain plastic into adulthood, certain functions and pathways set in motion during this early period are difficult to change and can influence our ability to handle stress and manage our emotions across the lifespan.
So what happens when something goes wrong?
Attachment and Trauma
A lot of what can go wrong during this period has to do with attachment and the attachment relationships we develop during our first months of life. We are socialised through these important relationships, which teach us how to be with other people, what to expect of ourselves and them, and how we might be viewed in the world. It helps us develop a healthy sense of self. When things go wrong, it can create an unconscious sense of wrongness in the developing child, a “working model” of self that leads to an ongoing sense of shame. “…the infant’s primary drive is towards attachment [and] they will accommodate to the parenting style they experience…They can make meaning of their circumstances by believing that abuse is their fault and that they are inherently bad.”
Unfortunately, although the term “abuse” leads us to think of the extremes of sexual or violent acts against young children, there are many more common and subtler forms of abuse, such as emotional abuse or neglect, which can lead to the complex trauma response. Systems of control such as the threat of withdrawal of love, when used as ongoing parenting strategies lead to a fear response in young children – the more sensitive the child, the more likely they will internalise feelings of shame and badness.
Researchers such as Judith Herman and Bessel van der Kolk argue that trauma lives on in the body and colours our thoughts and reactions in a visceral, and unconscious way. It’s hard to live alongside these sensations. The feelings are ones we want to avoid, yet we are often unaware of them – they cause us to act in ways that are often counterproductive and can puzzle – perhaps alienate - those closest to us. These embedded responses are our daily companions, coming to the surface at times when we are reminded of situations similar to those in which the original trauma occurred. A young person who was emotionally or literally abandoned as a child (for example) can experience intense feelings of shame after a relationship breakup or the loss of a friendship – or when someone important in their life says “no”.
For the traumatised young person it can be like living life in a minefield, without necessarily being aware that they might be in danger, or that they are “keeping a lookout”, they remain hyper-vigilant – on high alert for any sign that there are dangers present. “Infants, children and adults will adapt to frightening and overwhelming circumstances by the body’s survival response, where the autonomic nervous system will become activated and switch on to the freeze/fight/flight response. Immediately the body is flooded with a biochemical response which includes adrenalin and cortisol, and the child feels agitated and hyper-vigilant.” These dangers might be something as simple as a perceived slight or rejection, a failure to achieve what is expected of them or a mistake at work or school. Children and young adults with a history of developmental trauma can be threatened by events or interpretations of events that another (non-traumatised) person might view as innocuous.
Trauma can manifest in a constant feeling of “badness” as well as an inability to manage emotions. Often these intense feelings, originating in early childhood, are bypassed by consciousness because they are too traumatic for the developing brain. Pre-verbal trauma like this is seen as “unmentalised” – it stays in the right brain and the limbic system and influences our responses without the processing that occurs through left-brain frontal lobe mediation. “Traumatic memories are stored differently in the brain compared to everyday memories. They are encoded in vivid images and sensations and lack a verbal narrative and context. As they are unprocessed and more primitive, they are likely to flood the child or adult when triggers like smells, sights, sounds or internal or external reminders present at a later stage. These “flashbacks” can be affective, i.e. intense feelings, that are often unspeakable; or cognitive, i.e. vivid memories or parts of memories, which seem to be actually occurring.”
Often these feelings and sensations are defended against – they are just too painful. Sometimes young people with a history of complex trauma will be overwhelmed by panic and a desperate attempt to avoid the feelings that come close to a sense of annihilation or loss of self.
Sometimes trauma is intergenerational, meaning that parents can unwittingly pass on both the vulnerability to trauma and, in some cases the trauma itself. If a parent has been harshly parented themselves and has unresolved chronic shame, they may be at risk of passing this shame on to their children. The mechanisms of transmission are often unconscious, parents just aren’t aware that they have these feelings, because they were originally too intense to be experienced safely. For parents with a history of chronic shame, the strong emotions aroused during interactions between child and parent are unable to be mentalised because of their unintegrated trauma. Ideally, when a parent uses a shaming strategy to help socialise their child, they will work to repair the damage and help the child mentalise the intense emotions involved through reassurance, acknowledgement and soothing. Children often can’t self-soothe in these circumstances and need the intervention of an emotionally intelligent and self-aware parent. “Its OK, because mummy or daddy knows and cares how I feel, and wants to help me feel better.”
Parents with unresolved trauma can often find themselves confronted by strong unmentalised feelings, which throw them into unknowable states – places where they feel out of control. It’s not a safe space for them – or their children. “Babies are particularly attuned to their primary carer and will sense their fear and traumatic stress; this is particularly the case where family violence is present. They will become unsettled and therefore more demanding of an already overwhelmed parent.” Unfortunately for both parent and child in these circumstances, feelings can be passed on to children through interactions and right brain to right brain communication. Wordless gestures, facial expressions, the tenor and temperature of play and physicality – these are all influenced by underlying feeling states. It is not one moment of interaction that clouds the attachment relationship, but a series of them, an impetus and style of relating that is a helpless reflection of the parent’s own history and developmental trauma.
“Prolonged exposure to these circumstances can lead to ‘toxic stress’ for a child which changes the child’s brain development, sensitises the child to further stress, leads to heightened activity levels and affects future learning and concentration. Most importantly, it impairs the child’s ability to trust and relate to others.”
Young people who are affected in this way often behave in ways that are self-destructive – disruptive and challenging, they can have difficulty concentrating at school, have trouble developing friendships and they are vulnerable to bullying – or to becoming bullies themselves. “When children are traumatised, they find it very hard to regulate behaviour and soothe or calm themselves. They often attract the description of being ‘hyperactive’.” As van der Kolk points out, traumatised young people can often be mis-labelled “oppositional”, rebellious, unmotivated and anti-social. The behaviours and ways of relating that they use to minimise their distress and manage their underlying trauma can cause them to be seen as “problems” and lead to ongoing alienation and re-traumatisation.
Sometimes young people with this background can turn to drugs and alcohol to numb the terrible feelings that they endure everyday – but this can (and does) create more problems than it solves. It can lead to using these substances to avoid feelings that challenge their sense of awareness and perhaps any feelings at all. It can often lead young people to behaviour that is aggressive or anti-social and, for some young people - into contact with the justice system and a downward spiral into adult offending - and jail. These young people are very vulnerable – they can be angry and destructive, a danger to themselves and others and without early intervention they can end up lost – both to us as a society - and to themselves. As their behaviour becomes more and more challenging, they become more convinced that the responses they receive from the outside world are those that match their inner world – the feelings of badness and worthlessness that are part of their experience of themselves.
There are also young people who don't “act out” – whose responses and behaviour don't bring them to the attention of authorities. They are the “good’ kids whose inner trauma can only be recognised through anxiety and perhaps later on, depression. They can be perfectionists who are demoralised by a report card that isn’t all “A”s. Or they can be shamed by the bathroom scales that tell them they are worthless because they have gained a kilo - or haven’t lost 5.
These are the young people who might excel at school and university, yet harbour a secret fear that they will never be good enough and that they are just imposters. They are very vulnerable to stress and have difficulty handling change. Often they will take on a career that they think will lead to acknowledgement and self-worth, but no success will ever be good enough to salve their sense of worthlessness. Often when they face the setbacks and losses which are an inevitable part of life, they experience underlying feelings of emptiness, worthlessness and loss of meaning. For anyone, these are very hard feelings to sit with, and any event which brings them in touch with these feelings is likely to overwhelm their coping abilities.
Unfortunately, it can be very hard for those who care, for families and for those who are working with young people, to get to the bottom of why they are behaving in these distressing and sometimes bewildering ways. Often it is easier to “treat” the behaviours so that the young person can manage the school environment, stop offending and “fit in”…. But the underlying issues will never be resolved without trauma-informed intervention. That is why we need more funding to support these interventions and more professionals trained in identifying and working with trauma. But in our everyday lives – as teachers, workers and adults who care about young people, it can help if we raise our sensitivity and see beyond the compelling behaviour and the frustrating interactions into what drives these vulnerable young people. We need to ask the question - and be there to hear the answers.
(Quotes are from the Department of Health and Human Services Child Development and Trauma Guide unless otherwise indicated)