August 3rd, 2009
(Warning: Beginning with this blog, the next few will be about childhood trauma. If you are reading these articles and have a history of being traumatized, these articles could trigger a trauma reaction in you. If this should happen, contact a mental health care provider immediately).
Near the end of the movie Rambo, there is a scene in which Sylvester Stallone (“Rambo”) is in the police station surrounded by policemen who want him to surrender himself. On the contrary, Rambo is geared up for a fight. Also inside with him is his mentor and trainer. The police have sent him in to try to get Rambo to surrender. In a very heated scene in which his mentor is talking to him about giving up, Rambo breaks down and starts crying. In the midst of his tears he shouts at his mentor something like, “I can’t just turn it off!” People recovering from trauma often feel that way, “I just can’t turn it off.”
The Classic Rock group, Metallica, has a line that is repeated in one of their songs over and over again, “and the memory remains.” Trauma messes with our memory which in turn messes with our fight or flight tendency, and (especially in children) the result becomes a noticeable inability to regulate emotions.
Before going any further, it might be helpful to define trauma. One might say, “Trauma is in the eye of the beholder.” Two people can be in a car accident and one of them develops severe trauma symptoms while the other is unfazed. (It is estimated that between 18 and 45% of people in car accidents will develop Post Traumatic Stress Disorder.) So, while keeping in mind that trauma is a subjective experience unique to each individual, we can say in general that trauma is “an experience that produces psychological injury or pain” (dictionary.com). The Early Trauma Treatment Network defines trauma as it relates to children as “an exceptional experience in which powerful and dangerous stimuli overwhelm the child’s capacity to regulate emotions.” The Adverse Childhood Experiences study chose to refer to trauma-like experiences as “adverse childhood experiences.” In doing the study they chose the following as “adverse childhood” experiences: childhood abuse and neglect; growing up with domestic violence, substance abuse or mental illness in the home; parental discord, and a family member involved in crime. While technically one would not necessarily call these traumas, they increase the odds of a person later in life having physical and emotional difficulties.
The body and the brain remember, often wreaking havoc in the traumatized person’s life.
(In our next blog we will examine the results of the ACE study mentioned above and following that we will look at the specific impact of trauma on children and the diagnosis of Post Traumatic Stress Disorder.)
February 13th, 2009
There are many opinions as to what causes mental illness. Take Mikey for instance (story told in last blog entry); why is he having such difficulty? Is it the way he is being parented–or how about his absent father? His father has bipolar disorder. Did Mikey inherit it from his father? Was he born this way or did the illness develop over time? How can a 5 year old have such serious problems?
Unfortunately, there is still a lot of stigma around mental illness, even in 2009. A close cousin to stigma is a “blame the parent” mentality that sees all childhood problems to be the result of faulty parenting. In reality, even if “faulty parenting” is a contributing factor to a child’s problems, one must be aware that few problems are caused by one thing in isolation. There is usually a combination of factors. Besides, blaming the parent does nothing to solve the problems at hand when faced with a family’s frustration over a child’s emotional / social difficulties.
While no one knows for sure the cause of any specific mental illness, the best science of the day tells us that mental illness is caused by a combination of genetic and environmental factors, or as some put it, biology and environment. For instance, if you have a parent or sibling with bipolar disorder, then there is a 10-15% likelihood that you will develop it. If you have a second-degree relative like a grandparent or aunt, then the likelihood is half that amount (5-10%). If you have no family history of mood disorders, the percentage chance that you will get it is even less.
The more we are learning about the human genome, the more we are realizing the interplay between environmental experiences and turning on specific genes. Our genetic makeup is inherited but how and when certain genes are turned on can be the result of environmental factors.
The actual development of the brain—its neurons and synapses is use dependent. How the brain develops in a given child is as much the result of childhood experiences as heredity (“Genes are the scaffolding, but the fine detail is tuned by interaction with the environment.” Gazzaniga, Michael S. The Ethical Brain, p. 48).
A study that has its roots in the 80’s and was given flesh in the 90’s indicates that adverse childhood experiences contribute greatly to a person’s biological and mental health later in life. (ACE study by -The Centers for Disease Control and Prevention [CDC]-Kaiser Permanente and -Emory University Department of Pediatrics). Adverse childhood experiences include childhood abuse and neglect, growing up with domestic violence, substance abuse or mental illness in the home, parental discord, crime. For example, the study demonstrated that people who grew up with four or more adverse childhood experiences had a 460% greater chance of developing depression than someone who did not have adverse childhood experiences.
From a biological perspective, mental illness can be the result of chemical imbalances of the brain as well as head injury or other damage to the central nervous system. Recently, the news has indicated that the number 1 problem
Iraq vets are coming home with is “Traumatic Brain Injury” as a result of the concussive force of improvised explosive devices.
So what causes mental illness? Mental illness is caused by a combination of nature and nurture; biology and environment; genes and brain chemicals. Likely it is a combination of heredity and early childhood experiences that have contributed to Mikey’s behavioral problems. Next time we’ll look at warning signs for mental illness in general and then we will look at some specific disorders.
