Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Thursday, March 19, 2015

Trauma: The New Explanation for Everything, and a Bad Example

There’s no question that psychological as well as physiological trauma is very real and can have long-term ill effects. Infants and young children are not “too young to remember”, but can be harmed not only by their own experiences but by what they see happen to others. A trauma-informed approach is essential for understanding that children’s “naughty” behavior--  like roaming around in the night instead of staying in bed—can be the effects of earlier traumatic experiences and won’t be corrected by punishment.

There’s a big push on recently to make sure that caregivers are aware of the effects of trauma, especially in foster and adopted children. But as often happens, there seems to have been a good deal of “criterion creep” so that definitions of trauma and its effects have expanded dramatically. The same thing happened some years ago with ideas about attachment problems, and in fact it’s often those who used to focus on attachment as the cause of all difficulties, who now point to trauma as the great problem. (Or they may even link the two, as in the “Attachment and Trauma Network”.)

But, in spite of the ill effects trauma can have, it is not all about trauma. Claims that trauma is behind all kinds of behavioral and maturational difficulties should be regarded with suspicion and examined under a strong light.

Jessica Pegis and Lisa Sainsbury have passed on to me information about a Toronto organization, the Gap Academy (www.gapacademy.ca), which seems to have its major focus on children with learning disabilities or attention deficit disorders. However, their website also references Reactive Attachment Disorder and something they call “adoptee trauma” or “abandonment trauma” (www.gapacademy.ca/adopteetrauma.html. All three of these diagnoses are discussed on the same page and appear to be equated with each other, although the site notes that the term Reactive Attachment Disorder will not be used. (It’s not quite clear why this should be, as RAD is an agreed-upon diagnosis with “official” criteria, and the others are not--  or could that be the reason for their decision, which muddies the waters a good deal?) The site seems to connect all three categories with learning difficulties.

Having declared by fiat that Reactive Attachment Disorder is a matter of response to trauma, the Gap Academy site goes on to describe what that trauma must have been. The DSM description of RAD includes experiences of neglect and abuse, and the latter certainly can be associated with trauma, but these possible traumatic experiences are not sufficient for the argument that’s brought, and additional traumatic possibilities need to be introduced. According to the site, “Many psychologists now believe that the separation of an infant from its mother leads to immediate and permanent trauma.” Now, strangely enough, although I am a member of Division 37 of the American Psychological Association (child maltreatment section) and of the World Association for Infant Mental Health, I have never met any of those many psychologists or read any of their work in any peer-reviewed publications. Who may they be? Ah, here we have it: “One doesn’t have to go much farther than  Thomas Verny’s The secret life of the unborn child or… Neilson’s A child is born to clearly identify the primal connection. Psychologists and psychiatrists dealing with patients who exhibit the RAD set of symptoms have long ago identified a group of trauma related effects.” Later on the page, we see a link to a paper by Nancy Verrier, a marriage and family therapist (not a psychologist) and author of The primal wound, in which she argues that a child’s emotional attachment to its mother occurs prenatally, and separation from the birthmother leads to intense, traumatic grief and rage, even if it takes place immediately after birth.

In a few easy jumps, we seem to have gone from the existence of a diagnosis called Reactive Attachment Disorder, to the role of traumatic experiences in creating that disorder, to the idea that there are many more traumas at work than have ever been discussed before, and that these have may already have occurred shortly after birth. In other words, all adopted children have by definition been traumatized, and the effects of the trauma may be with them permanently, causing all kinds of problems, including (to return to the original focus of the Gap Academy) learning disabilities.

Why do I think this is probably not so? I have two kinds of reasons. First, there is what is well-known about early development; second, there are the sources of the ideas of Verny and Verrier.

Let’s look at what is known about early development. The first point is that babies in the first few months do not show distress when their care is transferred from one adult to another. They don’t show fear of any of the things that scare older babies, either.  They are capable of expressing distress and do so frequently, when hungry or when getting medical treatment, but they don’t seem concerned about separation from familiar people. By about 8 to 12 months, however, they show fear--  of falling, of loud noises, of people moving suddenly, but most of all of the approach of strangers and the movement away of familiar caregivers. This is the point at which we say that attachment has occurred; attachment is above all a way of finding comfort where there are threats to well-being.

So, why do I say that if a 2-month-old baby does not display fear or distress at separation, he or she is not feeling such feelings? Obviously I can’t know what is happening inside the baby,  I have nothing to go on except the behavior that lets me infer what may be inside. Verrier and other advocates of her Primal Wound ideas believe that they can know what the baby’s emotions are in spite of having no behavioral cues to support their guesses. There is no point arguing about this, because to do so would be to engage in the unwinnable battle between those who look for evidence to support their contentions, and those who “just know”.

This leads us to the second issue I mentioned. Given that research evidence does not support the belief that newborns are traumatized by separation from the birthmother, where did this idea come from? It dates back to some ideas suggested by a British theologian/psychologist, Francis Mott, who claimed among other things that prenatal development involved the pattern of a universal sexuality, including an erotic experience involving the connection of the umbilical cord with the placenta. His later colleague, Frank Lake, “confirmed” Mott’s views of the conscious and emotionally complex life of embryo and fetus by LSD experiments in which people reported what their prenatal experiences had been. Arthur Janov, the “primal scream” man, followed these two, and all of them provided the foundations for the Association for Pre- and Perinatal Psychology and Health, the organization that continues to advocate for Verny, Verrier, etc., etc. To my way of thinking, these beliefs do not provide evidence that unborn babies have emotional or learning experiences that are similar to those of older children or adults. LSD experiences, whatever they may be like, don’t show that newborn babies are traumatized by separation from their birthmothers.

One more issue I want to deal with here: what does the Gap Academy (which apparently employs three staff members) do to treat “adoption trauma”? First, they describe the symptoms they expect to find: “defiant behaviors, disconnectedness, stranger familiarity, lack of understanding of basic trust and familial responsibility, aggression, severe withdrawal, poor self-esteem, enuresis, inattention, and so on”. Except for stranger familiarity in preschoolers, none of these are symptoms or Reactive Attachment Disorder, so it’s clear that the Gap staff are on different ground here--  ground that they share with Attachment Therapists and their posited “attachment disorder”. What do they do about these symptoms? Like Attachment Therapists, they deny that any conventional treatment like behavior modification can be of help. They state, “We have found that treating these kids in a behavioural way…causes further deterioration”; considering that the three staff members could not have had many cases to “find”, one can only guess that they adopted this claim from one of many Attachment Therapy sites. They also say: “we use a collection of methods designed to break down their rejection-oriented impulses… We also believe in teaching the student directly about their problem, which in this case, translates into the teaching of a mini-course on the effects of trauma.” In other words, the treatment consists in part of pressing the children to accept the staff’s implausible view of the cause of their troubles, and indeed teaching them to expect themselves to be psychologically handicapped by past events that may in fact have had no developmental impact whatsoever.

When an organization claims to be trauma-informed, or to teach other people to be so, it’s very important to find out what they mean by trauma. Public funds should not be paying for the sowing of confusion and for potentially harmful interventions.  

   

15 comments:

  1. Thanks for getting this out there, Jean. The page on adoptee trauma to which you link is very disturbing. I hope more people get to read it and understand how harmful this kind of misinformation - although perhaps "misinformation" is too charitable a word to use, and "disinformation" would be a more accurate descriptor of what's going on here - creep can be.

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    1. It is disinformation, of course, but I've been scolded so many times for saying so that I've backed down to "mis-".

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  2. Another really scary self-proclaimed trauma mama who is livid that a psychologist misdiagonosed a kid with RAD, encouraged his/her parents to lock him in his room, feed him baby bottles etc Nancy Thomas-styles and is seems to think that her fellow 'trauma mamas' need to fight back against the 'unfairness' of, presumably, a state licensing board revoking the license of an incompetent psychologist!

    https://talkinrealhere.wordpress.com/2015/03/26/this-is-why-were-silent-and-yet-this-is-why-we-must-speak-up/

    She's up in arms that other trauma mamas might get in trouble with the law for, say, LOCKING KIDS IN ALARMED BEDROOMS, failing to let them interact with their siblings , MAKING BIG KIDS SIT ON DADDY's LAP TO EAT CARAMELS AGAINST THEIR WILL, and other stuff that 1) doesn't treat the illness the kid supposedly has and 2) constitiutes abuse.

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    1. I just hope they "speak up" with respect to the plausibility and evidence basis of these treatments-- that would be interesting! Thanks so much for sending this. I have forwarded it to a colleague on the Oregon licensing board.

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    2. That woman's blog is a doozy!

      https://talkinrealhere.wordpress.com/2015/03/28/help-america-story-2

      (My two cents: Leaving your Foster kids, heck, your biokids, with some near-stranger you barely know is not a good idea. And if two of your Foster kids end up dead as a result of that bad decision-- well, there are consequences for said Foster parent. Legal ones. This is as it should be -- it's not cruel or capricious of CPS to react badly to this sort of thing).

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    3. Surely this is why we have CPS to begin with? But then all the attitudes she expressed are pretty remarkable.

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  3. By that trauma criteria our daughter should be in an RTC!

    I do have an oberservation regarding this quackery and development. I've said indirectly in previous comments that our daughter does not have a fear of strangers, has poor impulse control, is extremely defiantat times (especially if candy is involved), and has problems following instructions especially if those instructions mean the end of whatever activity she is currently doing. She just turned 6 this past weekend and we noticed that compared to the other girls from her class she seems to be almost a year and a half to two years behind them in the emotional development department. She is ahead of them in intelligence and the clash between those two causes her a lot of frustration. Other than that they really are just frustrations and she continues to grow as a child and develops more control over her self.

    What is unclear is if this development is just her genetics or an effect of the emotional and physical neglect she endured as a toddler for about 6 months

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    1. I would expect that very early neglect, followed by good care, to have had more of an effect on language and intelligence than on emotion-- so maybe (I'm obviously guessing!) you're seeing a personality pattern affected by heredity more than anything else.

      Has she always been unafraid of strangers?

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    2. Considering her bio mother has BPD and her father is very independent and stubborn, I'm sure most of it is genetic.

      I don't recall her ever being fearful of strangers. She's always everyone's favorite and is an extrovert with energy that never ceases

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    3. I'm just curious-- even when she was a year old, she wasn't wary of strangers? It's interesting how personality patterns affect this matter.

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    4. By that point we did not have contact. Her bio mom was in full-blown BPD panic mode and had herself and everybody around her convinced that she was being stalked and emotionally abused. Never mind the harassment citation she got after 6 months of leaving abusive voicemails, emails, and pretending to be a friend on a support group for single dad's. She was almost arrested for that last stunt.

      Our daughter was diagnosed as failure to thrive at the age of one but there were clear signs earlier that something was wrong. In one doctors report from a visit the dr asked her how much our daughter ate and she couldn't give her anything more than a vague answer. Other notes indicate that her mother did not really have a realistic view of the needs of our daughter. There are complaints by her mother about our daughter being needy and other issues that were completely normal for an infant to have. It baffles me that nobody reported her to social services because our daughter weight was an issue from day one and she just steadily kept dropping in percentile every month. our daughter was also in withdrawal form a substance at birth. her mother claims it was the seroquel for her mental illness and she also claims the failure to thrive on that and says that she has studies proving that the failure to thrive was because of that medication. I have yet to find a single one though. After our daughter's first birthday she fled the state to get out of having to attend a paternity hearing and 3 months later our daughter was in foster care where we learned that conditions were worse than we thought. she ended up moving in with a 67 year old man who neglected to tell his wife that he was moving his mistress into the house!

      A medical exam and a feeding evaluation ruled out physical reasons for the failure to thrive. the conditions that she was living in were horrible. Instead of a crib our daughter was left in a 3x6 enclosure and was not interacted with much. The enclosed was on an unpadded carpet with blankets. She had a pigeon toe for a while. If she was upset or hurt she would rock herself. in her eyes every woman was mommy because to her that was the word for a female. Her mother also was not very discriminating when allowing other people to hold her or babysit her. anytime the doctors would try to tell her that she was the problem and that there was nothing physically wrong with her daughter she would call that doctor a quack and find someone else. Her shame driven BPD refused to allow her to take blame which caused our daughter to lose weight.

      She was put with really good foster parents and recovered quickly but she never became afraid of strangers and like I said before became the darling of everyone because of her outgoing attitude and playful personality.

      She is definitely attached to us and bonded strongly with the fosters. The main issue with her these days is behavior in school. She's got the impulse control of a much younger child but the vocabulary of a much older child and she's already finished both the reading and math goals for kindergarten last December. She is often the ringleader of any group of children around her regardless of age! If you have any insight I'm all ears. Her school behavior is driving us bonkers.

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    5. Oh-- I see I misunderstood-- you said "6 months as a toddler", and I must have read that as "6 months as an infant". It does sound as if she had an extremely tough time and has the "double whammy" of problematic heredity and experience with a dysfunctional mother.

      It sounds as though impulsiveness is the big problem here, and she needs a lot of guidance, but her intelligence is going to be her great strength. I do have a suggestion for you. This sounds like an ideal situation for Parent-Child Interaction Therapy (PCIT), if you can find it anywhere near where you live. It's an evidence-based treatment that guides parents to be better able to guide children who are impulsive and noncompliant-- I think it might help you get a handle on how to help her control her behavior in school, even though you don't seem to need to make changes at home.

      Congratulations on understanding that this is not about a lack of attachment!

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    6. I will call her former therapist and ask about that!

      She will pull the usual kid stuff at home and our consequences are usually she has to go to her room until she feels she is ready to behave. We recently removed a bunch of toys and stuffed animals from her room that she earns back by coming home on good behavior but she doesn't miss most of it! We also didn't remove items we know she is very attached to. Even when she comes home on green she won't ask to pick anything so we're probably going to donate most of it. On the flip-side she hoards drawings and papers from school as well as scribbles that she insists are important notes.

      When we were dealing with court it was difficult to combat the misconceptions about attachment and development. Even trained social workers don't have a clue! Transferring her from the fosters to our home was not nearly as traumatic as many said it would be. Other than her eating issues (which are going away) she was a child with The ability to bond and had lived with the same caregivers. A month into her transfer and our local worker felt coming was a waste of time but the court ordered it

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    7. Wow that was rambling! Basically there is a serious need for evidence based research on attachment that doesn't just make assumptions bases on the personal feelings and biases of the authority figures involved in cases. People shouldn't be able to use attachment as a legal reason to severe the rights of fit and willing parents. If you know of any I'm all ears but I spent 4 years searching.

      I wish there was some way to get in touch with all the other parents who regained their children after successfully fending off the "only home know" argument.

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    8. I think there is a lot of evidence-based work on attachment. The problem is that the courts don't know how to take that work into consideration and tend to apply their own concepts instead. Also, there have recently been some efforts to use attachment measures to decide about child custody after divorce-- I do hope that this doesn't become a popular approach.

      Anyway, the idea that a child is not capable of attachment seems to me to be highly questionable, unless he or she is cognitively very much impaired. What people usually think of as attachment behavior is what we see in toddlers and young preschoolers, not in older children, who have their own ways of displaying their preferences for familiar people, and who typically do not act fearful of strangers or demand to be near parents a great deal-- and how could we send them to school if they did??

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