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.