As I stated in my Review of
Nadine Harris’s The
Deepest Well, every mental health
professional should know that adverse (traumatic) childhood experiences (ACE’s)
- especially with parents who are abusive, neglectful, are perpetrators or
victims of domestic violence, have multiple partners, or have substance abuse
issues - are a major risk factor for children developing many different
psychiatric disorders, as well as being a risk factor for a variety of physical
illnesses. Yet therapists and psychiatrists often ignore this issue in favor of
theories about some sort of genetically-caused, pre-existing brain disorder.
In this fascinating book, the author also makes the case for the importance of ACE’s, especially in the case of pediatric psychiatric conditions, by examining the physiological effects of trauma on brain development. There is an extensive literature on this, although most of it neglects the fact that a continued relationship with an abusive or formerly abusive parent is usually continuing in some form throughout much of these patients’ adult life.
In any event, the author points out that organized psychiatry in 2011 refused
to acknowledge that “…childhood adverse experiences lead to substantial
developmental disruptions” and added that the idea that it is is “more clinical intuition
than research-based fact.” They then added, “There is no known evidence of
developmental disruptions that were preceded in time in a causal fashion by any
type of trauma syndrome.” (From the American Psychiatric Association rejection
of a Developmental Trauma Disorder diagnosis, as quoted in the book).
That last part
is misleading if not an outright lie. We don’t have high caliber causal evidence
on the causes of just about any diagnosis in the
DSM. Van Der Kolk has a list of references from an extensive literature on the
enduring negative effects of early maltreatment. ACE’s are a major contributor
to a variety of psychiatric symptoms
that are part and parcel of the genesis of many different psychiatric
disorders. Especially the childhood ones like ADHD, conduct disorder, and
oppositional defiant disorder, as well as many of the mood and anxiety disorders.
This blindness by the psychiatric community has led to what is called “malignant polypharmacy” – the tendency of some psychiatrists and psychiatric nurse practitioners to confuse symptoms that appear in different forms within a variety of different psychiatric diagnosis as instead being co-morbid (co-occurring) conditions. When I was in practice, I would find new patients who were on several different psych medications – sometimes including both uppers and downers simultaneously – because new drugs were added whenever the practitioner noticed additional, seemingly untreated symptoms.
Clinicians had misinterpreted these symptoms as
being due to their being indicative of other psychiatric disorders
that were not being addressed by the existing drug regimen. As the author
points out, what was really not being addressed is the underlying issue – the
history of abuse.
As mentioned, and as with the Deepest Well, this book unfortunately ignores the question of whether brain changes caused by ACE’s are at least partially reversible - were it not for continuing reinforcement of the trauma throughout the lives of the subjects of this literature. This question lurks in many of the book’s case examples and within the literature that the author quotes.
For example, he talks about a case where a woman continued to blame
herself for her father molesting her despite her rational mind knowing full
well that this was nonsense. He describes traumatized firefighters who were “desperately
trying to protect the system.” As part of a suggestion for criteria for a proposed
diagnosis of developmental trauma disorder, he included, “Intense preoccupation with the safety of the
caretaker or other loved ones.” He even describes himself as mistakenly
thinking that his own parents no longer had a major influence on him!
In the numerous,
highly interesting case examples, Van Der Kolk omits mention of whether or not the
patient still maintained contact with abusive parents. The closest he comes is
a statement on page 210 about a perpetrator "hopefully" not still being around
to hurt a traumatized individual.
Nonetheless,
this well-written and almost entertaining book is a good introduction to the
consequences of ACE’s on psychological and brain development, as well as
introducing some possible therapeutic ways to treat traumatized patients. Van
der Kolk is a master story teller.
