The effects of trauma, in the absence of effective therapy, can adversely affect our lives for years or even decades (for our WHOLE lifetimes, in fact) after it is over (indeed, the effects of trauma themselves can take years from when the traumatic experience ended to present themselves – in relation to this, you may wish to read my previously published article entitled : ‘Why Can Effects Of Childhood Trauma Be Delayed?’).
In his book, ‘The Betrayal Bond‘, Patrick Carnes, PhD, outlines eight main ways in which the experience of severe trauma can continue to affect us. I list these below :
Trauma reaction :
The ‘alarm’ response to the traumatic experience. These responses can be both biological and psychological. Extreme and prolonged trauma can lead to an individual becoming essentially ‘trapped’ in the alarm response which results in him/her becoming extremely, emotionally reactive and prone to flying into rages in response to the smallest of provocations. This state is sometimes referred to as hypervigilance or hyperarousal.
Furthermore, this ongoing trauma reaction frequently involves :
This refers to deriving pleasure from taking large risks, sensation seeking, and exposing oneself to high levels of danger or even from getting involved in violent situations ; individuals who are traumatized may behave in such ways to detract from feelings of emptiness and emotional pain.
Individuals displaying trauma arousal may :
find it difficult being alone
be intolerant of ‘low-stress situations’ (as such situations do not satisfy their cravings for mental stimulation).
need ever increasing ‘hits’ of stimulation and excitement due to habituation, leading to taking greater and greater risks
use stimulant drugs (e.g. cocaine)
associate with dangerous people
become increasingly addicted to the arousal state
Trauma blocking :
Trauma blocking refers to the individual’s attempts to numb him/herself so as to escape / block out painful feelings associated with the traumatic experiences.
Individuals displaying trauma blocking behavior may :
over-eat, especially carbohydrates to induce drowsiness
This refers to the unconscious process of avoiding the reality of the traumatic experience by ‘splitting it off’ from conscious awareness so that it is compartmentalized and unintegrated into personality so as to allow day-to-day functioning (if it was not ‘split off’ and compartmentalized, it would psychologically overwhelm the individual. Therefore ‘splitting’ can be categorized as defence mechanism ; however, such splitting prevents the information associated with the traumatic experience being properly processed which, in turn, prevents traumatic resolution. (For more about ‘splitting’, click here).
‘Splitting’ can manifest itself in various ways :
using hallucinogenic drugs (such as LSD) to ‘enter an alternative reality.’
In extreme cases, ‘splitting’ can take on the form of dissociative identity disorder (which used to be called ‘multiple personality disorder’) which may involve amnesia about what one has been doing and where one is
According to Carnes, self-deprivation may relate to the individual having been deprived and neglected during childhood, causing him/her to believe, as an adult, that s/he is unworthy and undeserving of ‘the good things in life.’ If such an individual also has a high level of arousal caused by childhood trauma such as severe abuse (click here to read my article about hyperarousal ), this may also have led neurochemical changes in the individual’s brain making him/her prone to addictive behavior. When these two two factors (i.e. self-neglect caused by a belief of being ‘unworthy’ and proneness to addiction) coalesce, s/he may become, as it were, addicted to self-deprivation.
Carnes provides the example of anorexia, explaining that self-starvation operates like an addiction to drugs because it can increase the production of endorphins, the body’s natural pain-killers (e.g. Tepper, 1992). He also states that such addictions to deprivation may operate to psychologically compensate for a sense of loss of control in other areas of life ; the example Carnes provides is that of a woman who is sexually out of control ‘compensating’ by becoming anorexic.
Food is just one example of what such individuals may deprive themselves of, other examples include :
putting up with being treated badly by others (e.g. in belief of deserving bad treatment or in belief that ‘nice’, ‘decent’ people would not ‘lower themselves’ to be friends with one / have a relationship with one).
This refers to an unconscious drive to recreate and re-experience the trauma through people (e.g. forming relationships with physically abusive partners if one was physically abused as a child) and situations and to repeat behaviors associated with the original trauma.
Trauma repetition may also involve the traumatized individual being unconsciously driven to treat others in the same abusive manner that they themselves had been treated.
There exist different theories as to why individuals often re-enact their original traumatic experiences later on in life. For example, Levy PhD (1998) proposed that reenactments might be caused by :
attempts to gain mastery (which may be adaptive or maladaptive).
Although there is now a vast amount of research that has been conducted on the link between childhood trauma and the later development of non-psychotic disorders, the amount of research that has been conducted on the link between childhood trauma and the later development of psychotic conditions has been rather less plentiful ; however, increasingly, researchers are focusing on this, so far, less studied link and in this article I will review some of what is currently known or theorized about the association.
Childhood Trauma And Psychosis :
‘The psychiatric profession is about to experience an earthquake that will shake its intellectual foundations…there is tectonic, plate-shifting evidence'[for the environmental basis of psychosis]’
-Oliver James (leading UK psychologist). Comment in relation to the now overwhelming evidence that psychosis is strongly related to childhood trauma and the need to stop over-focusing on biological causes.
There is now extremely strong research evidence showing the link between childhood trauma and the affected individual’s likelihood of developing PSYCHOTIC ILLNESS in later life.
It is, of course, already well-established that there is a powerful link between childhood trauma and psychiatric conditions which include depression, anxiety, substance abuse, eating disorders, post traumatic stress disorder, sexual dysfunction, personality disorder, dissociation and suicidal ideation. Now, however, it is becoming increasingly apparent that there is also a strong link with psychotic conditions such as BIPOLAR DEPRESSION and SCHIZOPHRENIA.
An ever-increasing body of evidence is now demonstrating the very high prevalence of experiences of severe childhood trauma in psychiatric patients who are suffering from psychotic illnesses
Indeed, many leading psychologists are arguing that researchers have neglected the importance of childhood experiences in relation to psychotic illness in the past. Here, then, I present some recent research which helps to redress the balance:
Studies About Childhood Trauma And Psychosis :
– Read et al reviewed 51 previous studies on causes of psychotic illness and found that 69% of female psychotic patients and 59% of male psychotic patients had suffered severe childhood trauma. It was also pointed out by the researchers that these figures, although already extremely high, may be UNDERESTIMATES due to the fact that experiences of child abuse are well known to be under-reported.
– Bebbington et al : these researchers, examining data generated from 8500 individuals, found that those suffering from psychosis were approx. 15 times more likely than the mentally well to have suffered severe childhood trauma.
– A Dutch study of 4000 patients found that those who had suffered severe childhood trauma were approx. 11 times more likely to have developed psychotic conditions in later life.
– A Californian study found that those who had suffered severe childhood trauma were 5 times more likely to have gone on to experience HALLUCINATIONS in later life.
HOW IS CHILDHOOD TRAUMA THOUGHT TO LEAD TO PSYCHOSIS?
– COGNITIVE THEORY: Due to adverse childhood experiences, the individual develops what is called a NEGATIVE COGNITIVE TRIAD of beliefs; these are:
– a negative view of self – a negative view of others – a negative view of the world in general
More specifically, beliefs such as the following are likely to develop: – I am vulnerable – others cannot be trusted – the world is dangerous
Such beliefs can become so ingrained and severe that they eventually manifest themselves in the guise of psychotic symptoms e.g PARANOIA.
– AFFECT OF CHILDHOOD TRAUMA ON THE BRAIN: Research is showing that extreme stress in childhood can adversely affect the physical development of vital brain regions responsible for emotional control (e.g the AMYGDALA) which can lead to extreme emotional dysregulation (INABILITY TO CONTROL STRONG EMOTIONS) and concomitant over-sensitivity and emotional over-reactivity. If the problem becomes sufficiently intense psychotic conditions may result.
IMPLICATIONS:
It is thought a new, over-arching theory of the causes of psychosis (known in scientific circles as a PARADIGM SHIFT) is likely take root in the field of psychiatric research – namely one that emphasizes the enormous importance of adverse childhood experiences.
It is argued that patients who present with psychotic symptoms should ROUTINELY undergo DETAILED ASSESSMENTS relating to their childhood experiences and that there should be a much greater emphasis upon the importance of psychological therapy (as opposed to drug therapy- so popular up until now- based upon theories of the biological origins of psychotic conditions).
Early Signs Of Psychosis :
Usually a person does notsuddenly become psychotic. Instead, the onset of psychosis is often a gradual process and sometimes individuals may start to show possible signs of incipient psychosis in their teens.
So what are the early warning signs? I provide a list based on the most current research in this area below. However, it is important to realize these symptoms are NOT specific to psychosis, they may also be due to numerous other conditions or set of personal psychosis. Anyone worried they or someone else may be psychotic or may be developing psychosis should seek an expert opinion and NOT attempt an amateur diagnosis based on the symptoms that follow.
Possible Early Signs That A Person May Be Becoming Psychotic:
These signs may be split into six categories as follows:
1) Cognitive symptoms
2) Neurotic symptoms
3) Changes in mood
4) Changes in volition
5) Behavioral symptoms
6) Physical symptoms
Let’s look at each of these six categories below:
Cognitive Symptoms:
– problems with concentration/attention/mental focus
– thought blocking (a sudden lapse into silence during conversation due to the mind ‘going blank’. This most frequently occurs when the individual is asked about something that is, consciously or unconsciously, psychologically disturbing to him/her. It is a psychological defense mechanism and form of repression.)
A PSYCHOTIC DELUSION results from a THOUGHT DISORDER that gives rise to BLATANTLY FALSE BELIEFS. Whilst the belief is clearly and obviously false, the person who holds it has an UNSHAKEABLE BELIEF that the belief is true, even in the face of utterly overwhelming evidence to the contrary.
Classification of delusions:
Delusions can be classified as follows:
They can be:
A) Bizarre or non-bizarre
and:
B) Mood-congruent or mood- incongruent
I define these classifications below:
BIZARRE – extremely strange and odd beliefs that are CLEARLY IMPOSSIBLE. For example, a belief that the birds’ singing is really Morse code and they are communicating with each other in such code in order to form a plot to take over the world.
NON- BIZARRE – the belief held is still clearly wrong but, theoretically, not totally impossible. For example, a belief that the government has placed listening devices in every room of one’s house.
MOOD – CONGRUENT – the delusion is in line with the mood the person manifests as a result of his/her condition. For example, a depressed individual who believes that aliens have removed the part of his/her brain the used to give rise to the experience of pleasure. Or, a person who is manic may believe s/he has supernatural powers
MOOD – INCONGRUENT – the delusion is not obviously in line with the individual’s prevailing mood (eg. a newsreader on the TV is talking about him/her. These are sometimes referred to as ‘mood-neutral’ delusions
Within these classification groups, delusions can also be of a specific type. I list these types below:
– Delusions of jealousy : an all-consuming obsession that one’s partner is being unfaithful when there is no evidence this is the case and there is no objective reason for suspicion.
– Delusions of nihilism : the belief that oneself, other people or the world do not really exist
– Delusions of grandeur ,: a belief one is a person of massive importance such as Jesus, Emperor of the World etc. Or the belief one has made a great achievement (that the world refuses to recognise) such as a belief one has written plays vastly superior to those of Shakespeare when, in reality, they are barely literate.
– Delusions of control : a belief that one is having one’s thoughts and behaviour controlled by an external force e.g. by aliens
– Delusions of reference : a clearly false belief that people are talking about one or making reference to one when they are not e.g. a belief that the newsreader on the radio is always referring to one in a or a coded or indirect manner
– Delusions of guilt : a false belief one is responsible for some terrible event (such as a belief one is personally responsible for all the starving people in the world
– Erotomania : the belief a famous person or person of high status (normally a person the sufferer of the delusion has never met) is deeply and passionately in love with one ( click here to read my article on this)
– Delusions of mind-reading : the belief that others are reading one’s mind
– Delusions of persecution : the belief that others are conspiring against one ( e.g trying to poison or drug one)
– Religious delusions: Delusions with a religious theme e.g .that one is a human incarnation of God
– Somatic delusions : these are delusions about one’s body ( e.g. that ants are crawling under one’s skin)
A study conducted at the University of Cambridge in the UK, involving 238 teenagers between the ages of 15 and 18 years, focused on investigating how GENES AND ENVIRONMENT INTERACT and in what ways this interaction increases or decreases an individual’s chances of being. diagnosed with depression in later life.
In the study, the teenagers were put into six different groups; the group they were placed in was determined by two factors :
1) Whether or not they had experienced significant childhood trauma (e.g. exposure to family arguments, stress and other trauma) prior to the age of 6 years
2) Their particular type of genetic variation in relation to a specific gene involved in the production of serotonin in the brain (serotonin is a neurotransmitter – a sort of chemical messenger which helps cells in the brain communicate with one another – and affects our moods and emotional state).The teenagers all had one of the following 3 types of genetic variation:
a) SS (two short versions of gene)
b) SL (one short and one long version of gene)
c) LL (two long versions of gene)
RESULTS :
Those who had been exposed to trauma before the age of 6 years were more likely to develop depression later on BUT ONLY IF THEY ALSO HAD A GENETIC VULNERABILITY (genetic vulnerability, the study found, was due to having the SS variation or SL variation of the gene, represented above by categories ‘a’ and ‘b’).
Specifically, it was found that exposure to discord between parents and/or neglectled to the individual :
ii) having greater difficulty processing their emotions
iii) having a tendency to respond especially badly to criticism
iv) being more affected by the emotional tone of other people’s voices.
According to the study, these four factors, in turn, make it more likely that the individual will later be diagnosed with depression.
CONCLUSION:
Having both the SS or SL variation of the gene AND experiencing early trauma is associated with a higher probability of being diagnosed with depression later on in life.
HOWEVER: having the LL variation of the gene and experiencing early trauma is NOT associated with a higher probability of being diagnosed with depression later on.
THEREFORE: having the SS or SL variation of the gene makes the individual MORE VULNERABLE TO THE EFFECTS OF EARLY TRAUMA, thus making it more likely that the s/he will eventually be diagnosed with depression, whereas, HAVING THE LL VARIATION OF THE GENE SEEMS TO PROTECT THE INDIVIDUAL FROM THE EFFECTS OF EARLY TRAUMA.
It may be inferred, then, that neither early trauma alone, nor genetic vulnerability alone, are sufficient to make it more likely the individual will be diagnosed with depression. It seems, instead, it is how the relevant genes and early life experiences INTERACT that determines the likelihood that a particular individual will develop depression.
N.B. It should be noted that research such as that described above is at a relatively early stage and more studies need to be carried out in order to clarify, build upon and refine these findings.
How Genes And Childhood Trauma Interact :
Starting with the top row of the diagram we can see that a person’s genes and childhood environment interact to produce the person’s phenotype (a phenotype refers to the characteristics a person develops as a result of the interaction between his/her genes and environment). The phenotype is also affected (as we can see on the second row) by the degree of stress the person experiences in childhood, but, also, by the amount of social/emotional support s/he receives.
For example, high stress and low support would clearly be more likely to lead to high vulnerability (see third row) to psychopathology such as depression, anxiety, PTSD and substance abuse (also shown on third row) and physiopathology such as poor immunity, problems with metabolism and cardiovascular disease (this, too, is represented on the third row).
The combination of factors shown on the diagram then determine how well or badly the individual is able to cope with life in general (represented on the diagram by ‘long-term maladaption/adaption’ on the fourth and final row).
MORE ABOUT ENVIRONMENTAL EFFECTS ON DNA :
Recent studies have shown that childhood trauma can actually change the structure of DNA in the person who has suffered it and consequently alter how these genes work (it has been known for some time that how genes express themselves is influenced by their interaction with the environment).
Animal studies support this finding: in rats it has been shown that QUALITY OF MATERNAL CARE HAS A LARGE EFFECT ON GENES RESPONSIBLE FOR THE STRESS RESPONSE IN OFFSPRING:
POOR MATERNAL CARE = ADVERSE EFFECT ON GENES OF OFFSPRING = HIGH SUSCEPTIBILITY TO STRESS IN OFFSPRING.
Indeed, there is a growing body of evidence that psychological abuse of children has BIOLOGICAL effects. Research suggests that the effects of abuse on the child’s DNA lowers their resistance to stress. This effect can persist throughout life and increases the suicide risk of the individual.
It is thought that trauma/abuse in early childhood (before the age of six) can have a particularly damaging effect on the DNA which controls the individual’s stress response.
(For those that are interested, environment affects DNA (and thus how it expresses itself) by punctuating it with what are technically known as EPIGENETIC MARKERS. It follows from this that the function of DNA is not permanently fixed from birth, but can be altered by its interaction with the environment).
The good news is, however, that the adverse effects on DNA caused by childhood trauma can be reversed in adult life by appropriate interventions. Key to these are the replacement of the traumatic environment with one which is supportive, loving, stable, safe and relatively stress-free. This is because just as traumatic environments can leave harmful epigenetic marks, good environments, over time, can reverse this effect.
CHILDHOOD TRAUMA, GENES AND DEPRESSION :
Just as trauma can affect genes, pre-existing genes can affect the impact trauma is likely to have on us; it is, to this extent, a two-way street then. It has already been stated in previous posts how exposure to trauma in childhood can lead to psychological problems such as clinical depression; studies now show that the risk becomes even greater if the sufferer of childhood trauma has a particular genetic make-up making him or her more vulnerable to the effects of stress:
So: children who are genetically predisposed to being particularly vulnerable to stress will typically be more adversely affected by the childhood trauma than those children who do not have the genetic vulnerability. THIS HELPS TO EXPLAIN WHY TWO CHILDREN WHO SUFFER SIMILAR TRAUMA MAY BE AFFECTED QUITE DIFFERENTLY FROM ONE ANOTHER.
Further study has shown that the children with the particular genetic variation are MORE SENSITIVE TO THE ENVIRONMENT AROUND THEM (they process emotional information differently) than children without the variation. The genes involved are responsible for the production of SEROTONIN (a chemical affecting mood, also known as a neurotransmitter) in the brain.
DISCORD BETWEEN PARENTS and NEGLECT (again, especially if the child is under six) have specifically been linked to the child developing HIGH EMOTIONAL SENSITIVITY and a greater susceptibility to stress. Again, if the child has the genetic variation making him or her particularly vulnerable, the adverse effects of the discord or neglect will be increase such vulnerability.
The research producing such findings as illustrated above is still in a relatively early stage and future research is likely to help clarify the complex interactions between our genes and how childhood trauma affects us.
Childhood Trauma Can Affect Our Genes In Such A Way That Our Ability To Cope With Stress Is Greatly Diminished :
A study led by Seth Pollak (University of Wisconsin) suggests that abuse can adversely affect children at a cellular level, including the turning off or on of particular genes (this phenomenon is called EPIGENETICS – the modification of genes by the environment).
The study involved examining the DNA of children who had been identified (by Child Protection Services) as having been abused. Blood samples were taken from each of the children in order to enable this analysis.
It was found that, in each of the children, the same, specific gene (NR3C1) had been damaged. When this gene is working properly, it helps the child to manage stress (i.e. to calm down in a timely fashion after having been upset). It does this, when healthy, by preventing too much cortisol (a major stress hormone) from building up in the body.
However, in the abused children, the damage to this gene means that, under stress, too much cortisol DOES build up in their body. The effect is that the children are unable to calm themselves in the way non-abused children are able to.
This damage to the gene can result, therefore, in the child being in a constant state of hypervigilance (i.e. perpetually tense and in a state of ‘red-alert’). As a result, the child is likely to perceive threats where, objectively speaking, they do not exist, and frequently become preemptively aggressive and very easily enraged.
Additionally, such children are more likely to suffer from depression and anxiety, to find any kind of significant change difficult to cope with, and, later in life, to develop physical problems such as diabetes 2 and heart disease.
THE GOOD NEWS :
Studies of rodents have found that rat pups that are abused in early life also incur damage to the same (NR3C1) gene that, when operating correctly, helps them regulate stress (the same as it does in humans, as described above).
The good news, though, is that it has been found that when these rats are removed from their abusive environments and returned to nurturing mothers, the damage to the NR3C1 gene is reversed.
By extrapolation, this suggests the same reversal of damage may be possible in humans. Unfortunately, however, the necessary research to establish whether or not this is the case has not yet (at the time of writing) been carried out.
Childhood Trauma, Life Events And Depression :
A recent research study, carried out by Wiersma et. al, focused on possible causes of chronic depression (chronic depression is long-lasting depression which has been continuous for two years or more – 20% of those with major depression suffer from this chronic form of it.
When major depression is also chronic, it is particularly serious; this is because those individuals who are chronically depressed are more likely to be hospitalized and more likely to commit suicide than those who suffer from episodic depression) found that the GREATEST RISK FACTOR LINKED TO THE DEVELOPMENT OF LATER ADULT CHRONIC DEPRESSION WAS CHILDHOOD TRAUMA.
The study ran over a time period of 8 years and involved 1230 participants (two thirds of whom were female). Amongst other factors, the study sought to determine the link between adult chronic depression and:
a) Childhood Trauma e.g. physical abuse, emotional abuse, sexual abuse
b) Childhood Life Experiences e.g. parental loss, parental divorce, parental separation
RESULTS:
– those who had experienced childhood trauma (physical/emotional/sexual abuse) were significantly more likely to suffer from chronic depression compared to those who had not experienced childhood trauma
however :
– Childhood Life Experiences which, according to self-reports from the participants, had NOT involved significant trauma, did NOT significantly increase the likelihood of the later development of adult chronic depression.
OTHER RESULTS FROM THE STUDY :
– the more frequent the experiences of childhood trauma were, the greater was the risk that the individual would go on to develop adult chronic depression
– those who had suffered most severely from childhood trauma were 3 times more likely to go on to develop adult chronic depression compared to those who had not suffered significant trauma. Furthermore, they were found to be at significant increased risk of developing co-morbid psychiatric conditions, such as anxiety. Finally, too, it was found that, on average, the age of onset of their depressive condition was earlier.
CONCLUSIONS :
– these findings are consistent with previous research findings
– it can be inferred from the results that IT IS NOT THE LIFE|EVENTS, PER SE, WHICH INCREASE THE CHANCES OF THE LATER DEVELOPMENT OF ADULT CHRONIC DEPRESSION; RATHER, IT IS THE QUALITY OF THE CHILD’S HOME ENVIRONMENT WHICH IS CRUCIAL.
IMPLICATIONS FOR THE TREATMENT OF DEPRESSION :
We are able to infer from the above findings that it is quite possible that :
a) depression associated with childhood trauma
and
b) depression NOT associated with childhood trauma
may react differently to particular types of treatment.
For example, studies extending on the one described above suggest that depression associated with childhood trauma is more likely to respond well to psychotherapy rather than psycho-pharmacology (treatment with drugs). Therefore, clinicians need to be aware of whether their depressed patients experienced childhood trauma, in order that a more informed decision about appropriate treatment may be taken.
Can Facing Up To Our Childhood Trauma Help Alleviate Our Depression?
Alice Miller (1923 – 2010), the world renowned psychologist and expert on the damage that can be done to individuals during their childhood, and its implications for their adult lives, states, unequivocally, that, if we are suffering from depression linked to our childhood, traumatic experiences, it is imperative that we start to understand, and to process mentally, the harm that was done to us when we were children.
Miller states that one reason we may not accept and acknowledge our childhood suffering and the responsibility our parents have for having inflicted this, or for having failed to protect us from it, is that we may still be idealising our parents. She goes on to say that it is necessary for us to overcome this psychological defence mechanism and attempt to recall, as fully as possible (in a therapeutically safe environment) how we were badly treated as children and how this made us feel at the time.
Above : Alice Miller
Only by getting in touch with these feelings, Miller explains, and then by acknowledging the psychological suffering our parents caused us when we were young and helpless, and, furthermore, by not being afraid to healthily express our pent up feelings of anger and rage, can we finally, perhaps after decades, free ourselves from our depressive state.
Putting it simply, Miller is of the view that by denying we were ill-treated, out of misguided loyalty to our parents, and by continuing to repress the rage that this treatment caused, we perpetuate our psychological illness. We must, then, according to Miller, unblock our original feelings.
In order to help us to get back in touch with these repressed feelings, we should ask ourselves if our parents would treat us now as they did then. If the answer to this question is ‘no’, Miller explains, then it begs the question : ‘were they taking advantage of our helplessness, vulnerability and dependency to behave as they did, at the time, with impunity?
As well as getting in touch with our repressed rage, Miller counsels us, we should also try to reconnect with the fear and deep sadness we felt as children, as well as with our childhood sense of helplessness and isolation. Then, by processing these authentic, original feelings, cathartically and under the supervision and with the support of a suitably qualified and experienced psychotherapist, can we recover our mental health and equilibrium.
NB. Those who share Miller’s views should only undertake such a process under the care and supervision of a properly qualified expert in the field.
Childhood Trauma, Depression And Learned Helplessness :
If we suffered a traumatic childhood in which we felt powerless to change our situation for the better, we may have become conditioned to believe that there is no point in trying to improve our situation in life as any such attempt will inevitably be doomed to failure. Such a state of mind, one of the hallmarks of clinical depression, has been termed ‘learned helplessness’ by psychologists. If we are suffering from learned helplessness, we will lack motivation to create positive change even when it is clearly possible to do so from an objective perspective.
The following experiment, involving dogs, helps to illustrate precisely what psychologists mean by the condition of learned helplessness. It is a controversial experiment which is ethically questionable and I do not think I would feel comfortable carrying out such a research activity myself. However, here are the findings :
PHASE 1 OF EXPERIMENT :
The experiment, part of a research study by Martin Seligman, was carried out in the 1960s and involved two sets of dogs. Both sets of dogs were given electric shocks ; however :
– one group of dogs could stop the pain by learning to press a lever
– the other group of dogs could not escape the pain whatever they did
PHASE 2 OF EXPERIMENT :
After this unpleasant experience, BOTH groups of dogs were placed in shuttle box with two sides separated by a short barrier. Again, electric shocks were applied through the floor in the cage. This time, however, IT WAS POSSIBLE FOR BOTH SETS OF DOGS TO ESCAPE THE PAIN by jumping over the short barrier to the other (safe) side of the box.
RESULTS :
– the first group of dogs (who had control in the first phase of the experiment by being able to press the lever to stop the shocks) learned to avoid the pain by jumping the barrier in phase 2.
HOWEVER :
– the second set of dogs (who had no control over the electric shocks in the first phase of the experiment) failed to avoid the punishment (they did not learn they could do so by jumping the barrier) in phase 2.
It is thought, in the same way, that if as children we have been in traumatic situations over extended time periods that we were unable to escape, as adults we might become, like the second group of dogs in the experiment, despondent, depressed and unable to try to help ourselves.
However, also like the second set of dogs in the experiment, we may falsely believe we can’t help ourselves (due to our past experiences) when, in fact, we can – it can be our depressed and helpless frame of mind, formed in our childhoods, that creates the illusion that there is no way out for us when, in fact, there is.
Behavioral Activation :
One of the hallmarks of serious, clinical depression is reduced ability to perform everyday tasks and activities. Again, in my own case, I was often confined to my bed for much of the day, stopped washing, rarely shaved and stopped brushing my teeth.
I know, therefore, that when very ill with depression, even basic tasks can feel impossible to undertake – indeed, even contemplating having to carry them out can, when one is so ill, create severe anxiety and distress. For those who have not experienced clinical depression, this is almost impossible to imagine or comprehend; such lack of empathy leaves one feeling devastatingly alone and terrifyingly emotionally imprisoned, compounding the problem.
Sadly, this loss of ability to carry out everyday tasks and activities tends to perpetuate and even intensify one’s depressive state, thus creating a vicious cycle.
Above : Avoidant behaviour can set off a vicious circle, whilst behavioural reactivation can set off a virtuous circle.
Behavioral Activation :
The psychologist Lewiston has carried out research showing how, by reactivating the behaviours we used to carry out before severe depressive illness struck, we can alleviate our depressive symptoms, or, indeed, rid ourselves of the condition entirely.
Lewiston suggests changing our behaviors may be more effective in treating depression even than changing our thinking style (as occurs in cognitive therapy). In other words, he postulates that:
Behavior Therapy (changing the way we behave)
may be a more effective way of treating depression than:
Cognitive Therapy (changing the way we think)
In order to test this hypothesis, Lewiston carried out the following research study:
– 200 hundred hospital outpatients suffering from clinical depression were recruited into the study.
– these 200 individuals were the randomly assigned to one of four treatment groups
– these four treatment groups were as follows :
1) individuals were treated with anti-depressants
2) individuals were treated with a placebo
3) individuals were treated with cognitive therapy (to change their thinking styles)
4) individuals were treated with behavioral therapy (to change how they behaved each day)
Results of above research study :
It was found that those in the behaviour therapy group, on average :
– gained more benefit than those in the cognitive therapy group and placebo group
– gained a benefit equal to the benefit those treated with antidepressants derived
Other studies have produced similar results.
In relation to this study, Lewiston devised a therapy known as ‘behavior activation.’
What Is Behavior Activation Therapy?
In basic terms, this therapy involves the depressed person :
a) listing how his/her illness has changed his/her behaviour. For example :
– stopped socializing
– stopped exercising
– spend far more time in bed
– stopped doing housework
– reduced self-catering
b) Then, in relation to list, set goals s/he would ideally achieve. For example :
– socialize as much as before the illness struck
– go to gym for an hour, every other day
– limit self to eight hours a day in bed
– keep house reasonably clean
– care for self in same way as prior to becoming ill
Once these goals have been identified, it is necessary to undertake behaviours that help one achieve them.
Now, clearly, achieving all these goals cannot happen immediately!
Therefore, it is usually necessary to take small steps. For example, if trying to attain the goal of going to the gym, for an hour, every other day, one may start off by going to the gym for twenty minutes once per week, then very gradually increase this rate.
The importance of adjusting our behavior positively and increasing our activity levels to help improve our mood seems hard to overstate. Even by starting with tiny steps, a powerfully therapeutic virtuous cycle may be set in motion.
Physical abuse of children can be defined as an action which physically hurts or injures them. Usually, this is not a one-off incident, but is a pattern of behaviour towards the child from the parent/s or someone else who is supposed to be caring for him/her. Very frequently, too, the child who is physically abused will also be emotionally abused.
It is estimated that approximately 1 in 6 reports of child abuse involve physical abuse. However, as has been pointed out in other articles on this site, child abuse is notoriously under-reported (not least due to the perpetrators’ desire to cover it up) so it is very likely that it is far more prevalent than suggested by official statistics.
THE PSYCHOLOGICAL EFFECTS OF PHYSICAL TRAUMA :
As well as the physical harm done to the child, s/he will inevitably suffer associated adverse psychological consequences. These can include :
It is common, too, for the child who has suffered physical abuse to frequently ‘act out’ his/her feelings. Essentially, this involves ‘problem’ behaviours, such as going into rages, as an expression (usually unconsciously) of his/her inner emotional turmoil and distress. ‘Acting out’ takes place because the child does not have the verbal skills or understanding to effectively verbally express his/her deepest feelings and inner pain.
Sometimes, however, in stark contrast to this, the child, in response to the physical abuse, will become emotionally ‘numb’, apathetic and resigned; s/he may become emotionally ‘flat’ and stop expressing his/her feelings.
UNPREDICTABLE PHYSICAL ABUSE :
The more unpredictable the physical abuse is (it is especially likely to be unpredictable if the parent/’carer’ is unstable) the deeper will be the sense of fear the child finds him/herself having to live with.
THREATS OF PHYSICAL ABUSE :
If the child is often threatened with physical abuse (ie it is always ‘just’ a threat, and never actually materializes), the effects can be just as serious. Indeed, the psychologists Knutson et al., (2005) found that living with such threats often led to depression, anxiety and aggression in the child.
THE LONG-TERM CONSEQUENCES :
A research study carried out by Silverman et al., found that 80% of young people who had experienced significant physical abuse in childhood, had at least one psychiatric disorder by the age of 21 years. These included :
On top of the above, those who have suffered physical abuse as children are much more likely to commit crime in later life. They are also more likely to become violent themselves, having learned, as children, that violence was an ‘acceptable’ form of expression and control.
There is no one, absolute and precise definition of childhood trauma. However, experts in the field of its study generally agree that an individual’s traumatic experience will be related to one or more of the following three types of abuse (or, including NEGLECT, 4 types of abuse) :
In the past it was generally agreed amongst clinicians that sexual abuse had the most significant adverse impact on the child’s subsequent development. However, it is important to point out that more up-to-date research shows emotional and physical abuse can be just as damaging (some children will experience a combination of two or more of the three types).
The exact nature of the abuse will be inextricably intertwined with the developmental problems which emerge in the individual as a result of it.
Neglect :
There is a problem, though, with the categorization method. This is because the three individual categories do not tend to take account of neglect. Neglect may involve a parent or carer doing nothing to intervene to prevent the child from being abused by someone else, or a parent burdening a young child with their own psychological problems which the child is not old or mature enough to cope with. A parent or carer might neglect a child knowingly or unknowingly.
How Common is Child Abuse?
It is difficult to know the true figures as childhood abuse is often covered up or unreported. Also, accurate figures are hindered by the fact childhood abuse cannot be precisely defined.
However, current estimates in the UK suggest about 12% of children experience physical abuse and 11% experience sexual abuse.
Whilst it is impossible to precisely define child abuse, what is important is the PERSONAL MEANING the sufferer ATTACHES to it. In other words, recognizing the problems a person has developed as a result of the abuse and providing therapy to help the individual deal with those problems is more important than precisely defining the traumatic experience which caused the problems, and arguing about whether it technically qualifies as abuse or not.
Events in childhood which cause trauma are often referred to as ADVERSE CHILDHOOD EXPERIENCES (or ACEs) in the literature. To view an infographic of ACEs, please click here.
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