Updated on 19th August 2020
Transforming Traumatic Dragons:
How to recover from a history of trauma – using a whole body-brain-mind approach
By Jim Byrne, Doctor of Counselling
Revised, expanded and updated: August 2020
Published by the Institute for Emotive-Cognitive Embodied Narrative Therapy, in cooperation with KDP-Amazon: June 2020
By Jim Byrne, Doctor of Counselling, August 2020
This is a book about slowly and cautiously processing, or digesting, old emotional traumas; so let us begin by distinguishing emotional trauma from physical trauma.
First let us look at physical trauma: When a child falls from a bicycle shed in a school playground, and can’t stand up and walk properly, concern is shown by their peers. A teacher is found and a report is made. The school nurse is called. If she suspects a broken leg, she explains that to the child, and an ambulance is called. A painkiller is given to the child to reduce the pain. At the hospital, an x-ray is taken to identify the nature of the problem, and, if there is a break in any bones, the child can be shown the nature of the source of their pain, right there on the x-ray. Then a plaster-cast – (or some modern equivalent) – is put on the broken limb to support it during the relatively show, natural healing process.
By contrast, when a child is physically abused by an emotionally damaged parent – by being slapped angrily – and then emotionally abused, by being shouted at, and frightened into some kind of submission or conformity to the parent’s unreasonable wishes – nobody calls the nurse. A pain is felt by the child; or, rather, two pains. The physical pain from the slap, and the emotional pain, of fear/shame/humiliation. No painkiller is administered. No ambulance is called. No x-ray is taken. No plaster-cast is fitted. Instead, a little trauma is stored in the child’s body-brain-mind. A little trauma is a kind of psycho-physical knot in the child’s self-concept. (A change in brain-wiring, and a change in hormone balances). A feeling-knot which they cannot process. They don’t have the words to explain the pain to themselves. They may blame themselves for the pain; or assume they are Bad or Ugly, to ‘deserve’ such punishment. Or they may get stuck with unexpressed anger at their persecutor.
When lots of these knots (in the body-brain-mind) accumulate over time, in a cruel family home, and/or in a cruel school system, a significant distortion of the child’s developing personality takes place. This reduces their capacity to process information; to manage their emotions; to adapt well to people around them; to communicate with those people; and so on.
This is called Developmental Trauma; or Complex Trauma; or Complex-PTSD. (Van der Kolk, 2015). It has to be distinguished from conventional PTSD, which normally seems to be triggered by a single (or circumscribed) incident, such as the collapse of the Twin Towers in New York City, in September 2011; or being raped on a specific occasion, as an adult; or watching a comrade being blown up in a war zone.
Prolonged child abuse produces layers and layers of twisting and gnarling of the mind-brain-body of victims of Adverse Childhood Experiences.
Back in the 1980’s, the creator of Erhard Seminar Training (est), Werner Erhard, drew attention to this kind of “twisting and gnarling” of a child’s psychological state, or personality, in his relationships course. He pointed out that, when such a child gets to their mid-teens, they will predictably “put a layer of peanut butter (or some kind of concealment) over all the twisting and gnarling, so it looks good”.
This ‘peanut butter’ metaphor is meant to communicate that, by the time a traumatized child reaches their teens, they will have created a ‘false self’, to cover over the ‘traumatized self’, so it looks good. (Even though it still feels bad!)
Of course, they don’t know they are traumatized, because “the school nurse” was never called. An “x-ray” was never taken of the psychological wounds. The source of the pain was never labelled, in language, for them.
So they have a lot of cumulative, interpretive experiences of emotional pain, with no storyline; no narrative; and no word labels. So the history of their developmental trauma is hidden from the victim; buried in the basement of their non-conscious brain-mind-body.
Astute observers of this child, (while they are still a child, or when they have grown up), will be able to see, from their behaviour, their posture, their facial expressions, and their general demeanour and social skill performance, that “something is not right” with them. (Despite the layer of “peanut butter” – which is a veneer of false selfhood. And despite their act or ‘public performance’). But the trauma is so buried, and unlabelled, that, even if somebody tried to help, it would most likely not help very much.
For example, if somebody said, “I can see that something went wrong in your earlier life. Please let me help you with that”, this would not communicate.
The child (as a child or when grown up) would be nonplussed; puzzled; unable to see what was meant; and perhaps even resentful of this ‘psychoanalysis’ of their behaviour or demeanour!
They might even respond angrily or aggressively, and get a ‘clever label’ from a psychiatrist attached to them, which changes nothing for the better, but further stigmatizes the individual, and causes more harm than good.
Victims of childhood trauma are often unable to accept offers of help, because they have no clarity about who they are; or how they show up for others; or how they got to be the unworkably distorted way they undoubtedly are. (And perhaps they cope with the unworkably distorted state of their existence by drinking alcohol; taking drugs; acting out violently, as in a war zone, or street fighting; or self-harming; or ‘going mad’; or comfort eating; or taking antidepressants or anti-anxiety ‘medications’; and other forms of self-medication, denial and drifting).
If you were such a child – a traumatized child – you might eventually wake up to the fact that you keep finding yourself in significant emotional pain, such as depression, anxiety or anger problems; unworkable relationships; or unsatisfying lifestyles; or in financial crises or living in unworkable accommodation situations; or unsatisfactory or unrewarding work.
You might begin to see that these experiences, of having an unhappy, unworkable life, are feedback from the world, telling you that there is something seriously wrong with the twisting and gnarling in the basement of your brain-mind-body, which cannot be wished away by covering it over with a false self; or engaging in denial, distraction or distortion of current experience.
I was woken up (if only briefly), at the age of twenty-two years, by unpleasant feedback from the world.
I then set out on a long (though intermittent and patchy) journey of self-discovery, and self-healing; which ultimately resulted in “finding the real me”. And discovering my capacity to love and be loved: (but this did not even begin to occur until after the age of thirty years.
This book is designed to help you to liberate the real you! And to heal your history of traumatic experiences.
Jim Byrne, Doctor of Counselling, Hebden Bridge, August 2020
Preface to the Revised Edition, 2020
By Jim Byrne, Doctor of Counselling
Copyright © Jim Byrne, 2020
Early childhood trauma (like physical and emotional abuse, and neglect), and other forms of prolonged trauma (like domestic abuse), affect the very structure of the human brain, and the behaviour of stress hormones in the body. This insight is expressed by Dr Daniel Siegel as follows:
“…(T)raumatic experiences at the beginning of life may have profound effects on the integrative structures of the brain… (A)bused children have abnormal responses of their stress hormone levels[i]… Cortisol (a major stress hormone) is sustained, and elevated levels can become toxic to the brain[ii].”
And, cortisol and other stress hormones are secreted throughout the body when it’s under pressure.
In the first and second editions of this book, we made the mistake of overlooking the role of the body in storing traumatic memories; and the need to involve the body in the resolution of traumatic memories. (This does not mean that counsellors and therapists must have physical contact with their clients – very much to the contrary! It means we must work with the client’s body awareness and breathing; and to promote their involvement in some helpful forms of physical exercise; as well as talking or writing in ways which gradually, slowly, carefully approach the problem of reinterpreting the traumatic experiences).
This revised, expanded and updated edition is intended to correct that omission (of the body), which was paradoxical, given that our main claim to fame, at the Institute for Emotive-Cognitive Embodied Narrative Therapy (E-CENT), is that we “added back the body” to the rational, cognitive and psychodynamic models of the individual client in counselling and therapy: (Byrne, 2020). The body is the very foundation of the human personality; which is actually a body-brain-mind, as shaped by social experience.
In Chapter 1 below, we want to address the following contextual questions:
What is trauma?
What is post-traumatic stress disorder?
What is Complex-PTSD?
How widespread is Complex-PTSD?
What are Adverse Childhood Experiences?
What are some solutions to Childhood Developmental Trauma or Complex-PTSD?
The meaning and importance of the concept of Traumatic Dragons.
And finally, a brief overview of the content of this book.
Chapter 1: Introduction to the key concepts in trauma therapy
1. What is trauma?
According to my Oxford English Dictionary, trauma means: “… (1) a deeply distressing experience. … (And) (3) emotional shock following a stressful event”. (Soanes, 2002, page 893)[i].
And my Oxford Dictionary of Psychology says it’s: “…a powerful psychological shock that has damaging effects”. (Colman, 2002, page 755)[ii].
To further clarify the meaning of ‘trauma’, let us take a look at how Sue Gerhardt, a psychotherapist who deals with childhood trauma, defines this concept. She describes the opening scene of the film, Fearless, in which Jeff Bridges plays the role of a man who survives a plane crash, with several others. He looks at the scene of devastation without a flicker of concern; walks away; gets into a taxi, and leaves the burning plane, ambulances, fellow survivors, and fire engines behind him. His friend and business partner has died in the crash; so, not surprisingly, the Jeff Bridges’ character is ‘traumatized’. As Gerhardt writes (describing how this character is when he returns to his home life):
“His relationships are affected: he has difficulty relating to his wife and son, and starts instead to form a bond with another survivor who lost her baby. He has flash backs to the crash, reliving the moments as the plane went down. He impulsively takes extreme risks with his body, walking blithely across a busy highway. He is dissociated (or detached – JB) from reality”. (Gerhardt, 2010, page 133).
Trauma disrupts our thoughts, feelings and behaviours. And, in the case of prolonged childhood trauma, the damage also affects:
– personality development;
– the ability to think critically/logically (cognitive development);
– the ability to engage effectively in social relationships;
– and the ability to regulate one’s emotions (which can therefore escalate into inappropriate shame, anxiety, anger, guilt and depression).
Indeed, as Dr Bessel van der Kolk (2015) writes, “All trauma is preverbal”. Traumatized individuals cannot find words to express their terrible feelings. They may freeze, like statues; or fight verbally or physically, with the wrong people; or find various ways of running away, as if you could run away from your own central nervous system’s panicky arousal! They may also ‘fawn’ over others to placate them, if they were bullied and abused by their parents.
As Van der Kolk expresses it: “Even years later traumatized people often have enormous difficulty telling other people what has happened to them. Their bodies re-experience terror, rage, and helplessness, as well as the impulse to fight or flee, but these feelings are almost impossible to articulate. Trauma by nature drives us to the edge of comprehension, cutting us off from language based on common experience or an imaginable past”. (Page 43).
Van der Kolk has worked with traumatized individuals for decades, including war-damaged soldiers and victims of childhood abuse and neglect. And his insights and approach to the subject have also been strongly influenced by working closely with Dr Judith Herman (1994/2015), who has been in the field even longer than him, and who has mainly worked with female victims of childhood sexual abuse, adult rape and domestic violence.
Eventually, trauma sufferers do come up with what Van der Kolk calls “a cover story”, which is their best attempt to tell a story which accounts for their trauma; but it rarely captures the essence of the experience. “It is enormously difficult to organize one’s traumatic experiences into a coherent account – a narrative with a beginning, a middle, and an end”.
I know that this is true from my own experience. I only became aware of my own prolonged childhood abuse when I was thirty years old, and I met a woman who cared enough to listen to my story, and to tell me “that was not normal. And that – what they did to you – was not okay!”
Trauma does not just affect our consciousness; our memories; our minds. Modern neuroscience, since the 1990’s, has revealed to us just how much the brains of traumatized individuals are changed (for the worst) by their horrible experiences. Trauma leaves its imprint on our brain, our mind and our body. And these imprints affect how we think, feel and behave in later life, even decades after the traumatic experience. Trauma changes our perceptions, and our capacity to think. But even when we begin to think/feel about our traumatic experience – and to create a helpful story of what happened – we are still left with the imprints in our bodies: the automatic physical and hormonal responses to present-time reminders of the trauma inflicted on us back there, back then. The ‘there and then’ is always with us, in our bodies, here and now: unless and until we process those physical and hormonal responses. To quote Van der Kolk again: “For real change to take place, the body needs to learn that the danger has passed, and to live in the reality of the present”. (Page 21).
In this section I have presented two kinds of trauma: discrete experiences of trauma, like the plane crash; and protracted experiences of trauma, like prolonged childhood abuse. It is important to be clear about the distinction between the first – which is called post-traumatic stress disorder (PTSD) – and the second, which is called developmental trauma, or Complex-PTSD.
Let us first define PTSD.
2. What is post-traumatic stress disorder (PTSD)?
The form of trauma illustrated by Sue Gerhard’s description of the plane crash victim – played by Jeff Bridges – is commonly called post-traumatic stress disorder (PTSD), since at least 1980, when a group of US soldiers, who had been traumatized by violent warfare in Vietnam, successfully petitioned the American Psychiatric Association (APA) to create a diagnosis which would accurately describe their symptoms and some appropriate treatments.
PTSD is defined by Mike Cardwell (2004)[iii] like this:
“Post-traumatic stress disorder refers to a distinct pattern of symptoms that develop as a result of some traumatic event (such as an aeroplane crash, kidnapping or rape). The symptoms of post-traumatic stress disorder begin shortly after the event and may last for months or even years. The symptoms include:
- re-experiencing the event – recurring recollections, including dreams and nightmares about the traumatic event
- avoidance – the person tries to avoid anything that is associated with the traumatic event; for example, if they have been in an air crash, they may avoid even watching movies that have aeroplanes in them
- reduced responsiveness – where the person feels a detachment from others and a sort of emotional numbness
- increased arousal, anxiety and guilt – people may experience hyper-alertness and sleep disturbances. In some kinds of event (such as an air crash), people may experience guilt that they survived where others did not.”
Some people who are prone to this kind of PTSD may have had earlier, childhood trauma experiences, though probably not in every case. For example, Van der Kolk (2015) has argued that it’s the intensity of battle that determines whether or not a soldier will develop PTSD; and, when there are no underlying childhood traumas, the person is likely to recover spontaneously from PTSD over the subsequent ten to fifteen years. However, a war stressed soldier who was carrying underlying trauma from childhood will not experience this kind of spontaneous recovery. And thus, for cases of underlying childhood trauma, we need a new diagnosis of Complex-PTSD, which required relevant forms of help and support and psychological treatment models of recovery.
3. What is Complex PTSD?
Let us look at a brief definition of Complex PTSD by Pete Walker, an American trauma therapist with thirty-five years’ experience, who also healed his own trauma of growing up in a loveless home:
“C-PTSD is a more severe form of Post-traumatic stress disorder. It is delineated from this better known trauma syndrome by five of its most common and troublesome features: emotional flashbacks, toxic shame, self-abandonment, a vicious inner critic and social anxiety.” (Page 3 of Walker, 2013)[iv].
Complex-PTSD is a relatively new concept, which owes a lot to the influential work of Dr Judith Herman (1994/2015). In her famous book about Trauma and Recovery (1992/1994) she wrote about the need to go beyond the definition and conception of post-traumatic stress disorder (PTSD), to include the extra-traumatizing effects of prolonged child abuse and/or protracted domestic violence, or captivity. On page 119 she writes:
“The existing diagnostic criteria for (PTSD) are derived mainly from survivors of circumscribed traumatic events. They are based on the prototypes of combat, disaster, and rape. In survivors of prolonged, repeated trauma, the symptom picture is often far more complex. Survivors of prolonged abuse develop characteristic personality changes, including deformations of relatedness and identity. Survivors of abuse in childhood develop similar problems with relationships and identity; in addition, they are particularly vulnerable to repeated harm, both self-inflicted and at the hands of others. The current formulation of post-traumatic stress disorder fails to capture either the protean symptomatic manifestations of prolonged, repeated trauma or the profound deformations of personality that occur in captivity”.
She recommended that this more complex form of trauma be given the new name of “complex post-traumatic stress disorder”. Although this proposal was rejected by the American Psychiatric Association, for reasons which have been challenged by Herman and Van der Kolk, it was eventually adopted by the World Health Organisation, in its International Classification of Diseases-11[v]:
“The World Health Organization’s proposals in ICD-11, released for comment by member states in 2018, introduce for the first time in a major diagnostic system a distinction between post-traumatic stress disorder (PTSD) and complex post-traumatic stress disorder (CPTSD).” (Brewin, 2020)[vi].
The story of the emergence of Complex-PTSD is taken up by Professor Steven Gold, who worked with trauma victims from the early 1980’s, and developed his own system of therapy to help them. Gold acknowledges that there are two factions within the world of psychology, psychiatry and psychotherapy, as follows:
– One, in line with the American Psychiatric Association (APA), holds that all forms of trauma, including those referred to by Herman, Van der Kolk and others, can be accommodated within the PTSD formulation within the Diagnostic and Statistical Manual (DSM-5) – even though DSM-5 broadly invalidates the idea that a person’s emotional disorder may have social roots!
– The other faction, in line with the World Health Organization’s ICD-11, “…maintains that C-PTSD differs in essential respects from PTSD and requires a distinct approach to treatment: a period of extensive ‘stabilization’ prior to confronting the traumatic history. The preliminary phase of treatment is aimed at reducing stress-related symptoms and bolstering coping capacities so that, when traumatic events are subsequently addressed directly, the outcome is beneficial rather than overpowering and debilitating”. (Gold, 2020b).
The position of this latter faction is also in line with the content of this present book, and the approach of this author when dealing with traumatized counselling clients. This approach has been supported by three strands of research:
- The one that resulted in the inclusion of C-PTSD in the World Health Organization’s ICD-11.[vii]
- The research by Dr Felitti on Adverse Childhood Experiences (ACEs) – which is discussed in the section 6, below. And:
- The research that firmly established that a broad range of symptom patterns beyond PTSD, including anxiety, depression, substance abuse, dissociation and even psychosis, may be elevated in individuals with a protracted history of trauma[viii].
Steven Gold adds: “In addition to the symptoms of PTSD, including enduring reminders of trauma, the studies (listed above) revealed three distinct signs of C-PTSD:
– difficulties managing interpersonal relationships;
– a compromised ability to control emotional reactions;
– a negative self-image.
“This triad of difficulties is referred to in the literature as disturbances in self-organisation (DSO). In fact, the research shows that C-PTSD was more common (in one study, three times more common) than PTSD alone.” (Gold, 2020b).
But what is going on inside the body-brain-mind of an individual suffering from Complex-PTSD? Bessel van der Kolk explains that “Research from (neuroscience, developmental psychopathology, and interpersonal neurobiology) has revealed that trauma produces actual physiological changes, including a recalibration of the brain’s alarm system, an increase in stress hormone activity, and alterations in the system that filters relevant information from irrelevant. We now know that trauma compromises the brain area that communicates the physical, embodied feeling of being alive. These changes explain why traumatized individuals become hypervigilant to threat at the expense of spontaneously engaging in their day-to-day lives. They also help us to understand why traumatized people so often keep repeating the same problems and have such trouble learning from experience. We now know that their behaviours are not the result of moral failings or signs of lack of willpower or bad character – they are caused by actual changes in the brain”. (Pages 2 and 3 of Van der Kolk, 2015).
Coming up to date, let us look at a definition of Complex-PTSD by Mind-UK, the foremost British charity that deals with mental health problems:
“Complex post-traumatic stress disorder … is a condition where you experience some symptoms of PTSD with some additional symptoms, such as:
- difficulty controlling your emotions
- feeling very hostile or distrustful towards the world
- constant feelings of emptiness or hopelessness
- feeling as if you are permanently damaged or worthless
- feeling as if you are completely different to other people
- feeling like nobody can understand what happened to you
- avoiding friendships and relationships, or finding them very difficult
- often experiencing dissociative symptoms such as depersonal-ization or de-realization
- regular suicidal feelings.”[ix]
One of the features of all forms of trauma, whether regular PTSD or Complex-PTSD, is the experience of flashbacks. Most readers will be familiar with the visual-experiential flashback which relates to circumscribed traumatic experiences, such as a plane crash, or the scene of a heavy battle during war, or being raped. The victims are prone to find themselves reliving the experience, months after the event, in full Technicolor in their minds, and with all the feelings of terror and shock that they felt at the time.
By contrast, individuals who are subjected to prolonged child abuse, protracted domestic violence, captivity (such as being a prisoner of war) and so on, will tend to have “flashbacks” without the images. They will just have the feelings; and just as if they related to what is going on here and now. So that, when a victim of abuse in childhood, which involved physical abuse, finds themselves in an argument with a spouse years later, they will tend to “flashback” to those childhood feelings of powerlessness, fear and pain, as if these feelings were caused by the current verbal conflict. This has a horribly complicating effect on the intimate relationships of those victims of Complex-PTSD.
It is shocking to think that the most significant abusive environment that many children face is their own home; and their abusers are the very people who are supposed to love and take care of them: their parents; and sometimes older siblings; or other relatives. As Judith Herman (1994/2015) points out:
“Chronic childhood abuse takes place in a familial climate of pervasive terror, in which ordinary caretaking relationships have been profoundly disrupted. Survivors describe a characteristic pattern of totalitarian control, imposed by means of violence and death threats, capricious enforcement of petty rules, intermittent rewards, and destruction of all competing relation-ships through isolation, secrecy and betrayal”. (Page 98).
Further down that page she adds:
“In addition to the fear of violence, survivors consistently report an overwhelming sense of helplessness. In the abusive family environment, the exercise of parental power is arbitrary, capricious, and absolute. … Survivors frequently recall that what frightened them most was the unpredictable nature of the violence. Unable to find any way to avert the abuse, they learn to adopt a position of complete surrender”. (Page 98).
What does Judith Herman recommend to those who need to diagnose childhood abuse in their clients? She suggests a set of seven diagnostic criteria for identifying Complex-PTSD in patients/clients, as follows:
- The person will have had a history of subjection to totalitarian control over a period of months to years.
- Their ability to regulate their affects – anger, anxiety, depression, guilt, shame, and so on – will have been damaged, resulting in having feelings which are outside of their “window of tolerance” – plus some extreme behaviour malfunctions, like suicidal preoccupation, self-injury and sexual behaviour extremes (too high or two low).
- Abnormal states of consciousness: Including forgetting the history of trauma; or not being able get it out of their mind; flashbacks or ruminative preoccupation with the trauma; dissociation and depersonalization.
- Negative distortions of self-perception: Including a sense of being very different from other people; or total personal isolation from others; senses of helplessness and drifting through life; sense of defilement by abuse, or stigmatized by the trauma, resulting in a shamed, guilt-ridden or self-blaming identity.
- Paradoxical distortions in their perceptions of their abuser(s): Including either preoccupation with revenge, or idealization of the perpetrator; sense of the total power of the abuser and powerlessness of the victim; internalizing the beliefs and values of the abuser.
- Unusual relations with others, including: repeated search for a rescuer, alternating with isolation and withdrawal; lack of trust in others; often fails to protect self from repeated abuse; great difficulty with intimate relationships.
- Problems with the meaningfulness of life: Including loss of a sustaining faith, or hope in the future; and a sense of despair and/or the pointlessness of their own life.
(Adapted from page 121 of Herman, 1994/2015)
4. How widespread is Complex-PTSD?
We have seen above that, in at least one study, Complex-PTSD (from protracted abuse, etc.) seems to be at least three times as common as regular PTSD, (resulting from a single-incident trauma). (Gold, 2020b).
Dr Bessel van der Kolk begins the prologue to his 2015 book, about how the body stores memories of our traumatic experiences, by pointing out that you don’t have to be a combat soldier or a refugee in the holding camp to encounter trauma. Trauma is all around us, and in us; in our friends, neighbours and family members. He points out that:
“Research by the Centres for disease Control and Prevention has shown that one in five Americans was sexually molested as a child; one in four was beaten by a parent to the point of a mark being left on their body; and one in three couples engages in physical violence. A quarter of us grew up with alcoholic relatives, and one out of eight witnessed their mother being beaten or hit[x].” (Page 1, Van der Kolk, 2015).
A quick look at the statistics for England and Wales for 2019 suggests that the situation in the UK is no better, as “…one in five adults aged 18 to 74 years experienced at least one form of child abuse, whether emotional abuse, physical abuse, sexual abuse, or witnessing domestic violence or abuse, before the age of 16 years (8.5 million people).” (ONS, 2019)[xi].
However, this may be an underestimation because of the problem of secrecy, as indicated by the fact that “…around one in seven adults who called the National Association for People Abused in Childhood’s (NAPAC’s) helpline in the latest year had not told anyone about their abuse before.” (ONS, 2019).
Furthermore, a prominent telephone helpline for children in the UK, called Childline, “…delivered 19,847 counselling sessions to children in the UK (in 2019) where abuse was the primary concern”. (ONS, 2019).
And in the Irish Republic, where I was abused, at home and in school[xii], the Irish Times reported that “…Over 10,000 children (were) referred to Tusla (The Child and Family Agency) for suspected emotional abuse”. Plus, “…Figures for last year show significant increase in referrals”. (Irish Times, 21st June 2019)[xiii].
The content of the article shows that the figure of 10,000 was misleading (because it singled out one category of abuse, the emotional, from all others):
“Some 24,815 children were referred to Tusla for various forms of suspected abuse last year, an increase from 20,357 in 2017.
“Neglect, physical, sexual and emotional abuse were the most common reasons children were referred.
“The figures show a significant increase in the number of children being referred for suspected emotional abuse last year – at 10,130 compared to 7,615 in 2017.” (Irish Times, 21st June 2019).
Back in the USA, Dr Judith Herman’s original study found that “The mental health system is filled with survivors of prolonged, repeated childhood trauma”. She goes on to point out that “the data… are beyond question. On careful questioning, 50-60 percent of psychiatric inpatients and 40-60 percent of outpatients report childhood histories of physical or sexual abuse or both”[xiv]. And she states that one study found 70 percent of psychiatric patients had histories of abuse. (Herman, 1994/2015, page 122).
She also points out these psychiatric patients are just the tip of the iceberg because “…most people who have been abused never come to psychiatric attention.” It seems that most victims of child abuse are left to resolve their trauma on their own, or not at all[xv].
Clearly, child abuse and neglect are widespread, and instead of declining with ‘enlightenment’ of ‘social progress’ can often increase! And, in this author’s opinion, there is not enough emphasis placed on child protection by modern governments, and especially neoliberal governments which want to leave the poor and needy to their own devices!
5. What are Adverse Childhood Experiences (ACEs)?
There is overwhelming evidence in the field of psychology[xvi] that childhood experiences shape our adult selves – even though the bible of American psychiatry (called the DSM-5) now denies this obvious, empirically verified fact[xvii].
Bessel van der Kolk (2015) raises an interesting question I this connection:
“How do you turn a new-born baby with all its promise and infinite capacities into a thirty-year-old homeless drunk?” (Page 143).
And he answers his own question by pointing out that, in 1985, this vast question was answered by Dr Vincent Felitti, head of preventive medicine at Kaiser Permanente, a health management company in San Diego, California. Felitti was trying to help obese individuals, mainly women, to reduce their weight, because of the adverse effect of obesity on general health outcomes (such as diabetes and cancer, in particular). He succeeded in developing a highly successful rapid weight-loss program; but then some of the women began to put weight back on again, very rapidly, when they found they were attracting unwanted sexual attention from men. When Felitti looked into the data, …
…End of extract.
 Protean means “…tending or able to change frequently or easily”.
 Mind-UK provides advice and support to empower anyone experiencing a mental health problem. They campaign to improve services, raise awareness and promote understanding.
 Some readers might find it incredible that very many parents would engage in death threats against their own children. My parents were not the most abusive parents in our neighbourhood, to the best of my knowledge and belief. They were seen by our neighbours as good, pious, religious people who cared for their religious, well behaved children. But I frequently had my mother and my father say, as they slapped me, with their face right in mine: “I’ll be hung for you!” (Meaning I’ll kill you, and then be tried and hung); “I’ll murder you!” “I’ll give you away to the gypsies”. “I’ll swing for you” (same message; “I’ll kill you!” “I’ll beat you within an inch of your life!” “I’ll strangle you!” And those are only the ones I can easily remember. I can’t remember very much from before the age of ten years, and not much between ten and fourteen. This kind of amnesia is common in cases of prolonged childhood abuse.
[i] Soanes, C. (2002) Paperback Oxford English Dictionary. New York: Oxford University Press.
[ii] Colman, A.M. (2002) A Dictionary of Psychology. Oxford: Oxford University Press.
[iii] Cardwell, M. (2000) The Complete A-Z Psychology Handbook. Second edition. London: Hodder and Stoughton.
[iv] Walker, P. (2013) Complex PTSD: From surviving to thriving. Lafayette, CA: Azure Coyote Publishing
[vi] Brewin, C. (2020). Complex post-traumatic stress disorder: A new diagnosis in ICD-11. BJPsych Advances, 26(3), 145-152. doi:10.1192/bja.2019.48
[vii] Elklit, A., Hyland, P. and Shevlin, M. (2014) Evidence of symptom profiles consistent with posttraumatic stress disorder and complex posttraumatic stress disorder in different trauma samples. European Journal of Psychotraumatology 2014, 5: 24221. http://dx.doi.org/10.3402/ejpt.v5.24221
[viii] Elklit, A., Hyland, P. and Shevlin, M. (2014) Evidence of symptom profiles consistent with posttraumatic stress disorder and complex posttraumatic stress disorder in different trauma samples. European Journal of Psychotraumatology 2014, 5: 24221. http://dx.doi.org/10.3402/ejpt.v5.24221
Murphy, S., Elklit, A., Dokkedahl, S., & Shevlin, M. (2016). Testing the validity of the proposed ICD-11 PTSD and complex PTSD criteria using a sample from Northern Uganda. European journal of Psychotraumatology, 7, 32678. https://doi.org/10.3402/ejpt.v7.32678
Brewin, CR, Cloitre, M, Hyland P, et al. (2017) A review of current evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD. Clin Psychol Rev. 2017;58:1-15. doi:10.1016/j.cpr.2017.09.001
[ix] Mind (2020) ‘Post-traumatic stress disorder (PTSD) – What is complex PTSD?’ Online information: https://www.mind.org.uk/information-support/types-of-mental-health-problems/post-traumatic-stress -disorder-ptsd/complex-ptsd/. © Mind. This information is published in full at mind.org.uk. Accessed on 20th June 2020.
[x] Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., et.al. (1998). ‘Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study’. American Journal of Preventive Medicine, 14(4), 245–258. https://doi.org/10.1016/S0749-3797(98)00017-8. Here is the Abstract to clarify that this is not just about physical diseases:
8,506 adults (aged 19–92 yrs) completed a questionnaire about adverse childhood experiences (ACEs). Seven categories of ACEs were studied: psychological, physical, or sexual abuse; violence against mother; or living with household members who were substance abusers, mentally ill or suicidal, or ever imprisoned. The number of categories of ACEs was then compared to measures of adult risk behaviour, health status, and disease. Results show that more than half of the (subjects) reported at least 1, and 25% reported more than 2 categories of ACEs. There was a graded relationship between the number of categories of ACEs and each of the adult health risk behaviours and diseases that were studied. The 7 categories of ACEs were strongly interrelated and (subjects) with multiple categories of ACEs were likely to have multiple health risk factors later in life. (PsycINFO Database Record (c) 2019 APA, all rights reserved). Acessed on 21st June 2020.
(The study also focussed on the link between ACEs and depression, suicidality, IV drug use, and other ‘mental health’ issues. See Van der Kolk, 2015, page 146.)
[xii] Byrne, J. (2020a) Freud, Mammy and Me: The roots and branches of a simple country boy. Volume 1 of the fictionalized autobiography of Daniel O’Beeve. Hebden Bridge: Alchemy Publications. And:
Byrne, J.W. (in press) Recovery from Childhood Trauma: How I healed my heart and mind – and how you can heal yourself. Hebden Bridge: The Institute for E-CENT Publications.
[xiii] McMahon, A. (2019) ‘Over 10,000 children referred … for suspected emotional abuse’. The Irish Times, Friday June 21st 2019. Online: https://www.irishtimes.com/news/social-affairs/over-10-000-children-referred-to-tusla-for-suspected-emotional-abuse-1.3933653. Accessed on 21st June 2020.
[xiv] Jacobson, A. and Richardson, B. (1987) ‘Assault experiences of 100 psychiatric inpatients: Evidence of the need for routine inquiry’. American Journal of Psychiatry, 144: 908-913.
Bryer, B., Nelson, B.A., Miller, J.B., and Krol, P.A. (1987) ‘Childhood sexual and physical abuse as factors in adult psychiatric illness’. American Journal of Psychiatry, 144: 1426-1430.
Jacobson, A. (1989) ‘Physical and sexual assault histories among psychiatric outpatients’. American Journal of Psychiatry, 146: 755-758.
Briere, J. and Runtz, M. (1987) ‘Post sexual abuse trauma: Data and implications for clinical practice’. Journal of Interpersonal Violence, 2: 367-379
[xv] Herman, J.L., Russell, D.E.H., and Trocki, K. (1986) ‘Long-term effects of incestuous abuse in childhood’. American Journal of Psychiatry, 143: 1293-1296.
[xvi] Siegel, D.J. (2015) The Developing Mind: How relationships and the brain interact to shape who we are. London: The Guilford Press. And:
Wallin, D.A. (2007) Attachment in Psychotherapy. New York: Guildford Press. And:
Bowlby, J. (1951). Maternal care and mental health. World Health Organization Monograph (Serial No. 2). And:
Bowlby, J. (1958), The nature of the child’s tie to his mother. International Journal of Psycho-Analysis, XXXIX, 1-23. And:
Bowlby, J. (1959). Separation anxiety. International Journal of Psycho-Analysts, XLI, 1-25. And:
Bowlby, J. (1960). Grief and mourning in infancy and early childhood. The Psychoanalytic Study of the Child, VX, 3-39. And:
Bretherton, I. (1992) The origins of Attachment Theory: John Bowlby and Mary Ainsworth. Developmental Psychology , 28, 759-775.
[xvii] ‘A group of 12 researchers have suggested that the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) does not give enough consideration to social factors that influence the diagnosis of mental health disorders. The DSM-5 will be published in May 2013.
“The identification and diagnosis of mental disorders are controversial and weighty topics. Mental disorders are complex, and knowledge about their causes and contributing factors is still evolving,” wrote Helena B. Hansen, MD, PhD, of New York University in New York City, and colleagues in a commentary in the online April Health Affairs.
The group of researchers say that the DSM-5 Task Force focused on identifying neuroscientific evidence for diagnosis even though such evidence is currently insufficient for those purposes”. ‘ (See: Hansen HB, Donaldson Z, Link BG. ‘Independent review of social and population variation in mental health could improve diagnosis in DSM revisions’. Health Affairs. 22 April 2013; [Epub ahead of print].
Source: LeBano, L. (2013) ‘DSM-5 Review Process Does Not Address Social Issues, Researchers Say’. Psychiatry & Behavioural Health Learning Network. Online: https://www.psychcongress.com/ article/ dsm-5-review-process-does-not-address-social-issues-researchers-say
[i] McGowan et.al. (2009).
McGowan, P.O., Sasaki, A., and D’Alessio, A.C., et.al. (2009). ‘Epigenetic regulation of the glucocorticoid receptor in human brain associates with childhood abuse.’ Nature Neurosciecne, 12, 342-348.
[ii] De Bellis (2005); and Rees (2010)
De Bellis, M.D. (2005). ‘The psychobiology of neglect.’ Child Maltreatment, 10(2), 150-172.
Rees, C.A. (2010). ‘Understanding emotional abuse.’ Archives of Disease in Childhood, 95(1), 59-67.
 An emotionally undamaged parent, a skilful parent, also has to discipline their children, but they do it in a way that means that whatever shaming of the child is unavoidable in a moment of emergency intervention, is then corrected by ‘rescuing the child from their shame’. (See Daniel Hill, 2015).
 The concept of ‘Adverse Childhood Experiences’ is defined in Chapter 1, but includes things like being beaten, seeing your mother being beaten, and so on.