The Body Keeps the Score

EFFECTS OF TRAUMA

Effects of Trauma

Part 1

1. Let’s talk about Marilyn. What were your thoughts and reactions to her case as described in the book? Do you think she can ever have a successful intimate relationship? What needs to be done for this to happen?

Marilyn has suffered so much, and it is saddening to know that her body has started to attack itself. The trauma she suffered and her being unaware of it has made her fearful, and her autoimmune system is working overtime, leading to her starting to lose her vision. Childhood trauma is more devastating, especially when it comes to incest. The child grows up having blocked the trauma they suffered, and when they grow up, they are unaware of what happened to them since they blocked it out (Van der Kolk, 2014). One feels sad and enraged on her behalf because she was a child when she was abused, and her escape was her hiding her head in the clouds, which has resulted in adulthood trauma that she cannot explain.

Marilyn can have a successful intimate relationship. However, she needs to be open about her past with her partner and let them know what happened to her. At the moment, she should avoid having any intimate relations because she has not worked on her trauma. Since she still struggles to remember what happened to her, she will still attack her intimate partner when their bodies touch at night. The worst will be that she might never be present during lovemaking, like when she was in college. Marilyn will take time before she can have an intimate working relationship. Her relationships comprise of her being unaware and her losing focus of what is happening.

Therapy is the only way she can recover and manage to have an intimate relationship. Therapy teaches her how to cope with what happened to her in the past and what is happening in the present. Learning calming techniques allows her not to become overwhelmed with what is happening around her, enabling her to remain present. Using the calming techniques, she can become intimate with her partner, and she won’t lose focus or escape allowing her to recall and enjoy the moment. The second way is being mindful of her surroundings. Mindfulness enables her to differentiate the past from the present. Making the differentiation is vital as she can now become intimate with a partner and recognize their touch as someone she loves and was spending time with.

2. What is Marilyn’s world view and why? What is Dr. Van Der Kolk’s clinical approach to changing someone’s world view?

Marilyn’s world view is one where she believes men do not give a damn about other people’s feelings, and they can get away with whatever they want. Women cannot be trusted because they are weak to stand for themselves, and they sell their bodies to get me to care for them. Marilyn was suspicious of everyone who attempted to be kind to her, and she wondered what their motive could be. She was a stickler for regulations, and when anyone tried to make the slightest deviation from the nursing regulations, she would call them out. Her world view of herself was that she was a bad person who made bad things happen to anyone around her. Marilyn did not trust anyone, and she suspected that people had sinister motives that made them be nice to her (Van der Kolk, 2014). Her suspicions made it hard for her to accept people for who they are, and when they make a mistake, she was ready to punish them or make them get punished.

Dr. Van Der Kolk’s clinical approach for modifying someone’s world view is challenging their thinking and trying to assist them to see the world in a more positive, flexible way (Van der Kolk, 2014). The doctor is trying to teach the patient to recognize their irrational thoughts and behaviors. When one starts to see the world from a positive angle, they can begin to recognize their distorted thoughts about others, allowing them to change how they react and behave. Reconstructing their inner map of the world is the best approach for modifying a patient’s world view. Without recognizing their irrational thoughts, a patient can’t make any changes. One can only change what they desire to be different. If a patient is not aware of their behaviors or thoughts, it becomes difficult for them to make any tangible changes.

3. What happens when we are abused or ignored as a child vs. adored and loved?

Children who are abused or ignored in childhood have a different message than children who were adored and loved in childhood. An abused child will grow into adulthood with a sense of self filled with contempt and humiliation. Therefore, when a person mistreats them, they are less likely to protest since they have been raised knowing they should constantly be mistreated. The child will have low self-esteem, and their sense of self is distorted even when they grow into adulthood. Later in life, when a person shows them love and care, they view it like the person has some sinister motive making them question the person instead of accepting the love and care offered. A child who was ignored or abused will know they should constantly be mistreated (Van der Kolk, 2014). Being poorly treated is their norm, and they don’t recognize it as something wrong because that is what they are used to. They will never complain and appreciate a person who mistreats them. It might explain why people stay with abusive partners, or wives still go back to their abusive husbands.

A child who grows up being adored and loved will believe they are adorable. No matter what someone else tells them, deep down, they will always believe they are adorable. Therefore, when someone treats them poorly, they are more likely to protest since they recognize the mistreatment and wonder why the person is being mean to them. Being poorly treated feels wrong, and they can identify it quickly, making them outraged (Van der Kolk, 2014). Even as an adult, the person will want to be treated the same way they were treated at home. Any signs of abuse will be met with protest, and the person will be ready to leave if they are accorded the respect and love they deserve. They are less likely to become abuse victims since they know they should be treated with respect and should not be harmed.

Part 2

1. How and why would it benefit our country if we treated trauma more like a medical condition?

Treating trauma as a medical condition would ensure that focus and more research is placed on the condition to uncover its underlying causes and the impact it has on traumatized people. Failure to treat trauma as a medical condition leads to the labeling of children suffering from trauma as having other conditions, and the treatments offered do not assist in curing or helping the child. The result is that the child grows up with multiple diagnoses and has undergone numerous treatments without success. Ongoing trauma is devastating to the child, and it has lifelong repercussions that manifest in adulthood. When trauma is viewed as a medical condition, we would be correctly defining what is going on with the patient, and they can receive the assistance they need. However, without recognizing it as a medical condition, we will be developing new drugs and trying to learn about their genetic composition to explain what might be causing the symptoms presented by the child.

The number of children who have been traumatized is high, and these children are given multiple diagnoses, meaning they rarely receive the treatment they need, and the underlying problems remain. It might explain why the United States has the highest crime rates and juvenile cases. If we began treating trauma as a medica condition, children would receive adequate treatment and assistance to handle their trauma. There would be increased interest in the medical condition, and studies would be conducted to uncover methods for assisting the patients. As we do with PTSD, we should realize that growing up could have its challenges, and these early in life challenges will negatively impact the person in adulthood. Therefore, the country would benefit by reducing the crime rates and juvenile cases because it would be dealing with the underlying causes of crime. The resources being used on the children treating the wrong conditions would reduce considerably since they would now be receiving adequate treatment. Welfare rolls and medical clinics would not be handling as many cases as they do without understanding the underlying issue. A proper diagnosis would be made, and there would be a recognized treatment methodology for trauma.

2. Why do you think the DTD – Developmental Trauma Disorder was not included in the DSM – 5?

Developmental Trauma Disorder (DTD) was excluded from the DSM-5 because it did not offer any new diagnosis required to fill a missing diagnostic niche. The APA might have rejected DTD because other diagnoses could be used to explain or diagnose the children. As has already been seen, the children are given multiple diagnoses and put on different regimens trying to treat the condition. There was little supporting evidence that diagnosing the children with the disorder leads to better outcomes than what is currently available. According to the APA, the prevalence of the condition was limited because there were not as many children affected by trauma. Considering that most children would not be willing and ready to talk about their trauma, it was difficult to determine if they genuinely suffered from trauma or another condition. The number of children diagnosed with trauma was low because most children are given other diagnoses to fit their presenting symptoms.

The research studies included with the proposal might have failed to convince the APA board regarding the credibility and prevalence of the condition. More studies should be included to demonstrate that others have confirmed the published results supporting the existence of trauma. Also, the trauma should not be explained by another current diagnosis. Whenever there is a mention of trauma, people associate it with a PTSD diagnosis. However, the children don’t talk about their trauma, making the diagnosis of PTSD out, and other diagnoses are included based on the behaviors presented. Rarely do we want to associate underlying issues of nurture with a mental condition. Most children who suffer from trauma come from underserved areas making them less interesting to study. Based on such backgrounds, it is assumed the child had behavior misconduct, and physicians or therapists are quick to make a diagnosis without considering the child could have been suffering from another condition.

Part 3

1. Provide personal reflection and impact on the readings. Journal explores how the chapters further inform trauma practice

The readings demonstrate that neglect and lack of physical touch to an infant have devastating effects later. Neglect is some form of trauma that a child experience where they learn from an early age that they are alone and have to take care of themselves (Perry & Szalavitz, 2008). The child stops crying because they know that even if they cry or try to get attention, no one will come, and the necessary connections required to form in their brain will not be formed. Most people do not understand the importance of touch and care for a child, and they see children as needy. However, the child is trying to form connections and learn to love. When a child is neglected, it is hard for them to develop emotional relationships with others.

In trauma practice, the therapist needs to ask questions regarding the kind of care offered to the child. In most cases, parents are not asked about the typical day in the child’s life. The failure to ask this question and the assumption that the parents are offering the best care to the child leads to continued neglect. For the case of Justin, it is clear that while Arthur brought the child for regular clinical visits, no one questioned why Justin had not developed as expected for a child his age. Also, no one asked Arthur how he cared for or raised the boy (Perry & Szalavitz, 2008). These questions would have shed light on the care offered and uncovered vital information regarding the child’s upbringing. Therefore, clinicians should be educated on questions to ask parents even if they assume the parents are loving and caring. Leon was raised by parents who had raised a decent boy, but he turned out different from his brother. Had people asked about the care he received and how he was raised, Leon could have been saved since it would have been discovered early that the mother was neglecting him. She would have been taught how to care for the child, preventing him from turning out the way he did.

2. Detail the steps Dr. Perry and other clinicians took as they began Justin’s therapy. How was each area of the brain given attention?

Dr. Perry’s first thing was to reduce the number of staff interacting with Justin and moving him to a private room to minimize chaos and sensory overload. A psychiatric staffer was spending time with him every day, and the doctor visited him each day. Since he lacked human socialization, Justine needed to become accustomed to a few people and receive routine treatment or interaction with certain people. With fewer people interacting with him, he could begin trusting people. After calming him down and building his social skills, Dr. Perry introduced him to physical therapists to assist him in standing and improve his motor skills (Perry & Szalavitz, 2008). While they doubted him, Justin demonstrated tremendous improvement, and within three weeks, he had taken his first steps. The next step was to bring an occupational therapist to teach Justin fine motor and fundamentals of self-care like dressing, using a spoon, and brushing his teeth.

Justin had to be taught that sniffing his food before eating was inappropriate. He had learned sniffing from the time he spent living with the dogs. Speech and language therapists were brought in to teach him to speak. Justin was given exposure to the words he had missed in childhood (Perry & Szalavitz, 2008). The care offered to Justin allowed him to develop the neural connections he did not have, and he demonstrated tremendous improvements within a short time. Justin was discharged and placed in a foster family. The clinicians handled the different areas of the brain necessary for proper development to ensure that Justin received the development he had lacked in childhood. The treatment was done in steps one after the other to ensure the brain built upon what had been taught before. Without first calming him down and teaching him how to interact with humans, he would not have begun his physical therapy, which led to occupational therapy and speech therapy.

3. What Core Concepts apply to these two cases and offer an explanation why they apply to the two cases.

Children can exhibit a wide range of reactions to trauma and loss, trauma and post-trauma adversities can strongly influence development, and developmental neurobiology underlies children’s reactions to traumatic experiences are core concepts that apply to these two cases. The children’s childhood experiences were similar in that the children were neglected and left alone for extended periods. The children did not receive the physical touch necessary during childhood, and they were left to care for themselves. Leon was left alone in a dark room the whole day, and when he cried, no one came to his rescue. For Justin, he experienced the loss of his mother and grandmother in a short span and when he was young. Leon demonstrated his reactions to trauma by becoming insensitive to emotions and feelings. He could not express his feelings, and he felt no remorse. Justin reacted to his trauma by throwing feces and food at others. Justin did not develop appropriately as other children his age because of the trauma he faced. While other children his age could walk and talk, Justin could not do the same. Leon never developed any emotional capacity, and he would only focus on himself whenever he was interacting with others. Leon did not learn to understand the feelings of others, limiting his development.