Different explanations have been given for the increased number of people suffering from mental illness. Some have claimed the increase is the result of ever-expanding diagnostic criteria and syndromes that risk medicalizing normal emotional reactions. Others argue the increase is the result of the pharmaceutical industry financially courting the medical establishment as well as using advertisements to attract potential users of their medications. While both these arguments seem correct, they nevertheless fail to address that an increasing number of people regularly experience despair and anguish and are struggling to make a meaningful life, if not keep themselves psychologically, socially, and financially afloat.
I would like to suggest an additional explanation for the increase in mental illness: The upsurge is the result of the collective failure to alleviate conditions that contribute to trauma-related stress. I also believe the mental health field has stood in the way of people overcoming mental illness and returning to growth-centered lives. In particular, models of mental illness as chronic, genetic-based disorders gives us the sense that we are reaching the origins of our suffering — that is to say, the genes we inherited — when in actuality, we risk denying the traumatizing conditions in which many of us grew up or continue to live. Although a diagnosis and medications may provide temporary relief, they may also cause Americans to evade making the challenging changes that are necessary for moving into an emotionally sustainable future.
Childhood abuse and other emotional damaging experiences are so prevalent today that trauma-focused psychiatrist Bessel van der Kolk claimed the single most important health problem facing Americans is our exposure to what are increasingly referred to as “adverse childhood experiences,” which have been rigorously associated with chronic psychological and physical illnesses.
Adverse childhood experiences include recurrent physical abuse; recurrent emotional abuse; sexual abuse; an alcohol and/or drug abuser in the household; an incarcerated household member; living with someone who is chronically depressed, mentally ill, institutionalized, or suicidal; domestic violence; one or no parents in the household; and emotional and physical neglect. (I would also add to this already long list living in a violent community; the conditions of poverty; and the effects of racism, sexism, homophobia, and other forms of oppression.) Based on self-reports of over 17,000 adults in America, a study conducted by Kaiser Permanente and the Center for Disease Control (CDC) concluded that more than two-thirds of the participants in the study had at least one adverse childhood experience when growing up; over two-fifths have a history of at least two of these experiences.
A study conducted at the University of Minnesota, Twin Cities, obtained results similar to the Kaiser/CDC study. Psychologist Patricia A. Frazier and colleagues administered the Traumatic Life Events questionnaire to 1528 college students. From their responses, they learned 85% had at least one trauma in their relatively short lives, and on average students reported a history of three traumas. The most common traumatic events included sudden bereavement (47%); life-threatening illness of a family member or friend (30%); witnessed family violence (23%); received unwanted sexual attention (21%); and involvement in an accident in which either self or someone else was hurt (19%).
If “normal” correlates with the greatest number of people, then coming from a normal household in America means growing up in conditions that contribute to poor emotional and physical health in adulthood.
The denial of trauma’s impact — or complete silence about its occurrence, such as the silence that often surrounds childhood abuse — has been the main approach to dealing with trauma’s aftereffects. There are benefits, of course, to denying trauma. For example, trauma-focused psychiatrists Alexader McFarlane and Bessel van der Kolk point out:
“Powerful social institutions such as insurance companies and the armed forces … benefit from downplaying the impact of trauma on people’s lives.”
Medicine’s reliance on clinical- and laboratory-based studies also allows its practitioners to ignore, or downplay, the role trauma plays in the development of mental disorders and diseases. McFarlane and van der Kolk remarked:
“Hitherto, science has generally categorized people’s problems as discrete psychological or biological disorders — diseases without context, largely independent of the personal histories of the patients, their temperaments, or their environments.”
The outcome is an anesthetic presentation of disease in which objectivity is prized over emotionally taxing “social work” and the more ambivalent outcomes that come with taking into account the actual lives of its subjects.
But the denial of trauma is more expensive than its benefits, and likely distorts the basic social fabric of our society. Again, quoting McFarlane and van der Kolk:
How are the memories of brutualization and cruelty stored at a societal level? How does this affect people’s capacity for loyalty, personal and social commitments, beliefs in individual sacrifices for the common good, belief in justice, willingness to delegate decision making to elected representatives, and belief in the meaning of laws and rules?
As I discussed in a previous post, America is a country born from trauma, and Modernity — especially its latest configuration as Neoliberal Capitalism — is a costly distraction from our deep, unhealed wounds. Modernity’s ethos of progress, and its continual need for expansion and growth, is not only a diversion from our emotional wounds, but also acts like an addiction, numbing the traumatic remembrances of our individual and collective pasts.
Medicine has gained prominence in our society as a method of denial likely because it successfully identifies in individuals’ bodies the effects of social ills for which we seem to have no solution — except going cold turkey off Modernity, which at this point we are ill prepared to do. Instead, we look to mental healthcare to ‘fix’ individuals enough so they can function ‘responsibly’ (often defined in terms of holding a job and paying the bills) in a society that habitually denies its responsibility to its members.
When we fail to grapple with the conditions that lead to suffering, and thus fail to address the root causes of mental disorders, we are resigning ourselves not only to repetition of the problem, but also to a prevalent sense of “stuckness” that has us collectively doubting the possibility of meaningful social change.
We seem to have forgotten how to grow after trauma, both as a society and as individuals. I say “forgotten,” because traumatic experiences — those events that activate defense responses such as fight or flight and overwhelm us with fear — have gone on throughout human history, and most early forms of social organization seem in part to have developed in response to the need for a cohesive and supportive community to heal trauma-related stress and defend against threats.
It’s time to rethink the nature of mental disorder and how, as a society, Americans need to respond to the conditions that contribute to early life trauma. During the past several decades we have witnessed a shift from unprecedented — and largely unquestioned — growth in science and technology, to the need to increasingly devote energies to managing the fallout and risks of the imprudent choices previous generations made in the name of scientific advancement. As we rethink our relationship with Earth and the other life forms that inhabit our planet, we also need to reconsider our relationship with ourselves. How can we save the world if we can’t even save ourselves?
Written By Laura K Kerr, Ph.D
Want to reduce mental illness? Address trauma. Want to save the world? Address trauma. was originally published @ Laura K Kerr, PhD and has been syndicated with permission.
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Lovely piece, as usual , Laura.
Assume you are familiar with John Read’s work “Childhood Trauma, Loss and Stress” in Models of Madness … (2004), which he edited with Loren Mosher and Richard Bentall. Validated my own experiences and is in line with what you just wrote. Thanks, JC.
Thank you, Jack. I’m not familiar with Read et al’s work, and I appreciate the reference.
You lost me at the end but I understand and agree that we have only touched the surface of the effects of trauma and its correlation to mental illness. Not to diminish biology but ignoring trauma is to ignore perhaps the most relevant theory of today. I wish I could share more of what I know! I have a very interesting job that affords me the opportunity to read the clinicals of many of our clientele hospitalized for mental illness. More often than not, the adults as well as the children are trauma victims. However, many also have a lengthy family tree loaded with mental illness. Which came first? I don’t always know. But what I do know is the relationship exists and we need to pay closer attention.
Thanks so much for sharing your thoughts and some of your experiences. With so much good research about the neurobiology of trauma, we no longer have to make distinctions between nature and nurture, which originally supported notions of mental illnesses as genetic disorders. And as more research is done on the intergenerational transmission of trauma, there is more evidence for how the effects of traumatic stress are passed down through generations, both in terms of biological markers and behaviors. My hope is that all of these efforts will lead to a more compassionate and effective approach to mental health care.
Hi, thanks for the reply. I have a question. How does research suggest trauma can change genetics? I have read much information on how trauma can change the brain. This takes it a step further. If it is easier, please refer me to some good reading. Thanks for your time.
I really like the following article on epigenetic expression. It gives a good introduction to epigenetics, and includes an interesting history about how the field developed. Not surprising, initially there was resistance to findings that suggested behavior could actually change genetic inheritance.
Grandma’s Experiences Leave a Mark on Your Genes
By Dan Hurley
http://discovermagazine.com/2013/may/13-grandmas-experiences-leave-epigenetic-mark-on-your-genes
Thank you, Laura Kerr. For your refreshing article, and the references as well
Wonderful. This is always the premise.I do acknowledge the biological basis of a few forms of Mental Illness( Schizophrenia, and Bipolar) but the vast majority is the result of Chilhood Abuse of all description( physical, sexual, emotional, and also neglect). Not only that, we know that Domestic Violence, rape, and other forms of abuse can create Post-traumatic Stress.I also specialize in Adult Children of Alcoholics. Most professionals don’t seem to understand how far that can go, unless they come from such a chaotic, traumatic background, and ACOA gets overlooked as a source of lifelong trauma.Children of alcoholics are often abused physically, sexually, emotionally , and suffer gross neglect. Not everyone, of course, but the presence of trauma in these homes is huge. I remain astonished as to why all this isn’t immediately obvious to all Counsellors, and Psychotherapists. I think it is a given. And, even people who suffer from a so-called “biological/genetic disorder may also have suffered trauma in addition to other forms of Mental Illness Just because someone may have Schizophrenia or Bi-Polar, or Major Depression, doesn’t mean that they did not also suffer Traum as well. Most often, I believe, they probably did. Great piece !!
Christina,
Thanks so much for your insights and broadening the discussion to include Adult Children of Alcoholics. Even when there isn’t abuse in the home, as you point out, the neglect can be profound when caregivers have substance addictions. Counselors and psychotherapists generally screen for substance abuse (or should!), but your comment has me thinking how helpful it would be to also know if the client’s parents abused substances and how that impacted the client, including how she or he coped with the parent’s use.
I want to add another level to the effects of addiction on parenting. My father wasnt an alcoholic but HIS father was a severe and violent alcoholic who beat his mother and children. Those learned and/or inherited patterns were obvious in my father’s parenting and behavior and shaped my entire childhood experience. If we are going to ask about addiction, we need to not stop at the parent level. We need to ask about family HISTORY just as we would a medical history. My father’s behavior was identical to that of an alcoholic. A dry drunk so to speak.
Thank you for sharing your experiences. You make an important point. My graduate program taught us how to create genograms. I suspect this is standard training for marriage and family therapists, since our focus includes family dynamics and intergenerational trends. More often, geneograms are used when working with families/couples, but I have used them with individuals too. As you point out, we can get a lot of insight into peoples behaviors, including our own, when we start to look into our family history.
Dr. Kerr,
Thank you for this excellent article. I have been practicing psychotherapy for several decades and successfully treating trauma on a consistent basis for about 5 years, thanks to the work of Jon Connelly, PhD and Rapid Trauma Resolution.
I have long been aware of trauma (both big “T” and small “t”) being at the root of many/most psychological and physical symptoms. I am grateful to have the means of reducing/alleviating its effects.
From a Social Work perspective, I am very aware that the therapist’s office has become the default space where the wounded can openly express their pain. Many of us have come to realize that as a society, we have fewer and fewer “indigenous healing systems” (a term I recall from my grad school days). There are few opportunities or structures in our modern lives for the expression of pain, let alone validation and healing.
As a clinician, I can make a difference one client at a time. Your work brings to light the larger societal issues and widens the discussion of “mental illness” and is very much appreciated.
Michele,
Thanks so much for sharing your experiences as a healer. I have been hearing good things about Rapid Trauma Resolution and am very curious about this modality. (I practice Sensorimotor Psychotherapy.)
Your comments about lacking indigenous healing systems hits at the core of why we have mental health services. I hope that with more open dialogue about the effects of trauma, as well as treatment modalities that are easy to use as well as easily taught, much of what we do as practitioners can be adapted to widespread use, or at the very least, lead to more peer support services.
I treated SPMI in Oregon; working with individuals who had found their way out of the state hospital after lengthy stays. I was told by this group of people that I was the only provider to listen to their stories from beginning to end! We were working in a therapeutic treatment home which enabled regular sessions weekly for three years. The people were tremendously healed in the experience; although forced to medicate. It is not as productive to be so medicated when processing trauma. That is what I experienced. I did not come out in tact as a professional. Watching what happened to the people by the system meant to help them was not the least of the trauma I endured in the position. Thanks to everyone for being open to the work of listening to trauma! Be with that…. and you will be unique.
Lesa,
What you share is so heartbreaking — for the people who went so long before having your willingness to hear their stories, but also how it impacted you as a professional.
I have been saving articles on the effects of vicarious traumatization as well as the impact of working in systems that deny trauma. I hope to someday do something with them. I started this collection because of the challenges I was facing and seeing others face when we try to both provide trauma-informed care and create trauma-informed systems. (I am also finding articles about emergency and medical service providers that are experiencing similar challenges.) Vicarious traumatization runs high, as does the potential for toxic work environments and burn out. The work is inherently heartbreaking, and it does change us. I think as a profession we need to think deeply about how systems need to change so that providing trauma-informed services can be an emotionally sustainable practice for those providing the care.
That was a confirmation of how nourishing it is to feel heard.
Dr. Kerr, you wrote “It’s time to rethink the nature of mental disorder and how, as a society, Americans need to respond to the conditions that contribute to early life trauma.”
I think you would agree that everyone of us are imperfect while living in an imperfect World.
To me, this means each of us carry, by varying degrees, emotions due to experiencing current and past emotional traumas.
Regrettably, I think, those LESS traumatized can function, some quite well, without feeling the uncomfortable emotions due to their traumas; thus, become insensitive to those MORE traumatized by labeling them with a “mental illness.”
Paul,
I have certainly witnessed what you write about, and it is distresses and exhausts me.
But I don’t think such behavior is a ‘natural’ response to human suffering. (I am hesitant to use the word ‘natural,’ since really, what counts as ‘natural’ in a socially constructed world?) I think the hieratic state we live in, and the constant struggle for attainment of social standing, if not just basic subsistence, perpetuates an “us” versus “them” mentality. Any perceived weakness gets labeled, which seems to have the added effect of pushing a person even further down the social climb.
I like to think if we lived in a more equitable society, one in which we fostered interdependency (this is what I think is ‘natural’), we wouldn’t have such a need for labeling people. And hopefully we would be a whole lot nicer to each other!
Thanks so much for your thought-provoking comment.
I was going to leave an original comment, but see that my own thoughts slide right into this thread between the two of you.
I think often about how we respond to traumatized individuals. I think about some of the best residential treatment centers we have in the US (therapeutic communities such as Spring Lake Ranch, Gould Farm, CooperRiis… The Refuge in FL and the list could go on and on…) and how effective they are at doing what you point to in your comment, Dr. Kerr. These wonderful places create an equitable environment of kindness that thrives thanks to the exchanges between people in meaningful relationships instead of the exchange of labels and otherness that you get with a very medical model.
Are you familiar with this study?
Betancourt, T. S., Borisova, I. I., Williams, T. P., Brennan, R. T., Whitfield, T. H., De La Soudiere, M., … & Gilman, S. E. (2010). Sierra Leone’s Former Child Soldiers: A Follow‐Up Study of Psychosocial Adjustment and Community Reintegration. Child development, 81(4), 1077-1095.
I often think of this study when I think about trauma… and that recovery has so much to do with being reintegrated into a supportive community than anything else.
Sadly, US society — at least here in the Northeast where I live — is geared much more towards the individual, ambition, autonomy and economic success. When you’re not ambitious enough or economically successful enough, you fall into a less-worthy category – as you pointed out with your “social climb” comment above.
I have had a life-long connection to therapeutic communities and the question always comes up in my mind: how can we turn these places more out towards the world so that people in our society can experience first-hand the value and benefits of equality and kindness… and so many of the other nuanced values that make a just and supportive soceity hum? My experience has shown me that most people just don’t know what that feels like… but I have seen it time and again, when they experience a therapeutic community for a first time there is this opening, surprised “ah-hah!” moment. It’s a concept accesible to almost everyone. So how do we make the leap across that which divides these places from mainstream society? I’d love to learn about anyones experiences of attempting this…
Best,
Steph
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