Teach Me Trauma

When looking at the many problems that children in under-resourced schools face daily, one can often be at a loss at how best to help these children. When events such as abuse, rape, depression, self-mutilation, gangs and teen pregnancy are common, where does one start? How can one help? Is the answer to work one on one with these children, or with their families, or with their communities or with the political system of the day? Perhaps the answer is ‘all of the above’ and ‘take your pick’.

This blog will focus on the school environment as an area needing intervention – transforming the school environment from one that arguably perpetuates trauma, to one that is an effective part of a child’s social support system.

Duncan and Rock (1997, as cited on National Children & Violence Trust site) argue that the structure and routine of school life is “calming” for children, and thus enhances their capacity for resilience when faced with a traumatic event.

While this ought to, perhaps, be the case, in many schools it is not a reality. Rather than forming a buffer to trauma, too many schools are actually the site of trauma.

Amanda finds being in class incredibly stressful. Her fellow students are noisy and aggressive, while the teacher does nothing to maintain order. Due to a background of domestic violence, Amanda is hypersensitive to the unruly activity in the classroom and finds it almost impossible to concentrate. Thus, not only is Amanda traumatised at home, but also at school, leading to truancy and risk of failing the year.

Nandipha is teased and taunted by her class because she is a committed, well-prepared student and the ‘teacher’s pet’. The teachers do nothing while students make comments to Nandipha, such as, (on Nandipha writing an answer on the board) “your writing is as ugly as your face”. Nandipha dreads school and feels that she cannot cope much longer. She feels hopeless and desperate about her situation.

Often, in an attempt to maintain control of the classroom, teachers will mock and humiliate a child in front of the class. In one case, this resulted in two teens attempting suicide. Another teen, with ADHD, is victimised by the teacher, who, when he is being disruptive will announce to the class that the boy needs his ‘crazy pills’. Other teachers are feared by the students, who know that if they do not give the correct answer, the wooden chalkboard duster or a pen will be thrown at their head.

These real life examples highlight that in too many cases, school is not the calming, orderly environment that Duncan and Rock (1997) envision. As such, students are losing out on a potential source of support, safety, respect and discipline. And something needs to be done. Perhaps the answer is more teachers. Better teachers. Teacher training sessions. Inspiring and educating educators of the vital role they play – to uplift or destroy.

Schools need to be reclaimed so that they can indeed be environments that strengthen children and protect them from the trauma they experience in other areas of their lives.

 

Childhood Trauma: A life-long Burden to Bear?

There have been many studies done, a number of them being longitudinal, on the lasting effects of childhood trauma.  The results have been staggering and clearly indicate the consequences of suffering a trauma as a child.

Firstly, what is childhood trauma? The American Academy of Pediatrics (AAP) in 1992 defined it as a repeated pattern of damaging interactions between parent(s) [or, presumably, other significant adults] and child that becomes typical of the relationship."  These damaging patterns would include physical, verbal and sexual forms of abuse, as well as neglect and anything that would make the child feel worthless, unloved, insecure or endangered. Childhood trauma would also have to include single events, like the loss of a parent before the age of 12.  The less obvious childhood traumas also include continually moving house, divorce, isolation from stimulation, and parental fighting.

Usually the damage is caused by continuous traumas, but tho is not always the case, as stated above.  The reason for this is that with most single-event situations, as the child’s brain develops, it disposes of the synaptic connections that are responsible for remembering the event.  When the events are repeated, the brain builds more of these synaptic connections and so is much more likely to remember the events, although not always in the recoverable memory.  This means that the person’s traumas may influence their thoughts, actions and behaviours but they are unable to connect that with their trauma and are unable to view their trauma with complete accuracy and clarity. One can imagine that this could have some serious consequences in later life.

What are some of the consequences of childhood trauma? With all categories of abuse, there are physical and psychological and behavioural consequences that can manifest in later life. There are the obvious physical damages such as broken bones, bruises or even death. In the long term though, abuse has been shown to lead to impaired brain development, and poor physical health (allergies, arthritis, asthma, high blood pressure).  Psychologically, research has shown that childhood abuse can lead to low self-esteem, depression and relationship difficulties.  Furthermore, Silverman, Reinherz, & Giaconia (1996) revealed that 80% of young adults who had been abused as children, met the criteria for at least one psychiatric disorder.  These disorders included anxiety, depression, eating disorders and suicide attempts.  ADHD has also been found to be connected to childhood trauma.  With regards to behavioural consequences, research done by Johnson, Rew, & Sternglanz (2006) showed that those who were abused as children were more likely to partake in risky sexual behavior, often resulting in STD’s like HIV. Child abuse victims are also 3.1 times more likely to commit violent crimes as adults. Another common long-term consequence is that of substance abuse.

As a result of the above consequences, the abuse victim often finds it hard to reintegrate back into society, hold a steady job or engage in fulfilling relationships.  The effects vary depending on the type of abuse, the child’s personal characteristics as well as their environment. The effects may be severe or milder and may last for varying amounts of time.  In most cases, the consequences extend to the entire family and oftentimes the community of the victim. 1 in 3 vistims who were abused as children will go on to abuse their own children, continuing the cycle.  It would therefore be fair to say that the effects of childhood trauma, resulting from abuse (of any type), are a burden that is often carried for life.

Trauma in Burn Victims

A severe burn injury is one of the most traumatic experiences an individual can go through. There are nearly 1 million burn victims who find it challenging just to survive their injuries, and also experience psychological distress that can be devastating for the individual’s ability to cope. Several studies have indicated that trauma related to a burn injury may cause several psychological problems. Literature on burn victims has pointed out Posttraumatic stress disorder (PTSD), as a relatively common element after a burn injury. Other symptoms of anxiety and of depression are also common. Acute stress disorder (ASD), has also been found to be quite common psychological problem in the burn literature. The diagnosis of ASD requires that the individual has experienced a traumatic event and developed symptoms of dissociation, avoidance, anxiety, re -experiencing the traumatic event, and increased vigilance in response to the trauma. (Difede, J., et, al. 2002). Furthermore, research on burn injuries has indicated that up to 50% of burn victims will be diagnosed with depression, and over 30% of burn victims will have developed symptoms of anxiety one year after the injury.   Between 20% and 45% of burn victims have developed PTSD approximately one year after the incident (Sveen, J. 2011).

                                                                                                                                                                                 

Burn injury has acquired a distinctive position in the trauma literature, because burn victims are normally confronted with a multifaceted trauma complex, because of the many psychological and social aspects associated with burn injury. In a qualitative study undertaken with burn survivors in Sweden, interviews were conducted with the victims in order to gain an understanding of their trauma. The victims described feelings of dissociation, re-experiencing, avoidance, and intense grief (Millstone, S. 2008). In the case of severe burn injuries, for example third and fourth degree burns that destroy hair, nerves, glands, vessels, and burning all layers of the skin tissue, the survivors were left severely traumatized. Those that experienced facial burns were particularly affected. Many reported having avoided their mirror image, and a few expressed how months later they were still in denial when they saw their own reflection.  Unlike many burn victims, those with facial burn injuries wear the scars of their trauma for the world to see (Freund & Marvin 1990). In today’s society where image has become very important, it is very difficult for the individual to live with a face or body that is different (Millstone, S. 2008). The assumption often conveyed by the media is that having an altered appearance also means having a damaged personality or lack of intelligence. It is quite common for burn victims to receive curious stares, impulsive questions and hurtful remarks on a daily basis, which can result to increased self-consciousness. In response a burn victim will tend to become isolated and, or believe they cannot have intimate relationships (Freund & Marvin 1990).

However, the reality is that given the proper treatment, therapy, support and information to cope with the emotional, mental, and social issues, it is possible for burn victims to live normal, successful lives and enjoy fulfilling relationships and achievements, regardless of how extensive their injury may be.

Difede, J., et, al. (2002). Acute Stress Disorder After Burn Injury: A Predictor of Posttraumatic Stress Disorder. Psychosomatic Medicine. 64:826–834.

Freund P.R. & Marvin J.A. (1990). Post burn pain. In Bonica J.J. (eds) The management of

Pain,  2 end edn. Philadelphia: Lea and Febiger. pp. 481-489.

Millstone, S. (2008). Coping with disfigurement 1: causes and effects. Nursing Times; 104: 12, 24–25.

Sveen, J. (2011). Posttraumatic Stress and Cognitive Process in Patients with Burns. Acta Universitatis Upsaliensis. Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine 639. 58pp. Uppsala.