Want to reduce mental illness? Address trauma. Want to save the world? Address trauma.

Our Earth and and moon.

Our Earth and moon

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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. The results showed 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 often 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?

© 2014 Laura K Kerr, PhD. All rights reserved.

Laura K. Kerr, PhD, IMFT is a mental health scholar and registered marriage & family therapist intern in the San Francisco Bay Area. For more information, visit her website.

26 responses

  1. Pingback: The Impact of Adverse Childhood Experiences (ACE)

  2. Thank you Laura for a great read. To understand mental illness is to understand it is the psychological state of someone who has emotional or behavioral problems serious enough to require psychiatric intervention. There are mental problems and mental illness. Mental problems may arise from environmental triggers, abusive situations, death/greif, bullying, etc. and can cause literal changes in the make-up of the brain, but are often able to be reversed through processing of the emotions and good psychotherapy. How we think actually changes our brain better or worse. Depression is a good example that falls under this category and is often treated with medication when therapy could be a more appropriate method. If the depression is severe and diagnosed as clinical major depression, a combination of medication and therapy are the best ways to approach the disorder Groll, K. (2014). Dear Counselor…(pp.65-66). Chicago, Il.

    • Thanks so much for your insights, Kimberly. I have read studies that show a combination of medications and therapy work best for some people, and have worked with clients who have done well with this combination. My hope is that as a society we will become better informed about the impact of adverse childhood experiences and other psychologically distressing events, and begin to take precautions to avoid them when we can, as well as provide appropriate and timely support when they aren’t avoided. I think if society made this approach a priority, and as healers we also made this our focus, together we could greatly reduce incidences of mental illness as well as the need for medications, many of which (if not most) have potentially harmful side effects.

      Thanks again for your feedback.

      • Thank you Laura. I just wrote a book, and I am speaking publicly with trying to bring awareness to the topic of mental illness with helping parents to recognize the signs and symptoms EARLY on. The purpose of the book is to reach out to an extended audience with providing valuable information into the initial stages of behavior, and to put a focus on addressing issues early on. The faulty thinking may be developing early on and parents will learn how to recognize the signs and symptoms in their children. They will learn ways to avoid negative outcomes and how to build balance in the family unit. A focus is put on an individual’s self-esteem while bringing attention to the coping mechanisms and defense mechanisms their child may be using. The information provided will allow them to have a better understanding on how their child may be responding and dealing with their outside realities.

  3. I am thrilled to find this article and the work that is being done in this area. It is so encouraging to finally see some research and science to back up the fact that “mental illness” is often related to our experiences and environments. I will use this information in my work! Thank you!!

  4. Pingback: Want to reduce mental illness? Address trauma. Want to save the world? Address trauma. | Affordable Alcohol and Drug Assessments in St. Louis

  5. Great blog. I would also add that our disconnection from community – something that seems to have been stronger in past generations – has contributed to our inability to heal from the traumas we experience individually and as a society. I think you’re on the right track, though! If we don’t address the trauma that occurs, it continues to increase exponentially into the next generation. Here’s to changing the world!

    • im sorry but some people are evil. And it is not because of trauma. seriously. i would do anything to not have that true. however, if we prevent child abuse before it begins, than those born with problems will be addressed much sooner. They can get they help they need or supervision they need to ensure they are unable to harm others AND/or self.. but the answer is PRIMARY PREVENITON. PREVENT PREVENT PREVENT. CHANGE THE UNDERLYING REASONS CHILD ABUSE OCCURS! END OPPRESSION, SILENCE/DENIAL AND NORMALIZED HARM. CULTIVATE SAFETY, EQUALITY AND RESPECT AS NORMS.

      • I have known people who gained pleasure from hurting others (my definition of evil). However, all of them had been hurt as children. And in part, based on knowing these people, I am committed to ending childhood abuse as a way to curb evil. I think there would still be emotions like envy, rage, and poor impulse control that can lead to violence. But evil? I don’t know.

        And I agree! “PREVENT PREVENT PREVENT.”

      • I wish i didnt know evil but I do. It is not the norm but it exists. I have seen it first hand for 50 years. Its not a normal story but its a fact. 99% yes abuse. One could label it 100 different personality disorders that cant be changed as the person I am thinking of was born that way but he was still very funtional and clear about the harm he caused. no excuses, concious decision to cause harm from the day he was born. not a good fella. evil in every way you can imagine. for real.

  6. Thank you for the article. I’m a Licensed Alcohol and Drug Counselor and I’ve come to recognize the importance of assessing and addressing trauma in clients I serve. I shared a link to this article in several groups I’m a member of on Linked in. I am continually disappointed by the number of addiction professionals who either don’t believe in or refuse to accept the importance of trauma in the treatment of addiction. I’m also a mental health counselor and perhaps that gives me a different perspective. Regardless, I’m frustrated by the apparent denial of the impact of trauma by some (certainly not all, but some) of those in the addiction treatment field. I’ll keep spreading the message and hopefully more of my peers will hear it.

    • Daniel, I am so glad to hear your perspective as a Licensed Alcohol and Drug Counselor/ Mental Health Counselor. Like you, I have witnessed a direct correlation between traumatic stress and substance use. Really, it makes sense. When people are overrun by traumatic stress, they often have difficulty regulating their emotions or shutting out intrusive memories. Substance use is one way (and a pretty common one) for shutting down overwhelming emotions and memories. I was fortunate to have a wonderful supervisor who stressed motivational interviewing techniques, which works well with a collaborative, client-centered approach to trauma treatment.

      Thank you for your feedback.

  7. Laura, I sincerely appreciate your work on ferreting out the non obvious, the hidden dimensions of our cultural worldviews which, when they are enacted, perpetuate and normalize traumatic conditions. You and other contributors to this forum are bringing to light what needs to be addressed through policy change and development.

    Many of us, if not most of us, in this forum have very personal experience with ACEs and other traumas and your work helps make sense of those personal experiences as well as the broader social and cultural determinants.

    That’s certainly been my experience. Keep up the good work. Maybe together we can change the world.

    • Thank you for much for your encouragement. Although I typically write as a “professional,” my motivation originates with my own woundings and the wounds of loved ones. And yes, together, I am hopeful we can make a better world.

      Again, thank you.

  8. Thank you for this great post on trauma. I scored a 3 or 4 on the ACEs test. A family member was not drug or alcohol addicted, but a sex addict instead, so I don’t know if I should count that one. To this day, I still sleep very tense…as if my body remains vigilant at its most vulnerable moments (sound asleep). My sister suffers with chronic insomnia. I’ve experienced personally, and seen as a practicing Licensed Professional Counselor, the devastation of trauma. I applaud your efforts at getting the word out!

    A wish of mine is that we could have mandatory mental health classes in schools from 1st grade through 12th…where we teach children about feelings, healthy coping/conflict resolution/relationships, etc. My hope would be that children would no longer go through traumatic situations “alone” and “unprocessed.” And, maybe, the next generation would be better equipped as parents, family members, workers, neighbors, etc. to raise the following generation.

    • Thank you for opening up about your personal experiences. I think you are right; having a caregiver with a sex addiction should definitely be included as an adverse childhood experience. I commend the designers of the ACEs study for being broad in scope, and yet as your experiences show, there are so many experiences that are overwhelming for a young child, if not also for the other adults in the household. I think experiences like yours show the importance of broadening how studies are done in the mental health field, perhaps including more users of services in the construction of studies. I don’t think this is a shortcoming of the ACEs Study, but rather how I think there needs to be changes in how studies are created and data is collected in the field in general.

      I share your wish! I have been thinking for years that Marsha Linehan’s Dialectical Behavior Therapy, which focuses on affect regulation, mindfulness, and distress tolerance, should be adapted for schools.

      Thank you for your reflections.

  9. Just before Christmas, we had a chimney fire at our house during the night. When the fire was completely extinguished, the fire chief said, “Chimney fires NEVER turn out this well.” No interior smoke or water damage and only one side of our roof and chimney damaged. Weeks later my family and I are still working through the stress and anxiety of nearly dying in our beds, but for the kindness of a passing motorist who roused us.

    http://floweringbrain.wordpress.com/2013/12/22/how-social-neurosciences-golden-rule-saved-my-life/

    Two years from now if you were to poll me about any significant traumas over the last 24 months, I feel pretty certain that I would NOT recall and identify this experience as being traumatic. It would be gone from memory. And yet, I have little doubt that it is/will significantly affect my neurobiology.

    It is this nature of trauma and memory that make statistical assessment so difficult to accurately measure in my opinion.

    • So glad you and your family are okay!

      “Near-miss traumas” really ought to be their own category. They can rouse the imagination in ways that often delve us into confronting our morality and entertaining “what ifs” we might not ever let ourselves think about. But as your mentioning of the kind motorist suggests, they can also leave us with profound gratitude. And how do you measure the gratitude for being alive, if not spiritual transformation, that sometimes comes from such traumatic events?

      Again, so glad you are all safe!

      • Thanks, Laura. I agree completely about near-miss traumas. To the body, through the process of neuroception, a near-miss incident is not a miss at all. Every one of our stress systems still gets called into action. Keep up the really informative research and writing.

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