Thursday, January 11, 2018

The Missing Link of Adversity

By David S. Prescott, LICSW

A recent BBC documentary highlights the work of a school in Glasgow, Scotland, to help young school children manage their aggressive behaviors. On its surface, the video is inspiring: with little to no resources, a group of dedicated teachers and behavior specialists design “nurture rooms” where these children can get specialized attention and guidance. This approach reduces the use of empty “time-out rooms” where adults sit with children who have no choice but to stew in their own challenges. The video ends with questions about how best to fund similar programs in the future. It can’t be easy; even the “comments” section of the video highlights the attitudes of many in the public. One viewer states, “A boy’s ears are in his backside. Bring back corporal punishment.”

Interestingly, 89% of the teachers in the video state that they blame the parents for their children’s behavior. There is no discussion of the ways in which the school environment itself may contribute to the children’s problems. Perhaps most revealing is that there is no mention whatsoever of the fact that many of these children likely have histories of adverse and traumatic experiences. It’s as though the same schools that would build handicap access for children with physical disabilities would not make similar accommodations for young people with the less obvious disabilities that can arise from growing up in adversity. Under these circumstances, blaming parents is perhaps less helpful than examining the broader context in which abuse and adversity occur. Parents should, of course, be held accountable for their actions. However, helping prevent further harm means understanding adversity and assisting people in moving beyond it.

These are not simply ideological statements. Research on complex trauma and aggression in secure juvenile justice settings – the obvious next step for the young people in the BBC video – by Julian Ford and his colleagues describes the extraordinarily high rates of traumatic experiences in the backgrounds of  incarcerated youth and the connection between formative events and future aggression. The study describes interviews with clinicians treating 40 youth who had perpetrated sexual abuse, finding that 95% of them had at least one traumatic experience in their past and that 65% of them met the diagnostic criteria for Post-Traumatic Stress Disorder. The clinicians viewed traumatic experiences as having set into motion the sex crimes of 85% of these youth. In other words, while many in the general public may see only the backsides in need of corporal punishment, a deeper examination of these youth reveals a much more disturbing truth. It should be no surprise that punishment-only responses don’t work.

Even among adults, it can be easy to overlook the amount of trauma and adversity in the backgrounds of men and women who sexually abuse. Levenson, Willis, and Prescott (2015; 2016) found elevated rates of adverse experiences (including over 13 times the odds of verbal abuse) in the backgrounds of these individuals. As lawmakers and the lay public talk about getting ever tougher on crime in the name of assisting victims, it’s easy to miss seeing how many of those who have abused have themselves been victimized. Indeed, the deeper one digs into research on people who abuse, the clearer it is that the forces driving abuse cannot be easily dismissed by statements such as “they should have known better.” As many have said before, recognizing abuse as a public health issue rather than simply trying to punish it away will be a good start.

In the “flashbulb moment” that comes in the immediate wake of abuse, it is easy – perhaps even natural – to experience the desire to destroy both the abuse and the abuser. Likewise, it can be easy for prison officials, supervising agents, and treatment providers to view irritating features of those in their charge, such as irritability, hypervigilance, emotional numbness, and apparent memory problems as efforts to avoid responsibility when they are also diagnostic criteria for PTSD. The real questions for all professionals include: How can we best understand the totality of our clients’ experiences and not simply view them as merely the sum of their worst behaviors? Can we stay true to our mission of assisting those who have been abused by including those who have also abused others? Can we go beyond holding people accountable and also teach them about accountability? Can we exercise the same compassionate working alliance (central to all of the world’s religions and successful forms of psychotherapy) with people whose actions can seem separate from their histories? Ultimately, can we accept the person in front of us even as we don’t accept abuse?

Understanding trauma in the lives of others has been a difficult undertaking in mental health practice since the time of Freud. Just the same, human beings have helped one another move forward from trauma as long as there have been traumatic experiences. Not everyone who has been traumatized needs specific treatment, but it seems that the majority of those who might be inclined to cause harm can benefit from trauma-informed care. 

No comments:

Post a Comment