There are stereotypes in families and particularly in the ways they handle emotions, dysfunction, and difficult issues. One stereotype is that of repression: we don't discuss or acknowledge “problems.” (Meaning: it's improper and embarrassing to bring up, and if you don't make a fuss, it will probably go away, or at least not disturb those around you.)
Another stereotype is that of drama: constantly verbalizing, emoting, discussing, and “processing” emotional, psychological, and behavioral difficulties. (Meaning: if you express your feelings, we can work through this and it will get better or go away.)
The dualistic and ambivalent aspects of sensitive emotional and mental health issues carry over into methods of dealing with them on personal, therapeutic, and societal levels.
Mental health problems still carry a stigma that presupposes a degree of weakness and failure to assert individual will. Because personal anguish is not quantifiable on medical tests, its intangibility and subjectivity are often assumed to be conquerable, manageable, or repressible by will and responsibility. The historical duality of mind-body disparities is recently blurring, as modern medicine increasingly presupposes organically based models and uses pharmaceuticals to treat mental problems as biological illnesses with chemical and genetic foundations.
Yet, the duality of mental health concepts and attitudes continues to assert itself ironically with the medical determinism (genetics + biochemical imbalances = need for long-term medication solution), prevailing in ironic parallel with societal attitudes that mental health issues are a problem of individual attitudes, personal, strength, and responsible choices.
Accordingly, our health care establishment relegates mental health to a subservient “necessity” on the hierarchy of covered services, severely limiting and marginalizing access to care and services. Mental health issues are pushed beneath the surface of legitimacy until they emerge as acting out “behavioral” problems. In a metaphorical parody, it's as if the entire gamut of human sexual behavior could be summarized in the “talk to your doctor” commercial about erectile dysfunction. We have a magic pill for you.
Unfortunately, there are no pills for dysfunctional relationships and lifestyles.
Fortunately, some productive inroads are emerging from converging research on brain function and early traumatic experiences. Accumulating evidence attests to the profound effects of psychosocial trauma on physical health and life expectancy, as well on psychological well-being and behavioral adaptation.
A large-scale study by headed by physicians Vincent Felitti and Robert Anda examined the relationships of adverse childhood experiences with disease in adulthood. Their study found significant correlations between adverse childhood experiences and incidences of obesity, heart disease, drug abuse, smoking, depression, anxiety, suicide attempts, sexually transmitted diseases, cancer, diabetes, traumatic brain injury, overall poor health, and early death. This study (known as the CDC-Kaiser Study “Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults”) included over 17,000 Kaiser patients.
Among the striking findings from the research was the link between mental health precursors in childhood and the development of physical, life-threatening illnesses in adulthood. This marshals quite a challenge to the attitude that “it's all in your head.” Statistically, it's in your body—literally—and wreaking havoc consequentially with health and longevity.
The basis for the study was correlations between scores on a self-reported instrument of childhood experiences and adverse adult health conditions. The instrument used for patient reports is called the Adverse Childhood Experience Test. It is a self-report based upon individual recollections and answers to the following questions:
While you were growing up, during your first 18 years of life:
Yes / No If yes, enter 1
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Yes / No If yes, enter 1
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Yes / No If yes, enter 1
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Yes / No If yes, enter 1
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Yes / No If yes, enter 1
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Yes / No If yes, enter 1
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Yes / No If yes, enter 1
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Yes / No If yes, enter 1
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Yes / No If yes, enter 1
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Yes / No If yes, enter 1
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Now add up your “Yes” answers:
_______ This is your ACE Score
An ACE score is a tally of different types of abuse, neglect, and other hallmarks of a rough childhood. According to the Adverse Childhood Experiences study, the rougher your childhood, the higher your score is likely to be and the higher your risk for later health problems.
According to the study results, a tally score of greater than 2—regardless of which questions were endorsed with “yes”—is highly correlated with adverse health outcomes in adulthood. The greater the number of “yes” scores, the stronger the correlation. Scores of 4 or higher were strongly correlated with incidences of adult health problems.
Persons who had experienced four or more categories of childhood exposure, compared to those who had experienced none, had 4- to 12-fold increased health risks for alcoholism, drug abuse, depression, and suicide attempt; a 2- to 4-fold increase in smoking, poor self-rated health, > or = 50 sexual intercourse partners, and sexually transmitted disease; and 1.4- to 1.6-fold increase in physical inactivity and severe obesity.
The link between ACE scores and physical and psychological problems is correlational. That is, there is a significant statistical probability of relationship between childhood trauma and predicted negative outcomes. This correlation is grounds for the assumption that there is indeed a high risk factor for those with such a history.
So, what can you do—and what can we as a society do—to mitigate the effects of early adverse experiences?
A primary and critical step in countering the potential harm from early adverse experiences is to allow and encourage mental health problems to be broached, identified, and treated. As a society, we can and must do a much better job at this than is done at present.
Firstly, the stigma about mental/emotional issues must be erased. This requires education and publicity at social levels and guidance for the public regarding truths about mental health and the deleterious effects of sustained toxic stress. We have made many strides (though not enough) in the struggle to address various forms of discrimination and harassment. We need to broaden these efforts to include issues in the mental health arena. We can't afford to suppress the legions of problems that afflict our population by denying, minimizing, or “explaining them away” as moral or individual failures. We do not and would not do that with diseases like cancer, so we should be more scientific and enlightened about disorders of the brain.
Secondly, just like “talk is cheap,” so, sadly, is the coverage by health plans for mental and “behavioral” health conditions. Benefits and care are stingily and arbitrarily restricted for diagnoses and treatment in the mental/behavioral domains. Such practices are disgraceful and impractical. Not only do reductions, limits, and disallowances discriminate against mental disorders—they make practically inaccessible the care that could avert far more expensive health problems and interventions, as well as promoting the quality of lives and productivity that would otherwise be possible.
Mental health and therapeutic interventions should include predictive detection (e.g., using the ACE score and other screenings), early intervention and preventive care, as well as providing treatment when symptoms become overwhelming or critical.
There is a metaphor for the difference between planned intervention and emergencies; it's called the “fence and ambulance,” where building fences prevents people from going over the cliff, and ambulances represent the more dire and expensive response. Thus, we need more fences.
Quantity (especially affordability and accessibility) and quality of interventions will determine how well we can curb the explosion and intrusion of mental health issues upon our population/s health and quality of life.
The “let's just not talk about it” mantra applies to treatment approaches as well as stigma. It's no wonder that health care organizations and patients alike are often dissatisfied with the traditional model of “talk therapy.” This psychotherapeutic model typically stretches on for months and years with little concrete and measurable improvement on the part of patients. Whereas developing a trusting, confidential relationship and milieu in which to bring forward private suffering is valuable, the validation, insights, and reassurances provided by therapists are insufficient to heal the maladies that are caused by neurological and brain habits and the continuing effects of earlier traumas.
Besides the ubiquitous and automatic treatment by psychopharmacology, patients with psychological, neurological, and developmental issues should be routinely offered EEG neurofeedback. This brain training method has a proven track record for reducing and eliminating symptoms on an enduring basis, and is without negative side effects. Many patients treated with neurofeedback can reduce their medications and dosages. Others can eliminate psychotropic medications entirely. Even parsing out the effectiveness of neurofeedback in addressing mental health conditions, just the benefit of reducing medications is in itself a worthy justification for this treatment.
While nothing can reverse the historical occurrences of adverse childhood experiences, the traumatic effects of such events are clearly the targets of effective interventions. EEG neurofeedback is quite effective at getting the brain to stop reacting to past traumas and relieving the persistent “fight-or-flight” mode that the nervous systems of these sufferers can endure for decades.
There are other direct trauma interventions, such as Thought Field Therapy (TFT), Eye Movement Desensitization and Reprocessing (EMDR), hypnosis, and others. I personally favor Thought Field Therapy, which I've been using successfully for decades.
The notion that one has to “talk through” and “process” old traumas is simply antiquated.
Though life is not easy and history should not be underestimated, most traumas can be eliminated in a few sessions. This is no simplistic exaggeration: it is backed by many thousands of successful treatments conducted by practitioners around the world.
An encouraging development in the field of education is the introduction of “trauma-informed interventions.” Though the methods vary, the underlying concept is to assume and interpret acting out behaviors on the part of students as resulting from unresolved traumas. Thus, instead of responding to misbehavior with only sanctions or punishments, students are offered interventions to address the underlying and predisposing traumas that cause them to act out. The appropriateness of consequences, boundaries, and decorum included, we need more of trauma-informed interventions.
Once the persistent deleterious effects (“fight-or-flight syndrome” triggers, flashbacks, perseveration) are diminished or eliminated, patients are at advantage to employ coping skills to rebuild what has been dormant, shattered, or arrested in their development. This is where psychotherapeutic counseling and mentoring can be most effective.
Just as physical training and getting in shape follows injury rehabilitation, so does the integration of healthy attitudes and life habits follow recovery from psychological trauma and injury. It's hard (and inappropriate) to train for a footrace with a broken ankle!
Healthy living involves more than recovery from illness and injury. Stress management and self-regulation are critical to normal and productive functioning. Being able to cope, withstand, and resist breakdown from stress and demands are necessary aspects of health and well-being. Aside from past traumas, so many people exist in continuing “toxic stress” situations that deplete their internal resources. This prolonged toxic stress exposure induces the onset or worsening of physical symptoms and diseases and may culminate in psychological and neurological breakdown.
Examples of toxic stress include abusive treatment and relationships, poor nutrition, poor sleep, excessive psychological, academic, or physical demands, untreated mental and physical illnesses (including poor or absent health care), social and economic harassment and discrimination, and a host of other stressors.
Though we cannot end the adversity endemic to human life, developing and incorporating systems of institutional care that recognize the traumatic effects denoted and providing comprehensive, appropriate, effective, and accessible treatment will go a long way toward averting the consequences of trauma and toxic stress.
We must end the dual dysfunction in our societal view and treatment of mental health: repressing, minimizing, or just not acknowledging or recognizing the existence and import of mental health will not make these problems lessen or vanish—it will only exacerbate them. We have to talk about it, bring the issues into the light, and make effective treatment accessible and affordable.
In treating mental health conditions effectively and wisely, we can't “just talk about it” as the therapeutic standard of care. We must offer and recommend the proven treatments that heal traumas, train neurological stability and self-regulation, inoculate the vulnerable population against toxic stress, and inform and educate our professionals regarding sane methods of overcoming and preventing the untoward effects of traumas, psychological distress, and eventual physical breakdown.
— Mark Steinberg, PhD
