Experts in the field of severe childhood neglect and trauma recognise that such patients should be classed as suffering from a range of conditions including complex PTSD type II, Dissociative Disorder, Reactive Attachment Disorder, Trauma Bonds, Stockholm syndrome, Autonomic hyper arousal- all of which contribute to considerable difficulties with interpersonal or attachment difficulties. There is also evidence that neurological damage to the limbic system and hippocampus can occur in cases of severe neglect and trauma especially where both parents are abusive or disturbed and where the child in such an invalidating environment is pre-verbal.
Yet there are few of these experts working in the mainstream NHS and such concepts are not part of mainstream clinical practice. Thus, mainstream psychiatric professionals tend to stick with labels such as depression, personality disorders, etc and rarely pick up long-term abuse specific conditions. The consequences of this can be fatal.
99.9% of so called mainstream “professionals” from counsellors to psychiatrists, when asked, say they are “more than capable of dealing with and understanding issues of child abuse survivors”. But this is completely false. Very few (if none) of NHS workers receive any appropriate training on neglect and trauma sequalae whatsoever, and do not even understand vital concepts such as Stockholm syndrome, Dissociation or Trauma Bonds. It is absolutely shocking that this is not mandatory knowledge for people working with victims of incest and childhood trauma.
Dissociation can help a person feeling overwhelmed by her feelings but will also stop the patient from learning from experience, each time she is told something or experiences something will feel like the first time, and interfere with her being able to do any ‘joined up thinking’, planning ahead or being fully aware of the consequences of her behaviour. This level of dissociation in intelligent and creative people can commonly be used to enable them to function very well in their careers with no one having any idea at all that there is any acute distress being experienced.
Thus, when abuse survivors present at a psychiatrists consultation, the psychiatrists looks for the classic signs of how well someone is coping to asses a persons eligibility for help based on “need”. They look for how well dressed a person is, how lucidly they speak, whether they give good eye contact. Trauma victims often misleadingly “present well” leading the under-trained psychiatrist to assume they are coping well. In a climate of tight budgetary control such patients are more often than not considered “too well to help”, and resources are directed towards classic mental health conditions such as psychosis, manic depression and schizophrenia.
Traumatised and distressed adult survivors then find themselves in a battle with the system desperately trying to persuade psychiatrists or other health professionals that the level of distress they experience is genuine, despite for example having experienced momentary high functioning and competency in their professional life.
The energy needed to maintain the high functioning cannot be sustained and major physical or psychological collapses are also common. These very often surprise and perplex colleagues, family members or psychiatric professionals who do not have the level of training or experience to fully understand the processes involved. When this collapse occurs the patient is then deemed “too ill” to help and commonly branded with a personality disorder.
This chronic ignorance amongst the psychiatric profession means that victims of severe childhood neglect and trauma often go without any psychotherapy at all. The “lucky” ones get some short term CBT or medication to address depression – but this is either inappropriate or downright dangerous. The so-called “treatment resistant” patients often go through the mill of misdiagnosis after misdiagnosis and one unhelpful (short term) treatment after the next. I return to this issue later.
Depression will be very difficult to treat unless any dissociation is also addressed as well.
Thus, the reason many “treatment resistant” patients have not responded to treatment is because they have been given the WRONG treatment – treatment that exacerbates and prolongs symptoms of trauma.