Journal Entry from ENTANGLED
I need to jot this down before I lose it again. Sometimes stuff comes together and I find an opening, a nugget of substance from all the chaos of self dialogue and ruminations about Janis that fill my day. My apologies in advance, this part gets a little more technical and pedantic. It will require me to do some review and editing, But it has been crucial to my thinking and pertinent to understanding from a more objective point of view, what happened to Janis. What happened to us.
One of the hallmarks of depression is a profound sense of helplessness. Stress, even in normal doses causes people to make lousy sometimes disastrous decisions. Trauma feeds that stress and can lead to PTSD which (vicious cycle) leads to chronic stress. Anxiety beats it all up, keeping the amygdala chronically over stimulated, and the brain swimming in glucocorticoids (a hormone secreted from the adrenal glands, and in large doses, no friend to neurons). When a child suffers abuse and little or no protective factors are involved, the development of the frontal cortex is ‘blunted’, offering little or no executive input to help the amygdala calm down.* Poor decisions continue and the cycle rolls on. The now over-active amygdala, expands, and buzzes with chronic over-stimulation (fear, anxiety) while the frontal cortex remains impaired and underdeveloped. Emotions run the gamut and the pressure takes its toll over time. Depression and anhedonia (the inability to experience pleasure) appears at some point and further interferes in the (frontal cortex) processes of decision making, judgement, emotional feedback, etc. All this and more, (e.g. the harm done to the hippocampus and other areas of the brain from PTSD), leads to a sense of helplessness, hopelessness, to anhedonia, to submissiveness, and submissiveness leads to vulnerability which all makes for a perfect brain storm in the development of the social/emotional life of the developing child.
*( I like this description by Sopolsky, of how the frontal cortex interacts with the amygdala: at some point in development around adolescence the frontal cortex develops the ability to inhibit the amygdala by intervening: ‘ “I wouldn’t do this if I was you.” But after childhood abuse the amygdala develops the ability to inhibit the frontal cortex, saying, “I’m doing this and just try to stop me.” ‘ fm Behave, by Robert Sopolsky)
When I worked as a liaison for the Department of Health and Human Services at the juvenile corrections center in South Portland, my assigned cases were youth (18 y.o and younger, some even preteen), incarcerated for crimes, some very serious, but most not so serious. My caseload were all in the custody of the State of Maine’s Child Protective Care (aka foster care). These were kids raised, most not all, in impoverished, abusive conditions, most already had DSM psychological diagnoses and a history of substance abuse. Many of these children came to my attention and sometimes to my office, with behavior problems including cutting behaviors. This self abusive behavior was deemed by Corrections as an attention getting manipulation. When I interviewed these kids, or asked a youth outright (individually), what they were getting from cutting themselves (a painful way to get attention) they responded, child after child, consistently, that they felt nothing, they described helplessness, hopelessness, being trapped, unable to feel anything; cutting helped them feel something. (One described it as needing to feel she was alive, that she existed). This cutting was the extreme in a list of behaviors throughout their young years, calling for help from abuse they could not speak of, (unspeakable ). These children had displayed behaviors throughout their childhood to get attention. The help they got was incarceration for their acting out behaviors. More isolation. More sidelining and ignoring. More abuse. More punishment. No one was asking (or caring) why. What happened to them that caused them to act out, to be so self abusive as young children, and then cutting themselves while in a child’s prison? It was as if they had reached the end of the road. Cornered. Cutting themselves was the next-to-the-last expression they could come up with. The last expression was suicide. Could these children have been suffering from depression and PTSD?
(Of course the flip side of all this is the opposite: the individual can lash out with aggression. Sometimes they may slip back and forth, aggressive/submissive. It’s a matter of degree. But that’s another story. These kids had acted out enough to get the attention of law enforcement. Most victims act on themselves. Act out. Act in).
The frontal cortex is the last development of the nervous system–think, brain. (The pre-frontal cortex is part of this). The healthy brain is not completely online and fully developed until well into the mid-twenties. Let’s consider this, the executive features of the brain, the reasoning, decision-making, judgement, (social decisions with our fellow humans is included here), problem solving, control of impulsivity, etc., is not even fully functional until the mid-twenties, on average; so what does this mean for a child exposed to ongoing abuse and neglect? Sexual assault, emotional abuse, physical abuse, cruelty, with little or no protective factors in their lives? What happens in their developing brains, and what is life like for them as young adults or as adults?: well, a lifetime of high stress and anxiety while navigating a complex maneuvering through not just decisions, but for them a minefield of decisions with loaded consequences; and PTSD makes for a heightened sensitivity to even minor stressors, of life’s little decisions (like paying the bills, sick child, getting homework done on time, car trouble, should I be hanging out with this person) with an impaired computer. Child abuse impacts not only the frontal cortex, but most of the limbic system, including the amygdala, hypothalamus, and the hippocampus. Now include genetics, social, economic, environmental, and cultural factors in a child’s development. Wait. We should think about this, right? Oh, and then add the societal implications, e.g.costs of treatment, physical health, medical…
Whoa. Childhood matters.
(More in Part 3.) The ACE study. Adverse Childhood Experiences