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Confronting Taboo and Stigma

July 8, 2010

The world of behavioral health is mysterious to those of us who are not trained in it’s many permutations. That became very clear to me as I read Mary Sykes Wylie’s article “The Long Shadow of Trauma.” (Psychotherapy Networker, March/April 2010, pp. 20-54) As she describes the battle to have Developmental Trauma Disorder (DTD) recognized in DSM V, it becomes clear that politics helps to define the debate. Therapists working in the trenches with traumatized children and adults who were traumatized as children are convinced of the  merits of a multi symptom diagnosis linked to traumatizing events as children. Researchers and academics like the simplicity of single symptom diagnoses that are more easily studied and differentiated from a multi symptom diagnosis.

In the meantime, the Report of the “Surgeon General’s Conference on Children’s Mental Health: Developing a National Action Agenda” (September 2000) presented a number of goals making access to mental healthcare screening and services a high priority. The DTD symptomology had been recognized as present in clients soon after Post Traumatic Stress Disorder had been accepted in DSM III in the 1980’s. We are now in 2010, or 30 years later, with few of the goals set in the National Action Agenda having been achieved. In the world I live in, DTD is rampant (yes, although not a therapist, I am of the same mind as those who recognize the merits of a DTD diagnosis).  And there are scant services available today. Why is this?

Well, I believe one reasonable explanation involves the “Taboo” cover for those who have perpetrated this trauma on our children, and the “Stigma” labels attached to acknowledging a need for mental health service. It appears to me that most of us do not believe that the types of actions that lead to DTD by parents or loved ones can actually happen. Can a father or mother really sexually abuse their own children? Do they severely abuse their own children physically or emotionally? And as found in the results of the Adverse Childhood Experience Study (ACES), there are other traumatizing events that are not necessarily intentional, such as depression experienced by a family member, absence of a biological parent, incarceration of a family member, or a substance abusing family member. As the ACES points out, many of the traumatizing events cluster in families, with outcomes for children in these clustered families being more severe than in others.

As an Adult Child of an Alcoholic, I am very aware of our hiding behaviors. We want to look normal to the rest of the world. This is reinforced in the home. When my mother appeared in public with bruises or a black eye, she wore cover-up makeup and dark sunglasses. Dark sunglasses indoors is a dead giveaway to hiding behaviors in my mind. But we do it because we don’t want others to stigmatize us as a troubled family. And as for the Taboo part, the perpetrator goes to great lengths to hide the traumatizing acts. In fact, the victim apparently goes to great similar lengths to do the same thing. As I read about the development of Dissociative Identity Disorder, I learned that DID actually allows us to avoid having to confront the Taboo. We dissociate from the bad acts being done to us in order to protect our fragile self. DID is apparently difficult to diagnose, in that it and may affect as much as 10% of the North American population, although 2-3% is cited by numerous other studies. (http://www.isst-d.org/education/faq-dissociation.htm).

Borderline Personality Disorder, Post Traumatic Stress Disorder and Bipolar Disorder all share common symptoms with DID and are likely to have linkages to childhood inflicted trauma. They also likely form defensive mechanisms that help us bury the trauma we experience early in our lives, although at a great price.

Despite this prevalence among our population, few of us want to be linked to mental disorders, despite our likelihood of having one. Nor do we want to implicate our parents in perpetrating trauma in our early lives. Confronting these attitudes will be one of the most difficult tasks we encounter as we begin our Restoration to Health journey. In order for us to get the services we need (beyond finding the actual service due to its limited supply), we will need to overcome the taboo of blaming the adults in our life, and the stigma associated with having a mental disorder.

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