Childhood Abuse and Mental Illness Part II
(Column: Ask the Doctor)
Exploring the two concepts
Stephen M. Goldfinger, M.D. & Ellen Tabor, MD
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Question from Last Issue: Is there a relationship between childhood abuse and mental illness?Ē
After 9/11, most New Yorkers felt some degree of sadness, anger, anxiety, sleep disturbance and so on. But many of us also felt paranoid, at least for a little while. I know that when I heard planes fly overhead, for a long time after 9/11, I would look up anxiously, fearing another terrorist bombing. This is an example of someone without an underlying illness (so far!) having a symptom brought on by stress. There are numerous situations like this, which I think people can relate to. Another very common situation that can provoke a loss of reality testing is when one goes to a social event where one doesnít know anyone there. When you walk in, donít you feel like everyoneís looking at you? And donít you realize pretty quickly that they are not, but it was you who felt self-conscious? This is another example of people developing symptoms under stress.
Child abuse is one of the worst kinds of stress. Children are more vulnerable than adults, they donít have good coping skills, they rely on adults to help them get out of trouble, problem solve, etc. So when they are hurt, they feel helpless more than adults. And helplessness is one of the two very worst emotions (the other being Hopelessness). A person has to have been feeling helpless for quite a while before he or she decides that the situation is hopeless, but the two do go together. We always ask patients whether they feel helpless or hopeless because if they do, they are at a higher risk of suicide. So psychiatrists and other mental health professionals do worry about situations that induce feelings of helplessness and hopelessness, because those could in turn be part of depression and lead to suicidal behavior.
Fortunately, there are therapies that can really help. Cognitive-behavioral therapy in particular is very useful in helping people to master their emotions. Whereas medications do control many overt symptoms, like hallucinations, some delusions, depression, mania and anxiety, therapy still plays a crucial role in helping people learn to cope in healthy ways with not only their symptoms but their lives in general. For example, people with a history of abuse often have trouble trusting others, often feel rejected easily, often have trouble managing their emotions, and psychotherapy can teach them what they need to know and to practice their new skills in a safe environment. In addition, people who have been abused often find it difficult to work through that experience, but dwell on it without making progress in understanding it; so that their past governs their present lives and prevents them from growing as mature adults.
Childhood abuse is all too common. Although the research does not consistently show that abuse causes mental illness, it seems intuitively obvious that people who have suffered might develop problems later on. Yet this is not always the case; the mental health of Nazi concentration camp survivors, is surprisingly good, with relatively low rates of post-traumatic stress disorders. Also, in a brand-new book called the Birthday Party, the author Stanley Alpert, who had been kidnapped at gunpoint, threatened that he and his father would be tortured and killed and was ultimately released, safe, describes what he believes was helpful in him not developing PTSD or other psychiatric problems afterwards. Mr. Alpert notes that he was never alone after the kidnapping, that his friends stayed with him, that he was believed by the police and that he got justice from the criminal justice system all contributed to restoring his sense of hope and personal power.
This is an important lesson for survivors of abuse. It is crucial to be believed, to feel vindicated and to be supported. This is what the mental health system strives to do. Symptoms may develop after abuse, but the proper support and treatment will minimize them and improve the victimís mental health.
Dr Tabor is a community psychiatrist with special interests in schizophrenia. Dr. Tabor is the Medical Director of Adult Inpatient Behavioral Health at Kings County Medical Center and Assistant Professor of Psychiatry and Behavioral Sciences at Downstate Medical School.
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