They’ll Never Be the Same

There is a new book about children and Posttraumatic Stress Disorder (PTSD), specifically written for parents. The author, the psychiatrist Michael Scheeringa, has an incredible amount of experience in treatment and research with children and young people in the USA.

I got to read a copy of “They’ll Never Be the Same: A Parent’s Guide to PTSD in Youth” provided by the publisher.

While it may not be what one would call a ‘modest’ book, it’s certainly informative. Scheeringa gives parents a helpful overview of what is known about traumatic stress among children in America, how to go about finding and choosing a therapist and what to expect from therapy. Many parents reading it will feel that Scheeringa is on their side. For clinicians and researchers it may be different, but then again they are not the intended audience.

Scheeringa shares multiple interesting insights. One that struck me was about barriers to mental health care. Only a small percentage of children who experience traumatic stress start and complete mental health treatment. What are the barriers for them and their parents? Several factors may be at play:

  • Stigma – seeking treatment is like admitting failure
  • Stoicism / Altruism – thinking that other people are more deserving of limited treatment resources
  • Privacy – talking about trauma seems more painful than having PTSD symptoms
  • Marshmallow children – adults expecting they will bounce back naturally without treatment
  • No clear ‘front door’ to care – it’s hard to find treatment even if you want to

The author’s view is that these factors can’t be the full explanation. He suspects people don’t want mental health care. Mental health is not a sufficiently attractive goal:

“Stigma, stoicism, privacy, marshmallow children, and problems of access with the lack of a ‘front door’ are all good guesses, but they do not quite add up in my mind. All of those guesses seem to have an underlying assumption that people want mental health. Through many of my interactions with patients and potential patients, over the years, I have wondered if that assumption is just plain wrong. What if people are not that interested in mental health?”

“If people truly are not too interested in better mental health, then it will never matter how much we reduce stigma or make access easier. There may be a fundamental issue that the process of asking for help is worse than the problem of living with psychiatric problems. …. (It) seems that many, if not most, trauma victims just don’t want the services bad enough to put up with our business model, or they just don’t want the services at all. Maybe we are trying to engage people the wrong way.”

Is he correct? What do you think?

2 thoughts on “They’ll Never Be the Same

  1. As a 50 year old survivor of childhood trauma of a few kinds:
    taken from mom, given to an abusive grandparent, involved in serious vehicle accident resulting in 2 month hospital stay and untreated head injury, followed by dysfunctional family dynamics, then foster homes, dropping out of high school, joining the military, then becoming a Paramedic

    My understanding of PTSD in kids is entirely retrospective. I’m just now uncovering serious triggers because of children in my home acting normally. I have to manage these reactions while deciphering what that energy came from.

    I was left alone to manage everything I was going through emotionally, and it became easier to go to a new place rather than face the experiences involved with having a ‘normal’ life. Mental health amounted to whether or not I was able to get out of bed every day. It wasn’t always easy because I didn’t sleep much, ever.

    I didn’t have ‘bad’ days, and still don’t because no matter what, I get up and keep on going. Eventually one realizes that slogging through mud isn’t working and the fatigue makes ‘working it all out’ much more appealing. In the meantime however, I’ve barely obtained a sense of self and feelings of worth. I’m always the first to be sacrificed and I chide myself for asking the universe for help or relief because everyone else has it much harder.

    The impetus for not obtaining adequate PTSD for children I’d guess is adult denial of the impact these things have on children. I do blame every adult in my environment, including doctor, other family, teachers, social workers, all who should have known better. I needed help and nobody could have missed it. I was shown that I wasn’t important – I internalized it and have had a long journey out of that pit. I feel that every adult who knew wanted to avoid the unpleasant experience of addressing the truth.

    Without a strong support network, without love in the household, the child PTSD sufferer becomes hardened and will intentionally avoid reliving the event. If left untreated (meaning if the child sufferer is ignored) then resentment easily rises that nobody noticed. This can lead to a host of issues involving social avoidance and undermining one’s own success. Another deep slippery pit that’s very hard to permanently leave.

    The sensations I went through still come back in dreams when I go to bed too early.

    I’ve needed to have a relief valve, a way to make sense of my life, for some time but don’t have the resources to obtain it. I spent many many years afraid to begin the opening process because I didn’t want to become debilitated.

    • Dear OG,
      Thanks you so much for sharing your story, I’m sorry to read about the lack of support you had. It happens frequently that adults do not properly see or act on children’s needs, and it has long-term consequences for everyone. It’s one of the issues that my colleagues and I try to work on; how to support children in ‘disclosing’ in a safe way (and adults to be aware), that leads to actual help. The way you describe your story and how you’ve coped is very impressive, and this short response cannot do that justice. I hope that the fact that your words are here on this blog will get others to read and reflect on them. Take care.

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