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?

Useful embarrassment (part 2)

What makes me feel embarrassed and how it can have productive outcomes was the topic of an earlier post already, so let’s dive in for part 2 of useful embarrassment in 2017:

PhD students in Australia ‘confirm’ their research proposal with a presentation at the end of their first year. Kati Marinkovic held her confirmation at the University of Melbourne this October, and I had the pleasure (while the embarrassment hadn’t hit) to read her fine report and attend her fantastic presentation.

Her project is titled “Is there a space for Participatory Action Research with Children in Disaster Risk Reduction Programs?”

Kati finds out whether and how children can be co-designers and co-researchers of disaster risk reduction programs. She collects data in both Chile and Australia, and has an impressive plan to set up a panel of co-researchers: children who live in disaster-prone environments.*

She aligns her work with a human rights perspective: children have the right to participate in decisions about their life. She cites Green (2015), saying that

“although many researchers advocate for children’s rights, many fail to involve them during the whole research process.”

And that’s where my stomach signaled a problem…embarrassment. Continue reading

Children bereaved by domestic violence need our support

“I was angry at everything. Angry that my mother was dead, I was sad as well. I was angry that my dad was in prison, I wanted to see him but that wasn’t allowed. That made me angry.”

This is a quote by a young Dutch girl whose father killed her mother. More than a third of female homicides worldwide are perpetrated by an intimate partner. Many of these women are parents. Since I’m back in Australia, I’ve tried to look into the local figures: in total, probably over 1,000 Australian children have been bereaved by fatal domestic violence in the past 20 years.

It is an understatement to say that losing a parent at the hands of the other parent has a major and lasting impact. It turns children’s worlds entirely upside down: at once they lose both parents – one to murder and one to prison or suicide – as well as their home and school environment.

Professionals have to make fundamental decisions for children after a domestic homicide. Where should the children live? Can it be with the family of the victim, or with the family of the perpetrator, or should it be a ‘neutral’ family? Should they have contact with the perpetrating parent? What kind of mental health support do the children and their caregivers need? Continue reading

What children who live with domestic violence say about their dads

“My ‘relationship’ with my Dad? I don’t have one….I feel like I am a pebble at the bottom of a stream and my Dad is this angry stream bashing me against all the other pebbles.”

This is one of the quotes that Stephanie Holt from Trinity College Dublin showed us this week. She presented an overview of her research with children in Ireland.

Domestic violence is a key marker for child abuse and neglect. Stephanie talked about the combination of fathers’ emotional absence on the one hand, and physically abusive presence on the other. She particularly focused on the context of ‘coercive control’, which limits someone’s freedom of movement and expression.

Being different, feeling powerless, and being scared were core themes for the children:

“I felt that I had a neon sign that told everyone what was going on in my family… I felt I wasn’t on the same wavelength as people…I thought that they were all happy families or whatever and I was kind of like the outcast”

“He shouts and curses and calls my Mum really, really mean names. I would say ‘stop Dad’, but he doesn’t listen.”

Stephanie showed that even very young children were able to convey experiences with domestic violence.

The children also talked about the pervasiveness of domestic violence. It was with them Continue reading