Summaries:
UNDERSTANDING THE EFFECTS OF TRAUMA ON CHILDREN

The four presentations at this Public Forum addressed such basic questions:

• How can mental health workers best help children exposed to trauma?
  
• What do people working in the juvenile justice system need to be aware of regarding children whose environment exposes them to repeated traumas?

The American Psychoanalytic Association is aware that the present Public Forum does not address the traumatic effect of a culture that needs to devalue, and scapegoat the poor and certain other groups. This important issue has not been overlooked and the APsaA will be addressing this topic in a future Public Forum.

For now, synopses of the papers presented at the Public Forum are presented below. For those who would like a more comprehenasive report of the papers please got to the Full-Reports section.

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Paper #1

Dr. Carl Bell has been studying children exposed to violence since 1976. He conducted a study in 1989 of 1000 children, in an area where guns and violence were prevalent. Dr. Bell found that 40% of the children had seen a shooting or stabbing, and 23% had witnessed a murder. The prevalence of violence was equal in poor white, Hispanic and black areas when controlled for socioeconomic class, with poor areas having a higher prevalence of violence than middle and upper class areas.  Dr. Bell looked for signs of post-traumatic stress disorder in the children. He found that the children manifested with either anxiety disorders, or behavioral disorders. More specifically, he found that exposure to ACUTE TRAUMA more often led to the development of anxiety and hysteric symptoms, whereas exposure to CHRONIC REPEATED TRAUMA more often led to behavioral/academic problems. Those children exposed to acute stress were also found to be more likely to go on to develop substance abuse problems. For instance, Dr. Bell cited a study of female cocaine addicts which showed that 80% of them had a past history of having been raped once or more. Dr. Bell stated he is dismayed that the recourse for an addict today is incarceration and not treatment of the addiction and the effects of traumatic experiences that were precursors to the addiction.

A gender difference was also noted. The girls developed more anxiety symptoms, whereas the traumatized boys tended to develop behavioral , acting out problems. Yet, Dr. Bell noted, these boys are often characterized as having "conduct disorders", and are relegated to the criminal justice system, instead of the mental health system. The impact of stress on children varies greatly. If they get mental health help early, within the first 48 hours, the outcome is better. It is important to identify the traumatized children early, within 48 hours. Dr. Bell observed that " poor children get disenfranchised for some reason," and don't get the mental health care they need. 

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Paper #2

Dr. Johnson-Powell gave personal vignettes of growing up in a segregated Boston, and trying to find her identity at Boston Latin school, were she, as an African &endash;American, was "invisible" to her white classmates. She stated, " I retreated to a closet and buried myself in the books to avoid the pangs of rejection that came with not being invited to after school events. I learned to live in two worlds, fortunately or unfortunately. I became a hybrid person- the hybridization that occurs for kids trying to develop in a culture where ' white is right, brown can stay around, and if you're black, step back'. Dr. Johnson-Powell also told of experiencing trauma from within her family. Her aunt noticed her "bookish ways" and in a classic case of "identification with the aggressor", repeated the view of the dominant culture ,where "black" is "bad" and "white" is "good", and called Dr. Powell 'my little white girl.' Dr. Powell's confusion in her new nickname was compounded by the fact she considers herself to be very dark skinned. The trauma didn't end there. Dr. Powell's siblings, who were all talented in their own right, envied the attention she got from the aunt, and ostracized and tormented her. Eventually, her mother banned the nickname. Dr. Johnson-Powell stressed the need to understand the context of an individual's background, in order to best be able to help her.

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Paper #3

Mr. Kurtz has been an analyst at the Harlem Family Institute since 1985. Prior to that , he worked at a clinic in the South Bronx. Mr. Kurtz summed up his experience at the South Bronx clinic, stating, "the spirit and the culture of the clinic was oppressive. But the patients were something else. I was horrified when patients were presented in Grand Rounds as diagnostic exhibitions. These were extraordinary people to me, who I worked with productively. It taught me what lies hidden in inner city communities, - hidden, that is, to those who never venture there. (I found) imagination, intelligence, wisdom, warmth, and great gifts, all prevented from thriving by the weight of concrete spiritual suffering." At the Harlem Family Institute, Mr. Kurtz observed that, "after a lifetime of demeaning social services, the parents were often too tired (to engage), but the kids were eager to spend time with me. They thrived on the focused care and attention like kids of every social strata. In analysis, an intimacy is established which reduces the weight of social constructs and creates a matrix for a new sense of worth.

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Paper #4

Dr. Marans is a psychoanalyst who works with the New Haven police department, treating children exposed to violence. Dr. Marans said that "children's exposure to violence may precipitate a host of responses that reflect the powerful convergence of internal and external dangers that derive from the past and present. With this unanticipated convergence, children's lives are affected by the experience that things which should reside only in the depths of the most primitive fantasy are no longer confined to fantasy. For too many kids in this country, the violent horrors that belong to the world of the child's most primitive fears and terrors are materialized in real life experiences on a regular basis, so as a result, the basic feelings of security that are necessary for a child's sense of mastery are undermined.  These experiences may offer a window of opportunity in which a range of psychoanalytically informed interventions can:

1. untangle and identify various sources of danger
2. bring the danger under greater ego control
3. help kids return to the optimal path for development.

Whether working with traumatized kids or adults, we can help patients make conscious the convergence between the external and internal dangers, and the defenses that give rise to the debilitating defenses, so optimal capacity for mastery and control can be resumed.