(The current article deals with child abuse and mental health. Other articles are found in the column on the right and are arranged by date of posting.)
Panic and panic’s mates under a magnifying glass. - The impact of child
abuse on mental health.
“…since I’m the
mommy’s dark child, quailed at birth, I see horrors everywhere, most in human
life.” (Eino Leino: Tumma) (Translation by the author of this article)
“Wainamoinen,
ancient minstrel,
As he hears the joyful tidings,
Learns the death of fell Kullervo,
Speaks these words of ancient wisdom:
“O, ye many unborn nations,
Never evil nurse your children,
Never give them out to strangers,
Never trust them to the foolish!
If the child is not well nurtured,
Is not rocked and led uprightly,
Though he grow to years of manhood,
Bear a strong and shapely body,
He will never know discretion,
Never eat. the bread of honor,
Never drink the cup of wisdom.”” (Kalevala. Rune 36). http://www.gutenberg.org/files/5186/5186-h/5186-h.htm
I first describe
the experience of assault and corporal punishment from a child’s viewpoint, as
well as the subjective experience during a panic attack. Next, I address the
elucidation of the connection between traumatic experiences and subsequent
mental problems in analytical psychotherapy, particularly with respect to
rejected memories. I also deal theoretically with the cause-and-effect
relationship. I turn to epidemiological findings about the link between
adverse childhood experiences and mental health problems (such as panic
disorder, anxiety, and obsessive-compulsive disorder). In the following sections,
I direct my attention to neural correlations of anxiety, fear, and panic, as
well as the psychosocial effects of adverse childhood experiences. Finally, I emphasize the acceptance of value-free notions and practices based only on
researched knowledge, both at the theoretical level and in the encounter of the
wounded person.
Horror or panic is not
just a technical term but precisely the truest truth, a subjective basic
essence that fills all consciousness and seems to be an unescaped state. It is
a threat of immeasurable, infinite pain and suffering. It is the certainty of
the end of one’s life without the comfort of the end of torment. Only death seems to relieve the suffering. On the other hand, the experiencer who has adopted the notions of certain learning systems is not able to comfort with the idea that death could free him from suffering. The
possibility of analysis has been ruled out in a panic attack. The thought
hangs, the memory doesn’t work, the muscles paralyze. Reality seems to change,
his own self-control weakens, and he is overwhelmed by the fear that control
goes completely and the fear of the shame that others will notice his paralyzed
state.
Child discipline in
the form of physical violence is not just an educational or legal act of the
father or mother. From the child’s point of view, he is completely helpless to
fight or escape punches, pain and agony. The punches inevitably just come to
whistle and incise his skin. The person he has unconditionally trusted deceives
him, causing pain and agony of fear. The child does not have the capacity for
any kind of analysis. It is not enough that in some cases he would identify a
well-deserved cause of violence. The state of experience is holistic,
completely incomprehensible and inevitable. Whistling pains and harsh grips
come and cannot be avoided. There is nothing but pain, rejection and helpless
loneliness.
The panic attack and
the child’s physical disciplinary event are strikingly similar for the
experiencer. Just as a child does not have the cognitive ability to break down
an event, so in an adult panic attack, the possibility of intellectual analysis
is ruled out. In practice, the memory of the connection between an individual’s
panic attack and childhood assault is often erased. Panic lives its own life in
its own bubble. A conscious or unconscious, external or internal factor
triggers a scene. And the interval between scenes is anxiety.
Does childhood assault
cause panic disorder?
The correspondence
between two cases may be due to a causal relationship so that A causes B or B
causes A in one direction or the causal relationship goes in two directions,
i.e. A causes B and B causes A, which leads to a continuous interaction, one
form of which is the circulus vitiosus, or vicious circle. As the value of A
increases, the value of B may increase (positive correlation) or decrease
(negative correlation). The effect of A on B may be mediated through additional
factor C and, correspondingly, the effect of B on A may be mediated through
additional factor D. Although we have an inherent tendency to search for
phenomena cause-effect relationships and often stubbornly hold on to the first that
leaped to our mind or adopted and accepted by our reference group, equivalences
can be, and often are, completely random or the cause-effect relationship goes
to reverse direction. These theoretical aspects should be kept in mind when
dealing with our subject.
Psychoanalysis has
focused on digging into childhood events and creating or finding logically
possible connections between childhood events and the mental problems at the
time of analysis. Disclosures of the investigation are considered prerequisites
for getting rid of problems or at least alleviating the problems. Alice Miller’s,
a psychoanalytic practitioner, who later denied the correctness of psychoanalytical
theories such as collective unconscious, Oedipus complex, the fear of castration
and archetypes, remarks and insights into
the importance of children’s abuse on their later development are worthy of
nota. The theories of psychoanalysts, she said, cover tightly and impenetrably
the real traumatic experiences of childhood. If one starts from theories to
explain childhood events, the patient easily accepts the theories and creates
in his mind events events, which have not actually existed. Based on the
researched knowledge, we know the fragility and formability of memory. The
formation of false memories is a known danger in dealing with past events.
According to Miller,
the body retains a memory of the horrors of childhood, but this memory does not
rise into clear consciousness but manifests itself as mental problems. The task
of therapy is to restore a conscious memory connection. Any theory may feel dry
and pale, it just refers to reality. Reality is the strongest and most
essential of our own selves, our very existence. If, despite our repression and
fallacious explanations, we succeed in reviving the memory of horror, and yet
our personality would endure without breaking,
we have the opportunity to at least alleviate our malaise. According to
Miller, the humiliated, despised, and underestimated fragile human saplings drift
into internalized self-contempt, inhibition of emotional expressions, introversion,
loneliness, depression, compulsion to repeat, fear of punishment, fear of one's own conscience, fear of one's own
soul movements, which they consider as forbidden and criminal. The abused tend
to continue the beating by making their fellow human beings suffer from the
blows they received themselves, with Adolf Hitler and Nicolae Ceaușescu as top
examples. It is well understood that those who realize the need to stop the
transfer of suffering feel aversion to violent entertainment, entertaining murder
programs, or programs whose main theme is malice or perversion.
In my opinion, the
most important thing in Miller’s observations is that an organic change, a
memory trace, remains in our nervous system. Physical violence, pain, horror,
hopelessness, loss of trust in the caregiver, contempt, disregard, blame, and
the like leave traces of memory that cannot but affect later development. Our
consciousness reaches only a vanishingly small part of the function of our
nervous system. In reality, the manifestation of consciousness requires
extensive cooperation between different parts of the brain in a time window of
a few seconds. Miller seeks to approach experientially subconscious nerve
functions.
The child-parent
relationship is an entity in which the child's behavior also affects the
parent. A restless, easily irritated, poorly cooperative child is likely to
induce stronger and rougher control activities in the parent, which can lead to
physical and mental trauma. In this case, the original source of trauma is more
inclined to the child himself. Even then, the parent's actions do not in any
way remove responsibility from the parent. The adult is obliged to choose the
most subtle means of control possible. The adult is morally and legally
responsible.
What does epidemiology
say about the link between child abuse and psychiatric illness, especially
panic?
Publications on the
link between certain harmful childhood experiences (such as physical or sexual
violence) and mental health problems are gloomy to read. Adverse childhood
experiences (ACE) can be diverse, occur over a limited period of time or
throughout childhood, and vary in quality and intensity. The combined effect of
several such factors can be more than the sum of its parts, and traumatic
experiences can be offset by positive experiences. ACEs are multidimensional.
The ACE categories used in different studies often overlap and the same
experience may include the characteristics of another experience category. Corporal
punishment and sexual abuse predisposed to subsequent panic attacks and panic
disorder in a New Zealand longitudinal study (Goodwin RG, et al, 2005). In
obsessive-compulsive disorder (OCD), symptom severity and depression correlate
with childhood abuse (Ou W, et al. 2021). The intensity of perceived childhood
abuse was associated with the severity of OCD symptoms (Boger S, et al. 2020).
The connection was particularly strong for emotional assault. Symptoms of OCD
in the battered were more severe than in the unbattered before treatment, after
treatment, and at follow-up. Childhood physical assault is associated with lung
disease, smoking, anxiety disorders, and depression even after consideration of
many confusing demographic factors (Goodwin RD, et al. 2012). Physical and
emotional abuse and neglect have causal links to depression, medication use,
suicide attempts, venereal diseases, and risky sexual behavior (Norman RE, et
al 2012). Recently (Sahle BW, et al. 2021), an extensive review article
(meta-meta-analysis) on the association of adverse childhood experiences (24
different ACEs) with general mental disorders and suicidal susceptibility has
been published. An association was found with anxiety disorders,
internalization disorders, depression, and suicidal tendency.
Understandably, epidemiological
studies of the link between ACE and mental disorders are associated with a lack
of adherence to golden scientific methods, in particular due to data collection
(availability) but also often because of the retrospective study settings.
Despite these shortcomings, the connections appear to be quite clear and
consistent. However, epidemiological studies have been able to elucidate rather
general adverse factors in the time continuum of childhood and the mental
states experienced. Likewise, it remains unclear how the nervous system
implements the consequences of the causes under consideration. In real life,
there are so many variables in the time continuum that each person definitely has
his own life journey and story.
What happens at the
nervous level in anxiety, fear and panic?
To understand anxiety,
fear, and panic at the level of the brain and body, we must have a theoretical
framework in which research, findings, results, and conclusions are placed. It
is evolutionarily justified to divide the functions of an organism into desire
and defense behavior. Simple organisms tend to approach life-sustaining objects
and withdraw from harmful objects. In mammals, desire and defense behavior is
diverse and is largely related to similar brain structures in different
species. Sharpening observation, directing attention, and preparing for action
are useful in both desire and defensive behavioral contexts and are independent
of animal or human approach or withdrawal directions (Lang PJ, et al. 2013).
The topic of our article concerns the defense system, for which Perusini and
Fanselow present (2015) a predatory imminence theory that combines anxiety,
fear, and panic into the same continuum in terms of both prior states and
response choices. The theory is supported by quite extensive research data on
animals and humans.
I will briefly present
the predatory imminence theory. More comprehensive and / or more in-depth
scientific articles can be easily and abundantly found on the Internet (e.g.
Tovote P, et al. 2015,
https://www.frontiersin.org/research-topics/8045/pre-clinical-models-of-ptsd#
articles). The first part of defensive behavior is to study the environment for
potential hazards before the actual hazard, i.e. the predator, is encountered.
At this stage bed nucleus of stria terminalis (BNST), lateral septum, ventral
tegmental area, and basolateral amygdale is activated. In anxiety disorders,
activation and risk assessments of brain regions at this stage are
overemphasized. The second stage starts when the predator is encountered. In
this case, the medial prefrontal cortex-amygdala-periaquaductal gray (PAG)
neural network is activated as a result of perceived external factors or
imagined hazards. The usual behavior associated with the situation is freezing.
Fear describes the second stage. When a beast attacks or the situation has
otherwise become terribly inevitable, a third stage ensues. The subject escapes
or attacks. The neural response is the inhibition of the frontal control of the
brain and the activation of midbrain areas such as dorsolateral PAG. The
subjective manifestation of this stage is panic.
One essential
neuroscientific sub-area for our topic is the mechanisms of imprinting on one’s
memory and how many repetitions are needed to achieve a long lasting memory. It
appears that a memory trace at the synapse level (nerve cell junction) can be
achieved with a burst of nerve activation for a few seconds (Villers A, et al.
2012). Memorizing can occur not only by synaptic plasticity but also in
synapse-independent intracellular mechanisms. The memory transmission between
cells can occur by ncRNA (non-coding RNA). Also the epigenetic DNA methylation may
be involved (Abraham WC, et al. 2019).
Brain key areas for
anxiety, fear, and panic include the amygdala, some parts of the brainstem, the
front of the brain, the hippocampus, the cerebral islet, and the BNST. Learning
and quenching fear partly use different neural networks (Tovote P et al 2015). Current
studies make it possible to examine the connections within the cerebral region
(subunits of the nuclei) and subregions of different regions of the brain
(subunits of the nuclei) with the accuracy of individual nerves at the level of
both electrical potentials and molecules. No single area or neuron or class of
neurons is responsible for experiencing anxiety, fear, or panic. There is a
need for collaboration between many regions, different nerve classes, glial
cells, neurotransmitters, and hormones. The shaping factors are e.g. previous
experiences and selection of recall. Traumatization contributes to many diagnostic
disorders of defensive behavior (OCD, PTSD, panic disorder, and generalized
anxiety disorder).
The impact of
traumatic experiences on the psychosocial level
Human-induced
traumatic events, in particular, predispose to traumatic stress disorder
(PTSD). The effect is even more profound when the abuser is his or her own
parent. In this case, the source of safety is also a source of danger, creating
confusion and disorder in the child’s mind. A traumatizing parent makes it
difficult for the child to develop emotional regulation and the ability to use
the help of others in times of need. The child's ability to interact
effectively in a social network is impaired. They show rigid and situationally
inappropriate emotional expressions, impaired emotional self-esteem, difficulty
in adjusting excitement in emotionally arousing situations, and difficulty
recovering from shock or suffering. Such children tend to isolate themselves or
withdraw in situations of conflict and are less likely to engage in social
interactions with adults and peers. They hardly expect help in difficult
situations and are inclined to judge the ambiguous or even helpful efforts of
others as hostile. Their ability to join and benefit from social networks has
declined. These statements are not assumptions based on arm chair musing but on
scientific studies and I borrowed them from the review-article (2008) of Charuvastran
and Cloitre "Social Bonds and Posttraumatic Stress Disorder".
Child abuse is not
limited to physical violence but can also include blaming, belittling, instilling
shame, and turning a blind eye. All this, or even small parts of these, cannot
be without leaving traces on dignity and self-esteem. To keep things not too
simple, hardly any child would not also receive safety, protection,
encouragement and other positive input from their parents. Traumas,
consolations, and emotionally less charged events are so diverse during
childhood that everyone develops her or his very own story and coping strategy,
plus their own neural network with synapses, molecular models, epigenetic
transformations, and brainwave patterns. One must also remember that a child is
not just a “reflex machine” that can be adjusted from the outside, but the
brain of each individual functions spontaneously, combining sensory information
with these spontaneous brain functions, resulting in finding meaning from
environmental events.
Observations on
dualism-based conceptions of horror and its causes
So far, I have dealt
with mental health consequences of child maltreatment according to modern,
scientific, monist model. By the monistic model, I mean that measurable
physical and experiential states are two different sides of the same thing when
an individual operates in her or his environment, and that causes and
consequences can be calculated using variables belonging to these domains. As
for the pluralistic Theosophical model, it states that our conscious states
exist independently of our physical body and are manifested through subtle
bodies. The exact mechanism of cooperation between the various bodies is not
known to the signatory. According to the doctrine, the laws of karma and
rebirth prevail in our lives. They teach that the evil deeds of past lives are
rewarded in subsequent lives with suffering and the good with positive
consequences. Thus, in the simplest, slimmed down form, the following applies:
If in this life I get beaten by my parent, I have in my previous life panned
her or him concretely or done something similar to horror her or him. The
conclusion was clear: I'm responsible for my hiding. In childhood, the battered
suffer from a variety of ailments in childhood and later in life such as
anxiety, fear, panic, obsessions, compulsions, tic symptoms, depression,
worthlessness, loneliness, etc. They have internalized reproaches and blame themselves
for inferiority dealing with whatever thing at any time. They are suicidal. If,
in addition to all their misery, they themselves believe that they have caused,
by their own previous cruelty, their present spanking with the psychic
consequences, it may be the last stalk on the donkey’s back in treir endurance,
or at least a pain-increasing burden. To better understand this, let’s take a
concrete example. The young man has not received a study permit or a job. The
object of his love has rejected him for another. Lonely and anxious, he finds
no resources to get out of his predicament or to direct his life. Whenever a
panic and a sense of altered reality is alleviated, he is overwhelmed by
self-blame for not being able to get out of his panic attacks. On top of all
that, he is overwhelmed by the preoccupation that is not based on researched
knowledge, harmful to him, that he is guilty for his own fits because of the
beating of his own child. I think it is thoughtless, adventurous and
reprehensible to increase the suffering of these wounded tortured and drive
them into possible suicide. In this regard, the interpretation of the law of
karma must be wrong and requires re-evaluation. The mere sympathy and humanity for
the victims requires that this cannot be right. The law of empathy is paramount
and anything that wars against it is wrong. If we have enough psychic resourses,
we can react coldly to our adversities (including those we classify as
self-inflicted as we meant in this context) and suffer and act hopefully in the
way we deem ethically right. What concerns more detailed scrutinizing and
assessment of the basis and mechanisms of the laws of karma and rebirth are
beyond the scope of this article.
Within Christianity
and Rosicrucianism, it is considered that the object of unjust treatment should
forgive the assaulter. According to Miller, a traumatic act should not be
forgiven. Demanding forgiveness prevents the psychological treatment of abuse
and liberation from experience. I understand that Miller means by forgiveness acceptance.
Therefore, the beating is not acceptable and must be condemned. I assume that
this interpretation is easily accepted. The other side of forgiveness is the
conscious statement of a fact and the decision to let it be, and not
emotionally (and legally) seek redress afterwards. In this case, the emotional
bond with the matter is broken and the victim of injustice can continue his
life and actions liberated. However, this is not the end of all dimensions.
There are indelible structural and functional traces left in the brain that have
inevitably effects on thoughts, feelings, and behavior. They bias unconsciously
and the consciousness does not reach them, although they can be influenced
deliberately to some extent. Panic and its mates horror, anxiety, fear,
compulsions, and compulsive thoughts pop out anytime anywhere. In this sense,
the will and decision of forgiveness are no longer in our power. According to
the laws of rebirth and karma, it can be explained that the new incarnations
overcome the above obstacles. This can be argued. However, scientific evidence
is needed to support this claim.
Conclusion remarks
Corporal punishment of
children is prohibited by law in Western democracies and has decreased in
recent decades (Pinter S. 2012). Attitudes towards violence have also
sharpened. During at least a couple of generations, the proverb “he who saves
the birch, he hates his child” has already traumatized enough. The effects of
children’s traumatic experiences on brain structure (Brooks SJ, et al. 2015) and
function have been undeniably demonstrated, as have subjective suffering and
negative effects on social behavior. Therapy is not covered in this article,
but I want to mention some general principles.
A person who is
shocked must be approached with respect, sympathy, empathy and
matter-of-factness. One should be careful not to increase his burden and
understand his impaired ability to deal flexibly with his condition. His
ability to change his mental attitude, to supplement his knowledge and to keep
it in working memory, and to proactively restrain automatic responses has been
impaired. With respect to these states of mental resilience, he has declined,
at least in most acute stages. It is imperative to avoid etiological assumptions,
claims, and allusive or unspoken allusions provided by different isms and
doctrines if they are not based on researched knowledge. These claims can be
decisively destructive to him. An open and confidential relationship is needed,
a lack of which he has certainly suffered from. In addition to these general
conditions, the helper is required to have a wide range of knowledge and
experience. If these conditions are not met, in the mildest case, the helpless
will be left without help and, in the worst case, the person to be helped will
find oneself in an increasingly confusing state and in risk of irreparable
damage.
References
Abraham WC,
Jones OD and Glanzman DL. Is plasticity of synapses the mechanism of long-term memory
storage?. npj Sci. Learn. 4, 9 (2019).
https://doi.org/10.1038/s41539-019-0048-y.
Boger S,
Ehring T, Berberich G, Werner GG. Impact of childhood maltreatment on
obsessive-compulsive disorder symptom severity and treatment outcome. Eur J
Psychotraumatol. 2020 Jun 8;11(1):1753942. doi: 10.1080/20008198.2020.1753942.
PMID: 33488994; PMCID: PMC7803079.
Brooks SJ,
Naidoo V, Roos A, Fouché JP, Lochner C, Stein DJ. Early-life adversity and
orbitofrontal and cerebellar volumes in adults with obsessive-compulsive
disorder: voxel-based morphometry study. Br J Psychiatry. 2016
Jan;208(1):34-41. doi: 10.1192/bjp.bp.114.162610. Epub 2015 Sep 3. PMID:
26338992.
Charuvastra
A and Cloitre M. Social Bonds and Posttraumatic Stress Disorder. Annu Rev
Psychol. 2008 ; 59: 301–328. doi:10.1146/annurev.psych.58.110405.085650.
GOODWIN, R.
D., FERGUSSON, D. M., & JOHN HORWOOD, L. (2005). Childhood abuse and
familial violence and the risk of panic attacks and panic disorder in young
adulthood. Psychological Medicine, 35(6),
881–890. doi:10.1017/s0033291704003265. https://pubmed.ncbi.nlm.nih.gov/15997608/
Goodwin RD,
Wamboldt FS. Childhood physical abuse and respiratory disease in the community:
the role of mental health and cigarette smoking. Nicotine Tob Res.
2012;14(1):91-97. doi:10.1093/ntr/ntr126
Lang PJ,
Bradley MM. Appetitive and Defensive Motivation: Goal-Directed or
Goal-Determined?. Emot Rev. 2013;5(3):230-234.
doi:10.1177/1754073913477511
Lang PJ,
McTeague LM. The anxiety disorder spectrum: fear imagery, physiological
reactivity, and differential diagnosis. Anxiety Stress Coping.
2009;22(1):5-25. doi:10.1080/10615800802478247
Miller Alice. Lahjakkaan lapsen tragedia ja todellisen
itseyden etsintä. Werner Söderström Osakeyhtiö. Porvoo – Helsinki – Juva. 1986.
ISBN 951-0-11911-3.
Miller, Alice. Murra vaikenemisen muuri. Werner Söderström
Osakeyhtiö. Porvoo – Helsinki – Juva. 1991. ISBN 951-0-16981-1.
Norman RE,
Byambaa M, De R, Butchart A, Scott J, Vos T. The long-term health consequences
of child physical abuse, emotional abuse, and neglect: a systematic review and
meta-analysis. PLoS Med. 2012;9(11):e1001349. doi:
10.1371/journal.pmed.1001349. Epub 2012 Nov 27. PMID: 23209385; PMCID:
PMC3507962.
Ou W, Li Z,
Zheng Q, Chen W, Liu J, Liu B, Zhang Y. Association Between Childhood
Maltreatment and Symptoms of Obsessive-Compulsive Disorder: A Meta-Analysis.
Front Psychiatry. 2021 Jan 20;11:612586. doi: 10.3389/fpsyt.2020.612586. PMID:
33551875; PMCID: PMC7854900.
Perusini
JN, Fanselow MS. Neurobehavioral perspectives on the distinction between fear
and anxiety. Learn Mem. 2015 Aug 18;22(9):417-25. doi: 10.1101/lm.039180.115.
PMID: 26286652; PMCID: PMC4561408.
Pinker,
Steven. The Better Angles of Our Nature. A History of Violence and Humanity.
Benguin Books 2012. ISBN 978-0-141-03464-5.
Sahle,
B.W., Reavley, N.J., Li, W. et al. The association between adverse
childhood experiences and common mental disorders and suicidality: an umbrella
review of systematic reviews and meta-analyses. Eur Child Adolesc
Psychiatry (2021). https://doi.org/10.1007/s00787-021-01745-2
Tovote, P.,
Fadok, J. & Lüthi, A. Neuronal circuits for fear and anxiety. Nat Rev
Neurosci 16, 317–331 (2015). https://doi.org/10.1038/nrn3945
Villers A,
Godaux E, Ris L. Long-lasting LTP requires neither repeated trains for its
induction nor protein synthesis for its development. PLoS One.
2012;7(7):e40823. doi:10.1371/journal.pone.0040823
