(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.

 

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