Sanctuary for the Abused
Friday, November 03, 2006
A Priceless Legacy for Future Generations
by Penny Bain, Executive Director and Lynne Melcombe, Communications Consultant,
BC Institute Against Family Violence
The recent release of the annual report of Child, Youth and Family Advocate Joyce Preston stimulated much discussion among staff at the BC Institute Against Family Violence. In particular, we note Ms. Preston's urging for an expansion of early development and early intervention services. Current medical research strongly supports the need for these and other services in the fight to eliminate family violence.
Research reveals that children exposed to family violence, which can stimulate a prolonged, physiological "fight-or-flight" stress response, may suffer a kind of brain damage. This damage can lead to dissociative disorders, in which the individual becomes emotionally detached from his or her surroundings and may lead to what was formerly referred to as "multiple personality disorder". Posttraumatic Stress Disorder, which is characterized by hypervigilance to external threat, over-arousal and persistently intrusive traumatic memories, among a variety of other traumatic stress responses, is a possible unfortunate result of environmental adversity.
The stress response begins when a gland in the brain called the hypothalamus receives information about a perceived threat and initiates a series of reactions resulting in production of the hormone cortisol. Once the presence of cortisol is detected in the bloodstream, the system's demand for this natural pain-killer temporarily ceases, and in much the same way that a thermostat detects when a furnace has generated enough heat and shuts itself off, production of this essential hormone stops.
Cortisol converts fat and muscle into glucose, which is the brain's fuel. It enables us to "think fast" while simultaneous release of adrenaline, noradrenaline, and testosterone enables us to act quickly. This is the fight-or-flight response. It's a good thing.
When people experience repeated and/or prolonged stress, cortisol levels rise and can remain high for hours, days, or longer. One ongoing study of teenage girls who reported sexual abuse showed cortisol levels that remained high over many months.
Prolonged elevation of cortisol is not a good thing. It interferes with glucose absorption in the hippocampus. The hippocampus is one of three parts of the brain involved in memory. Memories are stored in the brain's cortex, the hippocampus retrieves factual memories - "what happened" - and the amygdala retrieves emotional memories - how one felt when it happened.
The hippocampus is dense with cortisol receptors. This may facilitate its ability to retrieve information quickly under stress, but it also makes the hippocampus sensitive to cortisol overload. Too much cortisol actually shuts down the hippocampus' ability to absorb glucose, essentially starving it and impairing its ability to function.
Cortisol does not affect the amygdala this way, so individuals continue retrieving emotional memories. This is one reason why, years after a trauma, people may still experience fear, horror, or rage, often without being able to connect these feelings to a remembered event.
Prolonged stress can break the internal thermostat that controls hormone levels, resulting in chronic depletion of the substance. Low levels of cortisol in the body have been linked to emotional numbing. On the other hand, cortisol production can be activated by mild stimuli and the sudden "high" can evoke fragments of disturbing memories. At the same time, elevated levels of adrenaline, noradrenaline, and testosterone can cause reactivity and aggression.
These biochemical and organic effects of prolonged duress combine and frequently appear as symptoms of dissociative disorders and PTSD. An individual with a dissociative disorder may have difficulty in "reality testing" and demonstrate impairments in cognitive and social functioning. Dissociative disorders are extremely common diagnoses among individuals physically or sexually abused as children. For example, sexual abuse survivors often tell of "leaving their bodies" during abusive events. If episodes of detachment happen frequently, they can alter the individual's ability to have appropriate emotional responses.
An individual with PTSD has an excruciatingly low tolerance for environmental change. Even a sudden change in light or temperature, or a sound that's not loud but unexpected, can evoke an aggressive outburst - yet such outbursts can alternate with moods of extreme tenderness. It's also not unusual for individuals to move back and forth between dissociative disorders and PTSD, and more usual than not to witness other ("co-morbid") psychiatric diagnoses such as substance abuse, depression and generalized anxiety disorder also present within individuals with histories of traumatic stress. Some who suffered at the hands of others go on to perpetrate abuse in adult relationships.
Thus, the cycle of violence continues. Unless we intervene. And the earlier, the better.
Because if prolonged exposure to stress can damage the more fully formed brains of adolescents and adults, imagine what it can do to the developing brains of young children and infants. Research has shown that infants and young children exposed to family violence can be predestined for lives of violence.
The upside is that early intervention and treatment work. Studies of lab rats have compared newborn pups who were left in the constant care of their mothers (a model of loving parental care) with pups who were removed from their mothers' care for 15 minutes daily (a model of occasional exposure to stress) and pups who were removed for three hours daily (a model of neglect).
While the first two groups developed normal stress responses, the third group developed excessive stress responses, mirroring those of infants exposed to family violence. Left untreated, those responses continued into adulthood. In humans, when the effects of prolonged stress go untreated, the resulting disorders become increasingly resistant to treatment.
However, when some of the "neglected" pups were moved to an enriched environment and given extra care, their stress responses returned to normal and they developed into fully functional adults. In the same way, humans who receive therapy within days or weeks of a traumatic event usually avoid developing permanent psychiatric disorders.
In other words, if we want to short-circuit family violence, we must focus our efforts on new parents. But to do this, we must offer services that address the range of problems - poverty, poor housing, inadequate nutrition, for example - that can combine to make the challenges of parenting seem insurmountable and result in violent outbursts that are motivated by frustration.
But if we focus our efforts only on new parents, we'll miss opportunities to help troubled older children and youth in ways that can enable them to enter adulthood prepared to become parents. Thus, we must provide services for children, youth, and families before they are in crisis.
This requires adequate, trained staff, not only to deal with the provision of services, but to foster the development of what Preston describes as a mature and stable workforce. This cannot be accomplished without increasing, rather than decreasing, investment in the vulnerable members of our society.
And that is the way social service expenditures should be seen: as investments. The current approach to family violence drains our resources via too-little, too-late expenditures, criminal activity, and unrealized productivity.
A more solid investment would look something like a good down payment and a 20-year mortgage on a property with the potential to return our investment many times over. This investment would allow us to leave a priceless legacy for the generations to come.
For more information, please contact Penny Bain, Executive Director at the BC Institute Against Family Violence at (604) 669-7055 or visit our website at www.bcifv.org.