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Caitriona Mc Mahon
Welcome to Mental Health Hour the podcast. I’m Cat
And it’s episode 9, just like that.
So today… Last time we were here, before Karen came on, we spoke about my research. You had a great time putting me in the hot seat and trying to catch me off-guard with questions..
A little bit…
So this week it’s your turn. This week we’re going to talk about your research in childhood trauma. I’ve some questions I’d like to ask you if that’s ok we’ll get going?
That scares me a little bit actually because you just go for it like, straight to the bone.
Yeah, no – it’s going to be a nice conversation I think and it’s a really worthwhile conversation. I know we touched on trauma in one of our earlier episodes and we got some feedback on it and people seemed…
Like, trauma is something that people are really only starting to talk about now.
In a big way, I mean. Trauma has always been there of course, and there’s people who’ve been working in this space for many years but the conversation has only moved into the limelight I think now.. Is that fair?
Absolutely. I’ve been going to different events, one of which i was actually going to talk about in a little while but I may as well touch on it now.
Dr. Jane Mulcahy, she facilitates an event. We’ve been meeting every week, every two weeks for the last number of weeks. It’s called “Towards Neurodevelopmentally Aware Trauma Responsive Ireland”. In that, different people come on and talk, outside of that we get a topic and we discuss it.
One of those topics has been “Has trauma become a trendy word?” So, trauma informed care etc. It’s really interesting because it makes you really think about this… People are getting to know about trauma now a lot more I think because of the ACE study.
So, can you just tell us then, what are ACE’s?
Well, ACE’s were developed by Dr. Felitti. he conducted a study back between 1995-1997. It was like the biggest study ever conducted at that time.
Long story, short – He ran a weight-loss clinic. He started noticing that people were dropping out of his clinic, but were still losing weight. He couldn’t figure out what was going on around the weight.
He brought in some of those people, interviewed them and what he noticed was a re-occurring theme coming through. That theme was that some people felt that their weight was a protective factor.
For example, for some people – their weight made them unattractive to abusers, so their weight served another purpose. Which, for him – he went “Oh my God, there’s something huge here”. So he followed up with questionnaires.
I’m trying to remember exactly how it happened but basically something like – In one of the interviews he misspoke, and instead of asking “What age were you when you were first sexually active?” he asked, “what weight were you when you were first sexually active?” Someone responded with, basically, a weight associated with childhood and this nearly knocked him off his seat. He realized, “Oh my God, this is what’s going on”.
So, since then we’ve had people like Nadine Burke Harris – who has conducted remarkable research in this area. She has been conducting studies in her clinic in California (I think). So people have been following up on this, because she thought she was going off her head.
She started to notice people coming into her clinic, with all of these extra aliments like asthma etc but like me, she asks “why?” to everything. So naturally, she started thinking “there’s something going on here, I need to know more”.
So, one day one of her colleagues said “have you seen this paper?” It was Dr. Felitti’s and she thought “Oh my God, finally, someone gets it!”
So there are 10 ACE’s. Off the top of my head… I’m trying to remember them all –
Oh no, don’t feel pressure to name them all, just what you can.
So you have childhood physical abuse, emotional abuse, sexual abuse, neglect, separation of parents (divorce), mental health issues within your primary care givers, substance misuse in the home etc – there’s 10 in total. Do you know what, they’re a great starting point, I think. But what concerns me is that they’re seen as the be-all-and-end-all of trauma.
Yeah, so I remember the first time I saw Nadine Burke Harris’s TED talk. It was actually played in a lecture in college – a YouTube video, where she spoke about ACE’s. I remember us having a conversation afterwards where I was really panicking because “technically” I score about 8.
Well, 7 or 8 on the ACE scale. I was panicking. I thought that this meant for sure I was going to develop heart disease and all of these other things (in the video) whereas, I didn’t really feel as though it was….. While it was true, yes – I did score this, it didn’t feel like to me, that it impacted my everyday life. This will of course be really different for other people (and their experiences) depending on all sorts of different things, but you explained it… A couple of years later you jumped in and explained it a little bit better to me. So, what way did you put it to me at the time?
I think there’s a danger with ACEs that people take them at face value.
Yeah, which I did, right?
Yeah, in an isolated way. But just to clarify, and i should have said it a minute ago, what they did when they asses ok “has someone lived in a house with drug abuse” etc was they gave it a score of 1. If someone experienced neglect also, that score was 2, so they had 2 ACEs out of 10. So you had what, 8 was it?
7 or 8, yeah.
Right, so the danger with ACEs then is, you’re looing at that and you’re thinking “that makes me 7 time smore like to have” whatever illness. So you thought you were going to be on your death bed within like 10 years.
The other side of this is, we now know through current research that in the presence of buffering, protective factors – that is completely reduced, if not eradicated. What I mean by that is for instance, having one good adult in your life or multiple good adults in your life. A supportive network, repetition, routine, predictability – all of these good things.
Trauma isn’t a death sentence.
But, the danger is now that trauma is going unrecognized, particularly in Ireland. If you look at UHL (University Hospital Limerick) at the minute. It’s all over the news, Health Minister Stephen Donnelly was there the other day, just popped in and trolleys were going in all directions. No one is looking at why… Why are so many people on trolleys?
What’s causing for example autoimmune diseases, asthma, rheumatoid arthritis, what’s causing all of these things? The research is heavily pointing towards trauma in childhood. (Of course there are many other medical and genetic causes too).
So, would it be fair then to say then, while we know that trauma can have an impact and result in all of these aliments and illnesses, while we know all this is happening – so with UHL we know there’s lots of reasons for trolleys for example under resourcing and understaffing and all of these different things but is there then any way in which a country can prepare themselves for or respond more appropriately to trauma? is it that we’re not trauma aware enough on a public health level?
Oh absolutely. But we’re also not trauma aware on any level. I mean, it’s like firefighting, it always has been firefighting here in Ireland. Whether we look at the homelessness crisis, the levels of addiction at the moment – no matter what you look at it’s always “OK it’s happened, now how do we respond?”
The amount of money that is pumped into that firefighting response rather than thinking, if we want to change this is 20 years time, we need to change what we’re doing today.
Look at Finland for example. So, here in Ireland pre-schoolers start at the age of 4, in Finland, they start at age 7. You might find that mad?
Well, yeah it’s a bit strange to me but it’s always going to be strange when we’re not used to it but go on…
What they’ve done is, and I’m looking at this really closely because here, we tend to shove kids into school, these are your letters, these are your numbers whatever… In Finland, don’t get me wrong they’re introduced to different letters and numeracy skills concepts etc in a playful way but there’s actually very little to no classroom based stuff, a lot of it is outdoors.
The kids are though accountability and autonomy. So many minutes out of every hour they get to decide themselves what they want to do. They can put on an anorak and play in the mud. They can just do whatever, and it’s all play-based. So the emphasis over there is on a child’s self-awareness, accountability, so they take charge of their own bits. If they eat toast, they go and wash their little plates.
Pre-school doesn’t start over there until they’re 7 and they’re showing that the kids are getting higher grades then as they go up through the system. I’m interested to watch how it develops in the future because I think what you’re going to see is…
In the likes of the Scandinavian countries, even workplaces are more family friendly. You can come into work at a time that suits you and your family, you can leave at a time that suits you and your family. There are areas within your workplace that if you need to bring your child to work, you can. We’re not doing any of that.
So, is there an element of self-guided…. I know you’re saying there’s self-guided play and that your day is kind of self-guided really so there is that focus on autonomy so is that a time then where you think they are allowed to build their social connections, to build their social networks and supportive frameworks? Which, as you just said a few minutes ago, is a hugely beneficial protective factor later in life? Is that the premise?
Yeah, so its all social and emotional development. Their skills are already built ever before they reach actual school. Like, we’re putting kids into formal school who are already traumatized from different situations at home. And we know from the research that if a child is traumatized, you could be speaking Chinese at the top of a classroom in an English speaking country and that child won’t know the difference. You may as well be because the cognitive functions are switched off. They can’t focus because they’re stuck in that survival mechanism.
Yeah… It’s fascinating, I’ve heard you speak about what they’re doing in Finland so many times and I think it’s lovely. So, I think the next thing I should get you to do, because we kinda just jumped into that and we were’nt planning on just jumping in but could you tell us – what is trauma then? Because we all have different ideas around trauma. I know for me before going to college I associated trauma with the big, disasters, major life events that were really really violent. Obviously now, I know different but I’d love if you could explain or define what trauma is from your research – what is trauma in its most basic form?
Ok, and this is interesting especially in terms of research. People have different definitions.
So there’s no uniformed or universal approach to this?
That’s exactly what I was just gonna say, there is no universal definition at the minute, which might be part of the problem.
For example, Dan Siegal who has wonderful books out, says that trauma is an experience that threatens our physical survival and one that disrupts our sense of meaning. But then, if we look at, and it’s not a whole pile different but I really, really, really like this one because I think it’s more up to date, Peter Levine describes trauma as not something that happens to us but rather something we contain inside of us – but and this is the important bit – in the absence of an empathetic witness.
So that’s like our “one good adult”. So yes, it’s trauma but only if we don’t have that supportive person, that empathetic witness. You look at our suicide prevention work. How much trauma can be buffered by that empathetic person. Look at your research, it’s the same thing.
We’re all big children, aren’t we? We all need empathy and i just really love that definition, it really resonates with me.
Yeah, there’s so much in what you’re saying. Yeah, I do think we’re all children, and as adults we are just children with more language. We still have those fundamental, basic needs that we need to have met. It sounds silly but I know when I’m sick, all I want is my mam on the phone. So, I think these things don’t change as we grow older.
So, there’s lots there but what is it specifically about trauma that interests you, what started you out on this trauma research journey?
I suppose it was the work with Community Crisis Response Team. What we began to find was that nearly 9 out of 10 calls we were receiving involved an element of childhood trauma. The other thing to say about that is some people assume childhood trauma is being slapped or punched or physically or sexually abused as a child, it’s not.
It could be a child being over-protected, it could be something that happened at school like being bullied, it could be to do with having witnessed something as a child. It could also have an intergenerational like.
So, for example, what we’re seeing in Ukraine at the moment. That constant sense of fear is traumatic in itself.
So being in a fight or flight response mode?
Exactly. So, that in itself fascinates me but there’s just so much in trauma. So I started out on this journey going “right, I need to figure out what’s going on here, I can’t watch people suffering because its killing me in the process”. So I thought, I’ll go out there, quantify how much childhood trauma there is in Ireland and God was I naïve, and then I was going to fix it all. That was my plan for my MA. In two years, I was gonna end trauma.
So here I am now, two years later and have discovered that you just can’t eradicate trauma. And, you know what? Stress in the right amount, with the right supportive networks is a very helpful thing. It’s great for our development, it can teach us how to cope.
So, what I’ve learnt is that it’s about intervening sooner. it’s about our professionals, and this is where my research is after going now, I went from looking at the children – “how do we eradicate trauma” to “OK, we need to look at professionals” because we have professionals out there that are perpetuating trauma because they haven’t been given the right training before entering the workforce. That terrifies me.
Then, you have all these big concepts within trauma, like you have the “big T” and the “small t” which I hate because it’s basically saying your “big T” is like a massive traumatic event and your “small t” is just… How can you say which is which to a child? We’re all individual.
So that’s kinda trying to quantify your level of trauma versus my level of trauma?
Yeah, exactly. How do you do that?
Yeah that’s madness. So, you just touched on intergenerational trauma. Can you talk a bit more about that, what is it? Does it happen a lot? I know you mentioned Ukraine as well so i think that would be interesting to get your take on?
Yeah. Well, intergenerational trauma is kinda what is says on the tin. It’s trauma that runs from generation to generation. We all carry trauma of a different kind, particularly if you look here in Ireland, look at “the troubles”.
There’s one particular researcher I have to mention here, Rachel Yehuda. Rachel and her team went and studied Jewish people and how they experienced the holocaust. They also studied their children. There’s a field of study called epigenetics, and it’s basically the study of the ability of an environment to turn on and off genes. Can you believe that?
So, if you’re giving birth to a child and you experience trauma, the impact on your genes will have the very same impact on the child’s. Imagine that, even before they arrive into the world.
So what they’ve found are these epigenetic tags on the very same part of the gene in the child and the parent and this was to do specifically with aspects of their life that were relating to the trauma.
So, in Ukraine right now, yeah you’re thinking of the children of course, it’s awful for the kids and for their parents but you’re going to see this in those children’s children and you’re gonna see it in the generation after that. Living in constant fear, under constant threat. Can you imagine that?
No. That’s not me being smart, but I can’t. I can’t even picture a scenario where… [What’s happening in Ukraine] seems so far removed from my reality. That’s just the truth of it. I’m very fortunate, very lucky, that’s my privilege.
That’s fascinating, and I know you speak and think about intergenerational trauma a lot. The lovely thing about you in general and in terms of research is.. And I often listen to you giving presentations or speaking at a conference and the lovely thing about the way that you do it is, you take these big big words and big, big concepts like intergenerational trauma, epigenetics, neurodevelopment etc, all these things that are so far away from my understanding of the world, that language is so far away from how I am in the world but when I listen to you talk I always end up understanding it. I always end up learning something new or taking something away to think about.
So, I just wanted to say, that’s one of the many things I really admire about you and the way you do your research. I wish more people did it that way, I wish I could do it that way.
But it’s all very scary when we hear and talk about trauma. To hear you speak about trauma, how prevalent it is and how it’s affecting people across the world is scary. I know you touched on this, you said that professionals aren’t getting the training they need, I don’t believe we were as social care workers. I know what trauma is and I know that we need to be really careful around it but my question is – what actionable advice would you give to professionals working with individuals who may have trauma? What can we actually do? Your top tips? I know it goes much deeper, and we all need to seek out targeted training, but what can we do now on the ground?
Yeah, and this ties in too with one other thing I wanted to say about intergenerational trauma because it kinda focuses on that as well. Outside of the genes, your attachment styles and your traumas will impact the children because your stress responses will be higher, the way you respond to children’s needs will be different, all of these different things matter.
Now, as a professional, it’s the very same. I would ask any professionals listening to this, whether you’re a lawyer, an accountant, Gardaí, social care professionals – anyone, that you look at your own trauma history. Have you dealt with it?
For example, if I have experienced domestic violence, and I’m in an environment with a child that is being loud – I’m going to have a high stress response because that loud noise in the background is on some level going to remind me of what happened in my past.
Now, that child has no idea about what has gone on. So, they’re going to feel off me, “something’s wrong, they’re acting different, they’re not meeting my needs” and that’s because they’ll be too busy meeting their own because of their past domestic violence experiences.
So what I’m saying is, and this has become the focus of my research right now- we don’t have enough of an understanding of ourselves as professionals. We look at trauma informed care, which the main point of is to prevent re-traumatization… Surely, part of that has to be about looking at ourselves?
If you look at all of the definitions of trauma informed care, it’s all about helping people recognize their trauma. But no one is looking at the professional as a tool? As the mechanism? So as a professional I would beg you to look at your own attachment styles. Did you have a secure attachment in your home relationships?
We regularly see, and I’m seeing it in my research, kids having up to 50 foster care placements. You have to ask why? It is not that the child is the problem in that. I can agruntee you that there has been no assessment on the foster parents attachment styles or patterns before they have entered the fostering system.
So, if you have a home with insecure patterns – they respond to situations differently because f their experiences. Not their fault. But, if you respond to a child who needs something with that pattern, it’s going to impact that child. We can only do what we know and so if we don’t reflect on our patterns or attachment styles, it won’t change.
So, you hear about a child running away from a foster home, it’s not the child that wrong in that. We need to look at everything. It goes back to what Nadine Burke Harris says in The Deepest Well. She said (paraphrased)
“If people are drinking from the same well, and they’re all getting sick. You don’t keep treating them with tablets, you go back and you examine the well. What’s going on with the well?”
Meanwhile, we have endless foster care placements breaking down. We don’t even have enough foster care placements available here. Outside of that, look at all the social care and social work professionals burning out. You know? It comes back to the whole firefighting analogy. We need to look at WHY!
And I believe, because of the work we do in our charity, our work in delivering suicide response training with Driving Change and our work in research that it comes back to personal development and awareness.
We did personal development in depth in our social care training. We were very lucky, most professionals don’t.
Yeah, and the personal development module was intense. I often speak about it even now when delivering Suicide Response Training. I hated going to that [personal development] room. I hated it because you knew there was big work happening. I wouldn’t have hated it so much if it were easy. It was hard. We don’t hate what’s easy. It’s funny. Even though that was the module I hated the most, it’s the part I miss most about college.
Yeah, and the one where you remember the most. We learnt so much about ourselves, didn’t we?
Definitely. And I agree with your point, we were very, very lucky. I speak to other people working in social care and social work and other caring professionals who say they didn’t really do the same thing. They say it was fine, this is what we did – and I’m going wow, that’s very different from what we had to do… So yeah, I see that.
So, what’s the take-home message? I know you hit on the actionable tips but I mean specific to your research. Where is it now? What’s the biggest message from your research right now?
I suppose its that we need a trauma literate society. trauma literate professionals. I struggle to get a definition of this because at the moment everything is about “trauma-informed this and that” and this is something that really bothers me. it bothers me because it looks out at the other person the whole time. It doesn’t look at both the person needing care and the professional. I think it needs to be all-encompassing.
I did find one definition by Carlee Adamson, she has a website www.traumaliteracy.com and I spoke to her via email because I was blown away by the definition. I remember thinking, wow, finally – someone gets it.
She says that trauma literacy is very like language literacy because it enables people to understand one another AND themselves (which I love) and take responsibility for their actions and circumstances. So looking inward. It’s also about healing in a regenerative way.
So for example, look at childcare settings. A child is behaviorally acting out. Looking at the training out there for professionals in that area, they do observations on this stuff. They note the observations and maybe a psychologist will be brought in. Now, what’s scary about this is that there’s a huge over-lap between how behavioral issues, ADHD, trauma responses present. Professionals aren’t even told this.
So they are left to assume that if child doesn’t make eye contact, if their behavior presents in a certain way, that “oh my gosh, they could be on the spectrum, should we get an assessment?”
I was at a talk recently, where another girl spoke about this. She says that she has found this too, that our professionals are not trauma informed, the literacy isn’t there.
So professionals don’t know, they don’t think “Ohh ok, was it the way I reached for my jacket that triggered that child into this behavior?” You know? Or, “was it the fact that I moved my body in a certain way, triggered this child?”
I saw something shared in a Facebook group the other day. It had a list of the typical trauma responses but also had a list of common traits seen on the spectrum beside it. The overlap is completely shocking.
We don’t know enough. Our kids are with childcare professionals and teachers every day of the week and it’s not the teachers or professionals fault that they haven’t been given the knowledge. What I want to do is make this a core module in all college courses that are training people in the helping professions or with children. They should be hitting the ground running.
“I know what this is, I’m looking for it. I know how to rule out everything else, get proper assessments for thing but I know that it could also be this”. Whereas, right now it’s like “the only thing I know about is this, so maybe it is this”.
I agree. I think it should be a core module. I know I would have loved it and I know friends and colleagues of mine would have loved it too. The literacy thing too, so interesting. I suppose the only way we have learnt as professionals to recognize certain traits or signs that may indicate someone being on the spectrum – the only way we got good at that was because the message was constantly reinforced by research and by educational projects and programs. The same hasn’t been done for trauma. So, we don’t know how to watch for trauma responses or how to flag potential issues.
So, what’s the plan now with your research? You’re nearly the two-years in at MA level. What’s the craic now?
I’m trying to transfer to PhD level, at the graces of TUS (Technological University of the Shannon). If they’ll have me! All things going well, sun shining, I’m going to come out of this with the knowledge to design and implement core modules for people entering the workforce. Childcare, social care, social work, teachers, everybody! I’m not going to stop.
Failing that, and it’s alongside that I want to develop courses with our own consultancy Driving Change for professionals. So there’s a lot.
The other take-home message I want to make really clear is that trauma is NOT a death sentence. Relationships matter. Connection matter, and we have no idea how much connection matters. Safety matters. When I say safety, I don’t mean safety just in the environment you’re in. I mean safety in the professional you’re with.
Exactly. And above all, every story matters. You will never know how severely someone may have been impacted by something you consider to be minor.
You really need to help children to feel felt. I can’t remember who said that but it is in the literature, the importance of feeling felt.
There’s so much, I could do 5 more podcasts on it.
This is it. My head is always spinning after talking with you about trauma because there is just so much to it. It’s just so big and so delicate. We really need to be careful with how we work with trauma.
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