Therapist Musings

News Commentary: Blaming the Child Victim

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Friday, July 30th, 2010

Another Model Parent
Murders Her Children and Herself

When firefighters showed up to tackle the blaze at the apartment building in Staten Island, they discovered five victims: a two-year-old boy barely alive who would die later in the hospital; two girls, ten and seven, and a 14-year-old boy, all with their throats slashed; and their 30-year-old mother, also dead.  The teenager, CJ, had a straight razor under his arm.  Investigators quickly determined the fire was deliberately set.  (New York Times)

Because of his recent history of fire setting and an assault on his school principal, CJ was immediately deemed the murderer.  Much rumination followed about what might drive a youngster to commit familicide and those who knew the family were quick to share their observations about what a close-knit group they were, how Leisa Jones, their single mother, struggled to provide financially for her children, how in their home she insisted on proper manners and behavior.  (New York Times)

Only after the tragedy did some start to wonder about the pressures on young CJ to be the man of the house.  Those aware of the family’s circumstances shared observations of how he always took care of his younger siblings and did the things his mother needed him to do.

Where were they before when his behavior signaled the existence of serious problems, at least within himself but probably also inside the family?  A child who assaults a principal and sets fires clearly suffers from distress of some kind.  Did anyone try to find out what was troubling him?

And what sense did it make that he could set a blaze without slitting his mother’s throat, too?  Surely the screams of the children would wake her.  The youngest child was undoubtedly spared because he could do nothing to stop the perpetrator unlike the older children who could.  How often does someone, especially a teenager, commit suicide by slashing his/her own throat?  And how could the blade end up under his arm?

Far easier to blame the troubled child who acts out his/her distress than to contemplate the still unimaginable possibility that parents kill their children even though there are ample statistics testifying to that fact.  “In 2007, one or both parents were responsible for 69.9 percent of child abuse or neglect fatalities” and “more than one-quarter (27.1 percent) of these fatalities were perpetrated by the mother acting alone.”  (Administration for Children and Families)  Still everyone remains shocked when these murders happen in their neighborhoods.

It’s time that adults take notice of disturbing behaviors in the children they encounter and make the effort to find out what’s wrong, to intervene before tragedy strikes again and leaves them scratching their heads and trying to figure out how it could possibly have happened.


News Commentary: Another Papal Failure to Protect

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Friday, July 16th, 2010

Vatican Codifies Pedophilia As Offense Against Church

In the latest revisions to the internal laws of the Catholic Church (as reported by The New York Times), the Vatican has grouped pedophilia with heresy, apostasy, schism and attempts to ordain women, all threats to the church itself.  Additionally, the new amendments omit recognition that sexual abuse of children is a crime.

“It’s not for canonical legislation to get itself involved with civil law,” explained Charles J. Scicluna, internal prosecutor for sexual abuse cases.  It’s not for it to ignore it either.  In earlier guidelines, lacking the force of canonical law, bishops were advised to report sexual abuse to local authorities where laws mandated such actions.  Such directions don’t appear in the revised laws.

Additionally, the statute of limitations was increased from 10 to 20 years after the victim turns 18.  But those with any knowledge about the long-term impact of sexual abuse on children know that there can be a significant delay in the survivor’s ability to both remember and report such trauma.  Limiting reporting, and not holding priests responsible even years later, does nothing to support survivors.

The changes were touted by Scicluna as “…a signal that we are very, very serious in our commitment to promote safe environments and to offer an adequate response to abuse.”  The revisions speak more to the Vatican’s desire to promote a safer environment for itself.

There can be only one appropriate and indeed moral response to dealing with those accused of sexually assaulting children: to report them to the police for investigation and to remove them immediately from any contact with children.  If found guilty, they must be held accountable.  For the Pope to continue to take the law into his own hands in such matters represents a negation of his professed role as spiritual leader and raises the question of whether he even knows the right thing to do.


News Item: Neuroscience

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Friday, July 16th, 2010

Exercise Builds Strong Brains

Add one more benefit to getting off the couch and moving.  Though scientists have known for a while that exercise increases neurogenesis (brain cell production), resulting in better thinking, until now they didn’t know just how that happened.  Recent animal studies described in The New York Times uncovered the process.

A chemical circulating throughout the body, bone-morphogenetic protein (BMP), curbs cell proliferation by preventing stem cells from dividing and developing into the assortment of cells that keep the body going.  The brain contains lots of stem cells just waiting to become neurons but with aging, BMP becomes more active and neurogenesis, and mental agility, declines.

Mice given access to running wheels showed drops in BMP production of about 50 percent within a week.  At the same time, the BMP antagonist Noggin (a protein that interferes with BMP’s activity) increased.  When mice were injected with Noggin, they showed great prowess in mazes and other tests of smarts.

But before drug companies rush to create a Noggin pill to be used and abused by those who want the benefits of exercise without the sweat, consider the unintended consequences of its overuse.

Noggin added to mice stem cells in petri dishes resulted in runaway production of neurons through its interference with BMP’s ability to check such growth.  Sedentary mice injected with Noggin showed similar results;  eventually the stem cells exhausted themselves and everything slowed to a crawl.

What does that mean for the real world effects of exercising?  Is it possible to overdo it?  So far there’s no evidence of that; the revved up neurogenesis eventually plateaus.

It doesn’t take much to get results, either.  So don’t wait around for the pill that does it all.  Take a walk, jog, swim or bicycle.  Even a little can keep the brain young and spry.


News Item: Child Development

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Friday, July 9th, 2010

Facial Expression Recognition Develops Over Time

The ability to decipher the emotional content of facial expressions requires time to develop, according to a recent study, and disgust takes the longest.  Not until age five can most children tell the difference between disgust and anger.  In fact, until age three, children see the world of faces divided into two types: happy and angry.

Perhaps only with the development of the left (verbal and logical) side of the brain do children become equipped to decode what faces communicate.  That process doesn’t start till age two and doesn’t advance enough till age seven to dominate the right (emotional) side of the brain.

In research described in Science News, scientists came up with a developmental timetable based on observations of very young children.  They found that most three-year-olds correctly linked faces to happy, angry and sad.  Four-year-olds stopped misattributing angry faces for other expressions, and by age five children could recognize disgust as such.  The report omitted mention of surprise and fear, the other two of the six major emotions previously believed to be innate across cultures.

Yet well before children possess the visual acumen to read faces, they can use the language of emotions appropriately, with words like “gross” and “yucky,” for example,  to describe the experience of disgust.

Anyone who interacts with children regularly would be well advised to keep in mind these new discoveries.  Trying to teach a toddler to refrain from ingesting nonfood objects by turning up one’s nose at them just won’t do the trick.  And looking at a child with anything other than a happy face will be read as anger.  It might make more sense to describe rather than display those other feelings.


News Item: Neuroscience

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Friday, July 9th, 2010

Serotonin Transport Gene Implicated Again

Already linked to depression and PTSD, the 5-HTT gene has been found to play a role in how bullying affects its victims.  Having two short versions of the gene seems to predispose a bullied child to developing emotional problems severe enough to require treatment.

In a study described in Science News, researchers looked at sets of twins with identical versions of 5-HTT where one had been bullied and the other not.  The results showed that 33 percent with the two short versions had symptoms of depression, anxiety and/or social withdrawal.  One long and one short version conferred some protection;  29 percent had severe problems.  The most resilient bullied children had two long forms of the gene;  only 15 percent had observable negative reactions.

The 5-HTT gene, which has a critical role in regulating serotonin, the neurotransmitter involved in mediating stress and producing feelings of wellbeing, continues to be linked with how well a child responds to stressors.  In other research, teenage girls who suffered various kinds of ostracism by their peers had worse outcomes than those fortunate enough to have two long, or even one long and one short, gene.

Important to keep in mind:  a significant majority of even those children with short versions of 5-HTT do not develop serious symptoms.  While such a combination does not doom children to misery, having it probably explains why some adults who were abused as children do better than others.  It’s long past time to stop blaming victims for their negative reactions to their childhood trauma.


News Item: Pregnancy & Antidepressants

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Tuesday, July 6th, 2010

The Impact of SSRIs on the Developing Brain

These days many depressed women contemplating pregnancy face the dilemma of whether to take antidepressant medications and risk harming the fetus or avoid the pills and suffer other consequences.  Now, a growing body of knowledge offers them help with this decision though it still remains a tough call.

The most popular medications for depression, the selective serotonin reuptake inhibitors (SSRIs) such as Prozac, Zoloft, Paxil and others, work by preventing neurons (brain cells) from reabsorbing serotonin, a neurotransmitter involved in mood regulation.  Keeping more of it around in the synapses (spaces between the neurons) increases feelings of well-being and decreases activation of other brain chemicals like those in the limbic system involved in sex, aggression and overeating.

Because of the powerful effect SSRIs have on brain functioning, researchers have been concerned about their effect on brain development.  A recent study, discussed in Science News (June 5, 2010), revealed that “…children exposed to antidepressants in the womb are more likely to appear sad or withdrawn at age 3 than those whose moms didn’t take the drugs.”  In other cited research, “…babies born with SSRIs in their systems had lower birth weights and were more likely to experience respiratory distress.”

Earlier animal studies linked antidepressant use in pregnant mice and rats with anxiety and depression in their offspring.  On the positive side, some animals showed “improved decision-making and spatial-learning abilities.”  In other animal experiments using SSRIs, additional effects of these antidepressants included “faulty brain organization and abnormalities” and an increased sensitivity to serotonin.

It makes sense that the brain would be affected by artificially altering exposure to serotonin prior to, or during, the development of the system that regulates it, whether through medication or the stress of depression.  One theory holds that there is a critical period for the creation of the network of serotonin sites throughout the central nervous system.  During this time, if there’s too much serotonin already in the system, fewer sites would be established, and if there’s too little, too many sites would be produced, both outcomes affecting a child’s ability to cope.

Some researchers have explored other variables in interpreting the results of these studies.  Might the mother’s depressed mood also impact the baby’s serotonin system?  Depressed women have difficulty with self-care.  They are less likely to eat properly, exercise and get proper sleep, and are prone to risky behaviors like using drugs and alcohol, all of which can affect serotonin levels in the baby’s brain.  In studies that followed mothers and their children’s adjustment for three years, researchers showed that a mother’s current anxiety level played a more important role in their children’s adjustment than her mood during pregnancy whether or not she used SSRIs.

Genetics also plays a part in brain development.  The serotonin transporter gene (SLC6A4), implicated as a factor in susceptibility to depression and PTSD, has several variants.  Findings in one study showed that children with two short copies of the gene (less efficient serotonin reuptake) whose mothers were depressed during pregnancy tended toward depression and anxiety at age three.  Children with two long copies (more efficient reuptake) whose mothers were anxious during pregnancy showed increases in aggression at followup regardless of whether their mothers were on antidepressants.

What’s a depressed mother-to-be to do?  Clearly the stress of maternal depression has its own documented negative effect on the baby-to-be.  But taking SSRIs has potential for harm as well.  Since SSRIs have been shown to be most effective for moderate to severe depression, perhaps milder depression can be treated in nonchemical ways.  A woman needs to do her research, speak to her practitioner and consider her own individual circumstances in order to make an informed decision that minimizes the risks.


Letter to Editor: The New York Times

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Wednesday, June 30th, 2010

Re:  Private Trauma Sheds Light on Terrorism (6/29/2010)

The following is a copy of a letter sent to The New York Times in response to an interview with Jessica Stern, an expert on terrorists and terrorism, on the occasion of the publication of her own story, Denial:  A Memoir of Terror:

As a psychotherapist working for many years with adult survivors of childhood sexual abuse, I recognized immediately the phenomenon alluded to by Jessica Stern in the June 29, 2010 article by Charles McGrath, Private Trauma Sheds Light on Terrorism.

She describes a state of disconnection from her feelings, where she goes “into a calm,” elaborating on it later with, “I mean just lose feeling…like being in a fog.”

That experience has a name:  dissociation.  It’s a common reaction to overwhelming, life-threatening events.  Although Ms. Stern recognized it as “…a chemical change in my body,” she was reluctant to “…medicalize it too much.”  But everything that happens in our bodies happens first in our brains.

To maintain equilibrium, the brain produces both excitatory and inhibitory chemicals.  States of high arousal, like terror, trigger reactions that prepare the body for action.  When the threat passes, equilibrium is reestablished and the body goes back to a neutral state.

Most people are familiar with the flight or fight categories of response.  Fewer are aware that there is a third, freeze, that occurs when neither of the first two is possible or either could exacerbate the danger.  In the frozen state, the brain releases chemicals that shut down activity, produce a disconnection from the body and alter perception of the external world, conserving resources and seeking protective invisibility.

Ms. Stern could expect to react similarly when faced with any situation reminiscent of the original trauma, a defining symptom of Post-traumatic Stress Disorder.  Revisiting her history to write her book would certainly elicit her original feelings and concomitant coping strategies.

The brain always seeks to protect the self from intolerable feelings.  In her research into the motivations for violence, Ms. Stern discovered that a history of sexual humiliation played an important role.  In my work with sexual abuse survivors, I have witnessed feelings of humiliation instantly morph into what my clients have called defensive rage, a state far more tolerable because of its power than that of their unbearable shame.

In another recent article about her new book, Ms. Stern observed that shame could be sexually transmitted.  I would like to thank her for the perfect description of what happens to victims of sexual violence.


News Item: Biology of PTSD

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Wednesday, June 23rd, 2010

Epigenetic Changes Linked to Post-traumatic Stress Disorder

Most people who live through a traumatic event don’t develop Post-traumatic Stress Disorder (PTSD).  Knowing what differentiates those who do from everyone else could provide valuable leads for prevention and treatment.

In a recent study described in Science News, researchers discovered that people who suffer from PTSD have more genetic changes to their DNA than those who don’t.   It’s not clear, however, whether these alterations resulted from the trauma or predisposed individuals to develop a symptomatic response to it.

DNA is not immutable.  Genes can be altered through a process called methylation whereby a methyl molecule gets tacked onto a gene, limiting the gene’s ability to do its job.  Environmental factors can impact genes in this way.

One type of change to the PTSD group’s DNA involved less methylation in certain immune system genes, supporting previous research that implicated PTSD in immune system dysfunction.  Conversely, certain genes involved in brain cell growth showed increased methylation, which would inhibit production of proteins necessary for brain  functioning.

How these changes relate to PTSD and how they get expressed in the body still remains a question that hopefully future research will answer.


News Item: Animal-Cruelty Syndrome

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Friday, June 18th, 2010

Domestic Violence & Animal Abuse:  A Vicious Cycle

In a violent home, the family pet can become one more target—threatened, beaten, killed or disappeared.  One more way for abusers to exercise power and control over the household, animal abuse leaves its mark on not just the immediate victims but also on the children who witness it.

In a recent report in the Sunday Times Magazine, Charles Siebert gathered together some of the latest research and thinking on the subject of animal cruelty, describing a continuous loop that, once begun, cycles through domestic violence and animal abuse to children’s abuse of animals to criminality and back again to domestic violence.

Research sited in the article, The Animal-Cruelty Syndrome, revealed that households with child abuse, while containing far more pets than others in the same community, had very few pets older than two, the result of a high turnover rate;  animals died, were discarded or ran away, not unlike what can happen to children in the same situation.  Similarly, 90 percent of families with spouse and/or child abuse showed evidence of animal cruelty.

Of particular interest was the finding by a 1995 study that “…nearly a third of pet-owning victims of domestic abuse…reported that one or more of their children had killed or harmed a pet.”  Literature on hard to place young children from abusive households has described youngsters who set fires, attack other children and harm animals, behaviors categorized as “abusive reactive” in the article.

Children do what they know, emulating the actions of those around them.  When adults have carte blanche to rage, hit and murder, children learn to deal with their feelings in the same ways.  To accomplish that, they often have to cancel their naturally occurring empathic feelings—to kill their empathy to survive emotionally.

Unable to rescue their beloved pets, children have to stop caring, which they do by disconnecting from their loving feelings.  To gain some kind of control over the situation, and perhaps to get it over with for once and for all, they might even kill the animals they love.  Or they behave cruelly to animals in an attempt to gain mastery over their own vulnerability, as if to prove their pets’ pain no longer affects them.  Similar processes might be operating in the development of antisocial personality disorder, the hallmark of which is an absence of conscience.  Brutalized children often grow up to become antisocial adults engaging in criminal behavior.

These children are also prone to self-injury, the motivation for which might be to test the limits of their sensitization, as suggested by one of the researchers interviewed for the article.  But self-injury is also present in children who have been incested and has many other functions, including to feel something and/or not feel anything (dissociation).

In research that used brain imaging on older adolescents with “aggressive-conduct disorder” and an age and sex matched control group, videos were shown of accidentally experienced or intentionally inflicted pain.  While fMRIs (functional magnetic resonance imaging) of both groups showed similar activation of their empathic neural circuitry in response to the accidental pain (with some conduct-disordered boys showing more), the aggressive boys responded to watching intentionally inflicted pain with heightened activation of the reward center of the brain.

Studies have already determined that this reward center is activated when witnessing punishment of wrongdoers (see blog entry Brutality & the Brain).  Perhaps these aggressive boys enjoyed identifying with the aggressor in the videos, preferring the role of power associated with hurting another person rather than that of victim.

The good news comes from the treatment sector, where other brain imaging studies reveal that empathy can be fostered, perhaps more readily in younger children but still possible later on because of the brain’s plasticity.  Children open up to animals in ways they won’t with humans.

The opportunity to take care of horses, like in the increasingly used equine therapy, or to teach a dog tricks, provides an experience of a different kind of mastery.  Rather than the immediate gratification of running after birds to make them scatter, these programs attempt to teach the participants a kinder way of relating to animals, which will hopefully, over time, translate into a kinder way of relating to their own pets and their own children.


News Item: Neuroscience

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Friday, May 28th, 2010

Immutable Memory:  Research Challenges Long-Held Beliefs

Most people believe in the permanence of long-term memory, especially recollections of significant events, personal or shared—the kind that usually begin with “I remember where I was when…” and include assassinations (Kennedy, King, Lennon), tragic accidents (the space shuttle explosion) and deliberate acts of destruction (the World Trade Center).  Referred to as flashbulb memories, these have always seemed indelibly etched in the brain like a snapshot of a moment in time.

New research suggests otherwise.  In the May 2010 issue of Smithsonian magazine, Greg Miller in his article “Making Memories,” describes the work of Karim Nader who, after discovering that his own memory of September 11, 2001 included television footage from the following day (of the first plane hitting the north tower), began to wonder whether recalling memories altered them.  Support for his questions about the infallibility of flashbulb memories came in a 2003 study that found that 73 percent of the sample group (569 college students) had the same misperception about when they saw the first plane hit.

In the process of experimenting with memory (in rats, and later replicated in other species including humans), Nader found evidence that even a long-term memory could be disrupted by recall.  The more frequently it was remembered and retold, the more vulnerable it was to alteration.

In the brain, communication between neurons (of which there are over 100 billion) is facilitated by neurotransmitters.  These chemicals, produced by brain cells, are released into the synapse, the gap between the neurons, to be picked up by receptors on another neuron.  In the creation of short-term memory, the changes to neurons and their connections are much simpler than for long-term memory, which requires far more neurotransmitter production and the generation of additional receptors.

When a long-term memory is thus encoded, it has been consolidated and long thought to then be permanent.  Nader’s research (along with others’) suggests that reconsolidation of memories can occur under certain circumstances of recall.

Those who struggle to believe their often fragmented and dissociated memories of childhood sexual abuse might take this to mean now they really can’t trust those terrible feelings in their bodies and all their symptoms of Post-traumatic Stress Disorder–those reactivations of the original horrors.  Although some details might have changed in the telling, the essential nature of the original event, that the first plane did crash into the north tower, remained immutable.

In fact, this new conceptualization of memory has led to some hopeful experiments with trauma survivors.  Alain Brunet, a psychologist, had his own close enough experience of a life-threatening situation when a gunman killed 27 people before taking his own life on the campus where Brunet was studying (though he was not in the immediate vicinity).  Inspired by it to study traumatic stress, he has been looking into whether traumatic memories, or at least the distress they cause, can be ameliorated chemically.

Using propranolol, a blood pressure medicine known to produce memory loss by interfering with the production of norepinephrine (a neurotransmitter active in memory consolidation), Brunet had subjects listen to their previously written scripts about incidents (sexual abuse, assaults and car accidents) that occurred ten years before the experiment.  Those who took the medication as compared with those who took a placebo had measurably reduced levels of physiological arousal.

Those subjects who took propranolol and read their scripts weekly for the next six weeks experienced a 50% reduction in their PTSD symptoms.  Long after the effect of the drug wore off, they continued to enjoy a reduction in flashbacks and nightmares.  The memory remained but lost its disruptive impact on their lives.  A traumatic memory seems to have been reconsolidated into an ordinary bad memory offering support for the hypothesis that “recalling memory opens it to manipulation.”

A technique like EMDR that often elicits a powerful reexperiencing of the traumatic event, albeit in a condensed form, might owe some of its effectiveness to memory reconsolidation.  After telling their story, people often come to a different understanding about its meaning.  Sometimes, several weeks later, they will describe how a related negative belief about themselves has been replaced by a positive one.

More research remains to be done, of course, to replicate the propranolol study with other subjects, especially those who suffered family-based trauma during the critical developmental years of childhood.  But it does begins to offer hope for sexual abuse survivors that the very thing they fear about their memories, that they are unreliable and mutable, may end up being the source of relief from their distressing symptoms.