May 21, 2014

Hijacked :: Hope for Healing

by , in
Even though CSA puts one at risk for a long list of psychological challenges, many children are so resilient that they never develop PSTD or any psychiatric condition. Support during times of trauma may provide a buffer to the effects of severe stress response: "When rescued from extremely neglectful and abusive environments, some profoundly developmentally delayed maltreated children were capable of accelerated rates of catch-up growth, including remission of severe psychopathology and normalization of cognitive function.” Loving families, cognitive behavioral therapy, and medications may all help to lessen the effects and symptoms of PTSD, depression, and the like.[1] Apart from these more obvious mitigation activities, there may be additional actions one can take to help her hurting brain. Just as martial-arts is known to combat anger and reduce aggression, less obvious forms of treatment may offer solutions. There are several actions one can take to promote mental health. Thomas R. Insel is an American neuroscientist and psychiatrist who has led the National Institute of Mental Health since 2002. He says the following:
“Over the past two decades, neuroscience research has transformed our understanding of the brain. Three insights have been fundamental. First, we now recognize the brain as a dynamic organ, capable of remarkable changes in how cells are connected and even in the number of cells available throughout life. Second, we recognize considerable individual variation in the relationship between brain anatomy and function. Classic maps of the cortex with specific areas for motor and sensory fields are still useful but only as a broad generalization that varies greatly across individuals. And finally, we now appreciate a stunning level of modularity in the brain, with circuits dedicated to highly specific functions, such as verbs versus nouns or animate versus inanimate objects.”
The high complexity of the brain provides much hope.

If there’s a Will, is there a Way?

Genetics predispose us to develop in a particular way, but it is our experiences, positive and negative, that greatly influence how those predispositions are uniquely expressed. It turns out that both are required for ideal development of the human brain.[2] Nature vs. nurture is a term that was long ago coined due to an ongoing popular debate. Researchers have long argued the importance of one’s inherent qualities (nature) compared to one’s personal experiences (nurture) in causing unique physical and behavioral characteristics. In other words, if we take the top-down approach to break down the elements that feed into a particular outcome or expression, we’ll find that both a person’s predispositions (genetics) and environment (circumstances) both play a role, and virtually all features within a person can be explained as such. Whether predisposition or environment is the greater influence is the argument that often arises. For example, in the book Quiet, Susan Cain argues that we can stretch our personalities but only so much. While such characteristics can be altered to a degree thanks to free will and environmental differences, they are inherent within us and cannot altogether be changed. Cain summarizes research that suggests something important: “we can stretch our personalities, but only up to a point.” Perhaps what is more important is the interaction between genetics and experience.

Nancy Talbot of the University of Rochester Medical Center and her colleagues examined the relationship between specific dimensions of CSA and personality traits in adulthood. Their findings suggest that there are associations between personality traits and CSA characteristics in psychiatric patients. More specifically, women who experienced intercourse by a parent may be more introverted and less open to experience than women whose sexual abuse history does not include parental incest.[3]

Reduction in gray matter volume in certain areas of the brain may present a preference for alternative facial perceptions. The team of Harvard researchers has thought that this may explain why some patients have learned to see unclear expressions as signs of anger. Cain explains that the amygdalae of introverts tend to be more sensitive to unfamiliar faces, emotions, art, and even various types of stimuli such as caffeine. These additional facts make it difficult to determine the exact origin of personality traits such as high sensitivity. Regardless of the basis for possessing various personality traits, do we have a say in the person we become? In reference to past sexual abuse, Carl Jung once said, “I am not what happened to me; I am what I choose to become.” We cannot control that which is outside of ourselves—abuse, neglect, maltreatment, betrayal—but perhaps we can choose who we become.

In a study involving college undergraduates, psychology professor Dolores Albarracín and her colleagues had students write either the words “Will I” or “I will” 20 times. Students who wrote “Will I” performed better on an anagram task versus the students who wrote “I will.” Contrary to what we may expect, the declarative form of thinking (I will) didn’t win. In other words, this will I-type thinking “may elicit more intrinsically motivated reasons for action, resulting in goal-directed behavior.”[4] A possible explanation for these results lies within choice. “Will I” allows one to respond with yes or no, meaning if action is taken, it arises as a result of increased internal motivation and a desire to complete the task at hand.

In the same way, “must,” “have to,” and “should” ways of thinking aren’t nearly as beneficial as acknowledging the choice. For example, say I’m unhappy with my current job, so I begin to search for other available positions, yet after searching, I find nothing else worth pursuing. So I make the choice to remain in my current position. I am much more likely to be content in my job if I give myself the option as opposed to feeling imprisoned. Likewise, healing—even general change—isn’t required.

One may acknowledge that difficulties in her past clearly have affected the person she’s become; she may also appreciate those differences. For example, the introversion that may have initially evolved as the result of trust issues may actually prove to be a desirable acquired “skill.” Perhaps the abilities to self-reflect and slow down are advantageous. Maybe the scanning of one’s surroundings that once seemed to be an embarrassing nervous act now helps to protect oneself and children. At the very least, hopefully one can acknowledge the endurance she’s attained as a result of her pain, yet if the will exists to change, there must be a way. 

Change Blossoms from the Ground of Self-acceptance

Carl Jung once said, “We cannot change anything until we accept it. Condemnation does not liberate, it oppresses.” We begin by learning to accept our sinned against selves, acknowledging that what happened was outside of ourselves. More importantly, it’s important to note that CSA is a harm that affects not only the brain and the body but also the spirit and the lies we believe. Actively engaging in the war against unforgiveness and lies is an absolute must is one hopes to heal. These spiritual matters must be addressed. Wholeness is moving towards God in addition to knowing and accepting all I am. It means rejecting values and behavior which are inconsistent with the goal! 

Recognize Self-worth

According to World Health Organization (WHO), “in young people, depression and low self-esteem are linked with smoking, binge drinking, eating disorders and unsafe sex, putting them at risk of a range of diseases including sexually transmitted diseases […]” An individual’s emotional resilience, her ability to manage her thoughts and feelings, is associated with self-esteem. And it's all in the attitude. According to WHO, “Many studies since the 1950s support the idea that medically ill patients with negative attitudes have worse outcomes than those with more positive attitudes.” More recent studies show that those who are optimistic have lower death rates from conditions like heart disease. [5] 

Develop a Sense of Belonging

Family, friends, culture, country, and even the world—belonging is a universal desire. Motivation, happiness, and even health are linked to our sense of being a part of a greater community. There are plenty of opportunities to feel out of place.

(1) Anger, bitterness, unforgiveness, and /or lies are flourishing. Someone or a group of people have sinned against you and you carry this with you today. You may not even be consciously aware of your thinking process, but you’re convinced that others will repeat this. Let’s say someone decided against being your friend in the past because she felt like she couldn’t relate to your past. A past invalidation may stick with you if unforgiveness is harbored. You may believe that others feel this very same way about you without ever hearing the same words come out of their mouths. And perhaps the people you’re around are feeling the very same way you do. They’re cautious, maybe just as afraid to approach you. Maybe someone has also hurt them in the past, leaving them to assume that you’ll do the same. (2) Miscommunication is taking place. Someone or a group of people currently appear to not understand, validate, and/or care to hear about you or your past. Maybe the people you’re around are thinking and feeling nothing but wonderful things towards you, but they don’t know how to communicate this to you in a way that you’ll understand. Even small things can make us feel out of place. Jokes aren’t shared. Smiles aren’t returned. Interests aren’t common. (3) Unfortunately, a difficult situation is taking place. Someone or a group of people currently do not understand, validate, and/or care to hear about you or your past. People are sinners and are currently sinning against you, which is obviously unfortunate. One must be careful to see that the current situation doesn’t also lead to (1) and/or (2). As Christians, we must understand the spiritual war that is taking place. There are many reasons why Satan and his demons want us to feel as if we don’t belong.

(1) Isolation makes it easier for Satan and demons to attack and feed us lies. The lone sheep is sought after over the herd. Weak, secluded individuals are easier to deceive because they’re already deceived if they’re isolated. At the same time there’s less influx of truth due to a lack of friendships or community in general. (2) Isolation is a selfish act. Proverbs 18:1 reads, “Whoever isolates himself seeks his own desire; he breaks out against all sound judgment.” Isolation is selfish because it is based out of fear. Isolation is a protective, unhealthy self-preserving action. (3) Feelings of not belonging with other Christians point to feelings of belonging to the world by default. If we feel we belong to the world, we will act as if we belong to the world, but we must remember what John 15:19 says: “If you belonged to the world, it would love you as its own. As it is, you do not belong to the world, but I have chosen you out of the world. That is why the world hates you.” (4) Feelings of not belonging point to a lack of union with Jesus and the church. If we don’t belong anywhere, we don't belong in the body. We must remember what 1 Corinthians 12:12 says: “For just as the body is one and has many members, and all the members of the body, though many, are one body, so it is with Christ.” When we see all the reasons why Satan doesn't want us to belong, we’re more apt to consider that feelings of not belonging are often based on lies. Once the lies are acknowledged, there are several truths for the Christian to mediate on to create more feelings of belonging.

(1) Focus on knowing others’ stories. F. Scott Fitzgerald once said, “That is part of the beauty of all literature. You discover that your longings are universal longings, that you're not lonely and isolated from anyone. You belong.” If we take the time to get to know others’ stories, we’ll be less apt to think of ourselves so much. We’ll probably find that even if the details of someone’s life are different, they feel or think similar things. At the very least we can count on having our faith (and the struggles that come along with it) in common with other Christians. (2) Share your story. If we share our stories, they don’t have as much power over us, especially if they seem extreme, difficult, and “too much” for other people. Be vulnerable. Such stories are encouraging to others. This will broaden others' perspectives and help us to feel we have something to offer others—a testimony of God’s grace and love. And who knows, there are probably people in the room who have also gone through difficult things and are perhaps afraid to share them. (3) Release past bitterness and anger. We do this by focusing on Jesus and the forgiveness we have. We ask God to cleanse us of past wrongs and help us to discern which specific community we should be involved in. (4) Focus on belonging to God. He purchased us through Jesus. If we belong to the beautiful, perfect, loving, just God of the universe, how can we not belong with other Christians (who also belong to the God of the universe)? (5) Think of eternal belonging. We don’t belong in this world. We are in the world, but we are no longer of the world. There are going to be things about the world that we don’t like, including the sins of our own and other Christians. We’re all on the same (imperfect) journey towards wholeness. We belong with God and will one day be 100% reunited with Him. 

Consider Practical Actions to Promote Cognitive Health

According to Centers for Disease Control and Prevention and the Alzheimer’s Association, the majority of experts agree that healthy cognitive functioning includes health in the following areas: language, thought, memory, the ability to plan and carry out tasks, judgment, attention, perception, remembered skills (e.g. driving), and ability to live a purpose. The following may be associated with an improvement in cognitive health: “engaging in art or creative projects, reading, keeping physically active, playing games or doing puzzles, working, or spending time with family and friends."[6]

WHO defines mental health as “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.” Mental and physical health influence each other over time. The research of WHO has uncovered two primary pathways by which this occurs: (1) physiological systems and (2) health behavior such as sleep.[7] 

Consider Practical Actions to Promote Integration

The Music and Neuroimaging Laboratory (Beth Israel Deaconess Medical Center and Harvard Medical School) hopes to understand how the adult brain adapts in response to changes in the environment. Through ongoing research, another piece of the Music and Neuroimaging Laboratory's mission is to investigate the use of music and musical stimuli as an interventional tool for educational and therapeutic purposes. Gottfried Schlaug, the director of the lab, and his colleague state the following in their research regarding music making and brain plasticity:
Plasticity is a fundamental organizational feature of human brain function. Traditionally, the brain was thought to be hardwired following a critical period in development. However, it is now accepted that the brain has a remarkable capacity to modify its structural and functional organization throughout the life span, in response to changes in environmental input.[8]
Since playing music requires a multitude of sensory input and motor experience, it is thought that playing music can be used as an intervention for neurological disorders. Schlaug found that the musicians he studied have larger anterior corpus callosums compared to non-musicians. (This same area is smaller than controls in CSA survivors, leading to less integration of the two halves of the brain as well as shifts in mood and personality.) Musicians who started training early (before or at 7 years of age) had even larger corpus callosums than those that started later. These results suggest that music playing may promote interhemispheric communication. Enhanced cognitive development, skill transfer, and improved language skills include some of the implications for children. Other research suggests enhanced mathematical performance, even overall higher IQs.

In adults, Schlaug’s findings indicate that training can even lead to structural modifications post-development. Moreover, training may not be limited to practicing music. For example, differences in posterior hippocampi volume have been observed in tax drivers compared to non-taxi drivers.[9] In another study, fMRI was used to examine the brain of music academy students “before and after 2 semesters of intensive aural skills training […] This was also the first study to show that functional plasticity is possible in the adult hippocampus.”[10] The implications for CSA survivors may be increased integration of the brain hemispheres as well as lower risks of dissociative disorders and memory impairments.

It’s possible that Eye Movement Desensitization and Reprocessing (EMDR) therapy may be especially helpful in promoting greater hemispheric integration. The therapy uses bilateral stimulation to promote concentration, relaxation, and adaptation. According to emdr.com, “One of the procedural elements is "dual stimulation" using either bilateral eye movements, tones or taps. During the reprocessing phases the client attends momentarily to past memories, present triggers, or anticipated future experiences while simultaneously focusing on a set of external stimulus. During that time, clients generally experience the emergence of insight, changes in memories, or new associations. The clinician assists the client to focus on appropriate material before initiation of each subsequent set.”[11]

Dr. Uri Bergman is the medical director of the EMDR International Associations. According to Dr. Bergman, “[…] EMDR stimulation (DAS/BLS) may facilitate the activation of the ventrolateral and central-lateral thalamic nuclei, thereby facilitating the repair and integration of somatosensory, memorial, cognitive, and synchronized hemispheric functions.”[12] Left and right hemisphere integration has the potential to improve via activities that stimulate both sides of the brain and require cooperation. According to Teicher, “Cognitive-behavioral psychotherapy, which emphasizes correction illogical, self-defeating perceptions, may work by strengthening left-hemisphere control over right-hemisphere emotions and impulses.” Furthermore, playing a musical instrument, reading,[13] and EMDR therapy (bilateral stimulation through sight, sound, or touch) all appear to help promote integration. EMDR in particular seems to help by soothing the patient’s limbic response to the stress of the memories.[14] 

Conclusion

We do not have the option in this lifetime of removing the cancer altogether. The effects of sexual abuse are very real, and we know more today than ever the nature of those effects. The damage occurs on a very fundamental level, meaning the anatomy and physiology of an abuse survivor undeniably differs from that of someone who suffered little to no disturbance during her upbringing. Praise God that one day all will be made new and no longer will we feel these effects of sin.

The acceptance of Jesus is the ultimate antidote. Perhaps the efforts to heal in this life can only be termed acute treatments. Our search for a cure in this sense can be compared to treatments for cancer. Pain, time, money, and energy will undoubtedly be expended with the knowledge that the cancer may not be cured. And if and when healing comes, a scar remains. Part of the solution does lie within one’s ability to view that scar tissue as thick and durable—something that develops perseverance and builds character—rather than an unsightly wound. At the same time, we ought to continue to pursue healing, knowing that it will one day be made complete. Moreover, "to confront madness as a potentially transformative experience takes courage." Use the pain for your own good, and for the good of others. 

Additional Resources

The Chemistry of Joy WorkbookMy Father's Shadow.

[1] De Bellis MD, Spratt EG, Hooper SR (2011): Neurodevelopmental Biology Associated with Childhood Sexual Abuse. Journal of Child Sexual Abuse, 20(5):548-587.
[2] Shonkoff JP, Phillips DA (2000): From neurons to neighborhoods: The science of early childhood development. Washington, DC: National Academy Press.
 [3] Talbot NL, Duberstein PR, King DA, Cox C, Giles DE (2000): Personality traits of women with a history of childhood sexual abuse. Comprehensive Psychiatry, 41(2):130-6.
[4] Sanay I, Albarracín D, and Noguchi K (2010): Motivating Goal-Directed Behavior through Introspective Self-Talk. Psychological Science, 21(4):499-504.
[5], [7] World Health Organization (2005): Promoting Mental Health: A Report of the World Health Organization, Department of Mental Health and Substance Abuse in collaboration with the Victorian Health Promotion Foundation and The University of Melbourne. World Health Organization.
[6] Centers for Disease Control and Prevention and the Alzheimer’s Association (2007): The Healthy Brain Initiative: A National Public Health Road Map to Maintaining Cognitive Health. Alzheimer’s Association.
[8], [10] Schlaug G and Wan CY (2010): Music Making as a Tool for Promoting Brain Plasticity across the Life Span. Neuroscientist, 16(5):566-577.
[9] Maguire EA, Gadian DG, Johnsrude IS, Good CD, Ashburner J, Frackowiak RS (2000): Navigation-related structural change in the hippocampi of taxi drivers. Proceedings of the National Academy of Sciences, 97:4398–403.
[11], [14] Teicher MH (2000): Wounds That Time Won’t Heal: The Neurobiology of Child Abuse. Cerebrum: The Dana Forum on Brain Science, 2(4).
[12] Bergman U (2008): The Neurobiology of EMDR: Exploring the Thalamus and Neural Integration. Journal of EMDR Practice and Research, 2(4).
[13] St George M, Kutas M, Martinez A, Sereno MI (1999): Semantic integration in reading: engagement of right hemisphere during discourse processing. Brain, 122:1317-1325.
May 16, 2014

Hijacked :: Childhood Sexual Abuse

by , in
No two stories are the same. This statement is perhaps rather obvious, considering the factors that contribute to one’s story and the degree to which each of those factors may vary. The degree of trauma varies widely between individuals as well as the physiological and psychological responses that inevitably follow. The famous statistician George Box once said, “Essentially, all models are wrong, but some are useful.” Though Box was referring to the design of experiments, this same awareness should be remembered when modelling most, if not all, mechanisms and manifestations, especially when those mechanisms involve emotional and psychological responses. Each of us is a culmination of our traits, experiences, beliefs, and thoughts. We are a result of our nature as well as the way we’ve been nurtured. Some of these traits may be quite inherent while others may be a direct result of our upbringings. And while a patterned connection between our abuse experiences and our reactions may exist, variations in those reactions are certainly expected.

A dynamic model may be used to illustrate many of the potential outcomes and the pathways by which they come, namely the original concept model developed by the University of Southern California.[1] In their longitudinal research the authors identify what I like to call inputs—factors that influence the degree of trauma experienced. These inputs include the type(s) of abuse, duration, frequency, relationship to the abuser, the age and gender of the abuser, physical force or threats, and the age of onset. Additional factors may include telling or no telling, added effects of additional trauma(s), institutional response, and any other relationship(s) involved at the time of the abuse including parents’ reactions to the abuse.

The Child Welfare Information Gateway notes the importance of whether or not the child has a dependable and nurturing support figure in his or her life at the time. Most of the time, women aren’t abused by someone who “jumped out of the bushes, but by somebody they had a trusting, loving relationship (with),” Stephen Braveman, licensed marriage and family therapist of California, says. CSA experienced at the direction of a parent can lead to greater feelings of insecurity.

Psychological distress (suffering, including the effect to one’s memory) and physiological stress (strain and/or anxiety) are categorized as responses to the abuse factors. It’s no surprise that an abused child will focus her brain on responding to threats and mere survival. Such a focus can lead to a cascade of effects. Justin and Lindsay Holcomb sum up these effects in their book, Rid of My Disgrace:
Sexual assault causes harmful emotional, psychological, and/or physiological effects that are more severe than the effects of other crimes. These effects include: shame, self-blame, guilt, embarrassment, anxiety, stress, fear, anger, confusion, sexualized behaviors, loss of sex drive, interpersonal problems, denial, irritability, depression, despair, social withdrawal, numbing/apathy (detachment, loss of caring), chronic and acute somatizing (experiencing of physical symptoms in response to emotional distress), feelings of isolation and alienation, restricted affect (reduced ability to express emotions), nightmares, flashbacks, headaches, difficulty concentrating, diminished interest in regular activities, negative self-image, loss of self-esteem, emotional shock or numbness, erratic mood swings, feeling powerless, disorientation, OCD, panic attacks, body memories, loss of security, confusion with sex and love, extreme dependency, impaired ability to judge the trustworthiness of others, various phobias, hostility, aggression, change in appetite, suicidal ideation (thoughts of suicide and death), hyper vigilance (always being “on your guard”), insomnia or other sleep disturbance, decreased energy and motivation, exaggerated startle response (jumpiness), eating problems/disorders, self-mutilation (cutting, burning, or otherwise hurting oneself), sexual dysfunction (not being able to perform sexual acts), sexual effects (ranging from avoidance to compulsive promiscuity), hyper arousal (exaggerated feelings or responses to stimuli), inability to concentrate or focus, feeling uncomfortable being alone, gastrointestinal disturbance, substance use and abuse (alcohol and other drugs) and other compulsive behaviors, shock, impaired memory, and post-traumatic stress disorder (PTSD).[12]
These effects can be considered to be the consequences of CSA at a high level, but if we dig deeper, we’ll later find that the changes occur at the physiological and psychological levels.

Family and peer support in addition to pubertal stage are included as modifiers, and the potential outcomes include items that alter one’s social competence as well as one’s psychopathology. Specific outcomes may lie within the following areas: cognitive, social (difficulty trusting and saying no/maintaining boundaries in relationships), self-esteem, control, depression, anxiety (fear), dissociation (splitting the mind from the body), and hypersexuality. Effects not yet mentioned may include those that are a result of the items in the previously stated list, for example, sleep disturbances and self-harm.

Martin Teicher of Harvard Medical School, also confirms this list of effects. “We know that (lab) animals exposed to stress early in life develop a brain that is wired to experience fear, anxiety, and intense fight-or-flee reactions,” says Teicher. “We think the same is true of people.” Teicher’s research shows that growth in certain areas of the brain is stunted as a result of sexual abuse (possibly also as a result of verbal and other types of abuse). Other research has revealed that the brains of abuse survivors exhibit electrical irregularities similar to the brains of those with epilepsy, which is commonly characterized by seizures. Teicher says, “It’s puzzling. Childhood abuse can produce abnormal electrical brain activity that resembles a seizure state, but does not actually produce epilepsy.” Researchers have known that these abnormalities exist in incest victims for thirty-five years. What goes on inside of a survivor that could generate such a bizarre response within her brain?

It’s long been believed that children simply repeat and reenact what they see and hear. When parents are emotionally distant, it isn’t surprising that children tend to repeat the actions of the parents with their own children, yet some issues may be much more complex than a simple passing on of negative behaviors. Anatomical and functional changes occur in the brain when a child is exposed to adverse events.[2] Chemical and structural changes can be detected by relatively new technologies such as fMRI and PET among others.[3]

Often the abuser lives inside the home. If incest or neglect occurs, the child may suffer from a disrupted attachment process, which may lead to more susceptibility to stress, excessive dependency or isolation, and an inability to control emotions. If the child cannot obtain a feeling of safety and security with her caregiver(s), the attachment may be insecure or anxious.[4] Repeated negateve child-parent interactions effect the child’s perception, leading to unique emotions, perceptions, and behaviors. Another study suggests that duration of the abuse by a closely related individual matters more when it comes to memory impairment, whereas age of onset, number of abusers, or duration of abuse by another, less closely related individual were not more strongly linked to memory performance.[5]

Those with a history of sexual abuse are twice as likely as non-abused individuals to exhibit these abnormal electrical activities.[6] In other words, the biggest post-abuse issue is arguably the survivor’s mental health. According to Dr. Berman, the long-term tangible effects of childhood sexual abuse may include the following: Poor body image because the body was the instrument used during the sexual abuse; feelings of shame, guilt, isolation, depression and low self-esteem; sexual confusion or promiscuity as a result of not dealing with the emotions and feelings surrounding the abuse; confusing rape or sexual abuse fantasies; eating disorders, obesity and anorexia; drug abuse and alcoholism; poor decision-making in relationships; difficulty with intimacy; and self-destructive or even suicidal behavior. In fact, those with epileptic-type electrical irregularities appear to be more likely to be suicidal. A strong correlation exists between these irregularities and thoughts of suicide. Individuals whose brains display this kind of activity are four to five times more likely to consider suicide. And this correlation may be even stronger than the link between suicide and depression.[10]

The Merriam-Webster dictionary indicates that body image is a “subjective picture of one’s own physical appearance established both by self-observation and by noting the reactions of others.” Poor or negative body image is defined as an intellectual or idealized image of what one’s body is or should be. Body image is a mental idea, meaning it really is “all in our heads.” One’s perception of her own body is so intricate and bizarre in that no part of her perception may actually involve a single ounce of truth. Unfortunately, most women absorb the input from their mirrors, the world around them, and the media perhaps in addition to messages received due to past sexual abuse to determine just how well they measure up. Modern-day media and unrealistic cultural expectations have cultivated an environment in which body image distortion is nurtured. This distortion is a brain condition where the individual is unable to view her body accurately in the mirror. Features and size are distorted. What happens when sexual abuse is added to the list of inputs? When it’s mistreated me against the world and the media?

Eating Disorders Review concludes, “Those who have undergone sexual trauma have a more negative perception of their own body.”[7] Furthermore, an article in NCBI (National Center for Biotechnology Information) found that “Specific forms of childhood maltreatment (emotional abuse, sexual abuse) were significantly associated with body dissatisfaction. These results highlight self-criticism as a potential mechanism through which certain forms of childhood maltreatment may be associated with depressive symptoms and body dissatisfaction in patients with BED (Binge Eating Disorder).”[8]

It seems that the most tangible consequences of sexual abuse can be summed up (at a very high level) as distorted views of self, sex, and the world. Self-destructive behavior, confusion, shame, depression, anxiety, and difficulty with intimacy (potentially leading to dissociation) flow downstream from poor body image.

An abused child was presented with a logic game she seemingly could not win. The result? Sex becomes nothing or everything post-abuse. A survivor may shun sex in an attempt to protect herself from facing further damage to her worth, or sex and sex appeal may be pursued at all costs in attempt to gain or maintain worth. Braveman says, “They (abuse survivors) typically wind up with splitting behavior, where things become very black and white. Either they are very sexually active, or they shut down sexually.”[9] Those who become highly sexually active tend to dissociate (mentally and emotionally remove themselves) from the body during sex. The cables that connect the heart and the mind are severed during the act, meaning she goes through the motions absent of feeling.

In general, it appears that each survivor is presented with a fork in the road. In general, she either swears off all sexual activities, deeming them dirty and destructive in all contexts, or she vainly embarks on an endeavor to master the evil practice of it. Sex becomes only the means to an end, and sex appeal becomes a definitive quality. She may even believe that if she gives sex, no one can take it from her again. In this way, she may aim to attain “control.” Yet if we peel back the layers further, research may provide another explanation. Vasopressin has been found to enhance attention, learning, and memory, and research indicates that oxytocin may be a critical aspect of “love, maintenance of monogamous relationships, and normal non-sexual social interactions. In rats, Teicher says that early stress leads to a life-long increase in vasopressin levels and decrease in oxytocin levels in the thalamus. If this is true for humans, abused individuals therefore have a reduced ability to experience a reduction in stress due to non-sexual contact. They also may not be as likely to experience sexual fulfillment, and they may have difficulty committing to a single partner. In fact, developing stable relationships may be one of the most challenging aspects of recovery. “To the brain so tuned, Eden itself would seem to hold its share of dangers: building a secure, stable relationship may later require enormous personal growth and transformation.”[10]

One may also seek to have control over her performance in other areas of her life, which can very well lead to perfectionist tendencies. I find it quite interesting that someone who has a black and white sex view would also have a black and white world view. In Healing the Hurt Within, Jan Sutton says, “Perfectionists often think in black and white terms, either something is right or wrong, flawed or a failure—there’s no middle ground or room for shades of grey.” At the base of perfectionism lies the belief that one must or should be perfect. In turn, the low self-esteem cycle perpetuates. “The drive to succeed, to be the best and to avoid mistakes at all costs is limiting at best, crippling at worst…Perfectionism breeds low self-esteem, because the perfectionist rarely lives up to his or her standards of performance, leaving the perfectionist feeling like a failure.”[11]

What’s even worse, neglect and abandonment often go hand-in-hand with CSA. Neglect can be thought of as an overall lack of stimulation, i.e. a failure to meet a child’s physical, emotional, cognitive, or social needs. Researchers use the term global neglect to refer to the disregarding of needs in more than one area. Those areas may include language, touch, and interaction with others.

The difficulty that these effects present is that CSA prompts the child to anticipate only wickedness from the world. In other words, the child may actually have difficulty operating when the world instead presents her with kindness, nurturing, and all around goodness.

These effects are some of the most tangible ones—they can be seen in plain sight. But what’s really going on inside? If we’re considering the effects of abuse using a top-down approach, the previously listed effects are the fizz bubbles that rise to the top and are most easily seen. However, the real changes within an abused child lie within her neurochemical systems and brain structures. We'll examine these changes in the following chapter.

[1] Trickett PK, et al (2011): “The impact of sexual abuse on female development: Lessons from a multigenerational research study.” Development and Psychopathology, University of Southern California.
[2] De Bellis MD, Keshavan MS, Clark DB, et al (1999): A.E. Bennet Research Award. Developmental traumatology. Part II: Brain development. Biological Psychiatry. 45(10):1271-84.
[3] McCollum D (2006): Child Maltreatment and Brain Development. Clinical and Health Affairs.
[4] Understanding the Effects of Maltreatment on Brain Development (2009): Child Welfare Information Gateway.
[5] Navalta CP, Polcari A, Webster DM, Boghossian A, Teicher MH (2006): Effects of Childhood Sexual Abuse on Neuropsychological and Cognitive Function in College Women. Journal of Neuropsychiatry and Clinical Neurosciences, 18(1):45-53.
[6] Cromie WJ (2003): Child abuse hurts the brain. Harvard University Gazette.
[7] Trauma’s Effect on Body Image: Sexual trauma can lead to a more negative body image, especially among women (2010): Eating Disorder Review, Gürze Books, 21(4).
[8] Dunkley, DM, et al (2010): Childhood Maltreatment, Depressive Symptoms, and Body Dissatisfaction in Patients with Binge Eating Disorder: The Mediating Role of Self Criticism.” National Center for Biotechnology Information, The International Journal of Eating Disorders, 43(3).
[9] Thompson D (2013): The Aftermath of Childhood Sexual Abuse. Everyday Health Media, LLC.
[10] Teicher MH (2007): Child Abuse, Brain Development and Impulsivity. MASOC/MATSA Joint Conference. Marlboro, MA. 12 April 2007. Keynote Address.
[11] Pitts L (2013): Perfectionism Facts. LifeScript. <www.lifescript.com>.
[12] Holcomb J and Holcomb L (2011): Rid of My Disgrace. Crossway.
May 14, 2014

Hijacked :: The Developing Brain

by , in


As a fetus develops, neurons are formed and then move to different parts of the brain. The more basic areas of the brain are shaped followed by the more sophisticated areas. The brainstem and midbrain are the first to develop, seeing as they govern the most basic functions like breathing. These autonomic functions can be thought of as automatic—we don't need to consciously tell our lungs to take in air or instruct our stomachs to churn our food. In fact, when a baby is born, she has a nervous system that is very well developed, yet regions such as the limbic system and the cerebral cortex are present yet largely undeveloped.[1] The limbic system—the amygdala, hippocampus, cingulate gyrus, thalamus, hypothalamus, and parietal cortex—is a collection of more complex structures responsible for emotion, behavior, motivation, long-term memory, and smell and is particularly vulnerable to adverse events in childhood,[2] whereas the cerebral cortex plays a key role in memory, attention, perceptual awareness, thought, language, and consciousness. These regions will develop later in life. Experience helps to govern which neurons will stay and which will go. Experience will assign priority to certain connections, whereas others will be more passive. Select synapses will become strengthened, whereas others will be discharged.

Chemical messengers such as neurotransmitters transmit information between neurons and cells. This messaging system also makes it possible for young babies to be more than capable of breathing, eating, sleeping, seeing, smelling, making noise, and sensing touch, yet they are highly incapable of regulating their emotions and engaging in abstract thought until much later in life.

When a baby is born, she has just about all the neurons that she'll ever have. According to the Child Welfare Information Gateway, "Brain development, or learning, is actually the process of creating, strengthening, and discarding connections among the neurons; these connections are called synapses." While a baby has roughly 100 billion neurons at birth, she is born with very few synapses between these neurons. The only synapses (along with the amount of myelin, a fatty insulation tissue that ensures clear transmission across the synapses) she does have are the most basic ones, those that dictate the most essential functions needed to simply be alive.[3] Furthermore, that baby's memory is also most basic. She is born with only her implicit memory, meaning she can perceive and recall memories via unconscious means. For example, the baby can recognize her own mother's voice. Explicit, conscious memory is developed around the age of two.[4] Perception development, on the other hand, is a much more complex process.

The Formation of Perception

David Bohm describes the development of perception in the appendix of the book The Special Theory of Relativity. Bohm writes about the research of Jean Piaget, a Swiss developmental psychologist and philosopher known for his epistemological (theory of knowledge) studies with children.

In Stage 1 of perception development, functional aspects are formed. Reflexes develop to fit different aspects of the environment. The environment is recognized by functional aspects, e.g. food to satisfy hunger.

Impulse followed by sensation is learned in Stage 2. This is the beginning of perception. Eventually there is pleasure in the reflexes that are produced. The child discovers that a pleasant sensation is achieved by doing something and she begins to recognize this. Recognition that a past event has been repeated comes first. The ability to call upon this event in the memory comes much later. At this stage there is only the knowledge that a certain impulse will lead to a certain pleasure.

Performance and coordination are then developed during Stage 3. To recognize a similarity is necessary before seeing something as permanent in the flux of process. Early on there is no realization that the object that the child sees is the same as the object that she hears, but later on she learns that there is a coordination. The child can then understand that she sees what she hears. She grasps what she sees.

Patterns are then recognized in Stage 4. There is still no notion of permanence. In the total flux of experience, she can now recognize a certain pattern. These combinations itself are experienced as totalities. The object is not recognized outside its normal context. The child finally begins to develop a perception for what isn't considered to be normal in Stage 5. When the child can follow a moving object with her eyes, she is able to recognize the invariance of its form despite its movement. She is building up the reflexes to perceive objects apart from their normal context.

By stage 6, the child learns that something can be undone by a second operation. However, she doesn't understand yet that an object exists when she doesn't see it. The child isn't yet able to see herself as separate from the world. Then the child sees the relationship between cause and effect. The child begins to recognize other people, animals, and objects as the cause of things that are happening in Stage 7.

During stage 8, coordination of visual with tactile and movement is learned. The notions of space and time are being built. When the child handles objects and moves her body, she learns to coordinate her changing visual experiences with the tactile perceptions and bodily movements. During Stage 9, the notion of permanent places and objects is developed. At this stage he discovers that he can always return to a place in many different ways. There is the notion of permanent places and permanent objects.

Stage 10 includes the beginning of memory. The child learns to call upon images from the past. There is now a difference between past and present. The child will soon be able to perceive that there is a future when she starts to form mental images of what she expects. The formation of an image of an absent object occurs during Stage 11. The child is able to form an image of an absent object.

By Stage 12 the child can form a mental image of the world, with both perceived and unperceived things. She is able to create or produce something. She is then able to distinguish herself from the world in Stage 13. Because of the ability to create a mental map of the world (the ability to imagine), she sees places that are occupied by permanent objects. One of these "objects" is herself. She can perceive other people as well, meaning a general picture of the world is formed. At this point the child finds it difficult to distinguish between what is imagined or remembered in thought and what is actually perceived through the senses.

During Stage 14, the mental map becomes reality. What we see often depends on what we know about it. We learn to see the world through a certain structure of ideas. We react immediately to each new experience before we have time to think. We may even believe that certain (other) ways of perceiving the world aren't possible when in reality our perception is what we discovered and build when we were children.

Perception is translated into language during Stage 15. This stage is about translating the perception of the structure of the world in thought and language. This is very confusing as the ideas and words often contradict what is perceived. This learning is quite gradual. Finally, during Stage 16, the need arises for logical thought. She wishes to reflect on the structure of the world and to communicate with other people. She wants to apply her ideas to a practical problem. This is an ongoing part of development that builds up knowledge and understanding of the world.[5]

From the perception of being in a state of flux and uncertainty to the structure of a mental map, the development of perception is no simple matter. Throughout the development process, the child learns about relationship. The child becomes certain of endless relationships and those relationships create a mind map—a web of knowledge. Perception boils down to learned causes and effects. As an adult, immediate perception takes on the structures of these maps. In other words, she is no longer aware that the map only represents what has previously been perceived. Think of it as a nerve impulse. When you touch a hot stove, sensory nerves send an impulse up to the brain telling you that it's hot. It hurts. Move your hand! Similarly, I experience a "reflex" when I observe certain things.

In his book The Developing Mind, Daniel Siegel defines the mind: "A core aspect of the mind is an embodied and relational process that regulates the flow of energy and information."[6] This definition helps us to understand perception, experience, and the energy that flows between them. Because of this, the mind—including perception—can be thought of as a series of processes rather than a discrete object within us. In more tangible terms, the structure within us—the brain—physically changes and behaves as a function of both experience and genetics, yet there are limitations for structural changes and tendencies within the brain in adulthood. The mind—the lens through which we see the world—however, may continue to grow beyond infancy, childhood, and adolescence. Thus experience may be considered to be objective, for one's experience of something as simple as seeing red may not be exactly the same as another's. 

The Pruning of Synapses

As a child grows up in a (nurturing) environment, her synapses are formed at an incredible rate. At the peak of cerebral cortex development, some 2 million synapses may be created each second.[2] Many of these synapses are strengthened yet many are discarded as part of the normal developmental pruning process.[1] However, that pruning process may occur in excess if the child is deprived of vital stimulation that is neglect can lead to significant loss of synapses.

The synapses that are strengthened can be thought of as snowy paths that are continually trampled upon. With each pass through the pathway, the snow becomes more packed and the pathway more pronounced. By age 3, a child's brain is about 90% of its adult size, the size and growth of the various regions depending on the amount of stimulation they receive. The frontal lobe, the area responsible for reasoning, planning, anticipating outcomes, impulse control, self-monitoring, and self-awareness, experiences a great deal of growth just before puberty. Emotional and sexual abuse can both affect this area of the brain.[7] The limbic system matures throughout adolescence. And the main stages of brain development continue until at least the mid-twenties. (Some doctors, like Dr. Nemeroff of the University of Miami, say that the brain doesn't fully develop until age 23.)

Even though by the time a child reaches the adolescence stage roughly half of her synapses have been eliminated, brain development lasts a lifetime. How else would we continue to be able to learn, remember things, and adapt to changing environments?[8] This ability to change in response to repeated stimulation is known as plasticity, and plasticity is dependent on the developmental stage and region of the brain.[9] That's why it's common for us to comment on how we wished we'd learned certain activities while we were young, because then the learning would've been much easier. Cortex plasticity lessens as one gets older, but it's forever malleable to some degree. As said by Dean Buonomano, a professor of Behavioral Neuroscience and Neurobiology and member of the Brain Research Institute at UCLA, back in 1998, "It has been clear for almost two decades that cortical representations in adult animals are not fixed entities, but rather, are dynamic and are continuously modified by experience."[10] This fact suggests that sexually abused and/or neglected children may be able to make up for their negative experiences later in life, but it might be more difficult. The key takeaway is that infant and childhood experiences dictate the growth and survival of synapses as well as various regulations within the brain.

According to the Child Welfare Information Gateway, "Our brains prepare us to expect certain experiences by forming the pathways needed to respond to those experiences." These preparations equip us and enable us to adapt to our environments. The Child Welfare Information Gateway informative issue goes on to say, "Because the brain adapts to its environment, it will adapt to a negative environment just as readily as it will adapt to a positive one."[3] There's now scientific evidence that childhood maltreatment (abuse as well as neglect) results in altered brain functioning. There's even emerging evidence that there are specific time frames throughout an individual's childhood when the child's brain is more vulnerable to certain experiences.

The authors of Helping Victims of Sexual Abuse write, "Identity formation begins in infancy…If there is a delay in a child's need being met, the child's distress increases. At this point, significant "learning" takes place: A child might learn that needs will consistently be met, needs will inconsistently be met, needs will be met with violence, needs will be neglected or ignored, and/or needs will be sexualized." When a baby's cry leads to comfort, when her tears lead to tenderness, her neural pathways are strengthened. She learns how her physical and emotional needs will be met. When those needs aren't met or they're met with wickedness, the child's brain will reflect this anticipation of harm. These babies learn an entirely different lesson. Their pathways are strengthened under negative circumstances, preparing the children to cope in a malevolent world.

For example, from Barbies to babies, I hated dolls. Never understood the point of them. I preferred the stuffed animals, for what furry friend could ever bring about such negative emotions? At a young age, I knew that playing with people would be difficult, messy. I inherently knew that they weren't nearly as good as the other little girls were making them out to be. And undressing a Barbie for fun? More like re-victimization. I could never do such a thing to her or to me.

These developed (or underdeveloped) brain structures, synapses, and explicit and implicit memories all work together to synthesize instinctive processes. Eventually the child or adult no longer has to think much at all about these happenings, for her brain has finished learning them. And if we've experienced childhood sexual abuse (CSA), we possess memories that may "adversely color our view of the world" throughout our lives. More specifically, childhood maltreatment "has been called the tobacco industry of mental health."[11] Just as smoking increases one's risk for a wide variety of physical diseases, CSA may contribute to a long list of mental illnesses. So the question is, is there any way to maintain a healthy brain or at least "regain" one in a sense?

Clearly prevention of CSA is the optimal choice. According to Mary Dozier, chairman of child development at the University of Delaware, "If we can intervene and change a child's environment, we actually see plasticity in the brain. So, we see negative changes when a child is abused, but we also see positive brain changes when the abuse ends and they are more supported. Intervention can be very effective."[12] Yet the naivety of parents may cost their little one her childhood innocence along with a great deal of her adulthood energy. Parents must be educated and careful, yet often parent are the ones at fault. In the case where abuse has already taken place, the brain has already hopped on the trajectory of damage. Early, consistent, intense intervention is ideal. Signs that a child may have been abused may include: an inability to control emotions, submissiveness, difficulties learning in school, difficulties getting along with other children, unusual sleeping or eating behaviors, attempts to provoke fights or instigate sexual experiences, unresponsiveness to affection, and emotional or social inappropriateness for her age.[3] Yet some of us still find ourselves years later on the other end of a long history of sexual abuse. Is there hope for us too?

[1] ZERO TO THREE (2009): Brain development: Frequently asked questions: Retrieved February 2014, <www.zerotothree.org>.
[2] McCollum D (2006): Child Maltreatment and Brain Development. Clinical and Health Affairs.
[3] Understanding the Effects of Maltreatment on Brain Development (2009): Child Welfare Information Gateway.
[4] Applegate JS, Shapiro JR (2005): Neurobiology for clinical social work theory and practice. Norton & Company.
[5] Bohm, David (2006): Appendix A of The Special Theory of Relativity. Routledge Classics.
[6] Siegel DJ (1999): The Developing Mind, 2nd edition. The Guilford Press.
[7] Sexual and Emotional Abuse Scar the Brain in Specific Ways (2013): Time Health & Family. <www.healthandtime.com>.
[8] Ackerman SJ (2007): The brain in adult life and normal aging—The Dana Guide. <www.dana.org>.
[9] Perry BD (2006): Applying principles of neurodevelopment to clinical work with maltreated and traumatized children: The neurosequential model of therapeutics. The Guilford Press.
[10] Buonomano DV, et al (1998)
[11] Szalavitz, Maia (2013): How Child Abuse Primes the Brain for Future Mental Illness. Time Health & Family. <www.healthandtime.com>.
[12] Schulte, Brigid (2009): New report finds that effects of child abuse and neglect, if untreated, can last a lifetime. Current Psychiatry Reports, 11(1):63-68. <washingtonpost.com>.
May 12, 2014

Hijacked :: An Introduction

by , in
To seize control of a moving vehicle—the brain—by force so as to reach an alternate destination. The adult a child may have become apart from experiencing CSA is someone we'll never meet. The effects are so grave that the person one becomes is at the very least different, if not a world away from who she would've become. This isn't to say that this "alternate version" of oneself is inferior and the other superior. Rather, a child exposed to abuse is forever changed, for the better and the worse.

Hijacked considers how CSA seizes the developing brain, sending it on an alternative trajectory. The book provides a summary of development, the effects of sexual abuse, and the latest brain research using MRI technology. Hope in all forms is also discussed.

Hijacked isn't for everyone as one must be prepared to interact with the toxic realities that CSA presents. Hijacked is written for abuse survivors and counselors in search of an in depth understanding of the effects.

Introduction

Winter, 1913. Fantasies and dreams begin to make their way into small black journals. Failed relationships, emotional distress, loneliness, alienation, and a grand divide between professional obligations and personal aspirations all seem to unite to create a certain lunacy. And unlike many of his peers, the owner of these troubles is more than aware of the need to personally tend to such madness.

As a boy, this deep thinker had a depressed mother and a relationally difficult father who seemed to believe that religiosity and spirituality were contradicting. He was bullied as a boy for his uncanny intelligence, and he was sexually abused as a teenager. Mental health scholar Laura Kerr writes about the nature of such circumstances: “Inopportune, a perfect storm, a test of resilience, and sometimes a trial beyond measure, but also an opportunity to transform oneself, if not the world? To confront madness as a potentially transformative experience takes courage […]”[1] This boy grew up to view that which harmed him as windows of insight that, if harnessed, could renovate the world’s thinking on madness and mental illnesses. One man’s adversity and intellect was fuel in the small fire of analytical psychology.

A Transformative Power

The personal content within the black journals eventually landed in a red leather-bound manuscript and finally settled on the pages of published book despite all odds. Carl Jung’s The Red Book “transformed psychotherapy from a practice concerned with treatment of the sick into a means for higher development of the personality.”[2] If in fact the symptoms of mental illness caused by hardship are seen as transformative rather than obstructive, then the essence of madness isn’t shameful but honorably insightful. Romans 5:3-4 says, “Not only so, but we also glory in our sufferings, because we know that suffering produces perseverance; perseverance, character; and character, hope.”

In The Red Book Carl Jung wrote, “If we feel our way into the human secrets of the sick person, the madness also reveals its system, and we recognize in the mental illness merely an exceptional reaction to emotional problems which are not strange to us.”[3] Carl Jung saw mental illness as an expected response to harms outside of the self. Perhaps he also saw that suffering has the potential to transform an individual for the better. Indeed, Jung’s open-mindedness and non-judgmental outlook directed the course of his thinking and theories.

Sigmund Freud, one of the 20th century’s most influential theorists, seemed to disagree. The father of psychoanalysis and a father figure to Jung, Freud undoubtedly possessed his own philosophies. Most likely, his theories concerning child sexuality were at least partly liable for the rift between Freud and Jung. Separated by age and varying opinions, Freud and Jung’s relationship was transitory. Furthermore, when Jung was a teenager, an older man highly esteemed by Jung sexually abused him.[4] This fact undoubtedly made relating to Freud difficult. This led Jung to confess this to Freud the following with a significant undertone of regret: “[…] as a boy I was the victim of sexual assault by a man I once worshipped […] This feeling, which I still have not got rid of, hampers me considerably.”[5]

While it’s possible that one’s brain chemistry and physiology are also to blame for mental illness, Jung didn’t appear to criticize himself because of this. Proficiently self-aware, Jung was keenly cognizant of how not himself but his experience was at fault. In his biography, Memories, Dreams, Reflections, Jung described his personalities this way:

Naturally I compensated my inner insecurity by an outward show of security, or—to put it better—the defect compensated itself without the intervention of my will. That is, I found myself being guilty and at the same time wishing to be innocent. Somewhere deep in the background I always knew that I was two persons. One was the son of my parents who went to school and was less intelligent, attentive, hard-working, decent, and clean than many other boys. The other was grown up—old, in fact—skeptical, mistrustful, remote from the world of men, but close to nature, the earth, the sun, the moon, the weather, all living creatures, and above all close to the night, to dreams, and to whatever “God” worked directly in him.[6]
Abnormally insightful, Jung recognized that such observations were either inherited or explained by a person’s life. He still acknowledged the feelings of shame within himself. He also saw himself as aged beyond his years; however, the unfortunate circumstances that were likely to lead to a life of distrust and self-pity instead became the fuel that led him to dedicate his life to analytical psychology. 

The Evolution of CSA Research

These extraordinary inner workings of Carl Jung detailing his relationship with himself and God remained tucked away until 2009 when they were finally made available to scholars and the general public. It seems as though adversity, specially abuse and difficulties in childhood, compelled Jung’s research. That said, it’s curious that research on the blend of childhood sexual abuse (CSA), brain development, mental health, and personality is but an infant in the world of psychology. According to Michael De Bellis of the Department of Psychiatry and Duke University Medical Center and his colleagues:

Child maltreatment appears to be the single most preventable cause of mental illness and behavioral dysfunction in the US. […] Despite the fact that sexually abused children suffer adverse outcomes, there are few published studies examining the developmental and psychobiological consequences of sexual abuse.[7]
In The Etiology of Hysteria (1896), Freud was the first to propose a possible effect of CSA in a scientific context. He claimed that a sexual incident experienced during childhood is the sole origin of hysterical symptoms such as a complete loss of self-control due to overwhelming fear related to one’s past. Freud suggested that CSA was the only precursor to hysteria, meaning hysteria is strictly situational and not physiological or genetic. He originally went as far as to say that sexual abuse and even accidental stimulation are the predecessors to all mental illnesses in adulthood.

Though this theory was clearly off base (he later retracted it), perhaps at least Freud’s original concept of what constituted a “trigger” was appropriate. He proposed that permissible sexual actions experienced later in life triggered memories of the defiling acts experienced during childhood. Intense feelings of shame would then activate the hysteria. Little did Freud know that he was actually alluding to a condition that war veterans and CSA survivors experience alike; this condition would later be labeled Post Traumatic Stress Disorder (PTSD). Regardless of how inaccurate, Freud’s original hypothesis—CSA is the only precursor to hysteria—at the very least got people talking. His discussions regarding child abuse marked the beginning of psychoanalysis.

Some fifty years ago, research conducted by Seymour Levine, M.D., and Victor Denenberg, a developmental psychobiologist, indicated that even a few minutes of handling a rat during its infancy led to positive lifelong changes,[8] suggesting that the same might be true for humans. It wasn’t until 1962 that C. Henry Kempe proposed that the battered-child syndrome is a cause of childhood disability and death, a nation-wide survey of hospitals being the primary source. He and the authors of The Battered-Child Syndrome wrote, “The Battered-Child Syndrome is a term used by us to characterize a clinical condition in young children who have received serious physical abuse, generally from a parent or foster parent.” This new awareness of physical abuse prompted the emergence of child abuse reporting laws.[9]

Reports of CSA were on the rise in the 1970s. CSA was gaining attention and was beginning to be recognized as a serious problem. Around this same time, sexual abusers were beginning to be classified. At first offenders were seen as either fixated or regressed, meaning they either were solely attraction to children or they also maintained relationships with other adults respectively. Researchers began to publish scientific findings on CSA in the late 70s and early 80s. In 1978 Groth and Birnbaum showed that the sexual orientation of the abuser in fact didn’t play a role in who he/she decided to target. The term pedophile was later used to describe an adult who is attracted to prepubescent children, whether those feelings of attraction are acted upon or not.

In 1979 R. K. Davies reported data on children having abnormal brain waves and seizures. He supported the idea that these abnormalities caused children to be more vulnerable to experiencing abuse, thereby placing the blame on the child’s predisposed physiological makeup and not the circumstances.

In the early 80s it was evident that many abused children experienced neurological damage, though some didn’t believe that this damage could be attributed to the abuse. Martin Teicher (M.D., Ph.D.) of Harvard Medical School began to hypothesize around the year 2000 that “the trauma of abuse includes a cascade of effects, including changes in hormones and neurotransmitters that mediate development of vulnerable brain regions.”[10]

Nature and nurture have long been at war in the world of psychology. Whether nature or nurture is responsible for the greater number of casualties was disagreed upon until a new argument was made: Nature and nurture actually meld together to influence one’s psyche. Predispositions don’t help the matter, but sexual abuse in childhood clearly has disturbing effects.

According to Time (Health & Family), “To cope with overwhelming experiences of distress, the brain can alter patterns of signaling from the pathways involved, which can ultimately leave those regions underdeveloped from reduced input. The brain of a child who is raped, for example, may react be reducing connectivity of the regions that were hurt.”[11] As with the exercise of any muscle, muscles used will grow and become strong; those left unused will weaken and lose their function.

Associate professor of psychiatry Jens Pruessner of McGill University in Montreal provides hope: The brain has the ability to change drastically when the right type of support and emotional nourishment are present. Understanding how the brain reacts and during and after sexual abuse will help researchers find a way to make it right again.[12] Surely an increase of our knowledge base will help treat and support survivors, yet some effects may not be so easy to overcome. As Teicher has noted, early trauma or CSA isn’t something that you just “get over.” 

The Bigger Picture

God is the predecessor to every created thing, including what we now term to be psychology and science. God is the creator of every intricate interaction within our minds, our bodies, the environment. May we learn to see our limited understanding of these workings as gifts from the one who made them; however, understanding and healing must be appreciated within a larger context.

Carl Jung once said that “the sole purpose of human existence is to kindle a light in the darkness of mere being.” Healing in the most central sense begins with belief in a Savior and is completed through the death of Jesus on a cross. “This is love: not that we loved God, but that he loved us and sent his Son as an atoning sacrifice for our sins” (1 John 4:10). He has shown his love for us by giving us his own righteousness. Not only so, he is also the sacrifice for the sins that have been committed against us. “He is the atoning sacrifice for our sins, and not only for ours but also for the sins of the whole world” (1 John 2:2). This is the most fundamental definition of healing. Our ultimate healing holds an eternal perspective. For believers, our glimpses of healing point to the greater hope that one day even death itself will be no more. All mourning, crying, and pain will cease to exist (see Revelation 21:4). This isn’t to say that healing can’t exist throughout this life, but it won’t be completed.

The following discussion must be prefaced with the ultimate hope in mind, for we do not have the option in this lifetime of removing the cancer altogether. The effects of sexual abuse are very real, and we know more today than ever the nature of those effects. The damage occurs on a very fundamental level, meaning the anatomy and physiology of an abuse survivor undeniably differs from that of someone who suffered little to no disturbance during her upbringing. Praise God that one day all will be made new and no longer will we feel these effects of sin.

The acceptance of Jesus is the ultimate antidote. Perhaps the efforts to heal in this life can only be termed acute treatments. Our search for a cure in this sense can be compared to treatments for cancer. Pain, time, money, and energy will undoubtedly be expended with the knowledge that the cancer may not be cured. And if and when healing comes, a scar remains. Does the solution simply lie within one’s ability to view that scar tissue as thick and durable—something that develops perseverance and builds character—rather than an unsightly wound? Absolutely, but abuse isn’t simply gotten over or forgotten. While we excitedly anticipate our full redemption in Christ and allow Christ to live within us, is there anything that can treat our fallen brains and bodies?

No search for an adequate treatment ever started blindly. Many have chosen to reverse engineer the disease. Attention isn’t focused on the tumor itself but the mechanism by which it came to be. In the same way, researchers are beginning to understand the effects of sexual abuse by studying the changes in the brain. Depression, anxiety, PTSD—those are only a handful of symptoms that trace back to physiological and psychological changes within the brain. May we as abuse survivors learn to see these changes as the result of something outside of ourselves. May we strive to understand ourselves and be open to change. May we begin with understanding, continue with toiling towards change, and finish with seeing him face to face. After all, Carl Jung himself once said, “Understanding does not cure evil, but it is a definite help, inasmuch as one can cope with a comprehensible darkness.”

[1] Kerr LK (2013): “The Red Book”: A Primer for Healing Madness in a Mad World. Trauma’s Labyrinth: Retrieved March 22, 2014, <www.laurakerr.com>.
[2], [3] Jung CG, Shamdasani S (2009): The Red Book: A Reader’s Edition, book description. W. W. Norton & Company.
[4] Kerr J (1994): A Most Dangerous Method: The Story of Jung, Freud, and Sabina Spielrein. Vintage Books.
[5] Freud/Jung Letters, The (1974): Edited by William McGuire. Princeton University Press.
[6] Jung CG (1963): Memories, Dreams, Reflections. Random House, 44.
[7] De Bellis MD, Spratt EG, Hooper SR (2011): Neurodevelopmental Biology Associated with Childhood Sexual Abuse. Journal of Child Sexual Abuse, 20(5):548-587.
[8], [10] Teicher MH (2000): Wounds That Time Won’t Heal: The Neurobiology of Child Abuse. Cerebrum: The Dana Forum on Brain Science, 2(4).
[9] Kempe CH, et al (1985): The Battered-Child Syndrome. Child Abuse & Neglect, 9:143-154. Pergamon Press Ltd. Originally published in 1962.
[11], [12] Sexual and Emotional Abuse Scar the Brain in Specific Ways (2013): Time Health & Family. <www.healthandtime.com>.
April 03, 2014

This is My Story

by , in
Since being involved in a new church community, I've been asked a couple times to share my story. It's really had me thinking a lot about my story lately, not that writing it all down in a book didn't! But I've been thinking about how to simplify it. This is my story in poetic form as simplified as I can make it. Honest. Real. And easy to read. This poem basically sums up my entire story.

Staring at me from across the room.
Faces. Eyes.
They wait and watch me as I breathe.
Gasps. Sighs.

Unfortunately, I don't have
many positive early memories.
Because of this, I used to pause,
not knowing where to start,
when preparing to share my story.

I used to warn people
of the serious air about to filter in.
I don't do that anymore. I can't stand it.
I'd much rather speak openly about sin.

I was first sexually abused
around the age of five.
I know my age because I recall what I was wearing,
and it felt a bit like I had died.

And it was around the same time
that I'd so desperately wanted a cat.
Life was, needless to say,
rather quiet after that.

I willingly suppressed everything
for the sake of holding my family together.
On the inside, heavy.
On the outside, light as a feather.

Though shy and filled with shame,
I was still basically a "normal" kid.
I loved catching frogs and hunting bugs and getting dirty
just as the other tomboys did.

And I had an adventurous spirit
even as a young one.
Was in gymnastics even though I knew I was "heavy"
and coach seemed to be happy when her work with me was done.

I had normal crushes on boys
and normal sad days.
But when something else with my father happened,
my normal would never be the same.

I had no choice
but to share my secret with the world,
thereby thrusting myself into adulthood at the age of 12.
I was all grown up but still a little girl.

I mourned and grieved
the loss of my father.
Then I resumed living. Stopped caring.
Wasn't sure why I should bother.

I stayed in Stevens Point
during the summer when I was 13.
Prepared for college.
Maybe even began to dream.

I kept typed pages
of the things my father had missed,
thinking one day I'd be reunited with him
and I'd share with him my little list.

In time,
I stopped keeping track.
I somehow knew I wouldn't see him again.
And he wasn't coming back.

I loved the beginning of high school,
the beginning of dating
the beginning of sports, the beginning of belonging.
But things quickly went south. From track to the dance team,
more beautiful I thought I was becoming.

From boyfriends
to pointless promiscuity.
From friends
to drinking buddies and cruelty.

From masked sadness
to obvious hurt.
From knowing God a little bit
to not even acknowledging His name
and relishing in the dirt.

I continued living like this
for quite some time.
I hid my shame and hurt with good grades
and performance and hidden crimes.

It worked
For a little while.
I gleaned what I could
from the minuscule approving comments.
Covered up my actions with charm and a warm smile.

Applying for college also provided hope. Off to Minneapolis.
Felt the fleeting freedom that came with leaving home,
starting a new,
and doing whatever the heck I wanted to.

I drank and partied
and met many friends.
Aced most of my classes without studying. I felt free,
but I surely didn't feel cleansed.

Things changed though
When I decided to leave the "love of my life"
because he wouldn't stop controlling and hurting me.
I was sick of cleaning up his messes and taking care of him.
I suppose I really wanted to start taking care of me.

I moved out. Left. Literally tried to run, but feet wouldn't take me far enough away from him.
I boarded a plane to Italy, then France.
I relished in the sun
and a new-found confidence.

Yet I continued
to party.
I continued
to bury.

The following semester,
I continued in my ways,
finding hope, security, value, and purpose
in my overnight stays.

I'd run towards them then from them,
but again
my feet couldn't take me
as far as I'd wanted to go from them.

I boarded a plan to Australia, then New Zealand.
This time, the One I'd been running from followed me, met me there, wouldn't leave me alone.
God found me. Jesus comforted me.
Within a week, I knew I was His own.

A world turned upside down,
I was zealous for love!
And for the first time I really found it.
It wasn't in a bed. It wasn't in my head. It was real.
It was incredible, indescribable.
It could've only been from above.

Boys were friends
as they were in the first grade.
Cares were gone.
And I wasn't afraid.

I met God
at the intersection of "no worries" and overwhelming grace.
I couldn't have been more certain
that I was in exactly the right place.

I eagerly pursued God,
just as He was pursuing me.
This time I wasn't running.
I boarded that next plane to New Zealand out of freedom.

But I soon
slipped away.
Dated a non-Christian and reverted back
to how I'd done life in the other days.

The difference was this time I knew what I was missing.
I knew what I was trading in.
I boarded a plane in order to run.
I knew I couldn't have both, so I left God and chose him.

The fairy tale was for real,
but it didn't include God.
I was "living the life of a Christian,"
but deep down I knew I was a fraud.

Circumstances were wonderful, even perfect.
I was in New Zealand. Snowboarded. Biked to the beach. Played on the glacier.
Drank beers and journaled.
But what looked like bliss wasn't.
There was a giant disconnect.

I poured into school
and finding somewhere to fit in.
Unfortunately, I didn't realize that Christians
are just as capable of hurting me and succumbing to sin.

The people who hurt me
pointed me away.
So I boarded another plane.
And I continued to stray.

I was running from everyone and everything.
I didn't expect to find God in Canada
as much as I didn't expect
to find him in Australia.

Much like before,
God pursued me, showing up on the radio.
I heard a song I needed to hear more than anything.
It showed me something I had previously refused to see.

Blubbering like a baby
with my Bible in a bath tub,
I read His Word, finally went back to Him,
and acknowledged all the blood.

I left the man I was seeing
and bumped straight into who would one day be my husband.
As friends, we ran and ate and laughed and played.
Fell in love, even told him I wanted to marry him.

Then I hesitantly
boarded a plane.
I left for Costa Rica, then Honduras,
not wanting anymore to play the run away game.

I read my Bible
every day. I prayed and let him sweep me away.
I fell back in love with Jesus
before I celebrated my engagement day.

I ran home
after all that had happened there.
Robbed in Honduras and fearful for my life,
and maybe even fearful that no one would care.

As two in love Christians,
we began to do life.
I studied and applied for a job
and planned to be a wife.

Twin Cities Marathon.
Biomedical engineering.
Bungy jumping and sky diving.
My relationship with live was endearing.

In May of 2012 I graduated, got married, got a job
...and boarded another plane.
Either my life was crazy
or I was the one starting to go insane.

I ran with James
and started getting to really know him.
Then we came home
and reality sunk in.

I pitied myself.
Finally saw all the pain and shame.
Starting seeking counseling and therapy and drugs
and all I could obtain.

Started writing every day.
Around the same time I boarded another plane,
got stuck in a downward spiral where I listened to the lies,
took the drugs, and got lost along the way.

But in the fall of 2012 I said no to the prescriptions
and the people feeding me statements untrue.
I realized that listening to God
was the only thing I had to do.

I stayed in Minnesota.
I didn't board a plane.
I wrote and I wrote.
I even welcomed the rain.

Published my story.
And another book.
Wrote until my head was sore.
Started not to care about how I look.

I did marriage
and life
and community
and the like.

Saw progress between Gunflint Lodge trip #1 
and boarding a plane and Gunflint Lodge Trip #2.
And I meant it all the more when I'd say to James
"I love you."

A New Year's goal
was to start EMDR therapy,
partly for the sake
of hoping to one day have a baby.

I started digging
deeper than ever.
Kept on writing.
Continued to try and use my pain as a lever.

Which brings me to today.
Life is simple but so very complex.
At least things are much calmer now
from one day to the next.

Focusing on community
and a life lived for God's glory.
The pain, the problems, the paradise, the promises.
This isn't baggage. This is my story.

Gasps. Sighs. Faces. Eyes.

© Kara Rodriguez