The mental health needs of men and boys

March 14, 2015

The mental health needs of men and boys are undertreated. They are underappreciated. They are frequently misunderstood. Most of the world’s cultures often promote and have for centuries promoted instructing men and boys to keep their feelings to themselves, and in current American society, men and boys frequently hear the presumably well-meaning command, “Man up!”

Certainly, male and female brains and bodies differ in some critical ways. However, the feelings and behaviors of men and boys stem from their brain and body patterning, as they do in girls and women.

Just like females, males have brains and bodies. Just like in females, the male brain develops neural connections that control the functioning of the brain and body throughout life. Just like in females, the neural connectivity in the brains of males undergoes a dramatic burst of development and activity in the first years of life. Just like in females, this patterning controls behavior, feeling, activity, and experience throughout life.

Scientific evidence is now demonstrating that experience becomes embedded in human genes and that early life experiences affect the expression of genes. The signatures written on the genes through experience can be temporary or enduring and can even be passed down through the generations. This genetic composition is another level at which our brains and bodies control our experiences and behaviors throughout life. Of course, this happens in both males and females.

Evidence, including the groundbreaking Adverse Childhood Experiences Study out of Kaiser Permanente (“the ACE Study”), has also shown that adverse childhood experiences which may include things like divorce, childhood neglect, parental mental health issues, among other things, affect physical health, including even leading to an increased risk for cancer.

As is finally becoming more widely recognized in the United States, including through a new campaign by the First Lady of the United States Michelle Obama, mental health is as important as physical health and is irretrievably interconnected with physical health. Public understanding is behind and has not kept up with the recent evidence.

The mind is a part of the body, a fundamental part.

The male brain and body developed with some different patterning than the female brain and body. Historically and traditionally, men tended to be the hunters, while women’s brains and bodies developed to nurture their young optimally closer to home. Men’s brain architecture continued for generations to support behavior that was optimal for that need. When hunting, men tended to be quieter to keep from warning their prey, they tended to be more likely to be exposed to physical violence and thus tended to develop protection from reactivity to pain, including perhaps patterns that provide more of a capacity for compartmentalizing their pain, they may have been away from home longer when searching for food and thus may have developed patterning that supported less sentimentality and attachment to the women and children they love. These patterns are in line with the classic command, “Man up!”

However, society is developing and changing. In modern industrialized society, hunting is mostly unnecessary. Food production is now business. Men often go out into a structured and/or intellectualized workforce that is part of a large complex and organized civilization. Men still have more flexibility to be out of the home during childrearing years, as women are the ones who physically carry a child and breastfeed. However, female and male roles are evolving significantly.

The human mind and body is meant to evolve with changing conditions. Its amazing complexity adapts to evolution. As society has become more industrialized and intellectualized, the human mind and body gradually develop to support its optimal functioning under new environments. It happens gradually over the generations through neuronal patterning, epigenetics, and numerous other complex incredible processes that scientists are continuing to work at trying to understand.

As nature is varied and imperfect, individuals evolve at different rates. It is here we develop our current dilemma. In modern society, optimal behavior and childrearing involves men who are capable of loving attachment. Studies have shown that children with fathers who are involved and loving have brains and bodies that develop to be stronger and healthier emotionally and cognitively. In modern society, we generally seek to minimize violence and violent behavior by males. Hunting is no longer necessary. It is now a relic. Yet the patterns in the brains and bodies of males whose social and family patterning is taking longer to change remain more emotionally detached and more likely to engage in violence.

With increased male involvement in the home, the brains of the children of these fathers develop with more intellectual capacity, with stronger, healthier, more efficient neural connections through which signals travel more efficiently. The command, “Man up!” in this context makes little sense. It is a relic.

In addition, because nature is complex and imperfect (however amazing and beautiful), all this change and development has caused numerous problems and concerns. Change involves friction. In families and societies with numerous absent fathers and a high degree of violence, mental health issues are rampant. In families and societies where this process is at a more advanced stage, there is nonetheless friction through change.

In our modern world, it is time for men and boys to heal. Explosive anger and violence has little benefit anymore. We now know that war is a lose-lose proposition. No one wins through violence. No one wins through dysfunctional brain patterning. No one wins through pain and insensitivity. We all win through optimal social health and cooperation.

Public understanding needs to be brought in line with the evidence. The general public needs to see that the mental health needs of boys are a critical part of their health and well-being, as they are for girls. As in getting treatment for a physical illness, there should be no shame in addressing one’s mental health needs.

In fact, it is critical to actively develop systems and processes, including appropriately allocated funding, to ensuring the mental health needs of our population are addressed. In line with what research is showing, our governments need to allocate large amounts of funding to the development of the most effective mental health services and to their implementation.

Poignant description of how childhood traumas affect the present

February 20, 2015

As scientific evidence mounts demonstrating and explaining how our childhood experiences affect our brains, bodies, and adult experiences and behaviors, we can use that evidence to help us notice those effects in our daily lives. Bringing the subconscious to consciousness is the first step to healing.

I read a moving piece written by a woman, who like many of us went through difficult or frightening times in her childhood, during which her parents failed to make her feel safe and protected. With tremendous honesty in her self-analysis, she movingly explains her own life experience. Her genuine description of how it feels to be her powerfully demonstrates how childhood traumas, including even parental neglect or failure to reassure a child, can impact that child throughout life.

Please take a look at this moving and very real piece and start considering in what areas of your life childhood experiences are affecting you. What patterns and what pain are you re-living?

Weathered by My High ACE Score, at ACEs Connection, February 14, 2015.

Violence

February 3, 2015

I read a fantastic New York Times article about the impact of violence in the home on violence in society: To Stop Violence, Start at Home.

It has been shown statistically through a number of studies that individuals raised violently in their homes by their parents grow up to re-live violence as adults, both as perpetrators and as victims. The statistics now have backing in science.

Experiencing violence and observing a parent demonstrate violence against one’s other parent both constitute traumas to a young child’s developing brain. The developing brain is particularly sensitive to trauma in the womb and in the earliest years, when its very architecture is created. During this time, the developing brain is maleable. It forms numerous synaptic connections in line with the individual’s experiences and then prunes those that are unnecessary to create wiring that under ideal circumstances is efficient and well-functioning. Take a look at this video from the Harvard University Center on the Developing Child: Experiences Build Brain Architecture.

When an individual experiences a trauma, such as being beaten by a parent or observing a parent beating one’s other parent, that creates defective connections in the child’s developing brain. When it is severe and/or recurring, as violence in the home often is, it can also lead to brain dysfunction as well as Post-Traumatic Stress Disorder (PTSD).

PTSD involves a dysfunction in the body’s stress response system which leads to overreation and avoidance responses to triggers that remind an individual of the original trauma. It also involves a defective resting level of stress. A healthy stress response system reacts to stressful situations with a release of cortisol and a “fight or flight” response.

Those raised in a home with violence, even when it is experienced when in the mother’s womb as a fetus, grow up with defective stress response systems, potentially with PTSD or with post traumatic stress symptoms that don’t rise to the level of diagnosable PTSD, as well as with a brain whose synaptic connections are formed in an environment of violence. Among other effects, this type of brain programming leads to an adult who re-experiences violence throughout his or her life.

Violence breeds violence. This understanding now has a backing in science.

Pennsylvania enacts new stricter child abuse laws

January 11, 2015

The Pennsylvania Task Force on Child Protection convened in the wake of the Sandusky scandal and in 2012 recommended changes to Pennsylvania’s child abuse laws. Pennsylvania had been known as a state particularly lax in the structure of its child abuse regulations and as having consequently low reporting numbers. The Sandusky situation and the publicity it brought served to help bring the problem to light.

The new laws were signed by the governor on December 18 and are now in effect. They include 21 pieces of legislation.

The changes include a critically important redefinition of what is abuse. Specifically, the standard previously required “serious physical injury”, which was a high benchmark in cases where there was clear injury which doctors had trouble classifying as “serious”. The standard has been reduced to requiring “bodily injury” including “impairment of a physical condition” or “substantial pain”.

The new definition of child abuse is also changed to include relatives who don’t live with the child and a significant other of a parent, while the previous definition included only parents.

The laws put further protections in place, including expanding the list of mandated child abuse reporters, expanding background checks for school staff and volunteers, and adding training for certain mandated child abuse reporters, among other things.

One could say it’s unfortunate that these protections for abused children had to be fueled by a football scandal, which seems to lead to attention that child protection in itself does not receive. Nonetheless, these laws are a major improvement and a positive step forward in child protection.

Is there a holiday spike in domestic violence?

December 26, 2014

There are many factors involved in a victim’s decision whether to leave an abuser in a violent relationship – these include fear, threats of further violence, economic dependence on the abuser, patterns of power and abuse wired into the victim’s brain from the victim’s own childhood, etc.

Apparently, domestic violence shelters generally see an increase in activity around New Year’s Day. We can speculate as to the causes for this increase, such as the abuser’s efforts to keep it together for extended family and friends during the holidays and then resulting explosive reactions around New Year’s, as well as perhaps a victim’s perception of the inability to live another year with the abuse, and potential alcohol fueled violence.

Regardless, the fact remains that staff at shelters such as the District Alliance for Safe Housing in DC are doing amazing, difficult, and stressful work, to try to support victims and repair broken patterns running through society for generations.

Statistics about domestic abuse are staggering. It has been shown among other things that the second leading cause of death of women under age 50 in the U.S. is being killed by a domestic partner. Here is a link to a number of statistics on this topic complied by the CDC: Data Sources. Facts about abuse are often kept hidden, covered up, and protected from public knowledge.

Statistics also show that when children witness domestic violence, even when the violence is not directed at them specifically, they become significantly more likely to repeat domestic violence relationships in their future. The violence between one’s parents is a trauma to the observing child that literally becomes programmed into the architecture of that child’s developing brain.

Take a look at this informative article in The Atlantic.

Kennedy Forum Illinois addresses the impact of trauma on mental illness

December 11, 2014

The Kennedy Forum Illinois, formed by Chicago business leader Peter O’Brien, brought together educators, mental health professionals, advocates, and lawmakers last month to address issues relating to the importance of recognizing and treating mental health issues. O’Brien and his wife Mimi, who lost a son to mental illness, believe and advocate for the importance of de-stigmatizing mental illness so that earlier discovery can lead to more effective treatment.

The Kennedy Forum Illinois was inspired by the Kennedy Forum, which was created by the son of U.S. Senator Edward Kennedy, Patrick Kennedy, to make mental health an essential component of healthcare through the implementation of the Mental Health Parity and Addictions Equity Act of 2008. Fifty-one years ago, President Kennedy signed the Community Mental Health Act, the anniversary of which was commemorated last year with a big event held by the Kennedy Forum.

The thrust of these movements is to work toward eliminating the stigma of mental illness and the provision of effective treatment. Discussed during the Kennedy Illinois Forum last month were issues such as the prevalence of mental illness, including the fact that approximately 50 percent of us will have a diagnosable mental disorder in our lifetimes, the lack of treatment, as well as the impact of childhood trauma on mental illness.

Showing an understanding of the recent research on the effects of childhood trauma on the human brain, Kennedy spoke on the importance of prevention in his remarks to the crowd at last month’s forum. “The best way to treat mental illness is to prevent it,” he said, “and we do not have a prevention strategy in this country. Some mental illness is the result of people simply growing up in toxic environments where their brains are inalterably affected by the stress and trauma of growing up. . .” especially in cities plagued with violence.

The forum also included a panel discussion on children’s mental health including a discussion on the impact of toxins, trauma, and stress in utero on human mental health.

A number of notable people attended and/or presented at the conference on issues including depression, personality disorders, suicide, and the effects of murder on family mental health. This included dinner speaker Mariel Hemingway, Chicago Mayor Rahm Emanuel, Brandon Marshall of the Chicago Bears, and Illinois Supreme Court Justice Anne Burke, among others.

Abuse hides in plain sight

November 23, 2014

Consider the shocking recent stories of Bill Cosby and Honey Boo Boo. We assume those we see in the public eye to behave in line with their public images. In situations like these, when we discover that abuse was occurring, we often discover that there was coverup and fear by the victim of revealing the truth. Victims feel ashamed. They may be threatened by their abusers.

Victimization is often a pattern. Abusers and those who allow abusers to cover up are living their own negative and dangerous patterns.

The Honey Boo Boo situation sounds incredible, yet this terrible pattern is not unusual. We see similar patterns in child welfare court on a regular basis. Child sexual abuse involving a parent who is not protective recurs in certain families. It is not uncommon for a parent to fall in love with a child abuser and to allow the abuser into the family home, as well as to allow the abuser around the children. The more unusual thing is that this time it came to light. Abuse often hides.

The Cosby example is an illustration of this principle. I’ve heard people ask why now – why are the victims coming forward now?

The answer is that victims are afraid to reveal their truth, abusers often bully, abusers often blame the victim, abusers often threaten the victim that coming forward will lead to dire consequences. Sometimes, abusers even bribe to maintain silence. Victims are afraid, victims are ashamed to be victimized, victims are afraid to be re-victimized, victims are afraid of retaliation, victims live a private hell of personal distress. They came forward now because there are others and because this provides safety and lessens fear.

Perhaps surprisingly, studies show that victims are often re-victimized and even that prior victimization is a risk factor for recurring victimization. Victims were often abused first in early childhood – and then re-abused. Protecting their parents and blaming themselves is a standard behavior on the part of child victims – in part because children need their parents for survival. In addition, denial is perpetuated because dissociation and avoidance are common physiological responses to trauma in the brain.

When it comes to abuse, maintaining silence is a recurring theme. The rest of us are often clueless, except in unusual cases when the truth is revealed.

Early life stress may lead to PTSD despite loss of memory of the trauma

November 10, 2014

A recently published study out of the University of California at Los Angeles and the University at Albany has shown that Post Traumatic Stress Disorder (“PTSD”) may develop in people who have no memory of the trauma. These findings are significant on the subject of dissociation. It supports the understanding that the process people undergo when they suffer serious or ongoing trauma may include dissociation from the the pain or intensity of the experience which may lead to long-term memory loss of the incident. However, dysfunction in the body’s stress response system nonetheless occurs.

The researchers found that levels of the stress hormone corticosterone in the brain were increased in those who underwent early-life traumatic events and that despite the lack of memory of the event itself, the subjects continued to experience anxiety and fear when faced with similar situations. Stating that early life stress is particularly impactful, the study made the finding that traumatic experiences may cause life-long harm to “the ability to cope with future stressors and emotionally salient events.”

The study is published in the recent issue of the journal of Biological Psychiatry: Amnesia for Early Life Stress Does Not Preclude Adult Development of Posttraumatic Stress Disorder Symptoms in Rats.

Domestic violence does affect the children

October 25, 2014

Numerous studies have shown that domestic violence has a negative impact on children in the home, even where there is no additional direct abuse to the children, and that children who are so young that they are preverbal and cannot yet understand the significance of the violence are nonetheless harmed.

Among other things, scientists have shown that observing domestic violence constitutes a trauma which becomes programmed into a child’s developing brain and body leading among other things to significantly increased likelihood that the child will relive domestic violence relationships and ultimately negatively impacts the physical and mental health of the child throughout life.

The Washington University Institute for Learning and Brain Sciences has posted a very interesting video that shows a toddler responding to anger which is not directed to the toddler. The video has gone viral. It is enlightening to observe a preverbal child reacting and adapting to avoid being harmed by anger even though the anger is directed toward another person. The study reflected in this video made similar observations as to 149 other toddlers.

With regard to the principle and understanding that domestic violence harms children, this study is important in that one can observe the preverbal toddler’s reaction to anger though it is not being directed at the child. It is important to keep in mind, however, that the harm caused to a child who observes domestic violence is many-fold and all of its implications are not observable on a video.

Trauma informed care

October 10, 2014

“Trauma” is becoming a buzzword in the child welfare, mental health, and even medical communities. As the dissemination of the results of numerous recent studies on the subject continues, nonprofit organizations and governments are developing ways to incorporate trauma-informed practices in their work.

Reviewing recent studies, including MRI scans showing direct impact of early life trauma on brain structure and function, it has become apparent that such trauma impacts individuals and families in fundamental ways. Early life trauma is literally programmed into the brains and bodies of traumatized individuals during fetal life and the earliest years, and thereafter has been shown to affect their behaviors and experiences in negative ways, including, among other things, by leading or contributing to the development of Post-Traumatic Stress Disorder (PTSD), by leading to self-destructive behaviors, such as substance abuse or engagement in high-risk relationships, and even by leading to physical and mental health issues and premature cell deterioration and aging in part through its effect on telomeres at the ends of chromosomes.

The word about these issues and their significance is finally spreading, facilitated in large part by the revolutionary ACE study (the Adverse Childhood Experiences Study out of Kaiser Permanente and the Centers for Disease Control and led by Vincent Felliti and Robert Anda), which has shown that adverse childhood experiences lead to numerous adverse adult experiences and that the effect is proportional.

In one current initiative, Georgetown University has teamed with JBS International to create a web-based tool to support leaders and decision makers in government and private organizations in becoming more “trauma-informed” in serving their populations. I recommend taking a look at this important web-based resource: National Technical Assistance Center for Children’s Mental Health, Georgetown University Center for Child and and Human Development.