Disconnection from Childhood Trauma: A Potential Determinant of Depression and Ill-Health

Johann Hari, in his book Lost Connections: Uncovering the Real Causes of Depression, identified seven social causes of depression including the loss of connection to other people.  One of the surprising findings in his discussions with researchers and his colleagues, was the link between obesity, childhood trauma and depression.  In the final analysis, collectively they established that in many instances unresolved childhood trauma was a determinant of obesity and depression. 

Obesity and depression

Johann drew on the ground-breaking research of Dr. Vincent Felitti, Founding Chairman of the Department of Preventative Medicine of Kaiser Permanente – a fully integrated medical provider offering not only health care plans but also services such as specialist medical practitioners, a dynamic medical school, mental health services and education and an affordable housing initiative.  Kaiser Permanente views a healthy life for all as a cause to pursue, and is a pioneer in offering seamless health services along with leading edge research into preventative methods and treatment approaches.

Kaiser Permanente commissioned Vincent to undertake research into obesity because it was becoming the major factor in the growth of its operational costs.  Vincent started out by using a specialised diet plan supported by vitamin supplements that was designed to help obese people lose weight.  This approach appeared highly successful on early indications, but Vincent noticed that the people most successful at losing weight were dropping out of the program and returning to their eating habits and becoming overweight again.  Additionally, they often experienced depression, suicidal thoughts, rage or panic. 

Research by way of interview of 286 participants dropping out of the obesity program established that most had been sexually abused or experienced some other form of childhood trauma.   Obesity was their way to deal with the aftereffects of childhood trauma, including fear of sexual assault and the desire to hide their shame.

Childhood trauma and depression

Vincent was surprised by the findings of the initial study and realised that research of childhood history as a determinant of adult ill health had been avoided previously because of shame, secrecy and the taboo nature of the topic.  Yet his early findings established that childhood trauma played out powerfully decades later in terms of emotional state, biomedical disease and life expectancy.  He found, for example, that 55% of participants in the obesity study had suffered childhood sexual abuse.

The link between obesity, depression and childhood trauma was not well received by the established medical profession.  The video, A Tribute to Dr. Vincent Felitti, highlights the scorn he experienced when first announcing his findings at a medical conference and demonstrates the resilience of a man who had the courage to back his research and the bravery to pursue his creativity.

Vincent was convinced that he had to undertake research with a larger and broader sample of people to establish the credibility of his findings.  Through Kaiser Permanente’s processes of capturing the medical history of patients he was able, in collaboration with Dr. Robert Anda of the Center for Disease Control (CDC), to add additional questions relating to life history.  The questions picked up on the 10 types of childhood trauma identified by participants in the earlier study. The 17,500 participants involved in the second study were representative of the broader population of California where the study was done.  They were middle class with an average age of 57 and were employed.

The research titled the Adverse Childhood Experience Study (ACE) highlighted even more surprising results.  Two thirds of the participants in the research program had experienced one or more traumatic events.  One in nine had experienced 5 or more adverse childhood events.  They also established that the higher the number of different adverse childhood events experienced by an individual (their ACE Score), the greater the likelihood of that person committing suicide.

Typical strategies adopted by individuals to cope with the impacts of childhood trauma only exacerbate the problem of ill health, e.g. smoking or over-eating.  Vincent maintained that the experience of chronic, unrelieved stress affects the nervous system and the brain and can produce “the release of pro-inflammatory chemicals in a person’s body”, leading to suppression of the immune system.

What can be done about childhood trauma?

I have previously discussed principles and guidelines for trauma-informed mindfulness practice.  Johann Hari, in the section of his book on reconnection strategies offered several strategies that could have a positive effect on the negative impacts of childhood trauma, such as obesity and depression.  His recommended reconnection strategies include social prescribing and reconnection with nature, meaningful work and meaningful values.

Vincent Felitti, too, was concerned that people who had experienced childhood trauma need some form of hope about their ability to redress its negative effects.  He decided to do further research involving medical practitioners who were treating patients through Kaiser Permanente.  He provided them with a few simple questions to ask patients that related to life history and covered childhood experiences, and asked them to express genuine empathy and respect for the patient. 

Vincent found that the participants showed “a significant reduction in illness” once a patient shared their story of childhood trauma with a doctor.  He thought that the explanation for this was twofold – (1) the person was sharing their story with another person for the first time and (2) the recipient of the disclosure was a trusted authority figure who treated them with kindness and respect.  He postulated that the intermediate effects related to the fact that the experience removed the shame and self-loathing associated with the adverse childhood event.  The association of the childhood trauma with the experience of humiliation was broken. Vincent acknowledged that this was an area for further research.

Vincent argued that the ultimate solution to childhood trauma lay in “primary prevention” and advocated for the integration of their research findings into primary care medical practice.  He also supported the development of a life experience questionnaire reporting on childhood trauma as a part of a patient’s medical record that could subsequently be viewed by the treating doctor.  A healing conversation could take place if the patient was willing and able to share their story.

David Treleaven warns, however, that when dealing with someone suffering from post-traumatic stress disorder (PTSD), it is imperative not to tackle the trauma experience head-on.  He advocates a trauma-sensitive mindfulness approach.  Sam Himelstein also cautions against the use of direct questioning and talking where a person is outside their window of tolerance

Reflection

As we grow in mindfulness through research, meditation and reflection, we can begin to recognise the impact of our own experience of childhood trauma and address the negative impacts it has on our own life and relationships. We can also become sensitised to the experience of others who have experienced adverse childhood events and take this into account when dealing with individuals and groups who are seeking to use a mindfulness approach to improve their quality of life.

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Image by Pete Linforth from Pixabay

By Ron Passfield – Copyright (Creative Commons license, Attribution–Non Commercial–No Derivatives)

Disclosure: If you purchase a product through this site, I may earn a commission which will help to pay for the site, the associated Meetup group and the resources to support the blog.

What Do You Do if Mindfulness Does Not Reduce Your Symptoms of Anxiety or Depression?

I was approached recently by a young man who was experiencing severe anxiety.  He was able to cope well with his work but had all kinds of difficulties coping at home, including endless self-doubts, negative self-stories and an inability to relax or concentrate.  He indicated that he had “tried everything’ – meditation, mindfulness practices and reflection. 

He found, for example, that “reflection” only resulted in his entertaining negative thoughts about himself and re-visiting his destructive self-stories.  So, reflection for him resulted in a downward spiral rather than a release from self-deprecation.

What does “tried everything” mean?

The first consideration is how did he approach these attempts to develop mindfulness and reduce his symptoms?  Given the young man’s level of agitation, it was likely that his efforts were somewhat frantic and unfocussed.  One could question whether he engaged in a sustained meditation practice in a focused way, e.g. working on his self-stories with the aid of a meditation teacher or meditation group.

One of the issues is that there are so many different forms of meditation that it is tempting to “try them all” and flit from one form to another, without addressing your specific needs or the causal factors of your depression or anxiety.  This is where a professional psychologist or dedicated professional group could help.  Organisations like Beyond Blue and the Black Dog Institute can help by providing knowledge, resources, group support, access to programs and advice in identifying a suitable medical practitioner, psychologist or psychiatrist.  Other specialist carer support groups can assist people who are experiencing anxiety or depression as a result of caring for someone who has a long-term need for care and support.

The Mental Health Care Plan

You may need medication and/or the aid of an allied health professional to overcome depression and/or anxiety. In Australia, there is a specialist form of help that can be accessed through your local medical practitioner, the Mental Health Care Plan.   You explain your symptoms and needs to a doctor who develops a mental health treatment plan with you.  This may include medication, referral to an allied health professional such as a psychologist and/or other forms of activity designed to address your specific mental health condition.  Medicare will provide rebates for visits to an authorised health care professional where the visits have been the subject of referral by a medical practitioner as part of a Mental Health Care Plan.  The number of visits covered by Medicare rebate is 10 (subject to a confirming review by the doctor after the first six visits).

Advancing our understanding of the causes of depression and anxiety

Johann Hari, in his book Lost Connections, highlights recent research undertaken worldwide that shows that anti-depression medication can be effective in the short term to reduce symptoms but that, in the medium to long term, it typically has to be increased and can reduce in effectiveness over time.  In his book, Johann focuses on the social factors contributing to the global rise in depression and anxiety and proposes solutions that support rather than replace medication treatments, although some people are able to give up their medication after a period of successful use of one or more of these alternative approaches.

Johann identifies seven social factors that contribute to the rise in depression and anxiety, all relating to a loss of connection.  He describes them as “disconnection from”:

Johann acknowledges the research that shows that in some instances a person experiences depression and/or anxiety because of their genes or a brain change brought on by some life experience (pp. 143-155).

Reconnection: alternative anti-depressant treatments

Johann describes several ways to reconnect to overcome depression and anxiety.  These include reconnecting with others, with meaningful work, with nature and/or meaningful values. He also includes chapters on finding “sympathetic joy” while overcoming self-obsession (Chapter 20), and a compelling chapter on acknowledging and overcoming childhood trauma (Chapter 21).

What I found particularly intriguing, as well as very practical, was a chapter on “social prescribing” (Chapter 17).  In this chapter, Johann highlights the work of the Bromley-by-Bow Center which combines a medication approach (where deemed necessary) with hundreds of social programs.  This medical centre is very different to most doctor’s clinics that you would normally visit, both in terms of the orientation of the medical practitioner and the physical environment.  The emphasis is on listening, not medication prescription, and treatment is strongly oriented to “reconnection” strategies such as a walking group, employment skills group, start-up support to establish your own business and a casual group focused on “Create Your Future”.

What further intrigued me was the effectiveness of one project described by Johann through the experience of Lisa, who was experiencing severe depression.  The project was the brainchild of Dr. Sam Everington who was concerned about the over-reliance on anti-depression medication.  Basically, he assigned some of his patients to a community project focused on beautifying a strip of bushland that had become overgrown and neglected but was a popular walk-through. 

The group of people experiencing depression, who had difficulty interacting with anyone and typically kept to themselves, eventually started having conversations, sharing their life histories and their personal mental health challenges as well as plans to beautify the bushland strip.  They had to learn about the seasons, plants and their nutrition needs and how to plant and cultivate different kinds of plants.  They took pride in their project and started to gain confidence and competence.  A moving story was that of a person who had initially presented as very angry and aggressive who went out of his way to help two people who experienced learning difficulties.  Eventually, the members of the group decided to do a Certificate in Horticulture.

Johann pointed out that this creative project addressed two major reconnection needs – reconnection with others and with nature.  It can also be seen that each of these reconnections reinforces the other.

As we grow in mindfulness, we can be open to new ways of dealing with depression and anxiety.  We can learn to reconnect with key elements in our life that induce mentally healthy living, including mindful connection to others, spending time in nature, being grateful for what we have (rather than suffer “status anxiety”) and being willing to show compassion towards others.

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Image by Henning Westerkamp from Pixabay

By Ron Passfield – Copyright (Creative Commons license, Attribution–Non Commercial–No Derivatives)

Disclosure: If you purchase a product through this site, I may earn a commission which will help to pay for the site, the associated Meetup group and the resources to support the blog.