"Not Always Who They Seem"
We live in a harsh society, where adults are frequently unsympathetic and harsh on young people who fall foul of the law and of societal expectations. In the United Kingdom - a country with a history of reasonably liberal attitudes - there are signs of increasing illiberality. There continue to be cutbacks in Health and Social Services, with correspondingly reduced resources for helping traumatised and psychologically damaged young people. Increasing numbers of children are excluded from school. There have also been attempts to stigmatise and financially penalise single mothers. There is talk of Government plans to build more prisons, including military-style "boot camps" for young offenders. The current "get tough" policy is exemplified by the popular right-wing slogan "prison works", with little governmental emphasis on attempting to understand either the roots of crime, or possible roads to rehabilitation.
Many young delinquents have been been developmentally damaged by early experiences. At worst, some damaged young people can occupy, in the words of a poem by W.H. Auden:
"...the stinking fosse where the injured lead the ugly life of the rejected..."
and spend a life chronically involved with crime or drugs ,or prostitution, and corresponding involvement with social services, the penal system, or the mental health services.
The publication of "Not Always Who They Seem" is therefore timely. It is the fifth offering in the Understanding Psychological Trauma series, produced by David Doepal of Echo Bridge Publications. The series itself, in the words of the authors:
"....challenges audiences to take another look at the teenagers with whom they are working; to see them not as 'trouble makers' or 'lost causes', but as young people who have experienced childhood traumas and who have had no appropriate avenue of expression; young people in desperate need of support and understanding."This particular video aims to tackle the issue of "youth delinquency" - its etiology, its dynamics, and its management. The video ( total length about an hour) is divided into three parts. In the first part, four young people - Vincent, Christine, Clarinda and Bill talk about their childhood experiences, and their reaction to them.
Vincent suffered violence, never felt safe, and later found it difficult to accept help - in his own words:
" How do you open up to someone who is trying to help you, when you have never had help like that in your life ?"
Christine was made to be the housekeeper and cleaner for her father (who was violent to her if she forgot to wash the dishes). Clarinda's mother, who was abusing drugs, neglected her; her mother's husband sexually abused her. Bill was witness to his father murdering his mother, and his father's subsequent suicide. The experience left him numb; of his foster family he says...
"I didn't feel anything for the family, because I didn't want to get involved with the family"....I became numb, really numb...I didn't want to say anything, do anything, I didn't want anybody to express anything towards me, and I didn't want to express anything towards them"
Regularly bullied and emotionally abused by a stronger lad, Bill partially and temporarily retrieves his self esteem by bullying someone weaker than himself...
"He made me feel like crap, so the only way I could feel any better was by beating someone else up"
The second part of the presentation addresses the dynamics, and the relationship between past experiences and present behaviour. To quote from the accompanying manual....
"Beneath surface symptomatology, the real havoc wreaked by PTSD is a disordering of one's sense of self, relationship to others, and safety in the world. Children who have been abused, neglected, or exposed to unexpected early or unexplained violence live in a dark and sinister reality. The ones traumatised early or chronically may never have had the sense of the world as safe and predictable, and normal development gets derailed. By adolescence, these youth are living in a constant state of of frightened preparedness for yet another round of pain or terror. What we see then is the reckless, hostile, "acting out" behaviours which so exasperate us as their therapists, teachers, youth workers, and probation officers. Many of these youth are diagnosed as "Conduct Disorder" or "Oppositional Defiant Disorder"; they are seen as "unattached" or "juvenile delinquents. Under current nomenclature, these are probably defensible labels. They are not, however, particularly helpful in understanding these youth, nor do they offer sufficient guidance in terms of the etiology and treatment of presenting problems. The destructive effect of such labels also are well known. Individuals become stigmatised, develop shame-based ego-structures, and may increasingly act in ways consistent with the pejorative descriptors. Frequently an implicit consensus evolved among mental health professionals, school personnel, juvenile justice staff, and parents that these kids are beyond help. At 12 or 14 or 16 years of age, we have given up on them. In response, they have given up on us and on themselves."
We are reminded however that PTSD is only part of the picture. In a recent study of 200 young people in day and residential resources in Colorado, some 50% reported earlier traumatic experiences; of these, 30 % showed symptoms of PTSD. We need therefore to be vigilant, whatever the parent symptoms. To quote one professional in the video....
"The mental health professional has the responsibility of asking very difficult and painful questions to get at the source of that behaviour"
The third and final part of the presentation is devoted to the issue of treatment. There are various components to treatment. We are reminded that we must first create a safe environment with boundaries, limits, consistency and predictability, where the young person can learn to make choices, in a safe and predictable way, and gain empowerment. The process of repair is long and difficult, and there are "no quick fixes". We need to address each of the components of the trauma. A particular problem lies in the fact that the very behaviours that the therapist is trying to change those that originally developed as defence mechanisms to cope with original abusive situation. In the words of Bill's foster mother...
"He needed to act like a demon, or he would not have survived."
Furthermore, young people - who have no other yardstick - are apt to view the original dysfunctional family situation as "normal" . We need to remind them that their environment was not normal. Perhaps most important of all is unconditional acceptance...
"The first thing is to let them experience unconditional acceptance...you let them know that at their core you accept them, and that you care about them."
In addition, we are reminded that we must not only focus on undoing the damage, but also attempt to restore to the young people what they have missed out on over the years, in various ways helping them enhance their self esteem, "to give them a new picture of themselves". Young people need positive attachment figures. They also need to engage in various activities where they can learn new skills and build up a sense of achievement.
We enjoyed watching the video "Not Always Who They Seem". What were its strengths ? The young people told their own stories in their own words, and this captured our interest; their stories gave us some useful insights into the relationship between the trauma, the corresponding core beliefs ( or lack of them) and their subsequent behaviour. It seemed to me that the theoretical framework (not necessarily the treatment) was eclectic, combining a client-centered orientation with a developmental and cognitive-behavioural framework. I was impressed by the lucidity of both the young people's statements and the interpretations by the various professionals. The absence of arcane theorising or "psychobabble" will increase the range of possible audiences.
To whom would the video appeal ? Certainly any professional coming into contact with young people. This would include professionals in Health, Education and Social Services; it could also be of use to foster parents, police and the judiciary. It was useful to have to hand a volume of support material, which includes an extensive bibliography, together with questions for group discussion.
This is an important video. In our own Child Guidance team, with our current pressures, it is all to easy to give earlier priority to young people with "internalising disorders" such as depressive illness or anxiety disorders. When young people present with delinquency or "conduct disorder", there is a temptation to place them on our waiting list, refer to Social Services, or refuse to see them at all. This video will make me think carefully in the future.
Finally, we are left with a message of hope. Despite their traumatic backgrounds, all the four young people "made good". This was in part though their own internal resources, and in part though the professionalism and commitment of their carers.
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