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Pain that frays the ties between us

August 22nd, 2017

“I can’t feel it, I can’t feel it,” my son wailed.  He was nine and just coming out of a meltdown.  He had cried and screamed, knocked over furniture and hurt himself, but that was the least of it.  His eyes had changed and when I looked at him, the boy I knew had disappeared.  He could hear me, he could talk but he was overwhelmed with his psychic pain.  It was like he was lost somewhere inside himself.

As the meltdown came to an end, I held him as I always did.  Touch worked far better than words but I spoke anyway.  I told him I was there and loved him.  He cried as he often did, “But I can’t feel it.”  My mother’s heart was breaking. At times like this all I could do was love him through it.  If the medications and therapy and all the rest weren’t working, I hoped that would be enough get us through it.  But, would it, if he couldn’t feel it?

Some mental health problems in children (adults too) fill them up so completely with pain that it overwhelms them.  I understood that.  But that inner pain could also sever him from me and everyone else at times.  You could see his eyes change so that even the visual connection was broken. His everyday self simply disappeared. Without that emotional connection, no matter how frayed it feels, you feel helpless and I felt helpless then and many other times. In those moments, I worried that I would lose him completely.

It’s common to say that someone is “suffering from mental illness” but we don’t use the word suffering in our family.  We do talk about pain, however We also talk about what we should do next or how much we love each other.  We recast psychological pain as a temporary thing (even if temporary lasts for months) that will respond to new approaches and cannot erode our constant connection to one another.   When he was nine, I knew that children and teens change often, outgrowing and leaving behind yesterday’s mood, whim or obsession and I hoped that time and change would be on my side

Physical pain gets far more sympathy than psychological pain. We wince or gasp when we see terrible wounds or injuries yet often look away from someone’s emotional suffering. Doctors are more comfortable when you come in with a medical problem, asking you to rate the pain on a scale of 1 to 10.  There is no such scale for psychological pain.

The McGill Pain Questionnaire, created in the 1970s to help people talk about their pain to doctors, provides lists of adjectives. Pain can be described as throbbing, tingling, suffocating, agonizing or flickering, to list just a few options.  Many people use this language of physical pain to describe the pain of psychiatric illness. It’s helpful, I think, once your child is older and their vocabulary grows.

My son’s pain during these childhood meltdowns was like a tsunami, overwhelming him and separating him from friends and family.  He would feel a constant, lower level ache or sadness or even despair, then an earthquake would come along creating jagged rifts in his life.  Afterward, he would often be limp and exhausted as he slowly came back to himself. He always did come back, almost as an act of will since I couldn’t tug him back through feelings he couldn’t feel.  I would watch him closely, worried he would remain separated and adrift. Worried that I would lose him.

He had bruises afterward though.  Bruises I couldn’t see, even though I could see them slowly healing.  The meltdowns, outbursts and emotional storms leave wounds and after effects just as real as a car accident or an awful medical illness.

Psychological pain still doesn’t get the serious acknowledgement that physical pain does.  David Biro writes in his article, “Is There Such a Thing as Psychological Pain? and Why It Matters” that science often relegates “psychological sufferers to second-class status” largely because scientists and doctors who study and treat pain “consider the experience a strictly physical phenomenon, in the sense that it can only be caused by injury to the body.” Yet people who have experienced both physical and psychological pain frequently say emotional pain can be far worse.

Some studies show that the same part of the brain lights up when we feel psychological pain as when we feel physical pain and something as simple as taking a Tylenol can lessen mental hurt.  I’m not too sure that would have been the answer for the kind of pain my son experienced, but it’s good to know.

Children and teens (who are we kidding? adults, too) express their feelings through behavior more often than through words.  They rage, withdraw, weep softly, sob hard, lash out, hurt themselves or put up walls to deal with psychological pain.  As my son’s mother, I felt his pain keenly and constantly.  It hurt, but it was part of our connection.  Those times when it overwhelmed him and separated us were the hardest times. Pain can isolate but, if we are lucky, love and support builds bridges and keeps those bridges strong.

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Including parents should be part of effective trauma therapy

August 2nd, 2017

Some mornings as I drive to work, my mind wanders through my family memories.  I often wonder if my life is at all like other people’s lives.  I always think about my children first and then think of the many families and young people I have supported as they needed it. At times I think about all the kinds of therapy, services, supports and various medications that I have tried out. I think of the binders filled with IEPs, treatment plans, timelines and photos that I have taken to remember it all, and wonder if I remember all the facts. It can be hard with three children.  They are all unique and different but share one  thing – trauma.

Trauma is now looked at more and more with children (and adults) and there are lots of conversations about new supports, new research and new ideas. I have tried the Trauma-Focused Cognitive Behavioral Therapy approach, Eye Movement Desensitization and Reprocessingsensory dietAttachment Regulation and Competency and therapy after therapy. And you know how it works best? Including the family, especially the parent.

My child has received therapy in the residential setting and the community but when I have not been taught and included in the treatment, it really hasn’t worked most effectively.  Many therapists told me to focus on my trauma and they would focus on my child . The reality has always been that my trauma has already been worked on and the PTSD that I have incurred from going through the ongoing issues with my children has been just as hard.  The reality is that the one therapy where I was included resulted in both my son’s greatest gains and his ability to maintain his skills and improve in his journey.

Trauma has turned out to be so common that it is something more and more systems are identifying and seeking better outcomes. Is anyone noticing that when you include the parent, the treatment improves? Are we making sure the skills are taught to the parent so that the approach can be done during home time, day trips, holidays at home and more? Do people see the parent as an investment or a problem?  I would love to see more outcomes that look at how including parents helps the child. I absolutely know that improvement for the child is very much tied to the connection to the parent.

An underlying piece of the onion that no one sees and no one wants to understand continues to be the things many parents and caregivers do to make it feel safe for their child. It takes patience, understanding, empathy and sometimes just someone to show that they hear the parent and see them as the expert.  It has been the one area in my children’s life that has been a mystery to figure out.

As the brain develops things change, memories change, and behaviors to deal with it change too. My oldest son and I talk now about what memories we have and how we continue to feel lucky to be able to talk about it and how we are going to deal with it. Trauma comes up when you least expect it.

For us the biggest trigger is fire.  We remember a house fire that we were in. We are triggered by seeing the burnt house we drive by, a candle burning in a house, smell of smoke, a fire alarm and at times just people lighting a grill. It comes up and each of us deal with it differently. I approach it with a mindful approach, my middle son using the Attachment Regulation and Competency approach and my oldest using the Trauma-Focused Cognitive Behavioral Therapy approach. They are all correct and all okay- but without my understanding and embracing what works for them it would not work.

I appreciate being asked about trauma and talking to people about their approaches. It doesn’t go away. It is not the last peel of the onion for us– it is actually near the outside.

My last suggestions are the following:

  1. Include parents in your treatment model- teach them and include them
  2. Ask the parent what has worked and not worked
  3. If a parent asks for assistance to get outside support for trauma, help connect them
  4. Talk about positives that are possible so that parents know it gets better
  5. Remember that it doesn’t matter how large or small – if people use the word trauma LISTEN

Let’s change trauma to something we talk about and help.

Meri Viano is our guest blogger.  She is the parent of two sons and a daughter who continue to inspire her blog posts.

 

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