Post No.: 0607
Neuroscientific and general evidence from clinical psychology continues to reveal what increases the likelihood of developing mental health difficulties, that they can stem from events that happened many years ago (especially during the childhood developmental years), they’re not choices, and that people cannot just ‘snap out of them’ or necessarily automatically grow out of them. Linking up with the thread of posts on childhood maltreatment that we last visited on Post No.: 0600 – neurobiological changes as a result of experiencing childhood adversity (these short-term adaptations but long-term maladaptations) can appear long before the expression of a mental health problem like depression or anxiety. These changes in the brain are very similar to those in adults who have fully diagnosed mental health problems. And the more severe and negative the circumstances, the greater the impact on the developing brain.
There are also compounding vicious cycles where an abused person might overreact to social threats, which in turn will affect other people around them, who might ostracise them for it. Or even if other people do want to be friends with them, they might push others away for not being able to trust anyone, for instance.
Other stressors – including poverty or low socio-economic status, sexism, racism or not allowing a child to socialise with friends or participate in extra-curricular activities after school, for example – will amplify these problems too. Children living in poverty are more likely to face multiple adverse childhood experiences (ACEs), such as abuse, neglect, becoming refugees, parental incarceration, parental addiction and/or other parental mental health issues, which compound the effects of economic insecurity. Children who experience food scarcity may quickly grab or hoard things because that’s how they’ve learnt to survive, but this may mean that they fail to delay gratification generally.
This highlights the importance of prevention or early intervention before mental health difficulties manifest. The hope is that we’ll one day be able to identify young people at risk of developing mental health difficulties and intervene before an individual does, by removing the risk factors (the abuse or neglect) and bumping up the protective factors or buffers (such as the love and care). Science can provide evidence to support policy and clinical practice.
Although longitudinal studies that track maltreated children from childhood into adulthood will need to be conducted to confirm this – they may have a greater tendency to see the ‘glass half empty’ in life because of their learnt personal experience that everything is hopeless and the future is bleak. This can reduce their resilience.
We’ve also yet to analyse the long-term effects of the COVID-19 pandemic – the lasting threat of the virus itself, the lockdowns, disruptions to their education and social lives, and the uncertain future (apart from repaying the public debts) – upon the mental development of children and young adults.
Overall, childhood trauma or maltreatment physically affects the brain like a scar – the brain can adapt in ways that are helpful in the short-term but predispose a person to a higher vulnerability to mental health problems later in life. The theory of ‘latent vulnerability’ states that changes to neurobiological systems (such as a hypervigilance to threat) may be adaptations to cope with early abusive, neglectful or unpredictable home environments – hence such changes won’t be automatically regarded as ‘damage’. But these adaptations become a poor fit when the child moves into a normative environment (such as when they go to school or into another family) – hence they’re regarded as enkindling a heightened vulnerability to future problems.
For understanding this however – it presents an opportunity for us to intervene and support such a child in order to promote a more resilient outcome. Different children have different genetic risks for developing mental health difficulties but early adversity is a substantial risk factor for developing difficulties either right then or later in life. It’s a latent vulnerability because these brain changes are measurable before a young person has developed a mental health problem.
The brain is most easily mouldable when young – we can learn things much faster when young, for better or for worse depending on what lessons, habits, stress responses or (mal)adaptations are formed. But it’s important to realise that, as much as a child’s brain adapts during early-life adversity, it can also learn to adapt to a normative environment following adversity. Any mental health problems aren’t guaranteed to manifest if a maltreated child subsequently receives the right supportive environment – particularly the earlier this intervention begins. A child who has experienced maltreatment is probably about three times more likely to develop a mental health problem compared to a peer who hasn’t. However, about two-thirds of maltreated children don’t develop a diagnosable mental health disorder. Woof!
We at present need to learn a lot more about what helps promote a resilient outcome though. Resilience refers to the way in which a person can recover to lead a functional life despite any difficulties encountered so far in life. Social support appears to be a crucial component; albeit it’s currently unclear which specific social factors will promote a resilient outcome. A subsequent stable family environment and loving home, meeting the child’s nutritional needs, and creating lots of new positive memories to draw from, could be the positive environmental protective factors that tip the balance against the negative genetic and/or environmental abuse or neglect risk factors?
We currently cannot erase any memories at will. Trying to consciously forget about a specific memory will just continually recall and thus reinforce it. We can naturally forget things over time, but emotionally-charged memories are harder to forget. Yet it’s not really about forgetting bad memories as much as reframing them in a more positive way (e.g. the past happened but with enough understanding and support there’s hope for the future and the present is okay too). The anxiety triggers might always remain but we can cultivate skills to react more calmly towards them.
Indeed, those who’ve experienced maltreatment and have mental health problems will not change course without personal intervention and external support – if nothing changes in their life then they’ll logically carry on the path they’re presently on. Positive changes will need to be deliberately implemented i.e. they won’t just ‘automatically grow out of it’ without being lucky. They’ll also need the right support to change their life for the better. It’s like a person who doesn’t exercise now isn’t likely going to suddenly start exercising when older – unless something motivates them to and then they receive the right encouragement or support. It can potentially stunt a person’s mental development if they’re helped too much but it can also – according to research – stunt their mental development if they don’t get helped enough.
It’s ultimately the overall combination and balance of one’s risk genetic factors, protective genetic factors, risk environmental factors (for which childhood maltreatment is a major example) and protective environmental factors, as to whether someone will develop a mental health difficulty. Therefore one thing alone isn’t likely going to cause a problem but rather the interplay and virtuous/vicious cycle feedback of these four broad categories of factors. It could be the presence or absence of something (e.g. love or loneliness). A vicious cycle could be personal poverty plus a lack of child mental health support in a country, leading to a later life of crime and drug abuse as self-medication, leading to going to prison, leading to poor career prospects…
Based on their previous experiences of the world, an abused person not only perceives the world differently (e.g. sensing more threats), but also shapes the environment around them differently (e.g. behaving more antisocially because of sensing more threats). The virtuous/vicious cycle can involve other children too, such as a child abusing another child; where bullies are often victims of something themselves. Positive peer relationships can help these children build resilience through social support – and teaching children about empathy and compassion and mental health issues from a young age can foster these. Social relationships like good friends can help buffer the negative effects of adversity; but trusting others may be more difficult following childhood adversity. They need to learn to trust others even though trusting is what’s difficult for them – hence prevention or early intervention is again most preferable.
We need to teach children about why some people might be struggling with learning, friendships and other daily activities. Learning about mental health as young as feasible may prevent bullying, help open up children to talking about mental health issues, and reduce the cultural stigma. Awareness of, and procedures and support for, mental health issues in the workplace will also help to identify those who might need assistance before a valuable team member is lost.
Children shouldn’t be raised to be merely ‘seen but not heard’ – children should be heard too, and be allowed to openly, truthfully and confidently communicate how they think and feel to others, otherwise they might not adequately nurture that social skill and may suffer in silence as an adult if they develop a problem. Unless a parent is in abject poverty – parents must avoid merely raising their children with the minimum to physically survive into adulthood but raise them with enough to mentally and socially thrive.
Few or no sufferers are ever 100% cured from a mental health illness (well no one is ever 100% invulnerable to a mental health issue even if they’ve never experienced one before), with the constant risk around the corner of relapsing back to old thought patterns if an environmental stressor triggers them – hence the ongoing need to be protected from environmental stressors. A (re)trigger for a depressive episode could be perhaps family members insensitively commenting on a sufferer’s stalling life, with each episode setting the sufferer back for weeks as these negative judgements ruminate on their mind, thus affecting their day and sleep in highly disruptive and possibly destructive ways (e.g. via drug abuse or self-harm to try to silence the thoughts or gain some control).
But at least in general – before any harm has been caused either to those around them or to themselves, it’s never too late to expose vulnerable people to protective factors and prevent them from being exposed to any more serious risk factors i.e. it’s never too late to treat people better and more kindly and/or to take them away from bullying or prejudice. And although positive environmental factors when young offer the best chance of positive outcomes later in life – being young isn’t the only or last chance for positive outcomes. Childhood traumas can be moved on from over time, given enough present protective factors.
A metaphor may be like gravity, which holds us all down to varying degrees (because some people are more massive than others), yet we’ve figured out ways to fly anybody into the skies and even into space because we wanted to. So ‘difficult’ doesn’t mean it’s ‘impossible’ to fight a natural ‘propensity’. And achieving universal civilisational love and care isn’t against the laws of physics!
(As I’ve learnt more about mental health, I’ve realised how many of these symptoms of childhood adversity apply to me – from the ‘overgeneral autobiographical memories’ (due to having few happy childhood memories), the way I’ll ruminate for a long time on certain negative comments or events, the way I (used to) more likely stay quiet instead of fight (because of learning that I’d get hit even harder if I spoke back to my father), and most of all the way I prefer being alone and find it difficult to trust others. I still experience some bad weeks. Perhaps this relentless blog schedule doesn’t help either – I’ve never even had any time to promote it. But I do feel a bit better after publishing each post and that’s why I’ll continue doing what I’m doing. I’m still alive so I evidently still feel I have a purpose. And I hope this blog is educational to help anyone who reads it.)