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The Story of A Childs Path to Mental Illness and Suicide

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Title: The Story of A Childs Path to Mental Illness and Suicide


1
  • The Story of A Childs Path to Mental Illness and
    Suicide
  • Presented by her mother
  • Ann Jennings Ph.D.
  • www.TheAnnaInstitute.Org

2
  • There is no trust more sacred than the one the
    world holds with children.
  • There is no duty more important than ensuring
    that their rights are respected, that their
    welfare is protected, that their lives are free
    from fear and want and that they grow up in
    peace.
  • Kofi A. Annan

3
This is me, Ann Jennings This is my
daughter Anna She is the artist. She took her
life at the age of 32.
4
  • Two intersecting life journeys,
  • my own and my daughters

5
  • How did this happen to my daughter?
  • Why did I miss what happened?
  • How did we all miss it?
  • What could we have done differently?

6
Todays presentation
  • Snapshot of Annas life
  • Damaging consequences Research findings
  • The story of Annas early childhood and sexual
    abuse
  • Cumulative trauma making of a broken heart
  • Becoming Trauma-Informed - a personal and
    professional challenge
  • Reflection and Discussion

7
Handouts and Resources
  • ACE Chart
  • Website www.TheAnnaInstitute.Org
  • Slide Presentation(s)
  • Information and Articles
  • Art Gallery
  • List of Websites and Resources
  • Article Retraumatizing the Victim
  • Annotated List of Books for young children.
  • Books on Display

8
A Snapshot of Annas Life
9
Anna Caroline Jennings (19601992)
  • At less than 3 years old, my daughter Anna was
    sexually abused.
  • The abuse was severe and continued for nearly 4
    years.
  • Additional trauma occurred.
  • None of us recognized what was happening to her.

For the story of Annas institutional years, see
www.theannainstitute.org
10
Anna Caroline Jennings (19601992)
  • She broke at age 13, was diagnosed
    schizophrenic and at age 15 began psychiatric
    treatment.
  • For 17 years she was in the mental health system
    11 of those years in mental institutions. Many
    medications and treatment approaches. Nothing
    helped.

For the story of Annas institutional years, see
www.TheAnnaInstitute.org
11
Anna Caroline Jennings (19601992)
  • She took her life October 24, 1992, at the age of
    32, on the back ward of a state mental hospital.

For the story of Annas institutional years, see
www.TheAnnaInstitute.org
12
The damaging consequences of childhood trauma
Research Findings
13
Collaboration between Kaiser Permanentes
Department of Preventive Medicine in San Diego
and the Center for Disease Control and Prevention
(CDC)
  • The Adverse Childhood Experiences Study
  • (ACE)

14
What is the Adverse Childhood Experiences (ACE)
Study?
  • Decade long. 17,000 people involved.
  • Largest epidemiological study ever done.
  • Revealed health and social effects of adverse
    childhood experiences over the lifespan.

15
ACE Study Findings
  • Childhood experiences are powerful determinants
    of who we become as adults

16
ACE Study Findings and the Centrality of Trauma
  • Adverse Childhood Experiences are the most BASIC
    cause of most health risk behaviors, morbidity,
    disability, mortality, and health and behavioral
    health care costs.
  • Which means trauma is a crucial public health
    issue at the ROOT of and CENTRAL to development
    of health and mental health problems and to
    recovery.


17
(No Transcript)
18
  • ACE study views health risk behaviors as attempts
    to cope with impacts and ease pain of prior
    trauma,
  • NOT as symptoms, bad habits, self-destructive
    behavior, or public health problems.

19
Existing Practice
  • Existing practice commonly asks What is wrong
    with the person? vs what happened to the
    person?
  • Existing practice develops diagnoses, and treats
    symptoms instead of underlying causes.

20
Adverse Childhood Experiences (ACEs) are Common
  • Of 17,000 HMO members
  • 72 had attended college
  • 77 were white
  • 62 were 50 or older

21
Adverse Childhood Experiences are Common
  • Of the 17,000 HMO Members
  • 1 in 4 exposed to 2 categories of ACEs
  • 1 in 16 was exposed to 4 categories.
  • 22 were sexually abused as children.
  • 66 of the women experienced abuse, violence or
    family strife in childhood.

22
What is uncommon is
  • recognition
  • acknowledgement
  • action

23
  • The higher the ACE Score, the greater the
    likelihood of
  • health risk behaviors
  • adult diseases
  • disabilities
  • severe social problems
  • severe mental health problems
  • For example
  • The following information and slides are from
    September 2003 Presentation at Snowbird
    Conference of the Child Trauma Treatment Network
    of the Intermountain West, by Vincent J.
    Felitti, MD.

24
Adverse Childhood Experiences and Current Smoking

25
Current Smoking
  • A child with 6 or more categories of adverse
    childhood experiences is 250 more likely to
    become an adult smoker .
  • A person with 4 categories of adverse childhood
    experiences is 260 more likely to have Chronic
    Obstructive Pulmonary Disease (COPD) .

26
Childhood Experiences and Adult Alcoholism
4
3
2
1
0
27
Adult Alcoholism
  • A 500 increase in adult alcoholism is directly
    related to adverse childhood experiences.
  • 2/3rds of all alcoholism can be attributed to
    adverse childhood experiences

28
ACE Score and Intravenous Drug Use
N 8,022 plt0.001
29
Intravenous Drug Use
  • A male child with an ACE score of 6 has a 4,600
    increase in the likelihood that he will become an
    IV drug user later in life.
  • 78 of drug injection by women can be attributed
    to ACEs

30
Childhood Experiences Underlie Rape
4
3
2
1
0
31
Rape
  • Women with an ACE score of 4 are 500 more
    likely to become victims of domestic violence.
  • They are almost 900 more likely to become
    victims of rape.

32
ACE Score and Hallucinations
Abused Alcohol or Drugs
Ever Hallucinated ()
ACE Score
Adjusted for age, sex, race, and education.
33
The making of madness..
  • There is a significant and graded relationship
    between a history of multiple childhood traumas
    (ACEs) and hallucinations.
  • Compared to persons with 0 ACEs, those with 7 or
    more ACEs had a five-fold increase in the risk of
    reporting hallucinations
  • Whitfield et al 2005

34
  • Abuse and trauma suffered in the early years of
    development resulted in a far greater likelihood
    of pre-psychotic and psychotic symptoms.
  • Perry, B.D. (1994)
  • In an adult inpatient sample, 77 of those
    reporting CSA or CPA had one or more of the
    characteristic symptoms of schizophrenia listed
    in the DSM-IV hallucinations (50) delusions
    (45) or thought disorder (27) Read and Argyle
    1999

35
Childhood Experiences Underlie Chronic
Depression
36
Chronic Depression
  • Adults with an ACE score of 4 or more were 460
    more likely to be suffering from depression .

37
Childhood Experiences Underlie Suicide
4
3
2
1
0
38
Suicide
  • The likelihood of adult suicide attempts
    increased 30-fold, or 3,000, with an ACE score
    of 7 or more.
  • Childhood and adolescent suicide attempts
    increased 51-fold, or 5,100 with an ACE score of
    7 or more.

39
  • Suicidality is not usually caused by mental
    illness, drugs, rejection by peer groups, school
    pressure, failures, etc.
  • Rather, it is a coping device a way to manage
    or escape from the unbearable impacts of adverse
    childhood experiences and/or adult trauma.

40
ACE Score and Serious Job Problems
41
Much of what causes time tobe lost from work is
actuallypredetermined decades earlierby the
adverse experiencesof childhood.
42
Adverse Childhood Experiences andLikelihood of
gt 50 Sexual Partners
43
Adverse Childhood Experiences andHistory of STD
44
Frequency of Being Pushed, Grabbed, Slapped,
Shoved or Had Something Thrown at Oneself or
Ones Mother as a Girl and the Likelihood of Ever
Having a Teen Pregnancy
Pink self
Yellow mother
Percent who had a teen pregnancy
Never Once, Sometimes Often
Very Twice
often
45
Sexual Abuse of Male Children and Their
Likelihood of Impregnating a Teenage Girl
1.8x
1.4x
1.3x
Percent who impregnated a teenage girl
1.0 ref
Not 16-18yrs 11-15 yrs
lt10 yrs abused
Age when first abused
46
ACE Score and Unintended Pregnancy or Elective
Abortion
47
Effect of ACEs on Mortality
Age Group
0 ACE 60 live to 65 4 ACE less than 3 live
to 65
48
Many chronic diseasesin adults are
determineddecades earlier, in childhood.
49
(No Transcript)
50
  • Other Studies on Childhood Sexual and/or Physical
    Abuse

51
Sarah Joe, Anna John Mary
  • In my experience, early child sexual abuse
    (CSA)
  • especially impairs resiliency
  • My other children experienced multiple
    ACEs. They coped.
  • Anna experienced early CSA and ACEs. She
    broke.

52
  • A number of studies suggest that severe sexual
    and/or physical violation early in childhood
    appear to have the greatest impact and to be
    associated with the most serious disabilities
    later in life.

53
  • 2/3rds of men and women in substance abuse
    treatment report childhood physical and/or sexual
    abuse.
  • 75 of women in treatment programs for drug and
    alcohol abuse report having been sexually abused.
    SAMHSA/CSAT, 2000 SAMHSA, 1994

54
  • 51 98 of public mental health clients with
    severe mental illness, including schizophrenia
    and bipolar disorder, have been exposed to severe
    childhood physical and sexual abuse.
  • Most have multiple experiences of trauma.
  • Goodman et al, 1999, Mueser et al,
    1998 Cusack et al, 2003

55
  • There is a significant relationship between
    childhood sexual abuse and various forms of
    self-harm later in life, including suicide
    attempts, cutting, and self-starving.
  • Van der Kolk et al, 1991
  • One study found childhood sexual abuse to be the
    single strongest predictor of suicidality
    regardless of other factors.
  • Read et al, 2001

56
Yet the Silence Continues
They do not want to hear what their children
suffer. Theyve made the telling of the
suffering itself taboo From
Possessing the Secret of Joy, Alice Walker
57
Prevalence of the Problem
  • 1/4th to 1/3rd of all children and as many as 42
    of girls are sexually abused before age 18 with
    9 experiencing persistent, genital assault.
    Saunders et al, 1992
    Randall 1995 Epstein, 1998
  • 93 of psychiatrically hospitalized adolescents
    had histories of physical and/or sexual and
    emotional trauma. 32 met criteria for
    PTSD. Lipschitz et al, 1999

58
  • Teenagers with alcohol and drug problems are 6 to
    12 times more likely to have a history of being
    physically abused and
  • They are 18 to 21 times more likely to have been
    sexually abused than those without alcohol and
    drug problems. Clark et al, 1997
  • Among juvenile girls identified by the courts as
    delinquent, more than 75 have been sexually
    abused. Calhoun et al, 1993

59
The sexual and physical violation of children
results in alterations in self-perception which
are immediate, last throughout the life-span, and
contribute to suicidality as a way to cope.
Judith Herman, 1992
Lasting Alterations in Self Perception

60
Sense of helplessness, paralysis,
captivity,inadequacy, powerlessness, danger, fear
Continues over the lifespan
61
Sense of Shame, Guilt, Self-Blame, Being Bad
Continues over the lifespan
62
Sense of defilement, contamination, spoiled,
degraded, debased, despicable, evil
Continues over the lifespan
63
Sense of complete difference from others,
deviance, utter aloneness, isolation, non-human,
specialness, unseen, unheard, belief no other
person can ever understand
Continues over the lifespan
64
Lasting Alterations In Relations With Others
  • The sexual and physical violation of children
    results in alterations in relations with others,
    which often last throughout the life-span.
    Judith Herman, 1992

65
  • Isolation, Withdrawal
  • Disruption in Intimate Relationships
  • Repeated Search for Rescuer
  • Persistent Distrust
  • Repeated Failures of Self-Protection

66
So, what do our children ask of us?
67
  • That we
  • Pay attention
  • Overcome our lack of knowledge
  • Ask What Happened?
  • Overcome our fear
  • Speak out and break the silence

68
(No Transcript)
69
Annas Early Childhood What happened to her as a
child? What clues that she was being abused and
traumatized were not recognized? What
opportunities for prevention or early
intervention and healing were missed? What might
we do differently today?
70
Context
  • One thing I have learned is how important it is
    to be aware of the context we are raised in and
    in which we are raising our children.

71
Some of my context
  • Ideal was the nuclear family model vs village
    isolating.
  • Gender roles were prescribed.
  • Racial/Class/ Income/other cultural separation
  • Rise of consumer culture

The 1950s 1960s
72
More of my context
  • Women married young, not encouraged to complete
    education or pursue career.
  • Women deviating from norm - suspect, stigmatized,
    marginalized.
  • Greatest goal - to be a wife and mother.

Me, Married at Age 19
73
  • For me as a Catholic girl, great stress on
    sexual purity, skewed knowledge of sex.
  • Sense of self worth through husbands success,
    personal, home, childrens appearances.
  • Motherhood idealized, but no education in child
    development or parenting.

Me, Married at Age 19
74
Annas Parents Family Backgrounds
  • My family upper class professional Annas
    fathers working class
  • I was first of 9 siblings Annas father first of
    7.
  • Both raised (Irish) Catholic attended all
    Catholic schools.

75
  • Annas ancestry combination of Irish Catholic
    and German. One great-grandparent Irish
    immigrant. The rest rooted for generations in
    mid-west.
  • Interfamilial conflict may go back generations
    to civil war.

76
Substance abuse, depression, Alzheimers,
physical violence, divorce, my great aunts
suicide at age 16 in Germany.Secrets kept in
both families of origin. Many things one did
not talk about - ever.
Intergenerational
77
Spare the Rod, Spoil the Child
  • Annas dad and I raised in authoritative,
    punitive parenting model. Blame, shame,
    criticism, put-down, spanking, whipping, and
    removal of privileges used as discipline. Model
    same in schools.
  • Annas fathers dad physically and emotionally
    violent to him as a child.
  • My dad occasional intense emotional rage and
    negative judgment which conveyed sense of innate
    wrongness to us as children. My mother had
    difficulty nurturing.
  • In both our families of origin, wives kept
    house, kept peace, and kept secrets.

78
The model couple
Cover for record produced by Catholic
organization - of Annas parents giving advice to
other young married couples
79
Things are not always as they seem
  • We continued in the punitive parenting model with
    our own children.
  • Stress I felt economic insecurity, fear of
    husbands anger, fear of churchs and others
    judgment, dependency, low self-esteem, and
    lived in nightly terror of getting pregnant
    again.
  • Stress Annas dad had work and money problems,
    low self-esteem, and released his stress through
    anger directed toward me and children, especially
    oldest son.

80
Anna pre-natal environment
  • Annas dad and I both smoked and drank. At times
    I drank to excess .
  • I was prescribed amphetamines during pregnancy to
    keep weight gain under 20 lbs.
  • Religion forbade us the use of contraceptives
    Anna not a planned or wanted child I tried to
    abort pregnancy.

81
AnnaBirth to Age 2 ½ - 3
  • A major city in the Midwest

82
Annas Birth October 20, 1960
  • Birth and medical records healthy birth full
    term, 7 lbs., 14 oz pregnancy uncomplicated
  • Pediatric records no problems healthy normal
    baby and toddler
  • Nursing discouraged by medical profession
    formula and bottle-feeding seen as preferable.

83
Anna a few days old
  • Me, Annas mom
  • I remember being struck by how exquisitely
    beautiful she was, even as a tiny new born baby.
    A perfectly healthy and cuddly little baby girl,
    Anna snuggled in my arms, took to nursing and
    then to bottle feeding with ease, napped and
    slept abundantly, seemed content and trusting of
    the world.

84
  • Annas godmother Aunt Genevieve
  • I never remembered anything unpleasant. She was
    a wonderful child. I babysat for her for six
    weeks after she was born, when you first had her
    when she was a little tiny, brand new baby.
    She was delightful. And I saw her often after
    that.
  • Her Aunt Caroline
  • I remember her as a tiny baby, being real sweet
    and quiet, lying in her crib in the dining room
    next to the kitchen. She was such a little
    sweetheart, such a quiet, easy going baby.

85
  • Her grandmother J
  • I remember her as a very pretty and loving
    little girl, receptive to love and giving it in
    return. Im a hugger and she hugged me in
    return.

86
  • Her Aunt Caroline
  • She was fun. As a toddler I remember her being
    very active and outgoing. She was a little girl
    with a big mouth and big eyes. She would giggle,
    and that mouth was always open!

87
  • Her Aunt Alice
  • I remember feeling she was just the prettiest
    little girl Id ever seen in my whole life, kind
    of sparkly, a big smile, bright eyes. You could
    really see in her eyes her soul. An incredible
    kind of spirit would come through in her eyes and
    smile.

88
Me, her mom . I remember her gurgling
laughter how much fun she was. She was
exuberant, active, assertive, determined and
adventurous. I had my hands full with her once
she was up and walking!
89
Sudden intense change occurred in Anna when she
was about 2 ½ to 3 years old.
Self Portrait by Anna in art therapy age 25
90
  • All of a sudden, for seemingly no reason, she
    began to cry and scream inconsolably with unusual
    intensity and for prolonged periods of time
    different than terrible twos
  • She had frequent temper tantrums screamed at
    siblings and friends expressed extreme terror
    withdrew from others cut off her hair ate
    mud threw her feces at walls had trouble
    sleeping would not obey me.

91
  • Her Grandmother J
  • I remember her as a very pretty and loving
    little girl, and then just all of a sudden,
    whatever it was crept in and just changed her
    entire personality.
  • For no apparent reason she would have temper
    tantrums.
  • It came on rather suddenly.

92
  • Her Aunt Genevieve
  • It was when she was about 2 ½ or 3 when I
    noticed that she, instead of being sociable with
    other people, would go into hiding, like she did
    not want to be seen.
  • And she would not sing Edelweiss anymore, when
    John and Mary would.

93
Medical
  • Me, Annas mom re Pediatrician
  • I thought Annas upset was due to her constantly
    raw sore bottom which seemed like a bad diaper
    rash. But it was unusual compared to the other
    children.
  • Her pediatrician examined her several times and
    prescribed Desitin ointment for diaper rash.

94
Medical
  • Emergency Room and dental records
  • ER She became accident prone. Between age 2
    yrs 10 mo to 3 yrs 4 mo, was treated surgically
    on 3 occasions for lacerations on her face and
    head.
  • Dentist Anna noted as completely unmanageable
    several visits. They could not work on her.
  • For both ER and Dentist she was forcibly
    restrained.

95
  • Anna
  • I fell out of the crib when I was about two and
    a half or three years old, and I still got this
    ball on my head where I bumped myself. Then I
    remember going to the hospital and they put a
    sheet over my head.
  • You were there, and dad, and I was screaming and
    screaming while they did the stitches.

96
  • Housekeeper
  • When she was a little girl, if she go outside to
    play, shed come back screamin and hollerin,
    nobody never could figure out why she was cryin.
    She used to go out your side door and she used to
    just cry, poor little thing, she used to scream.
  • Always thought somethin was gonna get her out
    there. She used to say Its going to get me,
    its gonna get me daddy, its gonna get me mommy
    its going to get me. She was a little girl
    then, a little bitty child.

97
  • Anna
  • When I was about 2 ½ or 3 I used to go by the
    swings in the back yard and eat mud. And I used
    to throw my shit at the walls when I was in my
    crib in the bedroom upstairs. I would bump my
    crib across the floor and throw everything out of
    the drawers.

98
  • Neighborhood mom
  • She used to come over to my house and play with
    the kids dolls, blocks but there was something
    that was a little bit different about her.
  • She would grab a toy and run off with it and
    laugh a
  • strange laugh for a little kid kind of
    crazy, almost like a
  • squeal more like yelling than laughing. And
    she used to
  • scream, and became difficult for you to
    handle.

99
  • Annas dad
  • I remember around three or four she became
    over-reactive, real loud, and particularly angry.
    Her friend would come over to play with Anna in
    the sandbox the slightest thing that would
    happen, Anna would yell at the top of her voice
    at her friend who would then leave. She would
    literally drive her away.
  • She was very stubborn and difficult to
    discipline compared to the other kids.

100
I was overwhelmed
  • Me, Annas mom
  • Around this time I began drinking more heavily
    always in the evenings.
  • At one point I had 4 children under the age of 6,
    two in diapers and a 5th child on the way. I had
    a wringer washer and wire clotheslines in the
    basement, no diaper service, and tub fulls of
    dirty diapers. The drinking added to my
    exhaustion.

101
  • Me, Annas mom
  • There were times I could hear Anna upstairs
    crying to get up from her nap, and I couldnt get
    to her. Finally I would drag up the stairs,
    blurred in fatigue, and there she would be ,
    totally a mess -

- with tears in her eyes and down her face,
sobbing for me to come and pick her up and take
her out of her crib where she was all alone. I
felt so bad for her. Poor Anna, sobbing to get
out of her crib and nobody responding.
102
  • Anna
  • Spiders. I started to be scared of spiders when
    I was two or three years old, in a bunk bed on
    the top bunk. I had thought there were
    tarantulas creeping along the bed or something.
  • I hated mushrooms, I wouldnt eat them, from
    about three years old on.

103
  • What happened to Anna?
  • What caused all of a sudden, whatever it was
    to creep in and just change her entire
    personality??

104
Multiple Instances of Childhood Sexual
Abuse(revealed to me years later)
  • Age 2 ½ to 3 by teenage male relative
  • Age 3 ½ to 6 by male babysitter
  • Indeterminate age by older neighborhood boy

Child without arms encapsulated no way
out
105
Age 2 ½ to 3 By teenage male relative
  • Revealed to me by housekeeper 27 years later.
    (Anna had no memory of this reported abuse).
  • Somethin happened to her when she was small..
    She tried to tell me about the man, she say a man
    played with her where he wasnt supposed to. She
    told me that man hurted her, and thats what
    happened to the poor little child.
  • That shut her off you know. She seemed like that
    kept on her mind, you know how little children
    do. They dont tell you exactly whats goin on.
    They keep on thinkin about it. Thats a shame
    though, its sad you know.

106
  • Housekeeper goes on to tell me .
  • All along I had knowed that was X because thats
    why when that child used to go outside she used
    to scream so hard. She was scared X was gonna
    come.
  • And your mother knowed that. Yep, she sure did.
    Cause we had discussed it a lot of times, me and
    her did she used to talk about that was a shame
    because X was family
  • And she didnt want to say nothin.

107
Age 3 ½ to 6 by male babysitterRevealed to me by
Anna 20 years later
  • At age 23, Anna described to me the sadistic
    sexual abuse she experienced as a child.
  • Her disclosure came after she participated in a
    therapy group at a psychiatric hospital and
    learned for the first time from the stories of
    other patients - that she was not the only one
    in the world to have had such experiences

108
  • This is what she told me
  • He took me upstairs away from Mary and John and
    Joe and Sarah and told them to go outside and
    play.
  • He tied me up and put my hands over my head so
    that I couldnt move, blindfolded me with my
    little t-shirt, pulled my t-shirt over my head
    with nothing on below, opened my legs and was
    examining and sticking things up me. It hurt me.
    I would cry and he wouldnt stop.


109

  • To do that when I was a little kid was like uh
    I dont know, I dont know. It made me feel
    pretty bad.
  • I thought I was the only one in the world. It
    never happened to Mary or Sarah so I thought I
    was a bad seed..

110
I remember after he did that I was walking
toward the door out of the room and I was feeling
like I was bad. And why not Sarah and Mary, and
why just me??
111
Indeterminate age by older neighborhood boy
  • Me, Annas Mom
  • The only abuse I remember Annas telling me
    about as a child was of being fooled with by a
    young teenage boy who lived across the street
    from us. Annas dad spoke to his parents and I
    then took Anna to a doctor for a physical
    examination.
  • I thought of the fooling as childs play, and
    inadvertently, when I took her to the doctor, I
    subjected Anna to another invasive procedure.
    compounding the abuse.

112
Physical Examination by doctor a
re-traumatization
  • Anna
  • Then I remember the doctor you took me to when I
    told you. He did things to me that were
    disgusting (pointing to her genital area).
  • Me, Annas mom
  • I can see now so many ways in which we
    retraumatized Anna as a child. The above is just
    one example of many. This kind of inadvertent
    re-traumatization continued all through her life.

113
Intergenerational Impacts
  • Me, Annas mom
  • Its possible I was numb to Annas experience
    because of my own. At the age of about 60 I
    began having memories and one very severe
    flashback to an episode of sexual abuse by an
    aunt when I was around 6 or 7 years old. And I
    have experienced great discomfort and at times
    rage with some priests, for no reason.
  • I have always gone numb in the face of
    unexpected sexual aggression, in effect losing my
    ability to protect myself.

114
Screams, Tears, Obstinacy Met with Discipline
Punishment - Spanking
  • Her dad I still have guilt feelings. I can
    still picture me smacking her on the bottom going
    up the stairs. I was so frustrated that I could
    not control or communicate or get through to Anna
    like I could the other kids that I felt myself
    out of control Sometimes I would give her a swat
    and she would just look at me, and wouldnt even
    react.

115
  • Me, her mom I remember her screaming and
    crying with such piercing intensity and for such
    long periods of time that I would scream at her
    and spank her out of total frustration to try to
    make her stop. Since she had so many accidents,
    with all the scratches and bruises on her body
    there were times she looked to me like an abused
    child.

116
  • I felt helpless nothing seemed to work. If
    you wanted her to do something she would do the
    opposite. I would attribute it to obstinacy. I
    know now she must have been in terror, but I
    didnt see what was happening to her then. I
    just knew something had to be wrong...

117
Examination by child psychiatrist
  • Me, and Annas dad
  • We finally took Anna to see a well-known child
    psychiatrist when she was about 4 1/2.
  • After observing her twice in play therapy, he
    said he thought that the heart of her problem was
    that she was very uncoordinated. She was left
    handed, left footed and right eyed. He said that
    she would get coordinated in time and would be
    OK. To just treat her with lots of love and ease
    up on the discipline.
  • He suggested she needed a more structured
    environment, such as a nursery school. We were
    greatly relieved to be informed there was nothing
    seriously wrong with her.

118
  • Anna about her visits with the child
    psychiatrist
  • I remember being in a doctors office some
    doctor with some toys. I was sitting in a room
    and then he came in to the room and he said Hi,
    and I played with the toys. He said I was
    ambidextrous or whatever..

119
  • Me, Annas mom
  • We belonged to a Catholic group for married
    couples a peer support group to help each other
    with our relationships and our children. It was
    moderated by a priest. We met every month. Most
    of us were new parents.
  • We never talked about child abuse, and certainly
    not sexual abuse, as it was taboo to talk about
    sex at all.

120
Anna was telling her story
  • While we were all ignorant about sexual abuse and
    missed what was going on, Anna was conveying her
    experience through her behaviors - and her
    artwork.
  • 25 years later her childhood drawings were
    interpreted by a well known art therapist

121
Childhood Art
  • Annas childhood drawings consistently contained
    numerous indicators typically seen in the
    drawings of children who have been sexually
    abused..
  • Director Pediatric Play Therapy Program
    Clinical Instructor, Department of Psychiatry
  • UCSF (1991)
  • Notes accompanying each picture are the art
    therapists.

122
Child without arms encapsulated no way out
123
  • Phallic imagery
  • Wedge shapes
  • Rainbow colors
  • Missing eyes

124
  • Rain in abundance - Disorganization or chaos
    (purple part) Tears - Random chaotic scribbling
  • Distorted body parts (short arms)

125
  • Wedge Shapes

126
Missing arms on all four figures something
overhead figures, theme of need for protection
both pictures have 2nd figure less prominent
wedge shapes - rain
127
  • Phallic images
  • Line penetrates girls
  • genital area
  • Wedge shapes
  • Disorganized/ Chaos
  • Body part distortions
  • Body part omissions
  • Body part exaggeration
  • Bizarre imagery that is very sexualized
  • These pictures are very typical of sexual
    abuse seen in imagery

128
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129
House colored in wedge shapes no windows
130
Body parts missing wedge shapes
131
Red House Windows filled in
132
No arms Faces crossed out Distortions
Figures in big square except one to right -
overdrawing abdominal parts
133
Body fragmentation missing body parts rain
wedge shapes splitting up torso
134
Geometric body shape overdrawing
abdomen body part distortions
Themes of Protection
135
Nursery School Age 4 yrs 9 mo to 5 yrs 10 mo
Anna, far left in picture
136
Two perspectives of Anna
  • Annas Nursery School Teacher
  • She was a nice little girl, quiet. Nothing
    really stands out. She wasnt a real outgoing
    little girl, yet she wasnt withdrawn either,
    like others who would not get up and play or
    cried when their mother left them. Basically not
    a sad child, but a happy child.
  • It seemed that things were OK, no problems that
    we could see on the outside.

137
  • Another nursery school mother
  • When I took my daughter Stacey and Anna to the
    zoo, Anna seemed to be a little negative -
    Stacey has more potato chips than I do, and
    when asked to do something would be defiant and
    do the opposite. When I asked her to stay a
    certain place, she deliberately turned and walked
    and stood someplace else, defying me.

138
Cont
  • She didnt cooperate with me and she didnt
    cooperate with you. It bothered me that she
    didnt seem happier. I remember I thought she
    was a keen child, bright and intelligent. It was
    just her attitude.
  • I could see that she had a problem, that she was
    within herself, that she was a little against
    the world.

139
  • On the way home, she got very excited when she
    saw a car with her (male relatives) in it, they
    were teenagers, three or four boys in a car.
  • Then when we came home to your house, she
    climbed up on the top of your station wagon and
    would not get off. Your husband and you had to
    pull her off.

140
Cont
  • She did not mind you. She seemed determined to
    do what she wanted to do and she was not going to
    get off that car to come in for dinner.
  • Anna recalls another car incident with
    perpetrator
  • One day afterwards he came over with somebody
    else in a car and pulled up to our house. I
    screamed and cried and held on to you, then you
    talked to them and they drove off.

141
Her spirit fought to survive
  • Although the abuse continued, her spirit fought
    to survive and Anna carried on.
  • The flip side of her resiliency is that it masked
    the impacts of the continuing abuse.

142
  • Anna recalls
  • I remember wearing nice clothes. I had a pretty
    nice life, playing with April-May Smith, going to
    nursery school. The public pools were fun I was
    a good swimmer jumped in the six feet part.
  • Once I jumped in the shallow water of 3 feet and
    bumped my head. The baby pool was fun, and
    running out in the sprinklers, and getting ice
    cream cones

Anna, middle of front row
143
  • Anna
  • Happiest time I remember was when we went
    sleigh riding on Art Hill and I got to have a
    Baby Ruth candy bar at the end.
  • Then we went to visit Grandma J. She knit me a
    real beautiful sweater hand knitted it herself.
    She said I was her favorite granddaughter

Phallic imagery Rain/Snow Wedge shapes
144
  • Anna
  • I remember playing out in the backyard with the
    sprinkler. We were all running around in our
    underwear. I remember thinking Oh god, were
    all running around in our underwear.
  • I was about 5 years old. I thought, Im not
    letting anybody give me a bath anymore. Im not
    going to show myself to anybody anymore.

Red house Scar on Tree
145
Kindergarten Age 5 yrs 10 mo to 6 yrs 8 mo
146
  • Sometimes high achievement can fool people into
    missing signs of continuing abuse

147
  • Records show Anna scored in the 99th percentile
    in the Metropolitan Achievement test
  • Annas kindergarten teacher
  • The test was given toward the end of the school
    year to all kindergarten students. Its a
    national comprehensive standardized and graded
    assessment of a childs general strengths and
    weaknesses in a variety of different areas of
    aptitude. I cant recall who Anna was all that
    many years ago, but I do know if she scored in
    the 99th percentile, that you cant get higher
    than that!

148
Hope persisted along with love of family
celebrations
149
  • Anna
  • I was like, Mommy, mommy, mommy you know. And
    Dad, you and him would put all the Christmas
    presents out and it was so great! We would get
    up in the morning and all those Christmas
    presents would be there!!

150
and with love of artwork
151
Anna What stands out is doing art work. I
was drawing all kinds of things. I was learning
how to use my favorite materials and colors.
152
Collage of yarn, paper cutouts, drawing
153
Collage flower of colored or painted paper cut
outs and yarn
Cut out crayoned house with no windows.
154
Her Aunt Jane remembered..
  • Anna drew detailed, I mean beautifully
    detailed, pictures. I taught kindergarten and I
    thought, This isnt ordinary, her ability to
    draw is not ordinary.

155
Anna titled this picture A four year old Chinese
girl next to a bush of bell flowers. November
1966
156
Christmas. Created by Anna at her Aunt Dorothys
house. Age 5 ½- 6
157
  • Anna
  • I remember how much I loved to draw! I
    remember drawing something that was kind of like
    an egg. It was all different colors It was one
    of my favorite pictures back then

158
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159
Sexual Abuse continued through nursery school and
kindergarten
  • Sarah, Annas younger sister
  • Annas younger sister has one vivid memory of
    when she was about 2 and Anna was around 6. It
    was of going upstairs, there was a guy
    baby-sitter there with Anna in her room, and he
    said to get out, leave us alone, go do something
    else. Like he was doing something to Anna or
    something.

160
Sexual Abuse continued through nursery school and
kindergarten
  • Sarah, Annas younger sister
  • I was only about two, but somehow that memory
    stuck. I was feeling worried for Anna. I felt bad
    for her. The memory impressed itself on me. It
    was out of the ordinary, there was something not
    right about the situation, it was not normal and
    thats why somehow I remember that.

161
Then our family moved to the East Coast
162
Summary of following 7 years
From age 6 yrs 8 mo to break at age 13
yrs 6 mo
163
  • Note numerous categories of adverse childhood
    experiences (ACEs) which further overwhelmed
    Annas already severely compromised capacity for
    resiliency.

164
  • Multiple family relocations
  • Increase in our (parents) problems rage,
    physical violence, substance abuse, depression
  • In my escape from traditional roles and
    determination to become self-sufficient shifted
    childcare to oldest daughter
  • Marriage disintegration affairs seek
    lifestyle change.

165
  • Enroll children and live in alternative school
    communal setting
  • Exposure to
  • troubled children and teenagers
  • alcohol and drug use, self-injury
  • sexual harassment by other students
  • sexual permissiveness and promiscuity
  • Anna witnessing of sadistic physical and sexual
    abuse by adult male neighbor of 2 year old son

166
  • Frequent absence of parents geographically and
    emotionally, including 1 suicide attempt
  • Bitter divorce and subsequent disruption for
    children new schools
  • Legal custody of children to Annas father with
    limited visitation by me.
  • Abandonment by additional trusted adults

167
Anna breaks. Hides herself. Withdraws
completely.
168
  • I thought I could fix it.
  • Assumed full time legal custody of all children
    - while working full time and dealing with
    educational, mental health and social systems.
  • Annas acting out escalates at school and home
    sexual abuse still unknown to all of us. Trauma
    not asked about.

169
  • Many treatments Brain-bio outpatient
    psychiatric treatment medications counseling.
    No one asked about trauma. Nothing helped. I
    struggled to keep Anna out of residential MH
    settings.
  • Family stress overwhelming. Family Network
    community approach used as intervention.
  • Aunt and Uncle volunteered temporary custody.

170
Anna moves to Midwest
  • It was here that formal psychiatric treatment
    began, including 3 hospitalizations medication
    insulin and shock treatments.
  • The story of her 17 years in the mental health
    system and eventual suicide, Annas
    Institutional Years, can be seen at
  • www.TheAnnaInstitute.org

171
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172
The Costs Are High1992 Analysis of Cost of
Annas Care
  • Over 17 years, Anna was hospitalized a total of
    4,124 days. At 648 a day the cost was
    2,639,360.
  • Other costs entitlements, residential
    treatment, case management, legal, medical were
    estimated to be over 1,000,000, bringing total
    cost to nearly 4,000,000.
  • Adjusted for inflation (2005) total cost
    5,417,032

173
1992 Analysis of Cost of Annas Care
  • Intensive trauma based psychotherapy, figured at
    150 a session, 2 sessions a week, for 17 years,
    would have cost a total of 265,200
  • Had trauma been recognized and treated at age 3,
    costs would have been significantly less.
  • If parents had been trauma-informed, the abuse
    may not have occurred.

174
Annas story not unusual
  • 1/3 of girls 1/5 of boys sexually abused
  • Countless numbers of children exposed to multiple
    categories of adverse experiences
  • Many live with their wounds in silence
  • When not addressed early on the consequences can
    be severe and lifelong and may lead to early
    death, or suicide.

175
There are Many Faces of Trauma
176

At the heart the core the center of each - is
unaddressed cumulative trauma most often
occurring in childhood

177
  • What can we do today to help prevent child
    abuse and trauma?
  • How can we recognize and respond to children who
    have been traumatized?
  • How might we better understand and respond to
    adults with histories of such trauma?

178
Annas early childhood community
  • Annas mom and dad
  • Her extended family
  • Neighbors
  • Housekeeper
  • Priests
  • Couples group
  • Obstetrician
  • ER personnel
  • Dentist and assistant
  • Pediatrician
  • Child Psychiatrist
  • Nursery school teacher
  • Kindergarten teacher

179
  • Any one of the adults in Annas early childhood
    community could have saved her life
  • had they been trauma-informed
  • had they broken the silence

180
  • Becoming Trauma-Informed
  • A Personal and
  • Professional Challenge

181
Some personal steps to take
  • Become trauma-informed
  • Bear Witness Break the silence
  • Work to prevent childhood trauma
  • Intervene early when it occurs
  • Empower young children with knowledge and
    language.
  • Undertake our own healing process

182
  • One simple strategy
  • Give Young Children Language
  • Childrens Books

183
Some professional steps to take
  • Develop trauma-informed organizations - where all
    interactions, services and service settings are
    safe, respectful and non re-traumatizing
  • Basic trauma training for ALL staff, from
    janitorial to administrative
  • Adoption of 5 principles of safety,
    trustworthiness, choice, collaboration,
    empowerment
  • Modification of policies, procedures, physical
    settings, hiring practices, clinical guidelines
  • Support for direct care staff
  • Universal trauma screening
  • Trauma-specific services

184
  • Do Something!!

185
  • If you think youre too small to make a
    difference, try sleeping in a room with a
    mosquito.
  • African Proverb

186
  • In the context of your role, be it personal or
    professional, how might what youve seen alter
    the way you do your work?

187
  • Presentation created by
  • Ann Jennings Ph.D.
  • For further information contact
  • afj_at_gwi.net
  • www.TheAnnaInstitute.Org
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