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
3This 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?
6Todays 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
7Handouts 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
8A Snapshot of Annas Life
9Anna 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
10Anna 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
11Anna 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
12The damaging consequences of childhood trauma
Research Findings
13Collaboration 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)
14What 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.
15ACE Study Findings
- Childhood experiences are powerful determinants
of who we become as adults
16ACE 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.
19Existing 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.
24Adverse Childhood Experiences and Current Smoking
25Current 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) .
26Childhood Experiences and Adult Alcoholism
4
3
2
1
0
27Adult 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
28ACE Score and Intravenous Drug Use
N 8,022 plt0.001
29Intravenous 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
30Childhood Experiences Underlie Rape
4
3
2
1
0
31Rape
- 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.
32ACE Score and Hallucinations
Abused Alcohol or Drugs
Ever Hallucinated ()
ACE Score
Adjusted for age, sex, race, and education.
33The 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
35Childhood Experiences Underlie Chronic
Depression
36Chronic Depression
- Adults with an ACE score of 4 or more were 460
more likely to be suffering from depression .
37Childhood Experiences Underlie Suicide
4
3
2
1
0
38Suicide
- 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.
40ACE Score and Serious Job Problems
41Much of what causes time tobe lost from work is
actuallypredetermined decades earlierby the
adverse experiencesof childhood.
42Adverse Childhood Experiences andLikelihood of
gt 50 Sexual Partners
43Adverse Childhood Experiences andHistory of STD
44Frequency 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
45Sexual 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
46ACE Score and Unintended Pregnancy or Elective
Abortion
47Effect of ACEs on Mortality
Age Group
0 ACE 60 live to 65 4 ACE less than 3 live
to 65
48Many 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
56Yet 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
59The 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
60Sense of helplessness, paralysis,
captivity,inadequacy, powerlessness, danger, fear
Continues over the lifespan
61Sense of Shame, Guilt, Self-Blame, Being Bad
Continues over the lifespan
62Sense of defilement, contamination, spoiled,
degraded, debased, despicable, evil
Continues over the lifespan
63Sense 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
64Lasting 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
66So, 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)
69Annas 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?
70Context
- 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.
71Some 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
72More 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
74Annas 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
77Spare 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.
78The model couple
Cover for record produced by Catholic
organization - of Annas parents giving advice to
other young married couples
79Things 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.
80Anna 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.
81AnnaBirth 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.
83Anna 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. -
88Me, 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!
89Sudden 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. -
93Medical
- 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. -
94Medical
- 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.
100I 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??
104Multiple 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.
107Age 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..
110I 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??
111Indeterminate 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.
112Physical 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.
113Intergenerational 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.
114Screams, 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...
117Examination 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.
120Anna 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
121Childhood 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.
122Child 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 126Missing 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(No Transcript)
129House colored in wedge shapes no windows
130Body parts missing wedge shapes
131Red House Windows filled in
132No arms Faces crossed out Distortions
Figures in big square except one to right -
overdrawing abdominal parts
133Body fragmentation missing body parts rain
wedge shapes splitting up torso
134 Geometric body shape overdrawing
abdomen body part distortions
Themes of Protection
135Nursery School Age 4 yrs 9 mo to 5 yrs 10 mo
Anna, far left in picture
136Two 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.
138Cont
- 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.
140Cont
- 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.
141Her 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
145Kindergarten 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
151Anna 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.
152Collage of yarn, paper cutouts, drawing
153Collage flower of colored or painted paper cut
outs and yarn
Cut out crayoned house with no windows.
154Her 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.
155Anna titled this picture A four year old Chinese
girl next to a bush of bell flowers. November
1966
156Christmas. 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(No Transcript)
159Sexual 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. -
160Sexual 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.
161Then our family moved to the East Coast
162Summary 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
167Anna 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.
170Anna 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(No Transcript)
172The 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
1731992 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.
174Annas 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.
175There 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
181Some 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
183Some 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
184 185- 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