Platinum Author
Delayed Posttraumatic Stress Disorders from Infancy The Two Trauma Mechanism.
ANTECEDENT TRAUMA:
As with posttraumatic stress disorder from adult life, antecedent trauma sets the stage for a more severe response to subsequent trauma. Anxiety and suspense cause the event to be more frightening. If one is among friends, in daylight, and someone attempts to startle him, consider the response-versus, if he is walking down a lonely path, on a dark night, full of anticipation and fear, and the same person attempts to startle him.
Thus, we must look to antecedent trauma that could cause the early infant trauma to be experienced as more severe. It is possible that all the second trimester assaults may operate in this way, including viral infections, famine, malnutrition, paternal death, toxins, and anything that threatens survival of the infant or upsets the mother. For references see Second Trimester Factors in Chapter One. Another major antecedent trauma is the birth trauma. A number of researchers have found a higher incidence of schizophrenia among those who have experienced birth trauma. Trauma at birth has to be frightening to the newborn. Anoxia, brain injury, prolonged compression through the birth canal, near death experience-all must leave a mark. The average one year old still flashes back to the birth experience, which is why it fusses and screams when a tee-shirt is pulled over its head. An infant who is severely compromised with a near death experience at birth is even more primed for a later trauma to be more frightening.
In one family, the ninth of ten children had severe anoxia and brain damage at birth. All children were closely spaced and this one was 15 months older than the next. None of the others developed emotional difficulties, but when this one experienced a major separation later in life, there was a return to age 15 months reality. Had the person not experienced the brain injury at birth, it is possible that the age 15 month trauma might not have been sufficiently terrifying to allow for the reawakening as schizophrenia, 30 years later.
Birth trauma is not intentional and for the most part it can not be avoided. Child birth education and good prenatal care can eliminate some of the trauma, but when birth trauma occurs, it should serve as a warning to make greater effort to avoid subsequent trauma, particularly over the next 34 months.
A PREVENTABLE TRAUMA OCCURRING AT BIRTH:
The immediate clamping of the umbilical cord is one birth trauma/injury that has become common practice and which can be avoided. The immediate clamping of the cord prior to the infant taking its first breath has been shown to result in petechial hemorrhages throughout the brain in higher primates sacrificed at birth-as compared to ones in which the cord was not clamped. After the struggle through the birth canal, the infant needs all the oxygen he can get and the pulsating cord is still an important supplier of this oxygen. Thus, it should be left intact until the lungs have been inflated fully and are working properly. Conceivably this anoxia and brain hemorrhage at birth could set the stage for later trauma to be more frightening. Both the birth trauma and the brain anoxia/hemorrhagic trauma are associated with a separation (birth), and this may contribute to setting the stage for later separations being more frightening. Just as childbirth classes and good prenatal care are important for reducing birth trauma, prior discussion and planning are important for eliminating this unnecessary cause of traumatic brain hemorrhage.
CIRCUMCISION:
Another trauma, occurring shortly after birth, is circumcision. This generally is done without anesthesia-because the baby is thought to be too young and therefore unable to feel anything. More accurately, it cannot say or do anything. Undoubtedly it is traumatic and likely it has an effect. If this trauma were to increase the incidence of schizophrenia appreciably, then there would be a much higher occurrence of schizophrenia in men than in women-which reportedly there is not. Nonetheless, this could be studied by evaluating male schizophrenics vs. super normal males and comparing the number of non-circumcised persons in each group.
Other disorders that are more common in males should be studied for correlation with circumcision. This is particularly true with infantile autism. Currently great emphasis is placed on the neurological findings in autism, with the assumption that correlation proves causation. This assumption is false. Some of the neurological change may be the result of the disease process, just as it is in schizophrenia.
Autism is associated with conditions that have neurological lesions, such as congenital rubella, phenylketonuria, tuberous sclerosis, fragile X syndrome and Rett's syndrome and it is associated with infant trauma in the first 18 months of life.
Most autistics are mentally retarded, language is poorly developed, about one-forth develop grand mal seizures and as many show ventricular enlargement. Thus, a great variety of assaults to the brain appear capable of producing the group of symptoms called autism. Severe early emotional trauma-possibly including circumcision-must not be excluded as a major factor. Fixation and continued activation of early trauma sites-to the partial exclusion of later developing sites, such as the language centers-also can account for the symptoms of autism as well as the differences in brain volume and electrical activity.
There is growing evidence offered by the Pre and Perinatal Association of North America that circumcision may represent a serious trauma to many infants. For this reason it should be studied using our methods. While the trauma of circumcision might or might not heighten appreciably the later trauma of separation (depending on how closely it is linked with separation), it could heighten subsequent castration fears during the Oedipal stage of development. Sigmund Freud described castration anxiety as existing in men and not in women because women cannot be castrated. This explanation is plausible and likely is the primary reason why males have castration anxiety and females do not. Another possibility, however, is that women do not experience circumcision, and circumcision could account for added fear of further cutting injury to the same part later in life. A simple research study of circumcised vs. uncircumcised individuals, using an anxiety rating scale, could determine if this early trauma indeed had an effect on the later development of castration anxiety. Until all correlations between circumcision and emotional disorders are studied further, we recommend against circumcision without anesthesia, and against circumcision or any other painful procedure without the mother being present.
OTHER EARLY TRAUMAS REQUIRING SPECIAL ATTENTION:
Preemies:
Premature babies are left alone in the hospital. While we do not yet have good data on the separation in the first weeks of life, those who were adopted in the first two weeks of life experience an early separation, and they also have a very high incidence of the later development of mental disorders, including borderline syndromes.
If it is possible to stay with the premature baby during its hospitalization, without sacrificing an older infant or toddler, this is the safest alternative based on present findings and projections. The emotional difference may relate primarily to the early separation from the mother. An interesting study would be to determine the number of non-adopted borderline individuals who were incubator babies and compare this with the number of non-adopted super normals who were incubator babies. If the origin of the borderline syndrome is in the first month of life, the study would confirm this. Until the completion of such a study, we recommend the mother stay with the baby until it is ready to come home.
Fetal Alcohol Syndrome:
This carries with it physical attributes related to the in-utero blood alcohol level. While a host of emotional/mental symptoms also are attributed to the in-utero blood alcohol level, more likely these relate predominantly to the lack of mothering or the inconsistency in mothering that occurs in the first months or years of life, as a result of the mother's alcohol dependence. For prevention, this may be a time for institutionalization of the mother while she is pregnant, and a time for a continued serious treatment of the alcohol dependence after the baby is born. Ideally, the alcohol dependent woman should be informed about the devastating impact of alcoholism on the baby, and she should have her alcohol dependence treated before she becomes pregnant.
Adoption:
Adoption should take place at birth, not two weeks later. Nine months should be sufficient time to make the necessary arrangements.
With adoption there already has been a major separation. Every effort has to be made in the direction of providing security, to avoid reawakening and inflaming the original trauma. Adoption must be reserved for the person who wants to be a full time mother to the baby. She must delight over everything the baby does-each developmental landmark, every new utterance, all "cute" behavior. The adopted baby has already endured one separation and must have the devoted attention of one constant mother figure who will be as close at hand as a mother bear with her cub. The busy professional who is not able to take time for a pregnancy and who plans to utilize a "nanny" or a daycare service to rear the child, should rethink the decision in light of our findings. The idea of having an adorable loving child must begin with one full time mother who provides for the needs of the child during infancy. The needs of the mammalian baby for the mother have been established and are deeply entrenched. The adopted baby has already been traumatized or injured and therefore must feel fully protected by having its needs fully met. The adopted baby needs a devoted, full time mother, preferably beginning at birth.
OTHER EARLY TRAUMAS: OTHER PHYSICAL SEPARATIONS:
Histories of approximately 300 schizophrenics, and at least as many depressed individuals and borderline patients, have revealed other early traumas that occurred at ages that were specific to the expected age of trauma-based on the symptoms the patient experienced. For example, one patient whose symptoms matched those of a person traumatized at 24 months, was found to have moved into a new house at age 24 months. By using the clinically based expected age of origin, various other early traumas were identified. On occasion it was confirmed that the expected age of origin matched the time the mother was sick and was hospitalized.
Combination Traumas: Pain Plus Separation From Family Plus Separation from Familiar Surroundings:
If the infant/toddler is sick and hospitalized, this can be a multiple trauma. First, the pain or the sickness intensifies the need for the mother. The fear that accompanies the pain makes the child more vulnerable to separation. Furthermore, the child is not only separated from the mother for part of the hospitalization, but the child is separated from its familiar surroundings as well. If this occurs when the baby has stranger anxiety, the trauma conceivable could be even greater.
One parent described the look on the face of his oldest son shortly after his son had surgery at age 18 months. He knew then that something was terribly wrong. When the man and his wife divorced 16 years later, his son returned to age 18 months and spent the next 12 years in institutions. The surgery was the finest available and the surgeon went on to become one of the most noted in the land. Nonetheless, the emotional trauma eventually destroyed the mind of the baby (the parents were not able to follow the recommendation that would have brought about a total or near total recovery). Thus, as a preventive measure, when the infant/toddler is hospitalized, the mother must go to the hospital and remain there with him. This is especially true when painful procedures are involved.
A Second Child:
If there is another child at home under the age of 35 months, the mother must try to offer as much security, reassurance and support as possible to this child as well. The other child can stay with her or visit in the hospital lobby when the hospitalized one is asleep, and/or have telephone contact upon request. If the older child is very young and at an age of origin of schizophrenia or schizoaffective disorders, it could stay in the same room with the mother and baby. While many hospitals are not aware or tolerant of this need, it is necessary to insist because of the potential harm when the infant/toddler is separated from its mother.
When the mother has to be at the hospital and when it is impossible for the infant/toddler to be there with her, this is not a time for the father to place the infant/toddler in a daycare center or in someone else's home. This would be a double separation-a separation from the mother and a separation from home (which also represents a degree of security). A family member with whom the infant/toddler is familiar or attached, or preferably the father, should stay with the child in the child's own home. Ideally, the child should know that the caregiver will not leave until the mother returns.
In summary, physical separations are very traumatic to a child under two years eleven months, and the younger the child the more severe it can be. Thus, physical separations have to be avoided or attenuated as much as possible. This includes separation from mother and separation from home and separation from father. If the child is comfortable with the father, he may go places with the father as long as he does not exhibit signs of distress or withdrawal. One must not equate the vacant stare with not being upset. While this is not likely to occur when the infant is with the father, it certainly is present in the early daycare situation:
About this Author
Dr Clancy McKenzie is a widely acclaimed authority on the understanding of origins, mechanisms and treatment of schizophrenia. He graduated from the University of Michigan School of Medicine in 1962, and then focused his attention on the study of the human mind. Dr. McKenzie has studied the relationship between trauma and Schizophrenia. Through the years he has dedicated himself to the evaluation, analysis and treatment of trauma and its immediate and long-range effects on behavior and mental health. Learn More: http://www.drmckenzie.com and follow his blog: http://www.drmckenzieblog.com
Article Source: http://EzineArticles.com/?expert=Dr._Clancy_McKenzie
