Transformation and Healing After Trauma, Loss and Grief

My Mythic Garden

A blog by author and trauma expert Gary W. Reece, Ph.D.

There’s no place like home
By
Gary Reece, Ph.D.
As I drive around the city of Los Angeles, I am always saddened by the sight of a person, sometimes a family standing alongside the freeway onramp with a cardboard sign: homeless, need help, God bless you. I empathize; feel a mixture of feelings, guilt, sadness, fear, shame, and helplessness. There are so many and that there is so little I can do: I am glad it is not me. I can imagine how miserable it must be to live that way. There are a million reasons for being homeless; each person has their own story. They have fallen to the bottom rung of the socio-economic ladder. Mentally ill, bad luck, addictions, lack of marketable skills, it is a miserable condition to have no home, so vulnerable. Vulnerable because home provides so many things which we take for granted, seldom thinking of what it means: shelter, safety, legitimacy, grounded, investment, membership-belonging to a neighborhood, community, and sanctuary.

Yet, home also has other meanings, connotations. I am using home in this essay in a deeply psychological sense: home as the very ground of our being, our psychological framework. I got to thinking about this when I was re-reading one of my favorite books the other day and ran across these lines:
A home is the accepted framework which habitually contains our life. To lose one’s psychic container is to be cast adrift to become a wanderer upon the face of the earth. Henceforth, in seeking his own human completeness a man would have to do for himself what he once had done for him, unconsciously by his kin.
(William Barrett, Irrational Man, pg. 25)

Home is a place of origin, a reference point. It is the answer to the question where are you from? Many don’t consider that home is an essential part of their identity. Some see it as just the elusive goal in the physical sense as to strive to “own one’s home.” It is also a place of nostalgia, memories, and a tie to the past and most importantly a secure base where we feel connected, a tangible sign of our belonging. It is a place of refuge, foundational in an uncertain world that seemingly has become less safe, secure, and as the world becomes more uncertain, surrounded by global unrest, terrorism, epidemics, and economic stagnation we cling to it all the more tightly as the symbol of the “American Dream of the good life.” Yet, this is not the whole picture. Today, neighbors don’t know each other; we have become islands in the midst of well maintained, manicured pretty houses. Barrett frames our present condition this way:
A society coming apart at top and bottom, or passing over into a society running along smoothly in its own rut, contains the seeds of its own destruction as well. The individual is thrust out of his sheltered nest that society has provided. He can no longer hide his nakedness by his old disguises. He learned that much of what he has taken for granted was by its own nature neither eternal nor necessary but very contingent and impermanent. . . .Moreover, man’s feeling of homelessness, of alienation has been intensified in the midst of a bureaucratized impersonal mass society. He has come to feel himself an outsider. (Irrational Man, pg. 37)

Could this be the basis of the latent anxiety which seems to surface at the most innocuous times, like the Ebola “pandemic,” the fear of rioting and civil unrest in Ferguson Missouri, or families rushing to schools in panic because of an internet threat. Perhaps after 911 we will never feel totally safe. Like all trauma victims, we fear that if it can happen once, it can happen again.

The irony here is striking, we have homes, we are embedded comfortably in our carefully crafted suburban lives and yet he characterizes us as alienated wanderers, homeless even though most of us have homes. It is as if in his view, we are all standing alone on the underpass with our cardboard signs, but haven’t realized it yet: Alienated because we are not connected in a meaningful psychological sense. For example, I was sitting at a sidewalk café the other day with a good friend, it has become our daily ritual to have coffee and sit and talk. I have commented frequently to him that all the people around us are all staring at electronic devices. They are not talking to each other. Our talking probably disturbs their concentration. There was one scene which I found troubling, but probably typical. A young mother dressed like a soccer mom was holding a dog on her lap, and had a lap top open on the table in front of her, what was troubling was that she had a 6 year old daughter sitting with her, she also had a lap top in front of her: a charming scene, but an example of being together but not together.

I think that Barrett is pointing out a stark reality. A reality that most of us are not even cognizant of, that we are alienated from ourselves: our alienation and homelessness is a result of a loss of human connection. Bruce Perry, a psychiatrist and professor at Northwestern University writes:
A fundamental and permeating strength of humankind is the capacity to form and maintain relationships-the capacity to belong. It is in the context of our clan, community and culture that we are born and raised. . .Without others or without belonging no individual could survive or thrive. . . This powerful regulating, rewarding quality of belonging to a group, a family, a community and culture is not just focused on the present. We each feel a need to be connected to the people of our past and without being able to draw on this connection-narrative-it is almost impossible to envision hopes and dreams for a connected and safe future. (Life Story Therapy for Traumatized Children, pg. 7)

It is this function, this psychological dynamic which has become increasingly salient to me: The need to belong, to have roots, to be connected. Perhaps it is because as I age, I have been discovering how important my family is to me. Through illness, increased contact and communication we have become closer and more supportive of one another. It would be a huge loss, to no longer have this base.

The metaphor of home has also become a powerful way for me of looking at the experiences of people who have undergone sudden and shocking transformational losses. Probably because I have worked with trauma victims for so long, I now see the world through the lens of trauma. These losses take many forms. They are paraded before us on the six o’clock news. Whole families killed in a car wreck, a 9 year old girl killed by a gang drive by, a domestic murder suicide, the sudden, unexpected return of cancer, the death of a spouse or friend, on and on the litany goes. When trauma happens to you one’s life is transformed by the experience.

There are many ways to become victimized-deprived of our base, to lose our psychological foundation and framework for understanding the world, or to phrase it somewhat differently, lose the narrative, the story which holds our individual and collective lives together. It can happen by just the slow accretion of the anonymity of modern life, where the slow drift toward oblivion becomes the narrative. Or it may happen more suddenly and dramatically due to trauma which is one of the main causes of disrupting our narrative, of disrupting our psychic container. The traumatic experience which shatters our sheltered, predictable, meaning driven world results in our feeling alienated, shocked, and homeless, a wanderer amongst what was a taken for granted world after trauma becomes a wasteland peopled by strangers.

Helplessness, victimization, shock, numbing, terror, the loss of control of one’s life, this is the imprint of trauma: when the “psychic container, one’s home” is threatened, sometimes, even shattered. We lose the thread, we feel lost, metaphorically homeless. The loss, the most disturbing and disabling loss comes from the shaking of the foundations of our home, the pillars which sustain and stabilize our world.

We have grown up with these unconscious assumptions, deeply embedded in our psychic structure. They are collectively our Working Model of the World. We developed this WOM through the process of attachment. These assumptions are garnered through the simplest activities of nurturance and caretaking. These assumptions are: (1 it is a stable and predictable world-I can count on it, (2 it is a just and fair world, (3 it is a meaningful world, (4 it is a benevolent world, and (5 it is a world in which people are connected and matter and behave with care and are trustworthy. We operate unconsciously, daily on these assumptions, and for the most part they are confirmed and provide the basis for our ordinary lives. In other words, they work and are taken for granted like most routines of life. These are the threads of our narrative, the basis of our story, our identity.

And then the shock comes, and we are confronted with a different world, the rules are all violated. We feel confused, lost, bewildered, helpless, out of control and betrayed. We seek answers and ask the standard questions. Why, how could this possibly happen? Why me? We are left feeling like the whole event is unreal. These events are life changing because they leave us with a changed view of the world. The framework, the psychic container was shattered, our way of making sense of things no longer works. Not only a changed world, but the loss of that foundation leaves a huge psychic wound. We are facing a very different world. What on earth do we do? There are so many stories I could tell of people I have worked with, even my own, or just take the freshest of the day’s news story to illustrate. But one story sticks in my mind which illustrates how suddenly this world ending catastrophe can strike. It happened in San Diego, California.

In this story a man got up and went to work leaving his wife and family and home. When he came back from his day’s labor, a jet from the local air force base had crashed and totally destroyed his home and family. Just like that, one minute he had a home and family and in the next they were all gone, vaporized. What became of him? I don’t know, but based on the stories of others I can guess. He faced years of unimaginable grief after he got through the immediate shock, devastation and seeming unreality of the tragedy. Perhaps he is still stuck in the ashes of his life, never recovering.

Like all survivors, victims of the unimaginable horror of trauma, he was confronted with the need to go on living, but without a clue of how to do it, or not knowing if he had the strength to rebuild his life, and not only figuratively but actually rebuild his home. Traumatic Grief is a very long and difficult process requiring many steps, each step agonizing and filled with uncertainty. There is no standard formula for how long this takes, in my case it took years. And no, time does not heal all wounds. The first step is to confront the reality of what happened. The defense of denial which enshrouds our psyche must eventually be dealt with, we must, if we are going to heal, face what happened. This is the Recognition phase. The second step is Recollection, we must be able to recall and deal with the feelings and memories of the event and connect with the emotions by re-experiencing them. This sorting through, working through part is not easy, the feelings are deep and painful, but is a necessary step in being able to feel anything again. We because of trauma have in effect, become the walking dead and must awaken; I call it coming back to life. The third step in this process of transformation is Reconciliation. Reconciliation involves trying to rebuild our world of meaning and make sense of the senseless. We try to answer the question of why this happened to me. This involves re-framing the world and trying to encompass and understand how random, senseless, meaningless things happen to innocent people. What kind of a world is this? And finally comes the even harder part, Rebuilding. It also requires relinquishing the past and discovering-creating or finding new meaning and a purpose for our lives: Something which helps us to feel significant again.

This involves many steps, learning to trust, to care again, relinquishing the past, and being able to imagine a future before you can rebuild. Building a new world, designing, planning, getting the materials and putting things in place, starting with a new foundation, new connections, and healing wounds, we tentatively move into our unfinished home, trying to furnish it with new sacred objects and thereby create a new sanctuary, a new identity. This home will look much different from the previous structure, but there will be some things you still cherish from the past and a new sense of self as survivor based on the wisdom accrued from the transformation and healing you experienced, and fostered by your own hands. And perhaps with a little help from your friends and family. Then you settle in and appreciate that there is no place like home, a home of your own. After wandering a long time through the wilderness and badlands, it feels good to be home and reconnected to life and family.

For those on the street and those wanderers who are homeless, it is difficult not belonging, everyday is a repetition of the day before, “Groundhogs day,” days filled with hopelessness, helplessness and a perpetual state of limbo: not belonging, the identity of a street person, this is their narrative: The disenfranchised, shadow population. We see ourselves mirrored in them, just one event away from joining their ranks. Perhaps it is this wisdom which creates compassion both for ourselves and them, fellow wanderers.

A Manifesto
Coming of age in the foster care system.
By
Gary Reece, Ph.D

Aging out of foster care presents many challenges to those who may have spent a major portion of their crucial developmental years under difficult circumstances. Outcome studies which compare foster care youth with their peers (non-foster-care youth) reveal many disheartening statistics. At the present time there are estimated to be over 500,000 youth in foster care: 8 out of 1,000 youth. Nineteen thousand of those who were not adopted or remained in foster care aged out at age 18; in some states the age is now 21. Of those who aged out less than 505 were employed, 255 were homeless, and 75% of the girls had been pregnant. Nearly 60 % were convicted of a crime and over 80% had been arrested. Only 6% had acquired a two or four year degree. (See Appendix A for more complete details)

These statistics do not even begin to tell the story of the hardship, pain, suffering, and helplessness of the lives of these children. Statistics often have an empty, detached effect of distancing us from the harsher realities of their suffering. Statistics need to be made flesh, given personalities and a face. The numbers are actual individuals who are the by-product of many complicated multi-determining events. Analyses of this matrix I believe will help us better understand why the statistics are so grim and that the blame does not lie with the children and adolescents. Aging out is akin to the same developmental step other youth experience across America: leaving home. The difference is that non-system children have the support of a family and have not normally been subjected to the adverse conditions as foster care children have been subjected to. Foster children from the beginning have to deal with several traumatizing factors which alter the developmental trajectory of their lives forever.

First, the reason a child enters the system sets the trauma process in motion, because the family is deemed unable to care for him/her for reasons of abuse, neglect, mental illness, homelessness, or drug abuse and sometimes all of these factors. Secondly, the very fact of removal is another traumatic event, and the act of entering the system and subsequent placement adds to secondary trauma. So from the beginning, these children begin their lives being abused and or neglected only to be placed in a system which often continues the abuse. These all qualify as significant traumatizing circumstances. Why? Because disrupted attachment and ensuing loss of family connections threatens the very foundations of all later development: empathy, a conscience, a secure sense of self and identity, the ability to regulate emotion or soothe oneself, the ability to engage in trusting, intimate relationships, the ability to learn and develop a functional working model of the world. Not only does disrupted attachment forever alter the normal trajectory of development, it also creates an unhealed wound which becomes a deep reservoir of sadness, longing, fear, rage, guilt, shame, confusion and a sense of not belonging anywhere. Terry Levy phrased it thusly: “Traumatize a child and it becomes a life sentence.”

Family, neighborhood, community, attachment to parents and siblings, school, and religious institutions are the essential components of identity development. Without a sense of belonging, there is no secure base for attachment. Losses engendered by removal from family set in motion profound threats to the whole direction of a child’s life. Removal from the home and the severing of family ties with all that entails disrupts the very foundation of personality development. In some cases, this happens several times to children in foster care. Richard Rose cogently discussed the consequences:
A child who has experienced poor care, life-threatening actions and/or rejection at a young age may develop an impaired understanding of herself. her carers and the world in general. These beliefs can be deep-seated and act as the default concept for the rest of the child’s life. The traumatized state is a potentially lifelong condition which is linked to learned behavior, reinforced by the experience of repeated trauma. (Life Story Therapy with Traumatized Children, Pg. 49)

Research shows that young people raised in foster care are far more likely to endure homelessness, poverty, compromised health, unemployment and incarceration after they leave the foster care system.
• 54% earn a high school diploma
• 2% earn a Bachelor’s degree or higher
• 84% become parents too soon, exposing their children to a repeated cycle of neglect and abuse
• 51% are unemployed
• 30% have no health insurance
• 25% experience homelessness
• 30% receive public assistance
• An unknown but suspected high number of children migrate to the state prison system
660 children have died while in foster care in our county since 1990.

I entered the world of foster care after a 30 year career in private psychiatric practice working with a population of adult and adolescent patients in hospital settings and I have studied trauma for the past 40 years. I have spent the whole of my professional career working with trauma victims, consulting with agencies, and conducting critical incident debriefings during community-wide traumatic events. When I made a career change to work with a local Foster Family Agency, it unwittingly placed me in a new environment. This environment challenged me on multiple levels: I had to learn new skills to deal with an unfamiliar workplace, develop new knowledge sets in order to handle unfamiliar situations with families and children, and manage the emotional impact of, and personal identification with, children experiencing horrible life-events.

My career in the private sector of the child welfare system has been a 12-year odyssey. On that first day of my new career, I remember feeling totally overwhelmed, lost and shocked by what I encountered. Out of curiosity and a powerful need to understand what I saw, I searched the literature, went to workshops, and talked to experienced colleagues. As my investigation continued and I struggled to make sense of what I was seeing I began compiling notes and thinking about the families on my case load. So I began writing, thinking there were some interesting stories here. Over time, the urge to write became stronger. Then one day an event happened; it became the catalyst for a book. It was the death of Sarah Chavez. Sarah, a child whose case I managed was returned to her birth family after being in foster placement for six months–only to be killed by her uncle. After that incident, the momentum increased as my writing was fueled by the tragedy and my anger and a sense of helplessness. I realized I must tell this story. My book, I became my late-career mission. I witnessed too many children’s deaths, brutalized children, Social Workers not doing their jobs, bad decisions returning children to dangerous circumstances, unprepared birth parents lacking basic parenting skills, depressing staff meetings characterized by horrific story-sharing, and finally, too many new mandates and meaningless reports that were never read. The last was the proverbial straw.

No longer could I tolerate the sense of helplessness I felt over the countless children being abused, and it was my desire to understand the severity of their behavior problems which spurred me into action. For my voice to be heard, I began writing, reading, and conducting more research. The ideas began to formulate into chapters. Once the chapters were organized, I began to see the structure, and out of this structure, the narrative evolved. That was when I began writing Broken Systems, Shattered Lives. This paper is derived from that research and publication

Every year, over 800,000 children in this country are removed from their homes due to abuse, neglect, domestic violence, or parental drug and alcohol problems. At any given time, over half a million children are in foster care. These children have been removed because they have experienced multiple threats to their safety and security and are subjected daily to trauma which affects their health and development. These children are vulnerable and their physical, emotional, psychological, and social well-being is at great risk. Those who languish in the system in long-term foster care have a dismal record of achievement. They struggle because of their psychological and mental health issues as well as lingering effects of trauma and learning problems. As a result of all these factors, they do not find success in their school endeavors. Also, because of their unstable and often impoverished living situations, they do not acquire the most rudimentary social skills and motivation to succeed or plan for the future. Many of these young people are ill-prepared for adulthood and lack a safety net to support them in times of need. They struggle to acquire adequate housing, food, and education. These are some of the reasons foster children have difficulty after aging out of the system.

When I began my work with these children, I was shocked by the level of abuse children suffer at the hands of those who should be protecting them. As I encountered the foster care system for the first time, I was amazed at the extent of dysfunction on all levels. I also wondered how the system could be this horrendous and if anyone was aware of how dysfunctional it actually was. Eventually, I wondered if anyone cared. At least the stories in the Los Angeles Times indicated that there wwere attempts to bring these matters to public attention.

I also questioned how these children could suffer at the hands of adults with such apparent societal indifference. I thought “Why isn’t something being done?” I believe it is because the children are an invisible, voiceless and powerless minority. A minority in Los Angeles County, as well as nationwide, disenfranchised, discriminated against, abused, neglected, and, in some cases, murdered. Even though they have legal representation, their rights are often superseded by rights of other groups (primarily their parents).

Disenfranchisement happens for many reasons. Historically, the foster-parent child relationship has long been viewed as something less than valuable. As a consequence, it has often been poorly supported by social agencies. Because of the new emphasis on placement permanency, foster parenting is even more attenuated. Because of their ambiguous and often temporary role in children’s lives, the lack of agency support and the intrusion into their lives, foster parents are frequently underestimated, ignored, or devalued. The placement effects on this disenfranchised group of children are made worse because the children are not valued and their loss or trauma is not seen as significant. Consequently, what was lost is not valued and the impact of the trauma is minimized.

Another ramification of disenfranchisement is that minimal resources are provided to help foster families deal with the emotional impact that fostering children has on their lives. Frequently, by the single act of taking a child into their home, foster parents unexpectedly become at risk for emotional and psychological distress as they struggle to cope with the demands of foster parenting. Foster parents often experience an unanticipated reaction when they relive their own childhood traumas while dealing with and caring for foster children who often have numerous behavioral and psychiatric disorders. Finally, as a result of the huge cuts in state and federal funding for these programs, disenfranchisement occurs and is often seen as an unfortunate but necessary budget decision. It is common knowledge that the first programs to receive cuts are typically in the areas of health, education and welfare. This cutting cycle has been particularly virulent since the national and state budget calamity of 2008. “Special needs children” in placement are a unique population. Their special needs and circumstances exist because they have experienced multiple traumas which resulted in their placement: physical and emotional abuse, domestic violence, sexual abuse, neglect and abandonment. They have also experienced trauma from being removed and placed. What is not given credence is that entering the system results in serial trauma. This trauma comes in the form of going to court, losing control of their lives, having a cumbersome and impersonal bureaucracy determine their fate, and being handed over to total strangers who are responsible for meeting their needs for safety, security, and nurturance.

As a consequence of being removed to “protect them,” the children begin a journey characterized by sequential victimization. They often bounce from one court-ordered placement to the next and are placed with other children whose plight is similar to their own. Sibling groups are often separated. Group homes, residential facilities, foster homes, and temporary holding facilities become the tapestry against which the drama of their victimization is played out: first victimized by inadequate and often incompetent impaired parents, and then victimized again when their primary attachment is disrupted by their removal. The victimization continues as failed placements result in being moved from one placement to the next. Then, as if they have not suffered enough, because of the court-ordered reunification plan, they are forced to see the offending parent in a weekly visit or series of visits, thereby creating a situation that leads to secondary trauma. Imagine what would happen if a rape victim was required by law to spend several hours a week “visiting” her rapist. The effect on children is similar.

Well-meaning court and dependency workers and well-meaning caregivers, often ill-equipped to help these wounded children heal and normalize their lives, participate in this cycle of instability. The net result is a serial form of trauma where children are caught in a cycle of victimization, terrorizing and rendering them helpless, with little control regarding their future. The children in this system flounder and struggle to survive against overwhelming forces. Each time the system fails, the misery and wounding of children is compounded. In my view, it is a trauma epidemic, a shadowy force that is the tip of the social system iceberg.

In today’s climate of budgetary crises, the necessary mental health services are no longer available to provide the crucial help needed to allow these children to recover from their ordeal. In short, they are not well served by this system, the very system mandated to serve and protect them. In a perverse way, they have become a new social group victimized by discrimination.

As I entered this new and very foreign world I experienced a kind of culture shock. The first shock was seeing so many children with emotional damage. As I handled case after case of children placed with our foster family agency, I noticed a repeated constellation of symptoms in these children. Unlike the adults and adolescents I was accustomed to working with in the private mental health sector, the children seemed, to my surprise, to have a whole range of multiple disorders — primarily symptoms of Attention Deficit Disorder and Post Traumatic Stress-and in some cases, Childhood Schizophrenia and Bipolar Disorder, They also had combined attachment, mood and behavioral disorders. I wondered how this could be.

The second shock was the discovery of an underworld of violence and the horrible things parents do to their children. The third shocking discovery was the dysfunctional nature of the system serving the children. These heinous, horrific, unspeakaable discoveries have consumed my attention and professional curiosity. Pursuing and understanding the connection between the above three factors with the unifying theme of Trauma and Loss has been my purpose.

Through my observations, a thread of commonality became glaringly obvious among these children’s stories: a history of disruption permeated by parental neglect, abuse, addiction, homelessness or domestic violence, followed by removal from the home and placement in a large system. That these children experience these horrendous events when they are the most dependent and vulnerable added to the impact of the trauma.

As I continued, trying to make sense of what I was seeing, there came a more gradual discovery. I found that what I had learned about trauma in the lives of adult survivors was an inadequate model for understanding the complex behavior-psycho-emotional-social problems in the lives of the children I served. An even more disheartening fact was that trauma had very deep roots, even beginning before birth and then continuing, becoming embedded in the family dynamic of tragedy.

These children have genetic histories where there may be a long family history of mental illness and addiction. Add drug abuse during pregnancy, poor prenatal care, maternal stress, and domestic violence to the mix and one can see that children are suffering from complex and ongoing trauma. The complexity of the problem and how this dramatically increases the odds against a good start in life seriously tilts development in a negative direction, if not arresting it altogether. Their stories speak loudly of the trauma, the confusion, life-long scars, chaos, and uncertainty of having lives thrown completely off their developmental track through the accident of birth and placement. I have come to the conclusion that in order to grasp the complexity of the problem, it is best viewed in its entire context as a matrix of interlocking processes: Pre-placement trauma compounded by placement trauma and the ongoing trauma of being subjected to dysfunctional systems working against each other. My inevitable conclusion: Broken systems lead to shattered lives.

This is a social and national tragedy which, in the context of our larger national concerns, goes unnoticed. That is why I refer to these children as disenfranchised. They and their problems are overlooked. Not valued, they are the invisible, shadow population who only become visible as adults when they commit crimes, produce more children, are plagued by drug abuse and homelessness, and fill our jails and mental institutions.

This epidemic of family and societal failure is a major financial drain on our society as a whole through incarceration and/or homelessness and through over-burdening of other social support systems. It is estimated that 50-70% of children passing through the juvenile justice system have experienced trauma directly through drug exposure during and after pregnancy. Following birth, these children have acquired mental health disorders. In my experience, all of the children who have been removed from their homes have experienced significant losses which, if untreated, have the potential to become major impediments to functional adulthood.

Study after study confirms that early abuse and neglect have lifelong-effects which impair a person’s ability to have healthy relationships. Children who have been abused are more self-destructive, prone to addiction, likely to divorce, more likely to be involved in criminal activity, and have serious attachment problems as well. It is cliché to say that adult abusers were abused children, but it is nevertheless true.

The unrecognized effects of removal from their families of origin and the attendant trauma and loss are the greatest hurdles to successful adjustment and recovery for children dependent upon social services. I once attended a conference in which David Sanders, former director of Los Angeles County Department of Children and Family Services, said “As an agency we do a good job of protecting these children from harm but we do not do a good job of raising them. This is a massive failure.” In light of recent revelations about the deaths of children in placement, it appears we are not even doing a good job of protecting them. He believed that the solution was to prevent children from entering the system in the first place. “Family preservation and reunification should be the goal,” he said. However, there are many families ravaged by mental illness, homelessness, poverty and addiction who cannot, and should not be preserved. To return certain children to their families of origin often has had tragic results.

It has been my experience that the events of removal, placement and adjustment to foster care are largely overlooked as far as the traumatizing consequences are concerned. For example, I attended a conference in Los Angeles on death, grief, and trauma in the lives of children. During one presentation on traumatized children, I asked the presenter about the effects of foster placement. He said that was not within the scope of their study.

Again, my reason for involvement with this project is that placement in foster care is a major cause of trauma in the lives of children, and that children who are subjected to these traumatic events do not receive the recognition or specialized form of care they so desperately need. In fact, I have seen that the event of placement is treated as a non-event. Frequently, the child is removed and placed with little regard for its impact. When the anticipated adjustment, developmental, and learning problems occur, even the most minimal forms of intervention are seldom provided. Because the children often find it difficult to adjust, they are blamed, given seven day notices, and stigmatized as “difficult.” Care is inadequate, foster parents are poorly trained and inadequately supported, and services are difficult to obtain.

Psychological care for these children is often sporadic and not integrated into the total care of the child. Because of the recent economic calamity, services are being more severely curtailed. Foster parents are often viewed as ancillary to treatment and not kept informed of the direction and reason for treatment. When treatment is given, it is often by practitioners who are not trained in specific forms of trauma treatment. Though Permanency is the new code phrase in the child welfare system, it is seldom achieved without great effort and serial episodes of impermanence. Many fractured families come into the system and receive various forms of support and services in order to preserve the family. The children are left in these families while they try to overcome their multiple problems. Other forms of permanency are also being advocated and the net result is a system in a state of flux where the children suffer. Again, broken systems lead to shattered lives.

That all of this creates uncertainty, confusion, anxiety, and disorientation is a powerful understatement. I have long been aware of how troublesome, painful, and overwhelming the entire experience of placement can be and how frequently lifelong wounds are created. Out of personal experience working with particular trauma victims, I have come to understand why children aging out of this system struggle so greatly to emancipate. Their lives begin with trauma, they continue to be traumatized while in the system, they are supposed to attend “Independent Living Programs” but seldom attend. The social workers who are charged with ensuring that their wards receive the proper instruction often do not follow through and insist that the children get the training, and a 12 week program to help the kids become self-sufficient is clearly inadequate. It is inadequate because the damage incurred previously by trauma, neglect, abuse, and multiple failed placements has created such debilitating psychic wounds, learning disorders, and impaired social skills that their developmental lag is significantly greater than non-system children. In short, the levels of their needs are not being addressed by appropriate social, psychological and educational remediation. Their success is greatly hindered given the level of their dysfunction and the inadequacy of the programs designed to help them emancipate.

Pursuant to researching my book, it has been my deeply held conviction mythat the reason for failure to become a self-regulating, independent adult is due to early trauma. The significance of this fact is often unrecognized and given little credence; a brief look at some of the literature regarding the impact of early trauma will tell us why and how trauma has such s negative impact on healthy development.

The Effects of Trauma on Development
What are the effects of trauma on development and what are the specific mechanisms at work when a child is traumatized? These were the basic questions I pursued. As my level of awareness increased, I pushed my research efforts to find answers to why children are so profoundly affected by trauma, specifically the kinds of trauma experienced and what short and long term effects of early trauma and life-disruption exist. The answer may be known intuitively (yes, we know it is bad to abuse children), but let us explore some of the research in order to 1) understand the impact of trauma and why it is harmful to children, and 2) understand which developmental areas are most affected. For the sake of simplicity, we need a working definition.

The research consensus defines childhood trauma as those events in childhood that produce a sense of helplessness, anxiety, shame, humiliation, and/or abandonment for which there has been no satisfactory repair from a caregiver. When such an event occurs, it results in a breach of the crucial parent-child relationship. Though children are often rendered helpless by daily interactions between themselves and their caregivers, not all result in trauma. What are particularly disturbing to children and of lasting effect are what Siegel refers to as attunement failures between parent and child. According to him, these failures are always, by definition, small-t traumas, or life events that are more common experiences and are upsetting, but on the surface are not thought of as traumatizing. If they are repetitive, fixed and rigid, there is no way to process the negative emotion that the trauma creates, and the effects become cumulative, leading to disturbances (breaches) in the relationship. Siegel says small-t trauma is split off from consciousness and stored in largely inaccessible memories in the child’s unconscious (implicit memory system). When the child and his/her environment are out of balance and become disconnected in such a way that no repair takes place, small-t trauma occurs, resulting in anger, fear and eventually defensiveness.

What are the necessary and sufficient conditions that lead to a traumatized state of mind? In both the case of adults and children, the key ingredient seems to be a state of helplessness and separation in the face of actual (or perceived) danger, resulting in a state of victimization and alienation. A traumatized state then occurs when a child is unable to respond effectively to a situation; this inability to respond is, in turn, signaled by anxiety and/or panic, as no apparent way to restore harmony or the relationship seems to exist. We can see, then, that children are much more vulnerable to the experience of helplessness because of their dependence on caregivers. Bessell A. van der Kolk underscores the primary role of parents in protecting children and helping to maintain a stable and secure environment:
The primary function of parents can be thought of as helping children modulate their arousal by attuned and well-timed provision of playing, feeding, comforting, touching, looking, cleaning and resting—in short by teaching them skills that will gradually help them modulate their own arousal. Secure attachment bonds serve as primary defenses against trauma-induced psychopathology in both children and adults. In children who have been exposed to severe stressors, the quality of the parental bond is probably the single most important determinant of long term damage. (Traumatic Stress, Pg. 135)

The focus is now further refined and is thus aimed at small and even large trauma experiences processed in the parent-child dyad. However, when there is impairment of parental empathy, these effects are not processed interpersonally but are stored. Again, what is significant is that these events are often not one-time occurrences: daily repetition leads to a kind of serial trauma perpetrated by the very people who are supposed to be protecting and nurturing these children.

By linking trauma with development, an entirely new perspective for understanding the short and long term effects of trauma is presented. Siegel, Lillas, Schore, van der Kolk and Perry, along with many others, have created a new model for understanding how the human brain becomes organized in a way that is integrated, self-regulating and capable of complex cognitive tasks and behaviors necessary for healthy adult functioning. They have even found the particular areas of the brain that are responsible for organization and integration. There are a number of areas of the brain involved that make this happen:
A growing body of current evidence shows that the neural circuitry of the stress system is located in the early developing right brain, the hemisphere that is dominant for the control of vital functions that support survival and the human stress response. Because the stress coping strategies are deeply connected into essential organismic functions, they begin their maturation pre and post-natally, a time of right brain dominance…Attachment experiences of the first 2 years thus directly influence the experience-dependent maturation of the right brain. These include experiences with a traumatizing caregiver, which are well known to negatively impact the child’s attachment security, stress coping strategies, and sense of self. (Dysregulation of the Right Brain, Allan Schore, the Australian and New Zealand journal of Psychiatry, Pg. 29)

Connie Lilllas, an expert on infant mental health and parent-child relationships, further expands on the connection between experience and brain development and why the early years are so critical.

What we do for infants in our care may play a bigger role in shaping their lives than our efforts would for any other group of children. We know this because a child’s brain grows more during the first three years of his or her life than any other; growing to about 80 percent of adult size by three years of age and 90 percent by age five.

A Quick Lesson on Brain Functioning…
Our brains are filled with millions of neurons (also called nerve cells) that send messages to each other via synapses. The neuron together with the synapse forms a pathway for transmitting information, allowing each area of the brain to communicate with the others. It is this communication that allows us to do everything from recognizing letters and numbers to forming friendships.

We are born with all of the neurons that we will ever have – it is the synapses or connections between those neurons that are constantly being formed throughout life. However, it is during the first few years that we are genetically programmed to produce an explosion of synapses. What we know as “brain development” is actually the wiring and rewiring of the synapses. And, because the brain operates under the “use it or lose it” rule, those synapses that are constantly used, remain. Those that aren’t are “pruned” away. Every experience, from riding a bicycle to reading a book, or learning a new song excites certain neural circuits and leaves others inactive. Those that are consistently turned on over time will be strengthened, while those that are rarely excited may be lost. In a “normal” child, this is an efficient method of brain development – get rid of the excessive synaptic connections to make the remaining circuits work more quickly and efficiently.

However, in an abused and/or neglected child, synapses may be pruned away that are neglected, but not unimportant. The small owner of these lost synaptic connections will find him or herself struggling to do what would come naturally to another child.

Unfortunately, the brain becomes less plastic as we age and pruning ends – this means that we have a window of opportunity for certain connections to be made. Once that window closes, specific opportunities are lost. (Infant/Child Mental Health, Connie Lillas and Janiece Turnbull, Pg. 56)

These recent theories are based on the assumption that the structure and functioning of the developing brain is experience dependent, determined by how experiences, especially within interpersonal relationships, shape the genetically-programmed maturation of the nervous system. There are indeed critical periods for development. Current workers in the field of developmental traumatology now agree that the overwhelming stress of maltreatment in childhood is associated with adverse influences on both behavior and brain development, especially the right brain which is dominant for coping with negative feelings and emotions as well as the all-important skill of stress regulation.

By looking at the effects of trauma on development in this new framework, I believe we will be able to have a more complete picture of what a child within children’s services undergoes when removed and placed in a surrogate home. It will reveal not only how he/she is affected, but also why he/she struggles and what roadblocks exist to recovery. Perhaps we will then be able to devise better strategies for ameliorating the effects of trauma and placement on a child’s development. When we do this, we will be able to pinpoint specific parental conduct that is deemed detrimental.

Connie Lillas describes and lists the effects of these experiences caused by being in the foster/adopt system:
Children under 5 represent 39% in care, the presence of biological vulnerabilities within a context of unstable or absent emotional care takes a serious toll on the immune system: 80% of foster care children have at least one chronic health condition, 25% have 3 or more major health problems, more than 59% have developmental delays, 80% have been exposed to substance abuse in-utero, and 49% have low birth weight. The result is that these children are biologically more vulnerable, are more difficult to care for, have multiple placements and have been exposed to multiple risk factors. In sum they are biologically and psychologically vulnerable. Couple this with birth parents also being vulnerable because of substance abuse, domestic violence, depression, homeless, and mental illness: This is a prescription for predictable failure. (Infant/Child Mental Health, Pg.129)

This growing body of research on traumatized children reveals a wide range of effects over a broad continuum. The degree of trauma is a function of type, intensity, perpetrator, age of the child at the time of the trauma, and frequency of abuse or neglect. We now know with certainty that the effects of trauma create developmental delay, and often result in the child being frozen emotionally at the age when the events happened. Allan Schore writes in Healing Trauma regarding his view on relational trauma: “The concept of trauma, which is by definition psychobiological, is a bridge between the domains of both mind and body.” (Pg 109) This view of trauma makes it a very utilitarian concept; the bridge that allows us to understand complex relationships between environment, development, cognitive functioning, social behavior, and adult functioning.

This bridge has led to a whole new perspective on the devastating effects of childhood trauma, a perspective based on an understanding of how the brain becomes organized, leading to the formation of our basic sense of self and critical areas of brain function. What we must keep in mind is the ambient nature of trauma– what happens when the first thing a child encounters at birth is not a warm and welcoming environment but a trauma:
The fact that such trauma is “ambient” clearly suggests that the infant is frequently experiencing not single episode or acute but “cumulative and chronic unpredictable traumatic stress” in his very first interactions with another human. (Dysregulation of the Right Brain, Allan Schore, the Australian and New Zealand Journal of Psychiatry, Pg. 20)

At birth, as we are now coming to understand, a child’s brain is not completely formed and in very complicated ways it is profoundly affected by interaction with the environment. Understanding the basic assumption that children are not miniature adults leads to making critical distinctions between adult and child trauma. The first distinction is that children are more dependent and therefore more vulnerable. Secondly, during the process of developing, trauma has been found to profoundly affect that process because children are born with incomplete systems programmed genetically to develop in a predictable, experience-based sequence. Trauma interferes with this normal sequencing.
Trauma and Attachment
Siegel enhances the view of the importance of early childhood experience and parenting with this comment regarding the relationship between experience and development:
The central thesis of my work is that the early social environment, mediated by the primary caregiver, directly influences the final wiring of the circuits in the infant brain. These circuits are responsible for the future social and emotional capacities of the individual. The attachment relationship thus directly shapes the maturation of the infant’s brain and the human stress response. (Pg. 112)

Siegel’s work and that of others underscores the importance of attachment and that failure to understand these attachments leads to the problem of the unrecognized and persistent effects of trauma and loss. Failure to recognize these effects leads to subsequent difficulties in children struggling to adjust to placement without proper support. When not recognized and accounted for by those responsible for their placement, it has very tragic consequences. It is this lack of knowledge that leads to well-intentioned foster-adopt parents being overwhelmed and feeling inadequate when dealing with the task of caring for foster children. It also explains how they find themselves encountering behavior and situations for which they have little preparation and background—knowledge that would enable them to cope with children entering their homes. The behaviors they find most difficult to moderate are behaviors which are emotionally driven: temper tantrums, poor impulse control and volatile emotional mood swings, behavior which appears to be totally out of control–dysregulated. Finally, this lack of knowledge and subsequent interventions leads to the lack of comprehensive services to ameliorate the developmental problems of the children in their care.

There are critical brain centers that are responsible for memory, information processing, emotion, motivation, and judgment. These centers, all linked with neural pathways, are designed to lead to integration and organization responsible for development of a sense of self. Sudden, unexpected changes or elevated stress lead to the phenomenon known as dysregulation. In children this may be seen as episodes in which the child seems to fall apart at the slightest amount of change, fatigue or over-stimulation. This occurs because the child has not acquired the capacity to regulate strong emotions or cope with the stress of a change in routine.

Dysregulation
Once again, Schore takes us to a new level by discussing the importance of regulating affect, in particular, understanding that children so obviously out of control and volatile are not the exception, but the norm.
It has been said that the most significant consequence of the stressor of early relational trauma is the lack of capacity for emotional self-regulation, expressed in the loss of the ability to regulate the intensity and duration of affects….In light of the essential role of the right hemisphere in the human stress response, this psychoneurobiological conception of trauma-induced stress response clearly suggests affect dysregulation is now seen to be a fundamental mechanism of all psychiatric disorders. Dysregulation of the Right Brain, Allan Schore, the Australian and New Zealand journal of Psychiatry, (Pg. 11)

Regulating emotion refers to the general ability of the mind to alter various components of emotional processing. In many ways, the self-organization of the mind is determined by the self-regulation of emotional states. How we experience the world, relate to others, and find meaning in life is dependent upon how we regulate our emotions. Again, we come to this fundamental observation that the connection between experience and the emotions generated from those experiences alter critical areas of brain systems.

The area of the brain involved in emotional processing is the limbic system. The limbic system is centrally located in the brain and plays a vital role in coordinating the activity of higher and lower brain structures. The limbic region is commonly regarded as the emotional brain because it mediates emotion, motivation and goal-directed behavior. It is located in the middle brain and is comprised of the amygdala, hippocampus, thalamus and hypothalamus. The amygdala plays a key role in the way memories are stored and internalized based on sensory and emotional effect. The hypothalamus regulates body temperature, hormones and glands and is a major mapper as it gives the brain a sense of self through multiple layers of integration. The thalamus connects areas of the cerebral cortex with the spinal cord and other regions of the brain in order to assist sensory perception and movement.

The hippocampus filters and sends memories to the cerebral hemisphere for storage and can retrieve memories from storage when needed. The hippocampus is considered the cognitive mapper. It gives the brain a sense of self in space and time through multiple layers of integration. This process of the hippocampus functions through the narrative mode. Narrative is a part of social discourse and is inherently social. Narrative is also neurobiological, as it facilitates the integration of coherence within the mind. This is how the various layers of brain function are tied together and organized, and the narrative mode of cognition is fundamental to the mapping process. This may be the very heart of our autobiographical narrative and the way the mind attempts to achieve a sense of coherence, tying the past, present and anticipated future together. The capacity of the mind to create such a global map of the Self across time and various contexts is an essential feature of being human. What holds it all together is our narrative, or life-story. It is easy to see that when our personal story or narrative is disrupted through trauma or placement, there is a cascading effect in brain neurology, our sense of self and our behavior with others. The narrative, when disrupted early in development, produces adverse effects evident in the child’s behavior. It is frequently said that when you know a child’s history, her behavior makes perfect sense. This is how the notion of narrative pulls all of these ideas together and furthers our ideas about the development of a coherent identity.

Siegel states, “Neural integration is fundamental to self-organization, and indeed to the capacity of the brain to create a sense of self.” (Pg. 302) Over-arousal of the central nervous system also leads to changes in arousal levels, information processing, hyper-vigilance and irritability, and learning problems. These may be the permanent results of chronically high stress levels.
What this means is that a process that links distinct circuits not only creates a new form of information processing, but also establishes a more complex, integrated network that influences its own capacities. Integrated systems, by virtue of their coordinated activities, establish their own characteristic features…As we will see such neural integration becomes a central process that is directly related to self-regulation. (Pg. 304)

The Stress Response System
Neural integration and self-regulation are key factors that, when affected by over-arousal of the autonomic nervous system, result in disruption of the integration and organization of centers related to the development of a sense of self. Research indicates that the neurological circuits are directly affected by the residual effects of prolonged stress, resulting in chronic over-arousal of the autonomic nervous system, which then creates a significant effect on several important neurological centers in the brain: Amygdala, hippocampus, limbic system, frontal cortex, and other vital information processing centers. (Siegel, Pg. 330)

The dynamic relationship between emotional arousal and interaction of the various related brain areas can be understood through the functioning of the stress response system. When we are under a high level of stress, the autonomic nervous system is triggered in association with the endocrine system, causing the release of stress hormones that prepare our brain and body to respond to a perceived emotional or physical threat. Rose comments on the effects of constant threat as it pertains to current and future learning:
If trauma is constant, and threat is real and dangerous, the brain utilizes what resources it can provide to respond to protect the whole. This constant heightened response involves the child’s concentrating on the threat and her perception of it: However, the brain has already selected where it is required to respond and this means that healthy development in the brain is not underway. Important learning does not take place as the brain is on guard and the trauma is the focus of learning. (Life Story Therapy with Traumatized Children, Pg.49)

Because of threat, more specifically, constant, persistent threat, high levels of stress hormones may produce higher daily base line levels of hormone release. Chronic stress inhibits neuronal growth in the hippocampus which is involved in memory. “Excessive stress hormone release appears respectively to impair the hippocampal and amygdal contributions to memory processing.” (Siegel, Pg. 50) The value of these findings is present in research done in the last 10 years concerning memory of traumatic experiences. Through this research, the reason that traumatic experiences may remain outside of awareness and suddenly be triggered by something in our current experience intruding upon the survivor’s internal experience can now be understood.

Regulation of extreme emotion, like that experienced through exposure to trauma, becomes the pivot point for dealing with said trauma. Why is self-regulation fundamentally seen as emotion regulation? “Emotion, as a series of integrating processes in the mind, links all layers of functioning.” (Siegel, Pg. 275)

The importance of regulating powerful emotions, then, is critical for healthy development of the brain, cognition, memory, and even the developing sense of self, all of which are dependent upon the appraisal and arousal process of the mind. Again we come back to the critical relationship with the caregiver. Siegel notes that achieving self-organization, the pinnacle of psychological maturation, occurs within emotionally-attuned interpersonal experiences. Therefore emotional regulation is at the core of the self. (Pg. 274)

This principle cannot be stated too often. In my work with abused children who have been placed, my central observation was that these children were easily upset and had a great deal of difficulty regulating their behavior. In other words, they were volatile and had difficulty regaining a calm state. This, of course, led to the newly-found parental surrogates having the same difficulty of regulation (i.e., controlling out-of-control emotions and behavior). It is easy to see, then, why these issues become even more pronounced in late adolescence when the stress of emancipation begins to impact the individual.

Developmental Trauma Disorder
In retrospect, all of this information was coalescing for me as I managed my cases. The information helped me to make sense of my observations by synthesizing the various perspectives. It has been a rather steep learning curve. I began to understand how these children were severely affected by early trauma. Based on what I was learning, I developed a framework that allowed me to understand what I was seeing. I had discovered a whole new diagnostic category that was being used by Van der Kolk. Here is Van der Kolk’s position on childhood trauma, indicating how trauma leads to a separate diagnostic category for children:
A history of neglect, physical and or sexual and earlier onset of maltreatment was directly related to symptoms of emotional dysregulation. Symptoms of emotional dysregulation are also at the core of a construct called Developmental Trauma Disorder, in children and adolescents reflecting the complex adaptations to prolonged psychological trauma in childhood.(Life Story Therapy with Traumatized Children. Pg. 46)

Developmental Trauma Disorder: That was clearly what I was seeing in these young children. How this was related to parental abuse was the next link in my understanding. These findings indicate that brain development, organization and integration are directly dependent on interpersonal experience. The actual development of the neural circuitry is dependent upon the type and quality of interpersonal relationships. This last factor has been given considerable emphasis in the last few years by work done on attachment.
Indeed, current studies in developing traumatology now conclude that the overwhelming stress of maltreatment in childhood is associated with adverse influences on brain development. This maltreatment specifically refers to the severe affect dysregulation of the two dominant forms of infant trauma-abuse and neglect. (Dysregulation of the Right Brain, Allan Schore, the Australian and New Zealand journal of Psychiatry, Pg.11)

To recapitulate, if we step back for a moment, we can see this is why trauma is so devastating to a young and developing child’s brain. Trauma disrupts, distorts, delays and in some cases totally derails the developmental process, all because the child is (1) young, (2) vulnerable, (3) developing, and (4) totally dependent on caregivers. Research now clearly shows that emotion serves as the central organizing process within the brain, thereby determining the ability of the brain to make sense of experience, integrate events, interpret the data and then adapt to future stressors. Hence, overwhelming emotion via a traumatic stressor and its concomitant hormonal and neurological effects is the reason trauma has not only temporary, but also long-term effects on development. These profound effects have lasting consequences on emotional regulation, attachment security, stress coping strategies, and basic sense of self. These are wide and encompassing areas of psycho-social development and function. As van der Kolk notes on the role of trauma, specifically attachment patterns:
Recent research has shown that as many as 80% of abused infants and children have disorganized/disoriented attachment patterns, including unpredictable alterations of approach and avoidance toward their mothers. . . Thus early attunement combines with temperamental predispositions to “set” the capacity to regulate future arousal; limitations in this capacity are likely to play a role in long term vulnerability to psychopathological problems after exposure to potentially traumatizing experiences. (Traumatic Stress, Pg. 186)

These children who enter the system are not just suffering from trauma. They are suffering from Multiple-Complex-Serial Trauma. We can only conclude that this phenomenon accounts for the myriad effects we see manifested in their behavior. Van der Kolk observes, “The lack or loss of self-regulation is the most far-reaching effect of psychological trauma in both children and adults.” (Pg. 187)

Abused children are struggling to cope, adapt, and survive in circumstances which would overwhelm the defenses of any adult. These conclusions are now confirmed by the neurobiological theorists: van der Kolk, Siegel, Schore, Lillis et al. They are unanimous in their belief that the brain is dynamically related to environmental forces and that in order to develop normally, it needs a stable, consistent, nurturing environment. When this environment is disrupted by abusive or neglectful experiences, very serious developmental consequences occur. These results are all encompassing:
The lack of development or loss of self-regulatory processes in abused children leads to problems with self-definition (1) disturbances of the sense of self, such as a sense of separateness, loss of autobiographical memories and disturbances of bodily image (2) poorly modulated affect and impulse control including aggression against self and others, and (3) insecurity in relationships such as distrust, isolation, suspiciousness and lack of intimacy. (Traumatic Stress, van der Kolk, Pg. 186)

In my work, I saw the entire trauma spectrum on a daily basis. This was a different world than the world of single event adult trauma I had been working with up to this point. It was clearly tied to parental abuse. In fact, the specific parental attachment behaviors that were likely to be at fault have been described by Lillas, who gives us a list of parental behaviors that lead to dysregulation in children. Below are a few of the behaviors she observed in her studies on parent-child interactions.
• Parent constricted emotionally
• Parent hostile-critical to child’s emotions
• Parent anxious, intrusive or distracted
• Parent overly hostile in punishment
• Parent withdrawn, not present
• Parent impulsively changes themes in play
• Parent vacillates between being permissive and overly harsh or rigid
• Parent physically abusive
• Parent too controlling or parent sets poor limits
• Parent does not exhibit pleasure or delight (Infant/Child Mental Health, Pg. 94)
These kinds of parental behaviors set up patterns that become a part of the emotional memories generated through every-day encounters. They eventually become linked in the child’s nervous system with other patterns of sensation and arousal which are reinforced through daily repetition and become styles of interaction. In short, they become the attachment paradigm.
Trauma Defenses/Dissociation
Conclusions from the research are irrefutable: chronic stress and trauma have a direct effect on the organization of the brain, the self, and the ability to function socially through adaptation. This is the essence of adult functioning, namely, the ability to learn, self-regulate, profit from experience, and adapt to changing social conditions. It is no stretch to then include a byproduct of trauma, the numbing of emotions–fear, rage, terror, shame, and humiliation too overwhelming to process. When faced with overwhelming fear or terror, something must be done to survive, to cope. This leads to a psychological defense I have frequently observed in young children, a phenomenon known as dissociation. Present in both adults and children, it is often more pronounced in children. When dissociation occurs, there is an inability to feel or recall the trauma. This defense can be deceptive; it often leads observers to think that the individual is unaffected by the event. All too frequently when a child is placed, the foster parent often observes “how she seems to be smiling and pleasant” when introduced into the home. Lenore Terr, in her insightful book Too Scared To Cry, noticed in children:
At the moment of terror, young children tend to go on behaving almost as usual, even as their psychological underpinnings are being torn asunder…Seldom are there tears. Instead there is an immobility of expression, a failure to move the mouth, a lack of animation in the eyes. The face of horror in childhood is grave and relatively immobile, it may look dazed, but it rarely looks hysterical….The terror lingers even if the event is happily resolved. (Pg. 34)

Dissociation results from the failure to integrate experience. It is caused by an overwhelming event that leads to fight, flight, or in the above case, freezing. To illustrate, let us look at the child’s dilemma. The child is dependent upon unreliable, often abusive and frightening parents, in essence “terrorists”. What is the child to do? This is a problem without a solution, so the inevitable response is freezing, which leads to dissociation, which often appears in a child as a trance-like state. In essence, it is the inability of the self to take in and make sense of overwhelming experiences. For survival sake, the experience must be blocked out. The physiological response is to shut down in order to manage a surge in energy in the system caused by too much arousal. Schore precisely describes this phenomenon:
In the present period we are also seeing a parallel interest in developmental research on the etiology of the primitive defense that is used to cope with overwhelming affective states — dissociation. From the perspective of developmental psychopathology, an outgrowth of attachment theory that conceptualizes normal and aberrant development in terms of common underlying mechanisms, dissociation is described as offering potentially very rich models for understanding the ontogeny of environmentally produced psychiatric conditions. Disorganized-disoriented insecure attachment, a primary risk factor for the development of psychiatric disorders, has been specifically implicated in the etiology of the dissociative disorder. Neuroscience is now delving into the neurobiology of dissociation, especially in infancy. It is currently thought that dissociation at the time of exposure to extreme stress signals the invocation of neural mechanisms that result in long-term alterations in brain functioning. This principle applies to long-term alterations in the developing brain, especially the early maturing right brain, the locus of dissociation, withdrawal and avoidance, and a spectrum of psychiatric disorders. (Dysregulation of the Right Brain, Allan Schore, the Australian and New Zealand journal of Psychiatry, Pg. 12)

In sum, Schore and others conclude that trauma, when experienced early in an infant’s life and in relationship to his caregivers, has profound and often lasting effects that cover the entire gamut of human neural development. Early relational trauma has a significant negative impact on the experience-dependent maturation of the right brain, which is in a critical period of growth during dyadic attachment experiences. The effects are:
1. Cognitive: Memory impairment, information processing difficulties, distorted sense of time, learning difficulties, loss of academic skills, and impaired ability to concentrate.

2. Emotion (affective): Inability to regulate emotions, avoidance, depression, guilt and shame, feelings of helplessness and powerlessness, negative self-esteem and frozen or blocked emotion. In addition, children often exhibit uncontrolled rage, extreme emotional volatility with low frustration tolerance, and an inability to soothe or comfort themselves.

3. Behavioral: Increased aggression, oppositional behavior, regression with bed wetting and soiling, muteness, repetitive play, sexualized behavior, suicide attempts, chemical dependency, self-destructiveness, risk taking, poor impulse control, and anti-social behavior.

4. Physiological: Over-arousal of the Autonomic Nervous System leading to hyper-vigilance, and a host of neurological effects.

5. Attachment: In addition to all of the above, there are also the difficulties related to attachment. Children who have been traumatized have difficulty trusting, experiencing intimacy, and forming satisfying long-term relationships.

All of the above effects have been classified as a diagnosis which is called Developmental Trauma Disorder. These effects are a dynamically active part of the child’s ongoing experience. They continue as active influences throughout the child’s development and in fact may be responsible for many developmental delays, learning difficulties, lack of social skill development, and the ability to emotionally regulate, plan, organize and function as an adult, all skills needed when aging out of the foster care system.
Discussion
The troubling outcome statistics regarding emancipating foster youth reflect a natural and expected result, given all of the factors I have discussed. Early trauma, abuse, disruption of attachment bonds, multiple-placements, lack of appropriate remedial services for these issues affecting psycho-social-educational development all contribute to a difficult journey through a very flawed system. In order to have a significant impact on the lives of children in the foster care system, there needs to be (1) early intervention, (2) assessment and defined targeted problem areas, (3) attachment based treatment for issues of grief and loss, and (4) an integrated system which effectively coordinates all of these services. This is a tall order. As I concluded in my book, there need to be significant system wide changes:
In conclusion, given the above-stated problems and issues, within the entire context in which CLS, DCFS, foster parents, FFAAs, and mental health professional function, there are some things we can do to improve the quality of service and bring to bear our concentrated efforts at changing and revolutionizing the whole system. I call my proposal an Integrated Service Plan. It is based on the fundamental idea of making the welfare and mental health of our children our primary goal. This controlling value will inform all our decisions. When a child is placed, it must be done with as much humanity and compassion as possible. When the Reunification Plan is formulated, the impact on the child must be given priority. In my Integrated Service Plan, a comprehensive assessment of the family’s circumstances and parenting capacity would be performed. This would realistically evaluate the chances they have of providing a safe, stable, secure, consistent environment, free of abuse, neglect, domestic violence, drugs and alcohol, and without major mental health issues. This is done by integrating mental health professionals and others to give feedback to the CLC while the child/children are in a safe harbor. During this evaluation period, the children would also be evaluated to determine the amount of initial damage done to them, the kinds of services needed to facilitate their recovery, and assess whether it is in their best interest to be reunified.

It must be remembered that a major feature of trauma and loss is the shame and humiliation that often accompanies abuse, intentional infliction of pain by a trusted adult, and the tendency of children to blame themselves for their misfortune. These powerful experiences damage self-esteem and create major obstacles to healing. We must find ways to help children regain a sense of worth, hope, and trust in themselves as well as others. There needs to be a model with these values as its framework.

This particular model requires 1) collaboration, 2) cooperation, 3) communication, 4) teamwork, and 5) a philosophical change which puts the needs of the children first. In this model, foster parents are given greater training and support in order to help them deal realistically with problems attachment-disordered children bring to the placement, and in this regard there will need to be more targeted services tailored to the specific needs of each child. The “Needs and Service Plans” as they now function are useless. They are perfunctory, no one reads them, and they do not effectively state the goals of treatment. In addition, a plan must evolve to address the issues, and such plans seldom involve all parties who work with the child and family. When a child dies, more action needs to be taken than the formation of another committee and audits of paper trails and agencies. Each tragedy must be given a complete evaluation and determination of what exactly happened in order to learn from the tragedy.

The Formation of the Integrated Service Plan should be created in team meetings where CLC and DCFS and other team members meet to determine an actual treatment plan. This is where the inclusion, collaboration, cooperation, and communication are a functional and dynamic activity. This will solve many of the problems created by a fragmented system where there is no inter-agency communication or cooperation and each tries to do its job in isolation, more often than not while at odds with the others. The net result has been serial trauma to the children.

Adoption foster care advocates should be used when evaluating each case that comes before them so that the number of tragic outcomes may be dramatically reduced. If not, this broken system will continue to shatter lives.

I noted that structural changes also need to be made, including better training of social workers, mentoring, improved supervision, and accountability when a child is injured by malfeasance, incompetence, or ignorance. Also, the social workers need to be assigned realistic, manageable case loads. I have had situations where one case took all of my time and at others times the usual seven cases were quite manageable.

As I worked in the system, it appeared to me that the greatest number of problems centered on reunification and birth family visits. I saw these activities as the points of greatest risk and vulnerability for the children. There needs to be a better framework to prevent high levels of new trauma being added to the original traumatizing circumstances. The least that should happen is to put the needs of the children on par with the rights of their parents.

If we do nothing, we will continue to see adults emancipated from the system struggling with the lifelong effects of unrecognized and untreated early disrupted developmental trauma. The shelters are full, the prisons are full, and the streets are populated by casualties. The casualties are children of the system who have failed to negotiate the treacherous journey of placement for their “protection and safety” while an indifferent society drives right by them wondering where all of these derelicts came from. Again Beverly James has said it very well: “The work needed to help future generations of our global village is everyone’s problem and must be addressed on all levels, and we must recognize that children’s mental health issues are a priority for their survival and ours.” (Pg. XII)

Since I have relied heavily on the comprehensive work of Allan Schore, it seems fitting to me to end this narrative with a quote from him:

The mental health field must move from late intervention to early prevention in order to address the problems of violence in children, a growing concern of a number of societies. In these cases, the seemingly invisible “ghosts from the nursery reappear in horrifyingly sharp out line during the ensuing stages of childhood, where they haunt and destroy not only individual lives, but negatively impact entire communities and societies. The “ghosts from the nurseries that are associated with the early roots of violence…are in essence the right brain imprints of the non-conscious intergeneration transmission of relational trauma. These individuals represent about 15-25% of our prison population.

The answer to fundamental questions of why certain humans can, in certain contexts, commit the most inhuman of acts, must include practical solutions to how we can provide optimal early socio-emotional experiences for larger and larger numbers of our infants, the most recent embodiments of our expression of hope for the future of humanity. (Pg. 306)
(Gary W. Reece, Broken Systems Shattered Lives, Pgs. 237-240)

In the final chapter of my book, The Elusive Search or an Implicit Self, I discussed the issues graduates of the foster care system struggle with on a daily basis. As part my research I had the unique opportunity to meet and get acquainted with several individuals who had been in the system all their lives and now had established functional adult lives. They told me troubling, heart breaking stories, and recounted their heroic lives which resembled the epic struggles of most of the children who called the foster care system home. I learned a great deal from their frank disclosures of the intimate secrets of their lives. I salute their heroics.

These are their struggles: Disrupted attachment and ensuing loss of family connections threaten the very foundations of all later development, namely a secure sense of self and identity, the ability to regulate emotion or soothe oneself, and the ability to engage in trusting, intimate relationships. Not only does disrupted attachment forever alter the normal trajectory of development, it also creates an unhealed wound which becomes a deep reservoir of sadness, longing, fear, rage, guilt, shame, confusion and a sense of not belonging anywhere. These profound identity issues revolve around core dynamics: longing for home and family, dealing with feelings of abandonment, the trauma of placement, the shock to self-esteem of not being wanted by the original family, grief and loss, the rising tide of powerful emotions of shame, guilt and fear, and the difficulty of integrating the unfolding narrative into one’s current sense of self.

Now that these emancipated adolescents are on the brink of adulthood, they face many unfamiliar challenges. From difficult beginnings their lifelong struggles have been a search for identity, for an integrated, coherent, cohesive life story that makes sense to them. The very roots of our sense of self are in our families of origin and early attachments and if one is torn from that family, uprooted, and displaced, how can one possibly find a secure sense of self?

Whether they remained in the system in long-term foster care or a group home, their issues were similar to any adolescent coming of age in our complicated society, but were compounded and compromised by loss of family. As a result, all have many issues related to identity. It’s a longing to know who they are, to feel connected to family, to have roots, and somehow in the process trying to build a coherent narrative. They are driven by an urge to create a life story that makes sense of a partially-told, partially-grasped reality of being given away, deserted, surrendered, abandoned, or involuntarily removed. In so doing, they are tasked with trying to sort fact from fiction, and illusion and myth from reality. With each discovery, the story unfolds, and with each new discovery come feelings, often flooding and terrifying, feelings of shame and ambivalence, of wanting to know and not know. The mind, a bee hive of feelings, thoughts, and memories, begins to assemble the narrative in search of not only why but also who they are. The elusive search for self is a universal phenomenon, but for those who experienced early interruptions of their life narrative it is even more elusive, because it does not begin with the all-familiar family tree. For many the family of origin that is the foundation for our basic sense of self may be unknown. They often feel rootless, lost, and alienated from the larger society. They struggle, often alone and directionless without the framework of a structure called home. In this instance, I use “home” to mean a special framework which ordinarily contains our lives. To lose one’s home, one’s psychic container, is to be cast adrift, to become a wanderer upon the face of the earth. From this point on,
the wanderer must seek his/her own human fulfillment by doing everything alone, instead of with the aid of family. This is a burden, an anxiety-filled challenge, which for those who have already had their psychic container damaged. They need a transitional structure to support, guide, mentor and help with skill development, and a respite when they meet with failure and frustration.

In conclusion, these are the issues any adolescent would encounter when taking the next developmental step, leaving home and attempting to establish a viable adult identity. Most have the advantage of a secure base and an extended family as their orienting star. Children who age out of a broken system do not have that advantage. They suffer the consequences of all the unresolved developmental crises and unhealed wounds which make it difficult for them to make their way in a complex and often indifferent world, which they are woefully prepared to engage and navigate. We who would serve them must devise more effective strategies and programs to address their multiple problems in order to ensure that they too may achieve viable adult lives.

Appendix A
TABLE 6
Housing Arrangements of Foster Youth Who Aged Out or Ran Away

Of the male and female inmates surveyed ( California State Prisons) who had either aged out of foster care or run away from their foster care arrangement, 38 percent had housing plans that lasted for more than one year, 26 percent were “essentially homeless,”10 and 25 percent had housing plans for less than one year.

*Only inmates who had aged out or run away from their foster care arrangement were asked this survey question.
When you left Foster Care, what type of housing arrangement did you have?

MALE FEMALE TOTAL
Essentially Homeless With
No Plan for Housing 25% (26) 29% (6) 26% (32)

Had a Place to Stay for Several Months
Up to 1 Year 27% (28) 14% (3) 25% (31)

Had a Place to Stay for
1 Year or More 35% (36) 52% (11) 38% (47)
Other 12% (12) 5% (1) 10% (13)
Insufficient Information 1% (1) 0 1% (1)
TOTAL 100% (103) 100% (21) 100% (124)

TABLE 7
Homelessness in the First Year after Leaving Foster Care
Of the surveyed inmates who had either aged out or run away from their foster care arrangement, slightly more than one-third (36 percent) of the male and female inmates had been homeless at some point during the first year on their own. A higher percentage of females (43 percent) compared to males (35 percent) reported being without a home during their first year after foster care.
Only inmates who had aged out or run away from their foster care arrangement were asked the survey question.
*Source: Policy Matters: California Senate office of Research. State Survey of California Prisoners.

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