Give me a child until he is seven, and I will give you the man.
St Francis Xavier paraphrasing Aristotle (with a certain sinister undertone).

Amongst all the great apes, Homo sapiens has an unusual gift. The ability to hear a sound and then to copy it.  This skill arises from an innate drive to learn language, and to communicate.  This is a hard wired aid to social living that has developed over millions of years of evolution.

This drive to learn is seen in the “babbling” phase that we all pass through as infants.  We make repetitive sounds, as if practicing, before we start to speak words. This stage occurs in children of all language groups, all of whom make similar sounds; it is also present in those children who are born deaf.

Some birds and parrots have this same innate drive to learn sounds. Some birds, such as gulls and crows, produce innate, species specific sounds that all members of the species make, ones that still develop in birds that have never been exposed to the sounds made by other members of their species.

An innate drive to learn language, and to communicate.

Song birds however, do things differently.  They show an intense, early listening phase – which occurs while they are still in the nest, and have yet to learn to fly. During this period they pay close attention to sounds that are made by other birds in their family. Once they have fledged, and start to sing for themselves, they develop their own unique version of a species specific song.

These songs have a common melodic language that makes them species specific, at the same time each individual bird adds their own unique imprint.  This explains why some flocks of birds have regional accents and some have their own dialects.

This innate drive to learn does not only apply to sounds; humans beings have a drive to learn in general. What we learn depends on what is happening in our environment.  Within our family, our street, our town, and our culture.  It is these influences that decide what sort of human we become.

• Masai or Mexican.
• Australian or Austrian.
• British or Bushman.

We share a genetic link going back over millions of years, but it is our current world that determines our beliefs and outlook on life.

Humans beings have a drive to learn in general.

During our very early life we learn through an osmotic process, soaking up intrinsic knowledge from our world.  We are social creatures and evolution has prepared us for this situation. The human baby is born as a social sponge, and is able to copy facial expressions less than an hour after being born.

We come pre armed with a social brain, one that has been primed by evolution to form relationships.  Everyone around us displays behaviours that are influenced by a particular local belief system, and an associated way of being in the world that this produces; a set of basic rules and beliefs about how families, relationships, and the world work. We develop our own world view through our relationships.  We learn how to be human through our early attachment relationships.

This attachment system is the basis of the human, social operating system. The human brain develops best when it is stimulated in a social environment, and when this goes awry it has long-term consequences.

These environmental influences can have positive and negative effects.  They directly contribute to our personal sense of self, and help instil an initial sense of what we stand for. When our world exposes us to a reasonable mix of good and bad experiences – where our parenting has been “good enough” – then we develop a strong sense of self, positive self-worth, and a resilient world view. We are enabled to think about how we think, what we believe, and how much of this we actually agree with.

It is when our world has not been able to give us a “good enough” experience, that the groundwork for later complex trauma patterns can start to appear.

The same process that helps us to generate positive, internal mental models of ourselves and the world that we inhabit, can also have the opposite effect, leaving us with a set of strongly held, negative beliefs about ourselves, and our world;

• The suspicion that the world will just let us down.
• A belief that we are worthless.
• The inability to contain emotions.
• A constant, highly aroused state as we wait for the next threatening event to unfold.

This final belief – that the world is a dangerous place and will attack us – can be especially problematic.  If we have internalised a belief that the world will cause us harm, it activates our “fight or flight” response.  The result of this is that we find ourselves living in an even more aroused state, one that evolved to warn us of impending, life threatening danger, and not surprisingly, this is very insistent in demanding that we react appropriately, and very rapidly, to life’s triggers.

As our body is on high alert in the look out for danger, we perceive it everywhere and in everything.  We overreact when accidents happen – perhaps being bumped into on the street, or cut up by another driver, or we see danger where it does not exist – in the tone of someones voice, or their choice of words. These misinterpretations are the direct result of a threat detection system that is far too sensitive. Sensitive, in some cases, to the point of being triggered by our thoughts.

When we are raised in such a threat inducing environment, we naturally see the world as threatening, and we tend to take things personally – behaving as though the trauma was still happening, and we continue to behave, and think, in the ways that we have learned in order to survive.  These responses are almost “hard-wired” into the brain. They are things that we have learnt really well as they enable us to stay alive, both physically, and certainly emotionally.

Much of this “trauma” is not an active, deliberate process, but rather a passive one. Sins of omission rather than sins of commission. Situations arise where the conditions for the development of the human mind, and the brain that supports it, are sub-optimal for reasons other than intentional maltreatment.

• Perhaps a depressed parent who is doing their best, but is not emotionally available.
• The problems of living with poverty.
• Having to live in a dangerous locality.
• Living in a culture with unequal views about the roles of the sexes.
• Living in a society which is intolerant of diversity.

Sins of omission and not sins of commission.

Exposure to war and conflict are actively traumatising – through the overt effects of danger, and passively traumatising – through the effects that conflict has on communities and the consequent disruptions to normal life. The neurophysiology of such acutely traumatic events, and of abuse trauma, is remarkably similar to that seen when the trauma is related to chronic adversity during our early development.

It is during the period of early development that we start to make connections between different parts of the brain, connections on which our future relationship skills depend. These skills are not only important for the ways in which we relate to other people, but they also have major effects on how we see ourselves, and how we relate to our own thoughts and feelings.

From time to time, so-called feral, or wild children are brought to the attention of the world. These are youngsters who have been raised apart from normal human contact. Sometimes through misadventure, sometimes through deliberate neglect. They may have been brought up by dogs, or in one case that was recently reported, birds. Children whose maturational pathways have been thrown off course by the loss of important physical and emotional relationships, at crucial phases in their development.

Show me a child at seven and I will show you the man.  Aristotle – the original quote.

The emotional element of such an upbringing is lacking, and this represents a state of affective deprivation.  This is severely handicapping for the healthy development of both inter, and intra-personal relationships. A similar state is present, but to a lesser degree, in many who have had sub-optimal conditions in which to grow up. the institutional upbringing of children in Romanian orphanages in the 1980s would be a fairly recent example.

It was James Roberston’s film “A Child Goes to Hospital“, and John Bowlby’s work on “Attachment and Loss“, (initiated by his own experiences as a seven year old in the British public school boarding system), that laid much of the groundwork for the development of attachment theory, and its subsequent impact on modern theories of child care, and personality development.

Affective deprivation contributes significantly to emotional dysregulation, and to the unstable relationships that inevitably follow. Both of which make contributions to the way in which our personality develops.  Personality is the external manifestation of the habitual patterns of mind, and behaviour, with which we approach the world.  Much of this learning occurs during the first seven years of  life.

A kind of affective pas de deux.

Affective attunement, which develops through reciprocal emotional synchronisation between attachment figures and the developing child, is the main way in which we come to understand that our emotions are time limited, and that we can manage them without being either overwhelmed, or coming to harm.  This emotional interplay between mother and child, a kind of affective pas de deux, enables us to have a healthy emotional life, and is just one sign that our upbringing has been “good enough”.

When emotional and social development occurs under less favourable conditions, we develop implicit prejudices against ourself and others.  These are the ingrained habits of thought that we come to internalise as part of our personal situation, family way of being, culture, and world view in general. Beliefs that are mostly unconscious, and form part of the many mental subroutines we have created in order to live in our world.  Such subroutines help us to cope with the massive information overload that would result if all incoming stimuli had to be processed consciously.

We pick up ideas, beliefs, and emotional responses in much the same way that we learn to walk or talk.  Total immersion in our world generates these ideas in our mind, ideas that we respond to as though they were absolute truth, and not the time and situation specific entities that they actually are. One problem with this way of learning, is that we generalise from the specific situations where these ideas and beliefs are actually reasonable, and then apply them to the world at large.

In the same way that the knee jerks when correctly tapped with a hammer.

Where trauma is involved, many of these situations involve genuine danger and threat.  This leaves us with an activated fight or flight response.  The effects of this are advantageous in the very short term – by preparing us to fight or flee, they help to  keep us alive, but if this response is prolonged it carries significant risks for our mental and physical health.

One of the results of a chronic fight or flight response is seen in a narrowing of our cognitive focus, we become much more attuned onto possible danger, and a reduction is the brain’s ability to think logically and clearly.  We lose the ability to think about our thinking, and so cannot challenge our beliefs, or alter our responses to them. Stopping to think about the situation when we are in imminent danger is NOT a useful survival tool.

This creates an emotional Catch 22 for anyone trying to overcome the problems associated with traumatic early experiences.

1. Trauma involves a disconnect between our emotions, thoughts, and behaviours.
2. We lose the ability to think about our thinking.
3. Emotional regulation and control is one of the major skills that a traumatised person has yet to master.
4. Emotional dysregulation is a major feature of trauma responses of all kinds, from the emotional instability of a neglected, or abused child, to the hyper-arousal of a returning war veteran.
5. This emotional dysregulation is very easy to set off, even by apparently trivial stressors.
6. This makes it even harder to think about thinking.

To gain emotional control needs some emotional control, which a fight or flight response prevents.

When this way of responding becomes an integral part of our behavioural repertoire, something akin to a reflex is called into play.  In the same way that we are cannot stop our knee jerking when it is correctly tapped with a tendon hammer, it is very difficult, if not impossible to control these automatic emotional responses.  Behaviours that have become incorporated into a person’s mind in response to threat, generate a greater state of arousal, which switches off the ability to think about what is happening.  Sometimes even thinking about a situation can trigger this response. Sometimes just one exposure to a frightening situation can have lasting effects.  Lessons that involve our survival are, not surprisingly, very well learnt.

Any novel stimulus or information in the environment is interpreted in light of our previous experience, in effect we see what we expect to see.  When our responses are trauma defined, we see a person who has become hypersensitive to danger, every experience that they have is coloured by this.   Everything appears to be accompanied by sirens and blue flashing lights, as a consequence they are also excessivley reactive to the stuff that everyday life throws at us.  Someone who is no longer an active participant in their own life.

The client’s predicament is such, that at times they seem to be blamed for their difficulties.  People who cut, or self harm in other ways, may be seen as attention seeking time wasters, who do not even deserve to be treated politely and kindly, let alone receive the medical care that they need.  When this situation plays itself out, as it does every day in emergency rooms across the world, the client becomes even more traumatised and further emotional dysregulation will inevitably follow.  The response of services which are meant to help those in distress and in need of care, acts in ways that make the situation worse. This can result in forced admission to mental health facilities and even further trauma. Pejorative labels such as “Emotionally Unstable Personality Disorder” may often be used to describe such clients.

In the same way that it is helpful to have friends who share our interests, set us a good example, support us, and help us to change the stories that we tell about ourselves (and the world), it makes sense to help the caring services, who on a daily basis, deal with traumatised people, both young and old, to see these confronting issues for what they are, and not dismissively label them as attention seeking or manipulative.

The firsts area of focus in trying to help, lies in assisting people to first of all recognise, and then reconnect, the relationship between their emotions, thoughts and behaviours.  This is as true for organisations as it is for individuals.  A continuing process of psychoeducation and training can bring about lasting changes in these areas.

Where organisations adopt a trauma informed model of care, outcomes for both patients and staff, are much improved.  Acute services need just as much access to frontal lobe functions when they are under stress as do their clients.  Traumatised services often lose this ability, and as with an emotionally dysregulated client clear thinking is often the first thing to go.  In much the same way that some traumatised patients also blame others for their emotional state, stretched services may demonise some of their client groups, with develops into an us versus them mind set.  This is particularly prone to happen when we are dealing with an emotionally confronting group of clients.

If we can help this process to change, to some extent by providing “treatment” to struggling services, we can help them to see things in a different light.  Once this starts to happen, we will no longer have to tolerate environments where somebody who cuts, a very successful way to control their emotional overload, gets left with unsightly scars because an overly stressed ED doctor is demotivated and can’t take the time to do their job properly.  An attitude that arises because the environment in which they work gives them the message that it is acceptable for them to treat different patients with different levels of care.