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Recovering from Child Abuse

Chapter 5
Recovering from Child Abuse

Effects on Survivors
The Developing Brain
Body Memories
Triggering the Trauma Cycle
Is it Possible to Recover?
Coming Full Circle
A Safe Place
Meditation
Finding a Healer

“I thought I was one of the ugliest and most despicable creatures alive, inside and out,” writes child abuse survivor Anna Michener.

By the age of thirteen I was completely exhausted from merely existing in the cold, limited world my family had created for me. Although I escaped this world by sleeping as much as possible, I had constant rings under my eyes like bruises. The chronic, stress-induced stomach pain and nausea I had suffered ever since I could remember were considerably worse by the time I became a teenager, as were the headaches, dizziness, and fatigue. I was weak and sickly, always suffering from a cold or sinus infection or bronchitis. My skin was puffy and yellow, my hair dried out.21

Effects on Survivors

Michener's experience is typical. Physical abuse and neglect cause physical injuries and health problems such as malnutrition and anemia. But recovering from physical injuries and malnutrition is just the beginning of the healing process for most child abuse survivors. Even after a child recovers physically from abuse, emotional injuries remain. Many suffer from post-traumatic stress disorder (PTSD). Children with PTSD may suffer from unwanted memories of their abuse. Some have flashbacks during the day and nightmares at night. Others develop anxiety or depression. They may be startled easily. They may find it difficult to trust other people or to be affectionate. Some

are very irritable and may be aggressive or violent themselves. Many use drugs or alcohol to try to escape from their emotions and end up with a substance abuse problem as well.

Abuse survivors who do not develop PTSD may suffer from other psychological disorders. They may suffer from low self-esteem. Many develop anxiety or depression. These survivors may even become suicidal. Children who have been abused are more likely to develop psychological disorders such as schizophrenia. They are also more likely to develop behavior problems. They may tend to argue with adults and defy authority. Many have trouble paying attention in school or following instructions. Boys, especially, tend to develop behavior problems such as fighting or destroying property.

The Developing Brain

Psychiatrists are beginning to find, too, that the stress of abuse can affect a very young child's developing brain. Some babies who have been abused grow up unable to accept comfort from others. Preschool children who have been abused tend to have developmental delays. Developmental delays can mean, for example, that a child learns to speak later than other children or does not speak clearly. Or a delay can cause a child to take longer to learn to do physical activities that other children do easily, such as standing on one foot or holding a pencil. (There are also many medical reasons why a child might be developmentally delayed—developmental delays are not, by themselves, a sign of abuse or neglect.)

Psychologists have also found that preschoolers who have been abused have a harder time making full use of play materials at their preschools. They tend to touch or pound toys instead of playing with them. Some severely neglected children have never learned how to play. Instead of pretending to iron with a toy iron, for example, a preschooler who has been abused or neglected might pound the iron repetitively on the floor or put the iron in their mouths. Other children reenact their experiences of abuse in their pretend play.

Recovery

“I am deep into the recovery stage, but not done. Probably a few more years to go. It's hard to reverse 20 years of abuse and neglect overnight. I could not have done this, or gotten as far as I am now, without professional help. I strongly believe people have to talk to one another, and be heard, to aid in the recovery and to heal.” —Holli Marshall.

Quoted in HealthyPlace, “Transcript from Online Conference with Holli Marshall and Niki Delson on ‘Survivors of Sexual Abuse.’” www.healthyplace.com/COMMUNITIES/abuse/holli/interview_holli.htm.

The social skills of abused preschoolers also lag behind. These children tend to flit from one activity to another, finding it difficult to focus on one thing. They do not feel self-confident initiating a conversation with other children. They may seem hypervigilant, which means that they constantly monitor what is happening around them to make sure that the situation is safe. Children who have been physically abused or neglected sometimes act out in aggressive, disruptive ways in the classroom. They may hit or bite other children or destroy property. Children who have been sexually abused, on the other hand, more often become passive, withdrawn, and quiet.

Body Memories

Child abuse survivors often develop symptoms in their bodies that cannot be explained by a medical exam. Children may have

headaches, stomachaches, or feel unusually tired all the time. Some develop diarrhea, constipation, or urinary tract infections that have no physical explanation. These symptoms are usually classified as a somatic disorder, which means that they have a psychological, not a physical, cause. A few therapists prefer to call these symptoms “body memories,” because they feel that the symptoms are connected with the body's memory of having been abused. Psychotherapist Kathy Steel explains: “[Traumatized children] have problems with their body where they can't understand signals from their body and have a lot of somatic symptoms. They can't integrate their memories. They have difficulty, of course, relating with other people.”22

Triggering the Trauma Cycle

Abuse survivors who have behavior problems tend not to have them at random times. Instead, something happens to trigger a memory of their abuse. This memory is called the trauma cycle. It is similar to a flashback. In a flashback, the survivor reexperiences the abuse, seeing the same sights, hearing the same sounds, and/or feeling the same physical sensations that happened during the abusive experience. But in the trauma cycle, survivors may simply reexperience a part of the abuse, such as the feelings and emotions that went with it. These feelings rise up in a survivor because something happens to trigger them. The trigger could be anything that reminds the survivor of the abuse—an event or even the words or tone of voice used by a teacher or a friend.

When a trigger event occurs, survivors lose their ability to think rationally. They have a fight-or-flight reaction in which their bodies are pumped full of adrenaline. The survivor's limbic system—the part of the brain responsible for basic functions such as the need for food and sleep—takes over. Bruce Perry, a doctor who specializes in pediatric brain development, explains that trigger events make children feel threatened. In response to a threat, the heart rate increases, breathing quickens, and different parts of the brain take over. Says Perry:

The more threatened we become, the more “primitive” (or regressed) our style of thinking and behaving be

comes. When a traumatized child is in a state of alarm (because they are thinking about the trauma, for example) they will be less capable of concentrating, they will be more anxious and they will pay more attention to “non-verbal” cues such as tone of voice, body posture and facial expressions.23

When this happens, survivors become hyperalert and need help to become calm again. Therapists respond when this happens by using a soft, level voice and by using neutral body language.

Flashbacks

Survivors of child abuse often experience flashbacks, even years after the abuse is over. A flashback is a memory that is so intense that it feels as though the survivor is reliving the experience. Some flashbacks are so real that the person experiencing them sees, hears, and feels the abuse happening all over again. Other flashbacks are more fragmentary—a survivor might remember just an image, or a feeling, that dates back to the abuse. Either way, flashbacks can be very stressful and even terrifying.

Survivors who experience flashbacks often find that counseling and psychotherapy can be very helpful. During a flashback, it can help to open one's eyes and look around, making sure to notice things that make one feel safe. Some survivors carry a special rock or other object in a pocket and hold the object during a flashback as a way of trying to feel more secure. It can also help to notice what triggers a flashback—what words, images, smells, or sounds cause those memories to return.

For many survivors, authority figures can trigger the trauma cycle to recur. In their birth families, these survivors may have been subjected to parents or caregivers who insisted on obedience and who also abused them. These survivors feel more secure if they are in an environment where they have more choices about what they do and do not want to do next. When they are subjected to authority, such as the authority of a classroom teacher, these children may appear to have behavior problems. Girls may seem not to be paying attention. Boys may seem hyperactive. Both may have difficulty doing math problems, for example, when they are called to the front of the classroom. It is hard to do schoolwork after something has triggered a memory of abuse, because the memory brings up a compelling array of emotions. Therapists respond to this kind of situation by trying to give children more control. Perry explains, “If a child is given some choice or some element of control in an activity or in an interaction with an adult, they will feel more safe, comfortable and will be able to feel, think and act in a more ‘mature’ fashion.”24

Is it Possible to Recover?

When Illinois acupuncturist Nancy Floy was four years old, her father worked at a day care center. He and the other workers at the day care center joined a religious cult and began to ritually abuse all of the children at the day care center. (Ritual abuse is an extremely cruel form of abuse in which the abusers use torture to try to brainwash their victims, using the abuse to try to force victims to accept a religion or an ideology.) Floy's father raped her.

Eventually, some of the older girls at the day care center told their parents what was happening. The workers, including Floy's father, were arrested and went on trial. All the children from the day care center testified at the trial. Some of the workers were sent to mental hospitals, but Floy's father went to prison. Her mother had a nervous breakdown and was unable to continue to care for her. Floy was safe, for the moment, but she needed a home. She was placed in a group home, an institution that provided medical care for her physical injuries and psychotherapy for her emotional trauma. At age five, Floy says, she began to heal. Eventually, she was released to kinship care—she moved in with her grandmother, who helped her to continue the process of healing.

Mothers and Healing

“If it is a family member, an incestuous relationship, then the mother is the key to the healing. Research clearly demonstrates that children who have supportive mothers who acknowledge the molestation experience and clearly hold the perpetrator accountable, will heal faster.” —Niki Delson.

Quoted in HealthyPlace, “Transcript from Online Conference with Holli Marshall and Niki Delson on ‘Survivors of Sexual Abuse.’” www.healthyplace.com/COMMUNITIES/abuse/holli/interview_holli.htm.

Coming Full Circle

As an adult, Floy came full circle. She began to work with women who had been abused, running a battered women's shelter. Then she began to study Chinese medicine and became an acupuncturist. Finally, she opened a center for healing—the Heart-wood Center for Body, Mind, and Spirit.

Holli Marshall, like Nancy Floy, was severely abused at a very young age. She was raped at age five and continued to be abused and raped over a period of several years. Her mother was mentally ill and neglected her. “She couldn't take care of me, much less herself,” says Marshall. “I'd go days without food,

having my clothes changed, and without being held or nurtured.” Like other children who have survived abuse, Marshall developed physical symptoms and post-traumatic stress disorder. She says: “It's as if I've been through the Vietnam war and I experienced all the symptoms of PTSD. For instance, I had nightmares, flashbacks, hot and cold sweats, anorexia, abdominal distress, stomach pain, migraines and I'm a very nervous and anxious person.”25

Like Floy, Marshall has come full circle. She is disabled because of the abuse that she experienced and will be for the rest of her life. After many years of therapy, she decided to start her own Web site. She works to improve public awareness about child abuse and directs survivors to resources that can help them in their recovery.

A Safe Place

Floy's and Marshall's stories show that it is possible for an abused child to come full circle. It is possible not only to recover, but to help others to recover, too. The journey toward recovery, however, can take many years. The first step for Floy and Marshall, and for most child abuse survivors, was to have a safe place to heal physically and to begin psychotherapy. Dale Latimer, a high school teacher who works with emotionally disturbed children, explains why feeling safe is so important. “The first thing you have to provide for them is a safe, comfortable environment,” he says. “Number one, they need to develop a feeling of trust and comfort and security. And it needs to go for a long period of time—it's got to be something that they can count on day in and day out.”26

Former foster child Robert Kendall agrees. He says:

Deep down, kids all want the same stuff. They all want to be loved, they all want a family. And they all want to know why they didn't have a family and they weren't loved. They're trying to figure out why everything happened to them and can it ever be okay . . . so that they can say to themselves, “It will be okay, and I can relax, and these people aren't going to hurt me.”27

Not until children feel safe and secure can they really begin the process of healing. Once Floy had a safe place to live, she began her therapy. The institution where she lived offered psychotherapy, art therapy, and play therapy. Psychotherapy is sometimes called talk therapy or counseling. It means taking time to talk about the abuse and its continuing effects. Psychotherapists try to help children understand that what happened to them was not their fault and to find ways to process and release their memories of abuse. Therapists working with young children often use art therapy and play therapy as well. Art therapy means using creative processes, such as music, dance, movement, drama, drawing, painting, and poetry, to work through negative memories and emotions. Play therapy is a type of therapy aimed at very young children who may have trouble expressing their feelings in words. They can use dolls and toys to help them to

tell a therapist about what happened to them and how they feel about it.

Like Floy, Marshall began therapy at an early age. She says:

I've been through “talk” therapy, doing some hypnosis, meditation, relaxation and breathing techniques. I've also been put on medications, Prozac, Klonopin, Vistoril. All have been very helpful combined together. I also have a wonderful psychologist who specializes in working with those with post-traumatic stress disorder. The therapy, the healing process, creates safety about you and teaches you how to create a support system. You learn how to cope, nurture yourself, build self-esteem and confidence, build better relationships and boundaries within those relationships. You learn how to live with the feeling of “impending doom.”28

As they talk with children about abuse, therapists try to focus on the positive—the fact that children survived and are still

Psychotherapy

Many survivors of abuse find that psychotherapy helps them to reduce or manage their symptoms, such as depression, anxiety, flashbacks, and attention disorders. To get psychotherapy, survivors must go to a licensed psychologist—a doctor who has a PhD and has been licensed by the state to treat mental disorders. Not all survivors feel they need psychotherapy. But those who sometimes think of committing suicide or who consider hurting themselves or others usually can benefit from seeing a psychologist or psychiatrist.

Psychotherapy is also helpful for survivors who have trouble functioning in everyday life because of their symptoms. For example, some survivors have trouble concentrating in school or at work because of their feelings of anxiety. Others have flashbacks that interfere with their ability to function normally during the day.

Psychotherapy is often called talk therapy because it consists mostly of talking to a therapist. However, psychiatrists also have the option to prescribe medication if they feel their patients need it.

here to tell the tale of what happened. “One of the first things you need to ask,” says psychiatrist Bessel van der Kolk, “is, how did you survive this?” He goes on: “This is amazing that you're still here. It's amazing that you still have the guts to go on with your life. What is allowing you to function? What are you good at? What gives you comfort?”29

Meditation

For Floy, one of the things that gave her the most comfort was the practice of meditation. When she left her institutional home, she entered kinship care—she lived with her grandmother. Her grandmother, a Buddhist, taught her to meditate. Although Floy's meditation practice came from her grandmother's practice

of Buddhism, she encourages abuse survivors of any religious tradition to add meditation to their daily routine. Meditation is the practice of sitting quietly and being mindful. Although sitting mindfully and paying attention may not sound like a powerful experience, Floy explains that meditation can give survivors a safe way to be with themselves. “Then,” she says, “you have that to draw on for the rest of your life.”30

Another type of meditation that helps many survivors is moving meditation through the practice of martial arts or yoga. In fact, says Floy, any physical practice that a survivor enjoys, whether it be learning karate, doing yoga, or trying out for a sport at school, can help in the healing process. Enjoyable physical activities give survivors good body memories to balance the negative memories of their traumatic experiences. The good memories, unfortunately, do not overwrite the bad ones. But they provide a safe memory that survivors can try to go back to when they find themselves caught up in a flashback.

Finding a Healer

Floy believes that it is important for survivors to find a healer with whom they can connect. This healer could be a massage therapist, doctor, yoga teacher, coach, or meditation teacher. Whoever it is, it should be someone who has faith in the survivor's ability to heal and move beyond the abuse. Massage therapy can be especially good for survivors because it gives them a chance to experience another person touching their bodies in a positive, loving way. Yoga, says Floy, is also very helpful, because it helps the body to release tension that may have been stored in a survivor's body since the abuse occurred. Marshall agrees. For her, being on her school track team helped her to begin to recover. She also found that listening to music was very helpful.

For all abuse survivors, the key to recovery is to develop a healthy sense of self-esteem and self-confidence. “I believe that we are all born perfect,” says Floy, “with basic goodness. Abuse is like film on a windshield. We just need to scrape it away, or wait for the clouds to clear.”31 Then, she says, a survivor's basic goodness—his or her inner beauty—can shine through.

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