What’s Wrong With You?

Billy* was born to a teenage truant who had gotten pregnant by a man she met while on the run. Billy’s father left and mom soon took up with a different man, got pregnant with Billy’s younger half-sister and hoped for the best. The new “dad” however, fought a losing battle with alcohol. When he was drunk, which was most of the time, he would go into towering rages chasing the mother around the house with any weapon he could find. The three small children learned to hide in closets or under tables until the rage subsided and then they could emerge to help their battered mother clean up and brace for the next round.

When Billy was 9, he and his two siblings who had been removed from their mother’s home, were adopted by their second set of foster parents. Although his siblings adapted well to their new surroundings, Billy acted out and had to be hospitalized three times in two years. He spent a total of six months in two separate psychiatric residential treatment facilities.

When the impulsive and aggressive behaviors did not stop, but got progressively worse, the foster parents called the police. They restrained him and took him to the nearest emergency room for a psychiatric evaluation. The results got him admitted for the first time to an acute psychiatric hospital. When it was time to discharge, the foster parents refused to take him back for fear of their safety and that of his brother and sister.

Children like Billy don’t have to be beaten within an inch of their lives to suffer from the effects of severe trauma. Being a witness to violence or living in a constantly violent and unstable environment is enough. Having to endure the rejection of an immature and mostly incompetent parent inflicts deep and long-lasting emotional wounds. Those scars can last a lifetime.

The chronic, impulsive behaviors exhibited by Billy are often mislabeled as “anti-social,” “defiant,” “oppositional” or “bad.” The exposure to traumatic events in combination with the highly negative labeling can leave a youngster with a severe case of toxic shame that triggers a reaction against even those with noble intentions, like foster parents or professionals in the child welfare system. One noted child psychiatrist, Dr. George Thompson of KidsTLC in Olathe, Kan., recently stated in a treatment meeting, “The difference between guilt and shame is remarkable. Guilt is the inherent sense, ‘I feel like I have made a mistake. Shame is the unshakable feeling, “I AM a mistake!’”

The result is a child who is hyper-aroused, full of mistrust and highly prone to recreating the trauma that has been so damaging. However, it must be understood that the behaviors are not intentional, but are automatic and adaptive. Billy does not consciously think, “I’m going to scream profanities or try to hit someone with a lamp.” He just reacts instantaneously and intensely to anything that is even mildly upsetting. Experts in complex trauma agree that it has a notably adverse impact on brain development, which can take a lifetime to overcome.

Effective treatment includes the use of restorative therapy models that understand the impact on the brain. It seeks to first help the child find a calm and stable emotional place where the “fight, flight or freeze” mechanism in the primitive brain can be brought under some control and thinking before reacting has a chance to occur.

Clinical staff are trained to remain calm and stable in order to provide the kind of emotional regulation that begins to enable a less intensive reaction. Even though some very provoking and aggressive words or behaviors may be demonstrated by the child, the treatment team has been trained to not personalize or get defensive. Instead, they choose to see the behavior as an adaptive attempt to accomplish a purpose—recreate the trauma, so that the child has some sense of what to do.

Staff members are able to remain productively engaged with the child until, over time, he learns that the calm and stable adults in his life can be trusted. Successful treatment may take many months or even years to complete. The scars will most likely remain, but the person can function reasonably well in spite of them.

NOTE: To protect confidentiality of our clients, “Billy” is a fictitious character who is a composite of the type of child treated at KidsTLC, a Psychiatric Residential Treatment Facility (PRTF) in Olathe, Kan.

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HCF's Local Health Buzz Blog aims to discuss health and health policy issues that impact the uninsured and underserved in our service area. To submit a blog, please contact HCF Communications Officers, Jennifer Sykes, at jsykes@hcfgkc.org.


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