Severe stress harmful to children's brain

A study conducted by researchers at the Standford School of Medicine and Lucile Packard Hospital found that severe stress can affect children's brain development, according to U.S. researchers. Although this finding had been replicated previously with animals, this was the first study of its kind conducted with children.

Children with PTSD and high levels of cortisol (a stress hormone released by the adrenal glands) were likely to experience a decrease in the size of the hippocampus, a brain structure important in memory processing and emotion.

The children in the study were suffering from post-traumatic stress disorder, or PTSD, as a result of undergoing physical, emotional or sexual abuse, witnessing violence or experiencing lasting separation and loss. This type of developmental trauma often impairs the child's ability to reach social, emotional and academic milestones.

The researchers studied 15 children from age 7 to 13 suffering from PTSD. They measured the volume of the hippocampus at the beginning and end of the 12- to 18-month study period.
After correcting for gender and for physiological maturity, they found that kids with more severe PTSD symptoms and higher bedtime cortisol levels (another marker of stress) at the start of the study were more likely to have reductions in their hippocampal volumes at the end of the study than their less-affected, but still traumatized peers.

The researchers speculated that cognitive deficits arising from stress hormones interfere with psychiatric therapy and prolong symptoms.

Children predisposed by genetics or environment to be more anxious than their peers are also more likely to develop PTSD in response to emotional trauma, perhaps because their responses to other life experiences simply left them closer to that threshold than less-anxious children, according to the study to be published in the March issue of Pediatrics.

There is no such thing as a "repressed memory"

A few nights ago, I shocked my class by making the statement, "there are no such things as repressed memories". People seemed quite bothered by that. I needed to leave early from the class, so I wanted to publish some of my musings on the issue.

First, why is the concept of "repressed memory" so important to a school psychologist (or, why is it important for a school psychologist to know that there is no such thing as a repressed memory?)? It has particular relevance in cases of suspected or alleged physical and sexual abuse. It is important for school psychologists to understand how memory works and why the repressed memory is an urban psychological myth.

Second, let's get some clarity:

• A repressed memory, according to some theories of psychology, is a memory (often traumatic) of an event or environment which is stored by the unconscious mind but outside the awareness of the conscious mind.
• Some theorize that these memories may be recovered (that is, integrated into consciousness) years or decades after the event, often via therapy. They may also reoccur in dreams.
• The idea of "dissociative amnesia" makes the assumption that memory repression is possible. The repressed memory concept was popularized during the 1980s and partly the 1990s by the popular press, some feminist groups, and some psychological schools of thought
• The concept was originated by Sigmund Freud in his 1896 essay On the etiology of hysteria.
  Freud abandoned his theory between 1897-1905, and during 1920-1923 replaced it with his impulse-based concept of Id, Super-ego, and Ego.

There were two principle reasons that Freud abandoned his theory of repressed memory (Freud, Sigmund 1952. Zur Geschichte der analytischen Bewegung, from: Gesammelte Werke in Einzelbänden Volume 10)

• he increasingly came upon evidences in individual cases logically outruling any possibility the 'recovered' events could have occurred
• he found himself able to direct his more suggestible patients into any recollection of memory he wanted to (especially while they were undergoing hypnosis), even more so in an entirely boundless manner when he turned to sexual matters.

This is an important set of points, as the father of psychoanalysis, quickly retracted the construct of "repressed memory" for the same reason that modern researchers have also rejected this notion.

Third you may ask if there is there any scientific basis for the construct of a "repressed memory"? Well, there are some conjectures and possibilities. For example, one theory discusses how the hippocampus may selectively choose to not consolidate memories which are traumatic. Others point to the role of cortisol damage to the hippocampus. These "hypotheses" are explored in Faigman DL, Kaye DH, Saks MJ, Sanders J, eds. Science in the law: social and behavioral science issues. St. Paul, MN: West Group, 2002, pp 487-526.

I will tell you how it all turns out. These are just conjectures which don't make sense on any level neurologically.

Cortisol does indeed cause damage to the hippocampal structures and loops, but it does not erase traumatic events. In fact, what we have identified in PTSD is that many people have re-occurrences of the traumatic event, so the event memory is on a constant rewind. And, while cortisol damage may affect the person's accurate recollection of the trauma, there will still be a recollection that the event took place.

Studies of over than 10,000 trauma victims found none that repressed or recovered memories of trauma. (Pope HG Jr, Oliva PS, Hudson JI. Repressed memories. The scientific status of research on repressed memories. In: Faigman DL, Kaye DH, Saks MJ, Sanders J, eds. Science in the law: social and behavioral science issues. St. Paul, MN: West Group, 2002, pp 487-526). Similarly, some studies of thousands of abused children found no evidence at all for so-called repressed or recovered memories. Coupled with laboratory studies and other naturalistic investigations, most prominent researchers in the field agree with Harvard University's Richard McNally and consider the notion of repressed memory to be a pernicious bit of psychiatric folklore. (McNally RJ. The science and folklore of traumatic amnesia. Clinical Psychology: Science and Practice 11:29-33, 2004).

Then we get to young children. Young children's memory is incredibly inaccurate, as their hippocampal structures are developing from conception until about three years old. Although they may forget (I've blogged on this before), they do not "repress" the memory - they just developmentally cannot consolidate memories effectively and cannot recall them effectively.

Another difference is actual amnesia following a trauma. This is not due to any psychic events impinging upon mental makeup. Retrograde amnesia is a real neurological issue which comes about through some physical assault to the brain which causes hippocampal structures to temporarily (or in some cases permanently) not recall as effectively or efficiently. The important aspect of retrograde amnesia is that it is caused by physical etiologies and not by psychic or psychological etiology.

Later I will discuss some court cases which have impacted this area.

Suicides in New Orleans

This is a reprinting of a posting to a blog that I used to manage.

I worked for about 10 years in Nassau county, which is a suburb of New York. The last three years I coordinated a program for high functioning middle school students diagnosed with autism (I'm long since gone).

One of the things that focused on teaching was Theory of Mind, a complex skill that requires individuals to put themselves in other people's shoes, to think their thoughts - in essence, to feel their emotions, to be happy when they are happy and to cry when they are sad. I was rarely successful. Jack was not a success story for me. Sure he had develops some friendships while I was there, but he had not fully mastered the idea of Theory of Mind. But I enjoyed him immensely, despite his resistance to schoolwork and his chronic narcolepsy.

When I went back to visit him in 2005 and the others, he asked me to play chess, his favorite game. We sat there, enjoying each other's silence as the cool September breeze blew over us through the corner window.

"So, did you watch CNN at all?", he broke the silence.

"Yep"

"That's really a shame about those people in New Orleans."

My interest was piqued. "Yes it is-"

"I mean, when the waters are drained those people are gonna go back to destroyed houses, and wow - they might get depression or something bad- or even worse they might kill themselves"

"Why would they kill themselves?"

"WHY?! WHY?! - you're the psychologist - you tell me - they're gonna go home and nothing is there - if that happened to me - I have no idea how I would cope with it. Just no idea. Those poor people."
______________________________________________________

So if a child with autism could predict massive depression and suicides, why can't the Federal government, FEMA, the President, the governor of Louisiana or the mayor of New Orleanse predict it? Why couldn't they preliminarily deal with it?

The New York Times reported about a month ago that the suicide rate in New Orleans has risen to at least two times more than the average national rate. Many people who live though natural or wartime disasters tend to develop a disorder named Post Traumatic Stress Disorder or PTSD.

Common characteristics of the disorder include reliving the traumatic event through frightening memories, or nightmares that provoke the same feelings of horror, helplessness, and fear that you felt at the time of the event. These memories can be triggered by exposure to reminders of the event. Of course, the people who returned to their devastated, destroyed, demolished homes were forced to confront and relive the disaster over and over again.

PTSD is a type of anxiety disorder. Researchers from the University of Winnipeg in Manitoba, Canada found that the presence of an anxiety disorder as well as intense levels of hopelessness and despair increased the probability that an individual would commit suicide. It doesn't take a Ph.D. in psychology to know that hopelessness and continued exposure to a stressful event could lead to suicide. It also doesn't take an advanced to degree or a heightened level of civic-mindedness that something can be done to deal with this situation.

The science of prevention is a burgeoning field in psychology, which is guided by a principle borrowed from medicine. Prevention science has led to mandatory inoculations of children to fluoride in water. People who exercise more are less likely to get sick; some managed health care companies now fully or partially subsidize gym memberships. The same goes for psychology as well. Instead of attempting to heal once the damage has been done, we can either:

• prevent the problem altogether
• innoculate the individual so that the problem is not that bad.

Of course, if you have seen the examples I listed above, many of the prevention programs need to come from governmental agencies or need to be instituted by various corporate organizations. It would do no good if two or three socially conscious doctors began to dump fluoride into our reservoirs - we need the federal government to enact this into legislation.

While the entire population of New Orleans required some form of "inoculation" before re-entering the city (as well as ongoing interventions after entering the city), there are certain people who are more at risk for developing PTSD and then evidencing suicidality. Women are more likely to develop PTSD than men; minorities who come from a lower socioeconomic level are also more likely to develop PTSD. Then again, males tend to complete suicides more frequently than females, due to access to more lethal and more severe methods (e.g., guns).

While many people were ready to blame FEMA for the debacle in initial assistance to the residents of New Orleans, they were really not to blame. FEMA is an agency that deals with more long term, protracted issues. FEMA is responsible for initiating and maintaining rescue operations as well as clean-up and rebuilding. FEMA should also be responsible for initiating a suicide and PTSD prevention program for the city; this is FEMA's and the Federal government's most flagrant abuse in this whole matter so far.

The New Orleans problem is still at hand

This article describes how 10 months after the Katrina disaster, New Orleans and the surrounding area is still dealing with issues of depression and suicide. Click here to read the article. Although the article does not necessarily point any fingers as to who is at fault, my take is that the federal gov't., specifically, FEMA has really dropped the ball in providing mental health assistance.

Back in February, I wrote something on this issue on my other blog.




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