Researchers in children’s mental health have typically focused on more acute early-life interpersonal events that involve sexual or physical abuse, war, community violence. These traumatic and shocking experiences often occur within the child’s care-giving system by parents, relatives or childcare providers, and often include physical, emotional, and educational neglect and child maltreatment.
So What’s the Controversy?
It’s sad to say, but we have to say it. There are still a lot of well-educated, professional people who believe that what happens to children during the first years of life doesn’t have any impact on them, that it’s possible to “move on” from trauma. Digest that fact, if you can!
Part of this belief is anchored in very antiquated thinking that is remnant of the 18th and 19th centuries, when children were perceived to arrive in the world as unaware and unfeeling–“blank slates” so to speak. In this era, it was accepted that real memory didn’t begin until around ages three or four, and that what happened prior to that wasn’t important or remembered. This belief, of course, gave adults permission to do anything they wanted to a child, including using them for sexual pleasure or projective objects.
New research invalidates all of these beliefs. It shows that infants and young children are totally aware, acutely sensitive and feeling, and remember everything. A group of pioneers in the field of Pre- and Perinatal Psychology have spent the last 40 years proving this. And the brain researchers have also validated this information, showing that relational experiences during the first year of life pattern the brain and nervous system. These experiences create a template called the “internal working model of reality” that directs the rest of a child’s life.
So, to answer our own question, the controversy is between two groups of people with different beliefs about the significance of children’s experiences during the first years of life.
The next question is:
Why Is Developmental Trauma Political?
The American Psychiatric Association’s fifth edition of the Diagnostic and Statistical Manual, released in 2014, was heavily petitioned to include Developmental Trauma Disorder (DTD) as a new diagnostic category. The team submitting the proposal wished to encapsulate diagnoses such as bipolar disorder, ADHD, PTSD, conduct disorder, phobic anxiety, reactive attachment disorder and separation anxiety.
Dr. Bessel van der Kolk, who spearheaded this effort, estimates that as many as 8 million children in the U.S. have been diagnosed with Bipolar Disorder and/or ADHD and prescribed large doses of medication. He believes, however, that the cause of these problems is disrupted attachment and untreated emotional abuse and/or neglect. Here’s a short video of van der Kolk talking about how childhood/developmental trauma is different from PTSD.
The PTSD sub-comittee’s proposing to include Developmental Trauma Disorder submitted the most documentation ever to support a diagnostic revision in the history of revising the DSM. There were many exchanges between those at the helm of the APA (who hold the antiquated view of early childhood) and the many practitioners who see every day the impact of early trauma on children.
Those in the APA who resisted and discounted the mounts of research documentation had other reasons for their position than just their beliefs about early childhood experiences. Many of them were comfortable with the current diagnostic categories and the system of mental health care that had been built around them over the last 20 or 30 years. This system, of course, also included private practices, social agencies and institutions, research facilities, funding and financial streams–all of which impact the livelihood of people in this governing group. It became evident that adding DTD to the DSM-V had the potential to change everything in the practice of mental health.
The DTD diagnosis would require massive changes in the way that mental health professionals are trained, supervised and licensed. The textbooks would have to be re-written, insurance coverages would have to be updated, mental health practitioners already in the field would have to change the way that they practice, and require additional training. Long story short, the DTD diagnosis would “move the cheese” of a LOT of people . . . important people. After much discussion and controversy, the DSM Committee rejected the proposal.
DTD & the DSM: The Aftermath
The tragedy of the DSM sub committee’s verdict is that they were willing to sacrifice the over one million children who are confirmed to be abused and neglected each year, plus the countless millions of adults who cannot be treated for their disorder using insurance benefits. Unrecognized and untreated developmental trauma from prolonged acute and subtle child abuse and neglect costs the U. S. over $107 billion a year, a very conservative estimate. This makes it the largest under-treated public health problem in this country.
van der Kolk believes it will take a massive public crusade against child maltreatment to alter the political realities that are blocking change. He added, We need someone important in public life to have the courage to stand up and take a very visible stand on something like this it has a huge impact on science and society. He adds, We dont seem ready to acknowledge that the greatest danger to our women and children isnt Al-Qaeda, but the people who are supposed to love and take care of them.