| Delayed Posttraumatic Stress Disorders from Infancy | | | | Premature babies are left alone in the hospital. While |
| The Two Trauma Mechanism. | | | | we do not yet have good data on the separation in |
| ANTECEDENT TRAUMA: | | | | the first weeks of life, those who were adopted in the |
| As with posttraumatic stress disorder from adult life, | | | | first two weeks of life experience an early separation, |
| antecedent trauma sets the stage for a more severe | | | | and they also have a very high incidence of the later |
| response to subsequent trauma. Anxiety and | | | | development of mental disorders, including borderline |
| suspense cause the event to be more frightening. If | | | | syndromes. |
| one is among friends, in daylight, and someone | | | | If it is possible to stay with the premature baby during |
| attempts to startle him, consider the response-versus, | | | | its hospitalization, without sacrificing an older infant or |
| if he is walking down a lonely path, on a dark night, full | | | | toddler, this is the safest alternative based on present |
| of anticipation and fear, and the same person | | | | findings and projections. The emotional difference may |
| attempts to startle him. | | | | relate primarily to the early separation from the mother. |
| Thus, we must look to antecedent trauma that could | | | | An interesting study would be to determine the number |
| cause the early infant trauma to be experienced as | | | | of non-adopted borderline individuals who were |
| more severe. It is possible that all the second trimester | | | | incubator babies and compare this with the number of |
| assaults may operate in this way, including viral | | | | non-adopted super normals who were incubator |
| infections, famine, malnutrition, paternal death, toxins, | | | | babies. If the origin of the borderline syndrome is in the |
| and anything that threatens survival of the infant or | | | | first month of life, the study would confirm this. Until the |
| upsets the mother. For references see Second | | | | completion of such a study, we recommend the |
| Trimester Factors in Chapter One. Another major | | | | mother stay with the baby until it is ready to come |
| antecedent trauma is the birth trauma. A number of | | | | home. |
| researchers have found a higher incidence of | | | | Fetal Alcohol Syndrome: |
| schizophrenia among those who have experienced | | | | This carries with it physical attributes related to the |
| birth trauma. Trauma at birth has to be frightening to | | | | in-utero blood alcohol level. While a host of emotional |
| the newborn. Anoxia, brain injury, prolonged | | | | mental symptoms also are attributed to the in-utero |
| compression through the birth canal, near death | | | | blood alcohol level, more likely these relate |
| experience-all must leave a mark. The average one | | | | predominantly to the lack of mothering or the |
| year old still flashes back to the birth experience, which | | | | inconsistency in mothering that occurs in the first |
| is why it fusses and screams when a tee-shirt is pulled | | | | months or years of life, as a result of the mother's |
| over its head. An infant who is severely compromised | | | | alcohol dependence. For prevention, this may be a time |
| with a near death experience at birth is even more | | | | for institutionalization of the mother while she is |
| primed for a later trauma to be more frightening. | | | | pregnant, and a time for a continued serious treatment |
| In one family, the ninth of ten children had severe | | | | of the alcohol dependence after the baby is born. |
| anoxia and brain damage at birth. All children were | | | | Ideally, the alcohol dependent woman should be |
| closely spaced and this one was 15 months older than | | | | informed about the devastating impact of alcoholism |
| the next. None of the others developed emotional | | | | on the baby, and she should have her alcohol |
| difficulties, but when this one experienced a major | | | | dependence treated before she becomes pregnant. |
| separation later in life, there was a return to age 15 | | | | Adoption: |
| months reality. Had the person not experienced the | | | | Adoption should take place at birth, not two weeks |
| brain injury at birth, it is possible that the age 15 month | | | | later. Nine months should be sufficient time to make |
| trauma might not have been sufficiently terrifying to | | | | the necessary arrangements. |
| allow for the reawakening as schizophrenia, 30 years | | | | With adoption there already has been a major |
| later. | | | | separation. Every effort has to be made in the |
| Birth trauma is not intentional and for the most part it | | | | direction of providing security, to avoid reawakening |
| can not be avoided. Child birth education and good | | | | and inflaming the original trauma. Adoption must be |
| prenatal care can eliminate some of the trauma, but | | | | reserved for the person who wants to be a full time |
| when birth trauma occurs, it should serve as a warning | | | | mother to the baby. She must delight over everything |
| to make greater effort to avoid subsequent trauma, | | | | the baby does-each developmental landmark, every |
| particularly over the next 34 months. | | | | new utterance, all "cute" behavior. The adopted baby |
| A PREVENTABLE TRAUMA OCCURRING AT | | | | has already endured one separation and must have |
| BIRTH: | | | | the devoted attention of one constant mother figure |
| The immediate clamping of the umbilical cord is one | | | | who will be as close at hand as a mother bear with |
| birth trauma/injury that has become common practice | | | | her cub. The busy professional who is not able to take |
| and which can be avoided. The immediate clamping of | | | | time for a pregnancy and who plans to utilize a |
| the cord prior to the infant taking its first breath has | | | | "nanny" or a daycare service to rear the child, should |
| been shown to result in petechial hemorrhages | | | | rethink the decision in light of our findings. The idea of |
| throughout the brain in higher primates sacrificed at | | | | having an adorable loving child must begin with one full |
| birth-as compared to ones in which the cord was not | | | | time mother who provides for the needs of the child |
| clamped. After the struggle through the birth canal, the | | | | during infancy. The needs of the mammalian baby for |
| infant needs all the oxygen he can get and the | | | | the mother have been established and are deeply |
| pulsating cord is still an important supplier of this | | | | entrenched. The adopted baby has already been |
| oxygen. Thus, it should be left intact until the lungs have | | | | traumatized or injured and therefore must feel fully |
| been inflated fully and are working properly. | | | | protected by having its needs fully met. The adopted |
| Conceivably this anoxia and brain hemorrhage at birth | | | | baby needs a devoted, full time mother, preferably |
| could set the stage for later trauma to be more | | | | beginning at birth. |
| frightening. Both the birth trauma and the brain anoxia | | | | OTHER EARLY TRAUMAS: OTHER PHYSICAL |
| hemorrhagic trauma are associated with a separation | | | | SEPARATIONS: |
| (birth), and this may contribute to setting the stage for | | | | Histories of approximately 300 schizophrenics, and at |
| later separations being more frightening. Just as | | | | least as many depressed individuals and borderline |
| childbirth classes and good prenatal care are important | | | | patients, have revealed other early traumas that |
| for reducing birth trauma, prior discussion and planning | | | | occurred at ages that were specific to the expected |
| are important for eliminating this unnecessary cause of | | | | age of trauma-based on the symptoms the patient |
| traumatic brain hemorrhage. | | | | experienced. For example, one patient whose |
| CIRCUMCISION: | | | | symptoms matched those of a person traumatized at |
| Another trauma, occurring shortly after birth, is | | | | 24 months, was found to have moved into a new |
| circumcision. This generally is done without | | | | house at age 24 months. By using the clinically based |
| anesthesia-because the baby is thought to be too | | | | expected age of origin, various other early traumas |
| young and therefore unable to feel anything. More | | | | were identified. On occasion it was confirmed that the |
| accurately, it cannot say or do anything. Undoubtedly it | | | | expected age of origin matched the time the mother |
| is traumatic and likely it has an effect. If this trauma | | | | was sick and was hospitalized. |
| were to increase the incidence of schizophrenia | | | | Combination Traumas: Pain Plus Separation From |
| appreciably, then there would be a much higher | | | | Family Plus Separation from Familiar Surroundings: |
| occurrence of schizophrenia in men than in | | | | If the infant/toddler is sick and hospitalized, this can be |
| women-which reportedly there is not. Nonetheless, this | | | | a multiple trauma. First, the pain or the sickness |
| could be studied by evaluating male schizophrenics vs. | | | | intensifies the need for the mother. The fear that |
| super normal males and comparing the number of | | | | accompanies the pain makes the child more vulnerable |
| non-circumcised persons in each group. | | | | to separation. Furthermore, the child is not only |
| Other disorders that are more common in males | | | | separated from the mother for part of the |
| should be studied for correlation with circumcision. This | | | | hospitalization, but the child is separated from its familiar |
| is particularly true with infantile autism. Currently great | | | | surroundings as well. If this occurs when the baby has |
| emphasis is placed on the neurological findings in | | | | stranger anxiety, the trauma conceivable could be |
| autism, with the assumption that correlation proves | | | | even greater. |
| causation. This assumption is false. Some of the | | | | One parent described the look on the face of his |
| neurological change may be the result of the disease | | | | oldest son shortly after his son had surgery at age 18 |
| process, just as it is in schizophrenia. | | | | months. He knew then that something was terribly |
| Autism is associated with conditions that have | | | | wrong. When the man and his wife divorced 16 years |
| neurological lesions, such as congenital rubella, | | | | later, his son returned to age 18 months and spent the |
| phenylketonuria, tuberous sclerosis, fragile X syndrome | | | | next 12 years in institutions. The surgery was the finest |
| and Rett's syndrome and it is associated with infant | | | | available and the surgeon went on to become one of |
| trauma in the first 18 months of life. | | | | the most noted in the land. Nonetheless, the emotional |
| Most autistics are mentally retarded, language is poorly | | | | trauma eventually destroyed the mind of the baby (the |
| developed, about one-forth develop grand mal | | | | parents were not able to follow the recommendation |
| seizures and as many show ventricular enlargement. | | | | that would have brought about a total or near total |
| Thus, a great variety of assaults to the brain appear | | | | recovery). Thus, as a preventive measure, when the |
| capable of producing the group of symptoms called | | | | infant/toddler is hospitalized, the mother must go to the |
| autism. Severe early emotional trauma-possibly | | | | hospital and remain there with him. This is especially |
| including circumcision-must not be excluded as a major | | | | true when painful procedures are involved. |
| factor. Fixation and continued activation of early | | | | A Second Child: |
| trauma sites-to the partial exclusion of later developing | | | | If there is another child at home under the age of 35 |
| sites, such as the language centers-also can account | | | | months, the mother must try to offer as much security, |
| for the symptoms of autism as well as the differences | | | | reassurance and support as possible to this child as |
| in brain volume and electrical activity. | | | | well. The other child can stay with her or visit in the |
| There is growing evidence offered by the Pre and | | | | hospital lobby when the hospitalized one is asleep, and |
| Perinatal Association of North America that | | | | or have telephone contact upon request. If the older |
| circumcision may represent a serious trauma to many | | | | child is very young and at an age of origin of |
| infants. For this reason it should be studied using our | | | | schizophrenia or schizoaffective disorders, it could stay |
| methods. While the trauma of circumcision might or | | | | in the same room with the mother and baby. While |
| might not heighten appreciably the later trauma of | | | | many hospitals are not aware or tolerant of this need, |
| separation (depending on how closely it is linked with | | | | it is necessary to insist because of the potential harm |
| separation), it could heighten subsequent castration | | | | when the infant/toddler is separated from its mother. |
| fears during the Oedipal stage of development. | | | | When the mother has to be at the hospital and when it |
| Sigmund Freud described castration anxiety as existing | | | | is impossible for the infant/toddler to be there with her, |
| in men and not in women because women cannot be | | | | this is not a time for the father to place the infant |
| castrated. This explanation is plausible and likely is the | | | | toddler in a daycare center or in someone else's home. |
| primary reason why males have castration anxiety | | | | This would be a double separation-a separation from |
| and females do not. Another possibility, however, is | | | | the mother and a separation from home (which also |
| that women do not experience circumcision, and | | | | represents a degree of security). A family member |
| circumcision could account for added fear of further | | | | with whom the infant/toddler is familiar or attached, or |
| cutting injury to the same part later in life. A simple | | | | preferably the father, should stay with the child in the |
| research study of circumcised vs. uncircumcised | | | | child's own home. Ideally, the child should know that the |
| individuals, using an anxiety rating scale, could | | | | caregiver will not leave until the mother returns. |
| determine if this early trauma indeed had an effect on | | | | In summary, physical separations are very traumatic to |
| the later development of castration anxiety. Until all | | | | a child under two years eleven months, and the |
| correlations between circumcision and emotional | | | | younger the child the more severe it can be. Thus, |
| disorders are studied further, we recommend against | | | | physical separations have to be avoided or attenuated |
| circumcision without anesthesia, and against | | | | as much as possible. This includes separation from |
| circumcision or any other painful procedure without the | | | | mother and separation from home and separation |
| mother being present. | | | | from father. If the child is comfortable with the father, |
| OTHER EARLY TRAUMAS REQUIRING SPECIAL | | | | he may go places with the father as long as he does |
| ATTENTION: | | | | not exhibit signs of distress or withdrawal. One must |
| Preemies: | | | | not equate the vacant stare with not being upset. |