Q: Dear Frank, I received a question and thought it could apply to many trauma survivors. I will send you a few more details in an email that J shared with me.
Here is J’s question. I wonder if I could ask a question regarding depression, I have been diagnosed PTSD although I believe it’s more likely C-PTSD. I have also been a victim of domestic violence. My question: Can a child be born depressed? The reason I ask is I have begun antidepressants around 8 months ago and it’s the first time I have been able to think clearly ever in my life, my memory has also improved. I’m wondering also, if witnessing violence (but not having the memories) could have caused the same reaction?
A: Dear, thank you for sharing “J’s question. She raises several very interesting and important issues, based on her life experience. She witnessed serious violence in the family when she was young. She survived sexual abuse herself. She remembers some trauma episodes, but not others. She writes that she dissociates in some stressful situations and she wonders if she should work with a therapist to recover memories of forgotten trauma – things that she witnessed but did not retain.
Psychoanalytic therapies (Freudian and related approaches) are based on the idea that many if not most psychiatric conditions are rooted in repressed trauma. The traumas may have been violent and life threatening, but they may have been relatively mild and commonplace -like losing the attention of a mom when she gives birth to a younger brother or sister. These therapists use free association, dream analysis and other techniques to “make the unconscious conscious,” – to recover repressed or forgotten childhood experience.
My colleagues who treat traumatic stress injury understand psychoanalysis, but tend to use different techniques. Our patients have histories of blatant abuse or of exposure to terrifying calamity and their memories are too vivid rather than repressed. We have to help people like J reduce the frequency and the severity of unwanted recollection. We do that in many ways, including facing the images together with comfort and respect, allowing the event to be tolerated. Exposure therapy means that a person agrees to expose herself to her own past, including the emotions of fear, shame or rage, but at the same time to experience support and dignity. Eventually, tolerance is achieved. Self-esteem replaces self-doubt.
There may be parts of a traumatic memory that are buried, out of conscious awareness. I recall a woman police officer who was sexually abused by her commander. I helped with her lawsuit against him. I learned that she shot and killed a man in the line of duty and remembered everything but the sound of her gun. That sound was repressed. One of her PTSD symptoms was a recurrent nightmare in which the Chief of Police and that man she killed pulled her into a grave. Why was that repressed gunshot important? I believe it needed to become conscious so that she could master her past traumas and feel in charge of herself. That gunshot was real. It did register in her brain. It played a role in her dreams, connected to sources of strong emotion. Eventually, she did recall the sound and her memories were all there, on the “table” of her mind, where she could look at them, hear them, untangle them, and overcome their haunting quality.
“J” probably did witness acts of violence and may have felt impotent at the time, being young, overpowered, and unable to protect a vulnerable family member. “J” dissociates at times. That means she goes into a trance-like state. This protects her from anxiety, but it causes her to lose some pieces of personal history, including traumatic episodes. Recovering a memory from childhood, a disturbing memory, could be therapeutic. It could give J a sense of mastery. It may not be crucial. I wouldn’t consider that an essential goal of post-traumatic therapy. But I’d have it on a list of desirable outcomes. She asks if repressed memory can have the same effect as early onset depression and I believe it can. It isn’t the same thing, but the effect can be similar.
Let me turn now to early-onset depression — depression that is NOT caused by trauma, but is a result of altered brain chemistry. Medical depression is much like diabetes in that an important biological function is off-kilter and may be that way because biochemical pathways are diseased. The disease has genetic components and has environmental triggers. It responds to medication. Some depression is entirely environmental. A person feels helpless, hopeless and worthless as a direct result of terrible life events. But the condition I’m calling “medical depression” is a result of factors that are inherited. The first episode of depression usually occurs in late adolescence or early adulthood. But it may occur in childhood. Often, the child is seldom born depressed, but eventually becomes depressed. Therefore it is very likely that a person can be “born depressed” meaning that sooner or later the depressive symptoms will show up. Depression in infancy has been reported and specialists can treat the depressed infant, along with the mother. This is a serious matter although it is unusual.
J experienced an excellent result from antidepressant medication and wondered if this meant she was “born depressed.” That could have been the case. There is a condition now called persistent depression. We used to call it dysthymia. It is a long-term, low-grade depression. It usually responds to medication such as Prozac, Lexapro, Effexor, Wellbutrin and other similar pills. But complex-PTSD may also respond to these medications. Complex PTSD is a result of prolonged trauma, of trauma early in life, or trauma during formative periods of a person’s identity. It can damage a sense of self, lowering self-esteem and alienating one from sources of validation and support. C-PTSD and persistent depression overlap. One contributes to the other.
Treatment involves education in self-awareness, self-soothing and self-confidence. The therapist has to be trustworthy as a knowledgeable professional and as a human being. Drugs can be a very significant part of therapy, as J found out. Some doctors rely too much on medication. That is a problem. But it is also a problem if your therapist is prejudiced against medication, and doesn’t provide the opportunity that J had. J benefitted greatly from overcoming many, many years of sadness. I believe that her sadness had a medical dimension and I am thrilled that a good doctor provided an effective remedy.
Frank
