The Harsh Reality

My latest Mental Health article at The Volk magazine.

“It is in the homes and in childhood that the wreckage of human life begins.”

 ~Katherine Tingley

The above quote may seem harsh to some, and to others validating. For me, it is validating. At 15 years-old, I understood I had an issue with intimate relationships. I found out in my early twenties that issue had a name: codependency. I read a book called Codependent No More, by Melody Beattie. My copy of the book is full of fading purple highlights. Melody gave what I experienced a framework and language. Often codependency has its roots in the house of a child with at least one caregiver experiencing addiction. This was true for me. My mother had a drinking problem, later prescription drugs, and was in and out of treatment centers much of my childhood. My mother also has a mental illness which was not diagnosed until a couple of years ago. To put it simply, in my home life was unstable; the only predictability was the unpredictability and chaos that came from my mother. I spent three decades sorting most of this out.

Director: Michaela Rae // Camera: Ivy Christina Fashions: Meghanlee Phillips Hair: Kaisa Johnson // Makeup: Mikelle Brown //Model: Tyler Bakken
Director: Michaela Rae // Camera: Ivy Christina Fashions: Meghanlee Phillips Hair: Kaisa Johnson // Makeup: Mikelle Brown //Model: Tyler Bakken

Today the number of people experiencing mental health issues is staggering. According to NAMI (National Alliance on Mental Illness) 1 in 5 adults in the U.S. experiences mental illness in a given year. For youth, ages 13-18, 1 in 5 will experience a “severe mental disorder at some point during their life.” Specifically I’d like to discuss two common diagnoses: PTSD (Posttraumatic Stress Disorder) and ADHD (Attention Deficit/Hyperactivity Disorder). Diagnostic criteria for PTSD are exposure to traumatic event(s), recurrent and distressing memories of the event(s), avoidance of stimuli associated with event(s), and various changes in mood and behavior, which can include hypervigilance, problems with concentration, and sometimes disassociation (DSM-5).

According to SAMHSA (Substance Abuse and Mental Health Services Administration) “Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life-threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.” Approximately 70% of adults in the U.S. have experienced some type of traumatic event in their lives and 8% have PTSD (PTSD United).

ADHD is termed as a “heritable brain disorder,” where symptoms include inattention, hyperactivity, impulsivity, and can cause anxiety, boredom, and/or mood swings. One in nine U.S. (6.4 million) children is diagnosed with ADHD (Ruiz, R, 2014).

I focus on these two disorders due to emerging research which questions whether attention issues and the overall increase in ADHD diagnosis may be due to trauma. One of the reasons this matters is treatment. Seventy-seven percent of children diagnosed with ADHD receive treatment while thirty percent are treated with only medication (Centers for Disease Control and Prevention). From what I understand, ADHD medication will not help a child who does not have ADHD: therefore, having an accurate understanding of a child and their history, particularly trauma history, is important. From this research, this need is becoming clear.

One study of particular importance was done by Dr. Nicole Brown at Duke University. During her residency she began to notice that many of her patients were being diagnosed with ADHD. These patients were living in low-income neighborhoods, often characterized by violence. She conducted a study of 65,000 children.  The parents of these children were questioned about the ADHD diagnoses along with any Adverse Childhood Experiences or ACEs. These experiences can include physical and emotional neglect and abuse, caregivers with mental illness and/or addiction, or who were incarcerated. She found that sixteen percent of children diagnosed with ADHD did have at least four ACEs. There were only six percent diagnosed who had no ACEs. The recommendation from this study, according to Dr. Brown, is “We need to think more carefully about screening for trauma and designing a more trauma-informed treatment plan.”

Dr. Nadine Burke Harris, who is a pioneer in the ACE’s study and was just named California’s first Surgeon General, is calling for developmental screenings of Adverse Childhood Experiences much like we do already for mental health when we visit our doctor. The ACE’s study showed that the more adverse childhood experiences we have, the more it impacts our overall mental and physical health well into adulthood. This brings me back to the quote I shared at the beginning of the article.  We are witnessing, and many of us are experiencing, the wreckage of human life.

To point to our childhood homes as the root of this wreckage, again, may seem harsh. I must also state that there are systematic inequalities that can induce and enhance this wreckage. The truth is many of us grew up or are growing up in harsh conditions. This harshness can create trauma, which impacts us in a variety of ways through behavior, mood, relationships, and our experiences. To recognize this isn’t to blame our caregivers. It is to understand ourselves and, essentially, humanity. Understanding leads to a greater capacity for healing, growth, and compassion for ourselves and others. It is important to remember that we are our best resource and often what troubles us has solutions within. For those of us who commit to this, understanding will create less harsh conditions in our homes for our children. Specific to a diagnosis of ADHD or PTSD, it is important to be professionally screened, recognizing that symptoms of inattention can also point to a trauma history. Below you will find a list of resources—websites and books— that further this discussion and offer education on trauma and ACEs, including a site where you can find out your own ACE score.

To find what your ACE score is, go here: https://acestoohigh.com/got-your-ace-score/

Nadine Burke Harris on how childhood trauma affects health across a lifetime: https://www.ted.com/talks/nadine_burke_harris_how_childhood_trauma_affects_health_across_a_lifetime/discussion

The Body Keeps the Score, by Bessel Van Der Kolk, M.D. 

The Deepest Well, by Nadine Burke Harris, M.D. 


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Nikki DiVirgilio is a Licensed Social Worker and writer. If you’d like to contact her with questions, comments and guidance in going deeper, email her at nikki@nikkidivirgilio.com. To read more from Nikki, visit her blog at www.nikkidivirgilio.com

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