| Delayed Posttraumatic Stress Disorders from Infancy | | | | consider its prevention.Birth of a sibling has been |
| The Two Trauma Mechanism: | | | | recognized as a severe trauma having profound |
| The two trauma mechanism represents a new model | | | | effects.I would estimate this may represent as much |
| for the study of mental illness in the field of | | | | as one-third of severe infant trauma occurring after |
| psychiatry. My findings show that psychiatric illnesses | | | | age nine months. The prevention of serious mental |
| are based on early trauma and follow a pattern of | | | | disorders through the prevention of initial trauma |
| later activation precipitated by a major life crisis or | | | | must take into consideration either the spacing of |
| significant stressor, and then multiple | | | | children, or special ways of attenuating the |
| reactivations with little further provocation. This | | | | birth-of-a-sibling trauma in children who are born in |
| delayed posttraumatic stress disorder pattern of | | | | close sequence. |
| activation and reactivation holds true not only for | | | | If one chooses to space children close together, then |
| schizophrenia, but also for mood disorders, anxiety | | | | great consideration must be given to the |
| disorders, psychoactive substance use disorders, | | | | introduction of the new arrival. For a best case |
| eating disorders and more. | | | | scenario vs. a worst case scenario (based in part on |
| To the extent that early trauma are identifiable, it is | | | | cumulative case histories but without statistical |
| possible through educational means to prevent a | | | | study), picture the infant who is totally dependent on |
| large number of early trauma from ever occurring, | | | | the mother-who then suddenly finds the mother |
| and to modify or attenuate the ones that can not | | | | gone-and who even may be sent to a babysitter's |
| be avoided.My research design, allows us to | | | | house because the father is at work and is not |
| establish a peak age of risk for each emotional | | | | available to care for the needs of a one or two year |
| disorder or disease category related to early trauma. | | | | old. The baby is very upset at the sudden |
| Based on 25 years of clinical observations, early | | | | disappearance of the mother, is frightened, confused, |
| trauma is expected to account for a large number | | | | cries in distress, and is desperate for her return. Then |
| of disease categories, and in particular the | | | | the mother returns, holding and feeding a new baby. |
| schizophrenias and the depressions. Because of the | | | | Suddenly all fears may culminate in a dreadful |
| unique research design, the most likely peak age and | | | | realization; the first child experiences that it has been |
| age range of origin/vulnerability is identifiable for each | | | | displaced; its whole world, its entire existence has |
| disorder/symptom, as well as the relative degree of | | | | been lost; without the mother to care for its needs, |
| risk for each type of trauma. | | | | there is no life. The deepest fears of abandonment |
| Ultimately, large scale objective studies will reveal a | | | | and death, developed over 150 million years of |
| precise mathematical peak age of origin for each | | | | patterning of the old and the new mammalian brains, |
| symptom or disorder related to trauma. My studies | | | | can be triggered. Few people realize the extent |
| have demonstrated statistically significant correlations | | | | of this fear. Its meaning becomes lost and confused |
| between early experienced threats of separation and | | | | with such words as "sibling rivalry," "jealousy"-and |
| the later development of serious disorders, and | | | | other such attributes that have little or nothing to do |
| based on cumulative observations it is possible to | | | | with the absolute horror and terror that is being |
| post-dict clinically the approximate age of origin of | | | | experienced. To seal the book for the worst case |
| each symptom/disorder.This appears to | | | | scenario, some infants or toddlers then are sent off |
| be accurate to within a few months and soon will | | | | to the grandmother's house when the newborn |
| be tested in a clinical research setting. I do not yet | | | | arrives. |
| have statistical data to validate all the clinical | | | | To contrast this worst case scenario with a better |
| findings, but to not include the only set of predictions | | | | way to handle the same situation, let us picture a |
| that exist-and which are based on 25 years of | | | | family where the older child-as much as possible |
| cumulative observations-would be falling short of the | | | | (depending on age)-is told about the new arrival and |
| mark. | | | | about the older child's future role in the family. The |
| ORIGINAL INFANT TRAUMA REQUIRING | | | | first child remains at home, with a close family |
| PREVENTION OR ATTENUATION: | | | | member, when the mother (and father) is at the |
| Early traumas largely have one primary common | | | | hospital. When the mother returns, she is NOT |
| denominator: a relative degree of physical or | | | | holding and feeding a new baby. She rushes to the |
| emotional separation from the mother, which | | | | first child, tells him/her how much she missed him or |
| frightens the baby and may trigger primordial fears | | | | her, makes a great display of attention/affection |
| of abandonment and death. The cry response is | | | | over the first child, and then later introduces the |
| present throughout the mammalian species. | | | | subject: "Would you like to see your new baby |
| Mammalian infants need the mother for survival, and | | | | brother or sister?" After the introduction, the mother |
| without the mother they would die. Absence of the | | | | again makes a big fuss over the first child and gives |
| mother elicits the cry response. This is a distress | | | | it gifts. Thus, by actions-that speak louder than |
| signal, and when the mother hears it, she quickly | | | | words-the first is assured of its continued value and |
| returns. Both the cry of the infant and the response | | | | place in the family, and the threat of displacement |
| of the mother are well entrenched in the mammalian | | | | and abandonment is substantially lessened. |
| brain. (MacLean, 1973, 1985) This has been necessary | | | | This better case scenario was learned by the first |
| for survival in mammals since the ancestors of the | | | | author through an experience with puppies. We had |
| duck bill platypus, and natural selection assures its | | | | an adorable Pomeranian puppy for three weeks and |
| perpetuation. Without this means of bringing the | | | | then decided it needed a companion. When the |
| mammalian mother and infant together, infants would | | | | second arrived, the first snarled and pulled back. |
| die and the species gradually would become extinct. | | | | Instinctively I snatched up the first puppy, hugged it, |
| Thus the fear of separation is "built in," and it is part | | | | made a big fuss over it, and when I set it down it |
| of a primary survival mechanism. Separation, | | | | wagged its tail and walked up to lick the face of the |
| therefore, can be so frightening and can produce so | | | | second. All it had needed was assurance of its own |
| much stress that it literally can lead to death. | | | | position before it could welcome the addition of the |
| Anaclitic deaths among humans have been | | | | second puppy. |
| documented and this has been recognized in other | | | | The worst case scenario was gleaned from histories |
| mammalian species as well. | | | | of a number of patients who had schizophrenia or |
| Since separation from the mother is closely linked | | | | depression. The ideal is more hypothetical, based on |
| with survival, we must pay particular attention to | | | | practical experience and conjecture. While this does |
| anything that can cause the infant to fear separation, | | | | not represent scientific research, we must begin |
| as we explore the range of infant trauma and | | | | somewhere. |