Something I have learned in my almost two decades as a therapist is that even as science improves our understanding of people’s needs, it can take a while for large systems, like courts and child protective services, to change how they interact with the people whose lives they touch.
But in the time that it takes systems to learn, lives can be ruined.
“Charlie” is a client of mine whose situation should serve as a cautionary tale and hopefully an incentive for these systems to better understand how to work with trauma.
Charlie is no angel. He has been in prison and has a history of making threats, although no history of actual violence – unless he is physically restrained, but more on a that in a moment. He also has a tendency to loudly curse out anyone who he feels is threatening him, whether that person is a drug dealer, a judge, or a DCF worker. He has a young son in foster care, who he is working to be re-united with. He has been homeless for over a year, a situation which has caused a great deal of stress in his life.
Charlie spent much of his own youth in foster care, where he was at times bullied and abused by institutional staff and needed to fight off physical and sexual assault by other residents. Fighting sometimes got him in trouble, but it also kept him as safe as he could be in those situations, and gave him a sense of power where he would otherwise feel at the mercy of institutions far bigger and more powerful than he.
Charlie is also an intelligent person who has been very punctual and committed in his appointments with me for over a decade. He is an active volunteer at a local church that serves free meals to homeless people, and enjoys conversations about spirituality. Until the Department of Children and Families removed his child, (not because of any mistreatment of the boy but because of the way Charlie’s trauma history made him respond to adults who criticized his parenting) he was a devoted single parent. Since the removal, he has had twice- weekly visits with his son and has been working diligently to put his little family back together. Before the current crisis, Charlie worked for years as a restaurant cook – a job he loved. When he feels respected and listened to, he is capable of being calm, thoughtful and generous.
It is understood in psychotherapy, and particularly emphasized in trauma therapy, that when someone feels threatened, they will respond with either a fight, flight, or freeze reaction. This is not a cognitive process. In crisis situations, the “thinking part” of the brain, the prefrontal cortex, quickly becomes overwhelmed by the limbic system or “emotional part” of the brain. This is an evolutionary advantage that helps the body react immediately to imminent threats.
Trauma research tells us that responses that have worked in the past tend to become default responses in the future. We therapists say, “Neurons that fire together, wire together,” because these responses can become somewhat solidified in the nervous system. These responses can be unlearned, but it takes time. It also requires a relatively safe, calm environment: a stable living situation and the absence of re-traumatizing factors. Without this stability, a person will continue to repeat their previously successful responses to crisis, even if they bring negative results in the current situation.
Charlie was in court because of text messages he sent to a DCF worker, which the worker deemed threatening. Although Charlie’s defense lawyer had no concerns about his ability to understand what was going on or assist in preparing the case, Charlie kept talking out of turn and disrupting court, so a judge ordered an involuntary competency evaluation.
Perhaps understandably, Charlie quickly began to feel threatened and grew quite angry. The outcome is that he was placed in a state-run psychiatric hospital in order to “be restored to competency” for trial. The evaluators met with him for just two hours, and didn’t seek information about his functioning in the community from anyone with better knowledge of him. When I later spoke with one of the evaluators, she stated that there had been no problem with Charlie’s cognitive ability or his ability to understand the legal system. The sole problem, she stated, was his “presentation,” meaning they didn’t like his anger. The goal, she stated, was that he be able to “speak calmly and rationally about his court case.” In other words, they knew he was competent, but they didn’t like how he behaved.
Subjecting someone who has been traumatized by being institutionalized to yet more institutionalization, increasing his feelings of powerlessness, will not make him more calm or rational. It will trigger a trauma response, which in Charlie’s case was fight. He ended up being physically restrained and medicated against his will, which will made him feel more powerless and compounded his trauma, causing him to lash out even more. This was not lost on the psychiatrist assigned to Charlie, who informed me that she did not have the authority to discharge him. “It’s a conundrum,” she admitted.
It’s also a wildly ineffective way of dealing with the short-term problem of a person’s inappropriate expression of anger and the long-term challenges of their mental health. Who is actually being served by this? Certainly not Charlie, who is having a lifetime of trauma compounded by his current experiences, not the staff of the hospital, who have to physically struggle with a patient, nor Charlie’s young son, who now has to wonder why his father stopped seeing him.
I have continued to be in touch with Charlie regularly during his stay. Frequently, his words are slurred due to heavy medications and he has shown an uncharacteristic difficulty in remembering things like names and dates. This does not strike me as restoring someone to competency. It strikes me as over-medicating someone to make them more controllable in the short-term. In the long term, it is difficult for me to see how this will improve his mental health, reduce his trauma or help him manage his anger.
Charlie’s detention in the hospital has only complicated his life outside: I can only imagine the terrible impact that all this has had on Charlie’s son. I know, from talking to Charlie’s lawyer in the DCF case, that the boy had been insisting on in-person visits, which DCF initially refused, mistaking Charlie’s trauma responses for dangerousness. Once the child’s lawyer and Charlie’s lawyer convinced a judge to order visits, those visits went well.
Because of this, and because Charlie was never accused of abusing his son (again, his trauma responses were largely the root of the DCF case), he was well on the way to reunification with his child: the boy’s lawyer supported it, and a judge had ordered DCF to pay for temporary housing to facilitate visits and a quick path to bringing father and son back together. Charlie had also been working with a supportive housing agency to help him find more permanent housing, and an apartment was going to open up at the end of February. His forced hospitalization derailed all of that.
Mental health professionals, court personnel, and child welfare agencies are given a great deal of power over the lives of others, and our goal should always be to do what will be effective. We must always ask, “What will actually help improve a person’s behavior and help improve their mental health in the long term?”
Charlie’s story is a perfect example of how ignoring this basic rule can make things worse instead of better: if DCF had understood his verbal outbursts with adults as part of his trauma, they could have seen what I and his lawyer on the case see: that he is not dangerous and that he is capable of being a thoughtful parent. But instead, they removed his son, sought to curtail his visits, and involved him in criminal court – actions that triggered his trauma.
If the criminal court personnel had taken a moment to understand his condition before locking him in a psychiatric hospital, he would likely be housed and close to reunification with his son already – exactly the conditions that would actually help him behave calmly in court.
The road to institutions’ becoming trauma-informed will be long and complex. It requires more time and thought than a single opinion piece allows. However, even one basic principle could save people like Charlie, their families, and the professionals who work with them from a lot more effort and misery: staff must have a solid understanding of the way trauma functions and how it hijacks a person’s ability to think and behave calmly; helping a person become calm and rational means helping them reduce the activation of their nervous system, not putting them in an even more stressful, triggering environment.
People who have undergone serious trauma are entirely capable of being productive members of society and loving, responsible parents. But the way they are treated, by courts, child welfare agencies, and other institutions meant to help them, is impeding their well-being and hurting their families.
Donna Nicolino is a Licensed Clinical Social Worker in Willimantic.