Institutional Abuse: Untying the Gordian Knot. Dr Julian Parmegiani MB BS FRANZCP September 2018

Transcription

1 Institutional Abuse: Untying the Gordian Knot Dr Julian Parmegiani MB BS FRANZCP September 2018

2 Out of Home Care Current Statistics Heritability of Psychiatric Disorders Talk Outline The effects of trauma during childhood and adolescence Snowballing Effects of Trauma Protective Factors and Resilience False Memories Impact of legal proceedings

3 Children subjected to investigation = 115,024 Child Protection Services 2016 Substantiated = 45,714 Children on care & protection orders = 61,723 Children in out-of-home care = 55,614 *AIHW Child Protection Report

4 Child Protection Services Statistics Type of Abuse Primary + other abuse Emotional Abuse 43% 32.5% Neglect 27% 28.2% Physical Abuse 18% 15% Sexual Abuse 12% 1.7% *AIHW Child Protection Report

5 Out-of-home care 46% under 5yrs old Child Protection Services Statistics 94% in home-based care 49% in relative/kinship care 39% in foster care 5% in third party parental care 1% other 6% in institutions *AIHW Child Protection Report

6 Child Protection Services Statistics No information about the parents possible reasons: Alcohol abuse Drug abuse Mental illness Severe personality disorder In custody Cognitive impairment

7 Genetic vulnerability Mental illness might have manifested itself anyway Pre-existing behavioural problems Parents couldn t cope with uncontrollable child Evaluation of Adult Survivors Psychological trauma might have already caused irreparable damage before being taken into institution Targeting: Bullies and predators victimizing vulnerable targets Odd Socially inadequate Shy Anxious Depressed All of the above combined

8 MJA Volume 185 Number 9 6 November 2006

9 MJA Volume 185 Number 9 6 November 2006

10 MJA Volume 185 Number 9 6 November 2006

11 Alcohol Use Disorder - 50% heritable Heritability The heritability of alcohol use disorders: a meta-analysis of twin and adoption studies B. Verhulst, M. C. Neale, K. S. Kendler - Psychol Med April ; 45(5):

12 4- to 12-fold increased health risks for alcoholism, drug abuse, depression, and suicide attempts Effects of Childhood Trauma 2- to 4-fold increase in smoking, poor self-rated health, >50 sexual partners, and sexually transmitted disease 1.4- to 1.6-fold increase in physical inactivity and severe obesity The Adverse Childhood Experiences (ACE) Study, Felitti et al, Am J Prev Med 1998;14(4)

13 Effects of Trauma 3-fold odds of subsequently developing psychotic experiences The Adverse Childhood Experiences (ACE) Study, Felitti et al, Am J Prev Med 1998;14(4)

14 Increased odds (x2.3) of later psychotic experiences (PE). Effects of Trauma Maladaptive family functioning- abuse, neglect, and parent maladjustment, exhibited the strongest associations with PE onset in all life-course stages. Sexual abuse exhibited a strong association with PE onset during childhood. The association between childhood adversities and subsequent first onset of psychotic experiences: a cross-national analysis of respondents from 17 countries. Psychological Medicine, J. J. McGrath et al Volume 47, Issue 7 May 2017, pp

15 Do life events alter physiology? Epigenetics is the study of heritable changes in gene function that do not involve changes in the DNA sequence

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17 Radhakrishnan R. et al, Schizophrenia Bulletin vol. 43 no.4 pp , May 17, 2017

18 Final Report Royal Commission into Institutional Responses to Child Sexual Abuse Effects of Abuse p15 1. mental health 2. interpersonal relationships 3. physical health 4. sexual identity, gender identity and sexual behaviour 5. connection to culture 6. spirituality and religious involvement 7. interactions with society 8. education, employment and economic security 9. Some victims take their own lives Commonwealth of Australia 2017

19 Effects of low selfesteem Substance abuse, depression, suicide Poor interpersonal relationships Tolerate abuse Fear of commitment Antisocial peers Angry with others Poor physical health Low educational goals Parenting problems Unemployment External locus of control

20 Protective factors Resilience Biological factors MAO Gene IQ Temperament Locus of control Social support Sibling Grandparents Significant role model Peers NB: Temperament, IQ, Special talent Elicit support *Resilience Chapter 25, Rutter s Child and Adolescent Psychiatry,5 th Edition 2008

21 False Memory Syndrome A condition in which a person s identity and interpersonal relationships are centered around a memory of traumatic experience which is objectively false but in which the person strongly believes. *Kihlstrom JF 1998

22 >90% First sought therapy for depression then recovered memories during therapy 48% recovered memories of satanic ritual abuse 39% recovered memories of witnessing a murder False Memory Suggestive procedures Pressure to recover memory Told self-doubt is common but not a sign of inaccuracy Reading survivor literature Completing homework activities focusing on abuse Participating in survivor groups

23 A psychiatrist s experience Person becomes fully focussed on past trauma: Repeats story to commissions of inquiry, lawyers, doctors, courts, media, social support groups, online forums, spouse, children, parents, friends, employer. Impact of Legal Proceedings Psychological decline - Increase in anxiety and depression - Emergence of nightmares and flashbacks - Alcohol abuse escalates - Embarrassment, guilt, anger - Blames everything on past trauma Functional decline Loss of employment, further alienation,

24 Can causality be safely determined? Psychiatrist s Task - Limited information about family history of mental disorder Cannot isolate impact of early developmental trauma Cannot determine whether incidents occurred as described Cannot isolate impact of situation-specific abuse Cannot determine impact of free will on making wrong choices Cannot isolate impact of independent life events i.e. being in the wrong place at the wrong time with the wrong people Cannot determine contribution of legal proceedings to current psychopathology

25 Questions?