Category: In the News

Joker: A warning we should heed

At my teenaged kids’ insistence, I took them to watch Joker in the theater, expecting a typical action-packed, comic book movie – not a genre I typically enjoy. Instead, I sat in the darkness, stunned to near-tears by it’s devastating portrayal of how early childhood trauma and untreated mental illness can spiral into tragedy. 

The poignant film explores the backstory of comic book villain Joker: a man named Arthur Fleck who has a disturbing past and a troubling present. It is a compelling and nuanced portrayal of untreated trauma and mental illness. 

Joker is incredibly violent and disturbing, certainly earning its R-rating, but at the same time reflects a reality we are already seeing in our society today. Early childhood trauma is at epidemic levels. Our mental health system is in disarray. We aren’t meeting the needs of the vulnerable around us and sometimes violence and tragedy are the price we pay as a society. 

There’s a huge amount of controversy swirling around the film and it’s portrayal of mental illness. After watching the movie, I believe the real controversy we should be focused on is why we don’t have affordable, accessible, effective treatment for mental illness and early childhood trauma!

"You think Joker is controversial? What's really controversial is that we don't have affordable, accessible, effective treatment for mental illness and early childhood trauma." – Keri Williams Click To Tweet

*** Spoilers Below ***

In the film, Joker, we meet Arthur Fleck shortly after he’s been discharged from a mental health institution. He’s receiving mediocre city mental health services, living in poverty, and attempting to build a semblance of a life for himself.

While the film does not specify all of Arthur’s diagnoses, his symptoms include hallucinations, paranoia, delusions, and feelings of despair, loneliness, and worthlessness. Arthur’s one obvious diagnosis, Pseudobulbar Affect (PBA), fits of uncontrollable laughter, results in severe bullying. We also learn Arthur was abused and neglected by his mother during early childhood. This included severe head trauma as well as psychological and emotional abuse. Arthur has never been able to access the treatment he needs to manage his condition, much less heal, or thrive. He’s completely lacking social skills, unable to hold down a job despite his best efforts, and even with medication, unable to feel happy or optimistic.

Unfortunately, Arthur is not simply a far-fetched character. We have “Arthurs” living and breathing all around us – in our daycare centers, classrooms, workplaces, and neighborhoods. Early childhood trauma is a hidden epidemic affecting millions of people. While victims of early childhood trauma and/or people who have mental illnesses aren’t necessarily violent, the combination of untreated trauma and mental illness with psychosis can be dangerous. Furthermore, high-risk children are not receiving effective treatments in residential treatment facilities. They are aging out ill-equipped to function in the adult world and at high risk of criminal behavior and incarceration. Like Arthur, most of these individuals want to be happy. They want to have good lives. However, we, as a society, fail them by not providing effective, affordable, accessible treatments for trauma and mental illness. Like Arthur, these people struggle to navigate even the basics of life.

Arthur, though teetering like a wobbling house of cards, is trying to build a life for himself. He’s trying to find some happiness. But it’s obvious to the viewer that he simple doesn’t have the resources or skills to do so. And so begins Arthur’s devastating spiral that should be a warning for us all. 

  1. Arthur loses his services (therapy, medications, etc) due to city financial cuts.
  2. He’s fired from the job he loves – sure he made a mistake, but he’s given no mercy or compassion.
  3. He follows his dream to be a comedian, and falls flat. He’s mocked mercilessly.
  4. He’s physically assaulted for laughing (his Pseudobulbar Affect) and in self-defense shoots and kills two men on a train. In a panic, he kills another.
  5. He’s cruelly rejected by the man he believes to be his birth father.
  6. He learns his mother abused him as a child and anger that has been festering in his unconscious for decades surfaces.

The spiral tightens. Arthur is drawn to the rioters who praise him as a vigilante for the killing on the train (which was in fact, self-defense). He becomes more violent and murders several people. In his mind, his path has become inevitable as all other doors – all other options – have slammed closed in his face. 

Does this not reflect the crumbling path of so many young people in our society today? People who struggle on the edge of society: to hold down a jobs, to form relationships, to find their next meal, or place to sleep. This instability is the fate of so many people who have experienced early childhood trauma and/or are mentally ill because they are unable to access effective treatment and services. Is it any wonder that they are hopeless, desperate, and caught in a downward spiral? Is it any surprise that some end up engaging in criminal behavior? That some act out violently?

Towards the end of the movie, Arthur has fully transformed into the Joker. Wearing chalky make-up and a sardonic smile, he sits on a talk show stage and casually confesses to the train murders, Before shooting the talk show host point-blank in the face, Joker says, “I’ve got nothing to lose. Society has abandoned me.” And we can’t disagree: He has got nothing to lose. Society has abandoned him.

It only takes thumbing through the headlines to know that far too many of our most vulnerable have been abandoned by society and with nothing to lose have picked up guns and lashed out violently too. Read more about one recent incident here. This will continue until we prioritize affordable, accessible, effective treatment for early childhood trauma and mental illness.

NOTE: In case it wasn’t clear in this post, I am not saying that mental illness or childhood trauma lead to violent behaviors. What I am saying is that untreated mental illness and untreated childhood trauma can put people on a dangerous spiral.

Yoga at school may help your child, but what about mine?

Recently I’ve seen several headlines about schools who are introducing yoga as a way to address student behaviors. The West Fargo Pioneer (link no longer available online) explains this way:

Behavior issues stem from a multitude of reasons. However, studies show that students today are more likely to experience trauma and have mental health needs, increasing the likelihood of classroom disruptions and behavioral issues. 

In a classroom of 20, one or two students on average will be dealing with serious psycho-social stressors relating to poverty, domestic violence, abuse and neglect, or a psychiatric disorder, according to the Child Mind Institute.

This type of stress can shorten periods of brain development and limit brain growth in early years, making it harder for students to regulate emotions and concentrate on learning. 

And while schools can’t control students’ experiences outside the classroom, they can help students learn how to cope with stress and regulate emotional outbursts. Social-emotional curriculum aims to help students recognize and deal with emotions and tackle the increased presence of stress and trauma.

It’s absolutely true that every classroom has children who have experienced trauma. Early childhood trauma is an epidemic. It’s absolutely true that these experiences affect a student’s ability to learn and cope in school. It’s also absolutely true that some students will benefit from yoga. It will help by,

  • Reducing stress
  • Improving concentration
  • Increasing self-esteem
  • And more…

This is why PBS suggests Managing School Stress by Bringing Yoga Into the Classroom. And Education Week applauds Ditching Detention for Yoga: Schools Embrace Mindfulness to Curb Discipline Problems.

Great ideas, however news articles like these give the impression that yoga is an inexpensive, quick fix for childhood trauma. For kids on the moderate to severe end of the spectrum, this simply isn’t the case.

Here’s the problem

Many kids with developmental trauma are so dysregulated they cannot follow instructions or calm themselves enough to even choose to participate in yoga. A 10-year-old who flips desks, curses at the teacher, and fights with other kids is likely not able to safely or effectively participate in yoga.

Furthermore, kids who have extreme behaviors and emotions may be extremely disruptive during yoga activities. This can cause other students to be unable to focus and benefit from the exercises. A 6-year-old who refuses to follow instructions, pesters other kids, and runs around in circles, will disrupt the entire atmosphere.

If a child has a cold, a spoonful of honey does wonders. However, that same spoonful of honey is not able to cure a child who has strep throat. Here’s the ugly truth about trauma: Some kids who have experienced trauma have needs far beyond what a spoonful of honey can heal. Without comprehensive and specialized treatments, these children are unlikely to benefit from yoga at school. They probably won’t even be able to successfully participate.

A spoonful of honey soothes a sore throat, but it can't cure strep throat. Yoga in schools is wonderful, but kids with developmental trauma need comprehensive, specialized treatments. There are no quick fixes or easy solutions. Click To Tweet

I cringe at the “yoga in school” headlines because they minimize the devastating, often debilitating, effects of trauma on our kids. Most people who read the articles, or just skim the headlines, will assume childhood trauma is easily treated.

Don’t get me wrong – I applaud schools incorporating yoga into their curriculum and behavior programs because it can be helpful to so many children. However, yoga cannot curb extreme behaviors caused developmental trauma. It is a far more complicated and challenging issue.

Let’s get our kids to a healthy place where they can benefit from yoga. You can help by learning how trauma effects kids and sharing our video to help raise awareness for the need for accessible, affordable, and effective treatments.

How Racism, Trauma And Mental Health Are Linked

Research shows African-Americans are less likely to access treatment for mental illness.

Cultural norms and the stigma associated with having a mental illness are partly to blame, according to Shardé Smith, assistant professor of human development and family studies at the University of Illinois at Urbana-Champaign.

Smith studies the role that race-related stress and trauma has on entire families, and what strategies people use to cope.

She spoke recently with Side Effects Public Media about the barriers to mental health treatment for African-Americans and the relationship between racism, trauma and mental illness.

This interview has been edited for length and clarity.

What are some of the barriers that prevent African-Americans from seeking help for a mental illness?

Mistrust of the therapeutic system stems from events like the Tuskegee experiment and other systemic injustices where African-Americans were treated unfairly. There’s also shame and negative beliefs about mental health care, and the assumption that an individual or community failed in some way, which led to these issues. And for those who are part of a religious community, sometimes mental illness is seen as not having enough faith in God.

What is the role of systemic racism in all this?

Systemic racism is the institutionalization of racism through policies and practices that show up in all of our systems. And it’s through systemic racism that mental health issues arise and are maintained.

For example, living in an impoverished community with less access to proper food and nutrition can be very stressful and can create mental health problems among individual family members. Another example could be the funneling of black youth through the justice system, where they’re more likely to either go to jail or be a part of the system than to receive proper mental health care.

There are also inequalities in our education system that can create gaps in wealth. This can lead to mental health problems, and systemic racism also means there’s a lack of access to proper mental health care, cultural biases from health providers, misdiagnoses such as attributing certain behaviors to delinquency as opposed to survival coping strategies for the trauma people have faced.

What role does trauma play?

Trauma plays a huge role. The disparities that we see cause trauma, and a lot of times that trauma goes unaddressed, and it’s not named as such. So it’s difficult finding treatment for the trauma because we don’t have a name for it.

What are some examples of trauma?

Race-related trauma could include the traumatic experiences, emotionally, psychologically, physically that manifest as the result of experiencing one or multiple events. Sometimes we think of traumas, such as natural disasters, sexual trauma, or car accidents, which are traumatic events. But sometimes we don’t think about race-related trauma as a part of that, and it’s important to include that in our understanding of trauma and how it can effect marginalized communities and African-Americans.

To loosely quote Kimberlé Crenshaw, if there’s no name for a problem, you can’t see a problem. And if you can’t see a problem you can’t solve it. And sometimes we don’t name these traumas as racial traumas that black and African-Americans are experiencing.

This story was produced by Side Effects Public Media, a news collaborative covering public health.

Follow Christine on Twitter: @CTHerman

California Looks To Lead Nation In Unraveling Childhood Trauma

Imagine identifying a toxin so potent it could rewire a child’s brain and erode his immune system. A substance that, in high doses, tripled the risk of heart disease and lung cancer and reduced life expectancy by 20 years.

And then realizing that tens of millions of American children had been exposed.

Dr. Nadine Burke Harris, California’s newly appointed surgeon general, will tell you this is not a hypothetical scenario. She is a leading voice in a movement trying to transform our understanding of how the traumatic experiences that affect so many American children can trigger serious physical and mental illness.

The movement draws on decades of research that has found that children who endure sustained stresses in their day-to-day lives — think sexual abuse, emotional neglect, a mother’s mental illness, a father’s alcoholism — undergo biochemical changes to their brains and bodies that can dramatically increase their risk of developing serious health problems, including heart disease, lung cancer, asthma and depression.

“[Nadine] has probably single-handedly done more to elevate this issue than anyone else,” said Dr. Mona Hanna-Attisha, the pediatrician known for documenting the rise in children’s blood lead levels in Flint, Mich., after the city switched its water supply.

With Burke Harris’ selection as the state’s first surgeon general, California is poised to become a vanguard for the nation in embracing the research that traces adverse childhood experiences, or ACEs, to the later onset of physical and mental illness. In pockets across the country, it’s increasingly common for schools and correctional systems to train staff on how academic and behavioral problems can be rooted in childhood trauma. Burke Harris envisions a statewide approach whereby screening for traumatic stress is as routine for pediatricians as screening for hearing or vision, and children with high ACEs scores have access to services that can build resilience and help their young bodies reset and thrive.

As California’s surgeon general, she will have a powerful bully pulpit — and the firm backing of a new administration with deep pockets. In his first weeks in office, newly elected Gov. Gavin Newsom has made clear he intends to devote significant resources to early childhood development. He has named several recognized experts in child welfare, along with Burke Harris, to top posts, and is promoting child-centric policies that include extended family leave for new parents, home nursing visits for new families and universal preschool. In his first state budget proposal, released last month, Newsom called out ACEs by name and committed $105 million to boost trauma and developmental screenings for children.

“It should be no surprise to anyone that I’m going to be focusing on ACEs and toxic stress,” Burke Harris said in a phone interview just days into the new job. “I think my selection is a reflection of where that issue fits in the administration’s priorities.”

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A Game-Changing Study

Adversity is the sort of thing we intuitively understand, at least to some extent. Having a parent who struggles with addiction or mental illness is hard on kids, as is growing up in a neighborhood marked by poverty, gun violence or drug abuse.

A 1990s study laid the groundwork, however, for an understanding of adversity that suggests it poses a pervasive threat to public health.

During interviews with patients at a Kaiser Permanente obesity clinic in Southern California, Dr. Vince Felitti was shocked at how many said they had been sexually abused as children. He wondered if the experiences could be connected. (Kaiser Health News, which produces California Healthline, is not affiliated with Kaiser Permanente.)

As head of the Department of Preventive Medicine at Kaiser Permanente in San Diego, he had access to a huge pool of patients to try to find out. Together with the Centers for Disease Control and Prevention, he surveyed more than 17,000 adult patients about 10 areas of childhood adversity. Among them: Did a parent or other adult in your household physically abuse you? Emotionally abuse you? Sexually abuse you? Go to prison? Was your mother regularly hit? Did you often go hungry? Were your parents divorced? The researchers scored each patient, assigning a point for each yes, and matched up the responses with patients’ medical records.

What they found was striking. Almost two-thirds of participants reported experiencing at least one kind of adversity, and 13 percent — about 1 in 8 — said they had experienced four or more. Those who reported experiencing high doses of trauma as children were far more likely to have serious health problems as adults, including heart disease, stroke, cancer and diabetes. And the higher their ACEs score, the worse their health was likely to be.

This extended to mental health, as well: Adults who reported experiencing four or more ACEs were 4.6 times as likely to have clinical depression and 12 times as likely to have attempted suicide.

In the 20 years since, scientists have built on the research, replicating the findings and digging into the “why.” In the simplest terms, traumatic events trigger surges in cortisol, the “stress” hormone. When those surges go unchecked for sustained periods, they can disrupt a child’s brain development, damage the cardiovascular system and cause chronic inflammation that messes with the body’s immune system.

And where children really get into trouble is when they also are missing the best-known antidote to adversity: a nurturing and trustworthy caregiver. Without that positive stimulation, children can end up with an overdeveloped threat response and a diminished ability to control impulses or make good decisions. Children with high ACEs scores are more likely to develop attention deficit hyperactivity disorder, known as ADHD, and cognitive impairments that can make school a struggle. They are more likely to grow into adults who drink to excess, are violent or are victims of violence.

The research is compelling, because it has the potential to explain so many intractable health problems. What if some portion of Generation ADHD really has PTSD? What if obesity and hypertension are disorders with roots in childhood experiences, and not just what we eat for dinner?

‘What Happens To You Matters’

Until now, Burke Harris’ professional epicenter has been Bayview-Hunters Point in San Francisco. It’s a vibrant community with a history of activism, but also deeply impoverished, and blighted by pollution and violence. It was there that Burke Harris, at her pediatric clinic, noticed that many of her young patients with serious medical conditions also had experienced profound trauma. And patients who had experienced serious adversity were 32 times more likely to be diagnosed with learning and behavioral problems than kids who had not.

When a colleague introduced her to the ACEs study, she saw her patients written between its lines. Though these problems might be concentrated in Bayview, they certainly weren’t confined there. This was a health crisis transcending race, class and ZIP code.

In the years since, Burke Harris has worked to advance ACEs science though her work at the clinic and her nonprofit research institute, the Center for Youth Wellness. She regularly travels the country to train fellow pediatricians in trauma screening and treatment. She has written an acclaimed book on the issue, “The Deepest Well,” and her TED talk on the topic has been viewed nearly 5 million times online.

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Now, she’ll be directing her singular focus back on California.

She plans to start with a statewide tour to hear from doctors and other health leaders about barriers to increasing pediatric screening and care. She’ll also be talking about the science of ACEs. “It’s Public Health 101 that raising awareness is a critical form of primary prevention,” she said.

But even with the funding included in Newsom’s budget, there are challenges to standardizing trauma screening. For one: In medicine, it’s common practice that you screen only for what you can treat. Many doctors — even those persuaded by research on adversity — have raised concerns about the lack of established protocols for treating childhood trauma. What can a pediatrician, with her 15-minute time slots and extensive to-do list, do about the ills of an absent parent, or a neighborhood riddled with gun violence?

In general, experts working on the issue say a critical ingredient in helping kids heal is ensuring they find and develop healthy relationships.

“All of us want to feel seen, heard, understood and supported,” said Alicia Lieberman, a researcher at the University of California-San Francisco who specializes in early childhood trauma. Involving parents is an essential aspect of treatment, particularly because so many have experienced trauma themselves. “It has to start with an acknowledgment that what happens to you matters.”

Researchers have found early success in seemingly simple interventions: Therapists coaching parents by filming and playing back positive interactions with their child. Therapists working with teachers on how to support their students. Key to success, said Pat Levitt, chief scientific officer at Children’s Hospital Los Angeles, are quality programs that start early and recognize the role of relationships.

At her clinic, Burke Harris coordinates with a team that wraps a child in care, treating mind and body. When a patient scores high on the adversity scale, she can send them down the hall to a therapist; connect them with classes on meditation, nutrition and exercise; involve the family in counseling; and aggressively monitor for and treat any physical manifestations.

Most clinics aren’t set up for this staff-intensive approach.

Dr. Andria Ruth, a pediatrician with the Santa Barbara Neighborhood Clinics in California, is among those researching how to “treat” adversity within a more traditional doctor’s office. Her research team is randomly assigning patients who screen positive for trauma into one of three groups. One group is assigned a navigator who connects the family to services for basic needs, such as food and housing. A second group also sees a behavioral health therapist at their child wellness visits. The third group receives both those services, and gets home family visits from therapists.

Ruth has a healthy skepticism about what’s possible, but she and her colleagues are convinced childhood trauma does pose a potent health threat: None of them felt comfortable including a control group that wouldn’t receive any services.

In the big picture, these experts say, addressing the fallout of traumatic stress will require a broader paradigm shift, to a system that recognizes that bad behavior can be a physical symptom rather than a moral failing. Gov. Newsom has signaled a move in that direction: In January, he said he would transfer the Division of Juvenile Justice out of the Department of Corrections, which runs the state’s prison system, and into the Health and Human Services Agency.

Garnering that kind of official backing is a powerful boost, said Jason Gortney, director of innovation at the Children’s Home Society of Washington, that state’s oldest and largest nonprofit dedicated to child welfare. His organization has lots of programs with promising results, he said, but connecting them to state agencies that aren’t used to working together is a challenge.

With Burke Harris crusading from the surgeon general post, Gortney said, he and fellow advocates across the country are hoping California can provide a beacon.

“Maybe California can show some of the other states how to do this,” he said.

This story first published on California Healthline, a service of the California Health Care Foundation.

For a determined would-be school shooter, there’s always a way – until we address the underlying causes

 Only a few days ago, I had the opportunity to plant a gun in a school.

The doors were unlocked. There was no security guard. No office staff was signing visitors in. No one was monitoring the surveillance cameras.

It was Saturday morning, and I was attending my son’s recreational basketball game at a local public middle school. The school was wide open. I could have easily walked in with a duffle bag slung over my shoulder, an AR-15 and ammo hidden inside. If I was a student, I could have stashed the weapon in my locker, but the heap of lost and found items would make a good hiding place too. And just that easily, I would have secreted away a weapon for easy access.

There’s always a way to get a weapon into a school. More than once I thought about this as I watched students at my daughter’s charter school pass through metal detectors. They pulled three-ring binders, laptops, cell phones – anything with metal – from their bookbags and passed them around the detector. But couldn’t a pistol be hidden in a binder and pass into the school undetected?

As controversy swirls around efforts to keep guns out of schools –school officers, armed teachers, wanding, metal detectors – we must remember these steps alone cannot protect against every determined and resourceful would-be school shooter. It’s not enough to try to stop violent plans already in the execution stage. Instead, we must understand what leads young people to act violently and implement comprehensive, proactive measures to address the underlying causes.

It's not enough to try to stop violent plans already in the execution stage. Instead, we must understand what leads young people to act violently and implement comprehensive, proactive measures to address the underlying causes. Click To Tweet

Dr. Terry Levy of Evergreen Psychotherapy Center co-authored “Kids Who Kill: Attachment Disorder, Antisocial Personality, and Violence” in the aftermath of the Columbine school shooting. In it, he pointed to evidence of the relationship between early childhood trauma and violence.

Research has shown elevated cortisol levels caused by early childhood trauma,  typically chronic abuse and neglect, can impact a young child’s brain development. As a result, they may struggle with emotional regulation, linking cause-and-effect, abstract thinking, and other high-level brain functions. Not all, but some of these children may become aggressive and violent.

The correlation between early childhood trauma and violence is frightening given the number of students at risk. According to the Child and Adolescent Mental Health Initiative at Johns Hopkins, almost half of all children have experienced at least one type of childhood trauma. As a result, a staggering number of students walk into our schools every day with a festering wound borne of childhood trauma. Most often, the wound is unrecognized and untreated. At best, we might slap on a band aid, but rarely do we treat the underlying trauma.

We’ve known about the link between childhood trauma and violence for 20 years, yet little has changed. Our society does not recognize the devastating impact of childhood trauma on it’s victims or the collateral damage on our community as a whole. We do not prioritize funding for research needed for prevention and meaningful treatments. And as a result, our communities continue to face acts of violence from young people.

Just last month we learned about four North Carolina (my home state) middle school students who were planning a Columbine style attack on their school. This was thwarted, but you can be sure many other future attacks will not be stopped in time. For a determined would-be school shooter, there’s always a way.

Childhood trauma is an epidemic in our society and without treatment, children will not heal and will have little hope for a happy and productive future. For some, their trauma wound will grow so unbearably painful they’ll lash out violently. No metal detector, locked door, gun sniffing dog, or wand will stop them.

What happens when your child becomes violent … with you

Under my desk is an antique iron. It has been there since the day my mother hid it from my teenage son. That day, attempts to get him up had repeatedly failed. He was hungry but refused to eat, he became increasingly volatile until eventually he threatened to hurl the iron at my head.

I’d had enough objects thrown at me in the past to not take any chances. I ran out of the house and for the first time called the police. While I waited for them, my son punched through a window, the resulting cut narrowly missing his artery.

While some may find this shocking, for others it’s a familiar story….

Read the full story from The Guardian here.

School Shooters: What’s Their Path To Violence?

February 10, 20197:58 AM ETHeard on  All Things Considered

Many, though not all, of the perpetrators have experienced childhood traumas such as physical or emotional abuse, and unstable families, with violent, absent or alcoholic parents or siblings, for example. And most have experienced significant losses.


For example, the defendant in the case of the Parkland, Fla., shooting last year had lost his adopted mother to complications from the flu just a couple of months before the school attack. His adopted father had died when he was a little boy.

Read the full article here.

Don’t miss these posts:

My take on the Parkland Shooting, published by the Sun-Sentinel.

The Making of a Murder, published by The Chronicle of Social Change

Loss of Caleb, published by the Institute for Attachment and Child Development

What we might learn from another tragic story of mental health help given too late, too little

Caleb, 11, was thin with blond hair, glasses, and a big smile where crooked teeth jockeyed for space. He and his brother, Elijah, were adopted by Martin and Dena Lishing when Elijah was a toddler and Caleb was a baby. Their young birth mother struggled from addiction.

Born a preemie at 24-weeks-old and weighing only 1 pound, Caleb beat the odds. His 5th grade teachers remember him as shy, inquisitive and loving. He wore cowboy boots to school every day. He was fascinated by all things Titanic. A classmate says, “He was really funny. He always had jokes and puns to tell.”

It was a warm, overcast evening on April 23, 2018–Caleb was asleep in his bed. An adult babysitter was in a nearby room. Meanwhile, 13-year-old Elijah dismantled their grandfather’s locked gun cabinet to access a .357 Magnum. Caleb was sleeping on his stomach when Elijah shot him in the back, killing him.

This tragedy was the first murder in the small, sleepy town of Streetsboro, Ohio in 20 years. But it wasn’t the first time police were called to the Lishing home on Alden Drive.

Mental health interventions, too late

Over the years, the family had attempted – unsuccessfully – to get mental health treatment for Elijah although details are not public. Reports indicated Elijah tried to commit suicide twice. In 2017, Elijah was charged with indecent exposure on the school bus. In 2018, his stepmother called police because he became “unruly.” When he told officers he was thinking of harming himself, they transported him to a local behavioral health center for evaluation.

Only four days later, Elijah shot and killed his little brother Caleb. Police have not disclosed Elijah’s motive but say it was premeditated.

Psychologist Dr. Amy Thomas testified at the sentencing hearing that Elijah suffered early childhood abuse. Elijah claims, in addition to neglect from his birth mother, he was subsequently abused in the Lishing home. He details harsh punishments from a young age and says his adopted mother was more devoted to premature Caleb than to him. The Lishing couple also divorced several years after the adoption.

Thomas diagnosed him with reactive attachment disorder (RAD), also called developmental trauma disorder (DTD). This often occurs when a child experiences chronic abuse or neglect before the age of 5. A child with DTD has disrupted brain development and, if not provided early and highly-specialized intervention, can suffer long-term and devastating impacts. They have difficulty forming healthy attachments with caregivers and others which can lead to familial, social, educational and legal issues. Dr. Thomas also diagnosed Elijah with post-traumatic stress disorder and conduct disorder, both common diagnoses for children with DTD.

Elijah’s situation is even more complex than DTD alone, however. Dr. Thomas testified that Elijah also suffers from paranoia and stated that a previous clinician had diagnosed him with schizophrenia. Reflecting on the time of the murder, Elijah told the court, “I was living inside my head, unable to determine the difference between imagination and reality.” This points to serious mental illness in addition to complex DTD.

The worrisome correlation of complex developmental trauma and mental illness

Dr. John Alston, psychiatrist for the Institute for Attachment and Child Development, found a strong correlation between complex DTD and co-morbid mental illness. In his studies, Dr. Alston recognized that adults who abuse or neglect their children often do so as a result of a mental illness. Thus, their children may suffer the unfortunate combination of both the nature (genetics) and nurture (attachment) consequences.

And when children with complex DTD inherit a mental illness, it is often in a profound way according to Dr. Alston. He gives the analogy of more commonly-known childhood health issues. “You never hear of symptoms of childhood diabetes in a mild form, you never hear of childhood asthma in a mild form. They are always inherited in a severe or profound form and therefore the earlier the onset, the more severe the disorder, the more intensive the treatment needs to be,” said Dr. Alston. “It is exactly the same when we are talking about mental health disorders.”

Elijah told the court, “I was living inside my head, unable to determine the difference between imagination and reality.” This points to serious mental illness in addition to complex DTD.

Forrest Lien, Director of the Institute for Attachment and Child Development, is adamant that not all children with developmental trauma are dangerous. Rather, it is often the unfortunate combination of specific and severe disorders. “Developmental trauma disorder alone does not deem a child dangerous. Furthermore, not all children with DTD have a mental illness. Yet, some do,” Lien says. “Children with complex developmental trauma often feel angry and can lack empathy. When you combine a child who feels slighted and vengeful with a misdiagnosed or poorly-treated severe bipolar disorder with psychotic features, it can be dangerous.”

Neuroscience is an emerging science and this link between early trauma and mental illness is not well known. However, given the potential for sometimes dangerous antisocial behavior, it is critical that clinicians still give careful consideration to these correlations. It is vital, Dr. Alston says, to differentiate the impact of severe trauma from potential mental illness symptoms in order to properly diagnose and treat the whole child. 

The case for better mental health support

Unfortunately, Elijah’s developmental trauma and co-morbid disorders were not accurately diagnosed until after he was incarcerated—not in time to prevent this horrific incident. He did not receive appropriate treatment and the costs to his family and himself have been enormous.

Martin and Dena are heartbroken having suffered the loss of their children. Innocent 11-year-old Caleb’s life has been cut short. And they must now grapple with the incarceration of their other son.

“When you combine a child who feels vengeful and slighted with a misdiagnosed or poorly-treated severe bipolar disorder or schizophrenia with psychotic audio and visual hallucinations, it can be dangerous,” said Institute for Attachment and Child Developmental Executive Director Forrest Lien.

Elijah, now 13, is a convicted murderer facing a lifetime of struggles. He has been sentenced to juvenile detention until he turns 21 and at that time his case will be reevaluated with the potential for adult detention time. According to the Record Courier, “Judge Robert Berger said that despite abuse the boy suffered as a child, it did not excuse shooting and killing his brother.”

Perhaps with earlier diagnosis and interventions, Elijah wouldn’t be sitting in a prison cell today. Caleb might be running around the playground instead of being memorialized by the Titanic-shaped play fort the community is erecting in his memory.

Published originally by IACD. Updated 1/28/2019 after sentencing.

The making of a murderer?

Our Failed Solutions for Seriously Ill Foster Youths (published by The Chronicle of Social Change)

Justin Taylor Bean, removed from his abusive birth parents as a toddler, spent the next two decades in psychiatric hospitals and more than 40 residential facilities.

Over the years, his physical and verbal aggression increased despite treatment and medication. Then, at the age of 22, Justin strangled to death a fellow group home resident.

During his sentencing last month, District Attorney Laura Thomas argued almost sympathetically that Justin “did not have a chance — it was all over for him at age 2.” She then asked that he be sentenced to a life behind bars, which he was.

“There’s not a miraculous cure,” Thomas said. “The public needs to be protected from him forever.”

Many will be outraged by this story, but few will understand how something like this happens. After all, all the warning signs were there. Doesn’t that mean this could have been prevented?

Sadly, it’s not that simple.

More than a million children each year experience early childhood trauma, most often due to abuse and neglect. “Developmental trauma,” a term coined by leading expert Dr. Bessel van der Kolk, affects a child’s brain development. The impact can be devastating, including severe attachment and behavioral issues. These traumatized children need comprehensive, specialized professional intervention and treatment – treatment that’s expensive and not available in most areas.

Unfortunately, I know all too well just how true this is. My adopted son, Devon, has also attempted to seriously harm fellow residents in group homes – more than once. Like Justin, Devon has a diagnosis of reactive attachment disorder and has a similar treatment history. My son could easily have killed someone, he’s just been small enough that staff can control him.

He’s received medication and thousands of hours of therapy. He’s only become more violent and dangerous. Unable to safely live at home, he’s been in and out of psychiatric residential treatment facilities for years. All I can do is helplessly watch as he careens toward adulthood, an angry and violent young man.

What’s clear from Devon and Justin’s stories is that our mental health system does not yet know how to effectively treat children with the most severe developmental trauma. Residential treatment facilities, often the only available choice, are virtual incubators for violence, and many children leave more dangerous than they went in. And far too many end up institutionalized or incarcerated.

As a society, we take these already broken and vulnerable children, and like a gruesome medieval torture press, crush their hope for a good future. We perpetuate their trauma by piling on with broken systems that exacerbate the very problems they try to address: foster care, family court, health care, mental health services and juvenile justice, to name a few.

Further, our communities don’t understand developmental trauma and underestimate its impact. And so, schools, unwitting parents, therapists and social groups pile on too. Under this pressing weight, what hope is there for these children?

The vast majority of people with mental health disorders do not go on to commit murder. But given our apathetic and broken mental health system, developmental trauma can be its own life sentence for youth in the child welfare system. It negatively affects all areas of life – relational, legal, educational and financial. A few victims, like Justin, go on to commit violent crimes.

How many lives have to be destroyed? Isn’t it time to recognize developmental trauma as the unsolved challenge it is, and prioritize funding research, prevention and treatment? Until we do, too many broken children will continue to grow into broken adults and we will continue to see tragedies like the murder committed by Justin.

Believing “children are resilient” may be a fantasy | Psychology Today

How did resilience become a standard? How did we come to view children almost as nuisances who just need minimal support? How did children’s needs become dismissable?

via Believing “children are resilient” may be a fantasy | Psychology Today

I’ve tried the system. It doesn’t work.

Here’s my op-ed on the Parkland shooting printed by the Sun-Sentinel (Feb 2018)

When my son, Devon, was nine he pushed his four-year-old brother down the stairs. It was one big shove that launched Brandon through the air and left him sprawled on the tile floor below. At 10, he punched his teacher and several classmates. At 11, he attacked a woman and dislocated her thumb.

Told a man had fresh dental work, Devon (for the purposes of this oped, I’ll call him Devon) promptly slugged him in the jaw. He was 12. At 13, he punched a young girl in the back of the head, unprovoked, and used his pencil to stab classmates. He still does. At 14, he grabbed a woman’s breasts and genitals threatening to rape her; using a jagged piece of plastic he stabbed a man in the cornea. At 15, he bit a man, breaking the skin and drawing blood; he did $3000 worth of property damage in mere minutes.

Devon, now 16, has verbalized detailed plans to torch the group home he lives in. He routinely threatens to kill himself, me, his siblings, his teachers, and other students.

Nikolas Cruz, the Parkland high school shooter, is a troubled kid, too. While I don’t presume to know Nikolas’ history or diagnoses, Devon and Nikolas are both teenagers, adopted males with behavioral and mental health issues. I adopted Devon from foster care in Broward County when he was four. Like Nikolas, his disturbing record of deviant behavior telegraphs worse to come.

The media is calling the Parkland massacre “preventable” and pointing to missed warning signs. But, I’ve heeded the warning signs. Devon’s received comprehensive mental health services for years. Running the gamut — outpatient therapy, day treatment, therapeutic foster care, group homes, psychiatric residential facilities, mental health hospitalizations — he’s received thousands of hours of therapy. He’s been dealt diagnoses like a hand of Go Fish and is on a cocktail of anti-psychotic drugs.

All these mental health services, like water and sunshine, have unwittingly nurtured Devon’s proclivity for violence. He’s only gotten bigger, stronger, smarter, and more dangerous. I fear he could be the next teen paraded across the headlines in handcuffs.

When Republicans call for greater access to mental health services as a remedy to school shootings, they fail to recognize the mental health system has no meaningful solutions for violent kids like Devon and Nikolas.

Take a walk. Talk to staff. Hug your pillow. These are the coping skills therapists give angry teens to reel in their extreme emotions. The absurdity comes into focus when a teen like Nikolas opens fire on hundreds of innocent victims, taking 17 lives. Would tragedy have been averted if Nikolas knew to pull off his gas mask and take some deep breaths? To put down his AR-15 and hug his pillow?

Psychiatric treatment facilities are virtual incubators for violent kids. They focus on underlying mental health issues promising the negative behaviors will diminish. In these programs, Devon has no consequences for truancy, vandalism, criminal threats, and assault. Not even a time-out. Protected from criminal charges, he’s become desensitized to his own violence and indifferent to social boundaries. It’s normalized his violent responses to even the smallest triggers: waiting his turn, a snarky look from a peer, being served breakfast he doesn’t like.

It’s unlikely Nikolas’ trajectory would have changed even if he’d received the years of intensive mental health treatment Devon has. Mental health facilities are little more than holding pens for kids who are too dangerous to live at home.

I’ve tried the system. It doesn’t work.

Funding to offer these same ineffectual services to more would-be-shooters won’t stop tragedies like the Parkland shooting, especially since Trump nixed the Obama-era regulations making it easier, not harder, for mentally ill people to buy guns. I don’t pretend to know the answers, but I do know a bad idea when I see one: giving these kids access to guns. If we’re not going to do something as basic as keeping deadly weapons out of the hands of mentally disturbed teens, what mental health interventions can possibly keep us safe?

Keri Williams, a former resident of Broward County, lives with her family in Charlotte, N.C., and is working on a memoir about raising her adopted son.

Don’t blame workers for psych center woes

Here in Charlotte, NC we’ve recently had a lot of news about Strategic Behavioral Center, a Psychiatric Residential Treatment Facility (PRTF). You can read the full story from the Charlotte Observer here describing a disturbing riot on January 1st. Here’s an excerpt:

Patients at Strategic Behavioral Center — some wielding wooden boards — attacked one worker, barricaded themselves in a room and escaped through a broken window. Others fought with each other or vandalized the building.

Amid the mayhem, some hospital staff watched in fear and did not try to control the situation. They initially delayed calling for help because a former executive had erroneously told them to not call the police for trouble with patients.

Having dealt with workers at PRTFs and other mental health facilities, this article bothered me–or rather people’s response to it bothered me. I saw calls for the workers to be fired, and disgust by their behavior. What this article didn’t convey is the untenable position workers like this are in.

Here’s my op-ed response published by the Charlotte Observer:

Stripping naked is just one way my teenage son, Devon, thwarts workers at psych centers. Afraid of sexual misconduct allegations, they’re unlikely to physically restrain him despite the mayhem he causes. This trick has worked for Devon (an alias to protect his privacy) at multiple psych centers in Charlotte and throughout the state including at the Strategic facility in Garner.

The recent investigation into the Strategic facility in South Charlotte paints a picture of workers, afraid for their lives, standing by watching a riot unfold without trying to control the situation. While the workers’ actions are shocking to many, as the parent of a child who has been a resident of five different psysh centers, I understand why and really don’t blame the workers. Continue reading here.

What do you think?