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Published on January 17, 2008

Author: Teresa1

Source: authorstream.com

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Slide1:  The Story of A Child’s Path to Mental Illness and Suicide Presented by her mother Ann Jennings Ph.D. www.TheAnnaInstitute.Org Slide2:  There is no trust more sacred than the one the world holds with children. There is no duty more important than ensuring that their rights are respected, that their welfare is protected, that their lives are free from fear and want and that they grow up in peace. Kofi A. Annan Slide3:  This is me, Ann Jennings This is my daughter Anna She is the artist. She took her life at the age of 32. Slide4:  I am here to share with you two intersecting life journeys, my own and my daughter’s. Anna’s journey was tragic, full of unbearable pain both as a child and as an adult. My journey has led me to a place within where healing occurs when I confront, face and speak the truth of what actually happened, and my part in it. Since Anna’s death, and before, I’ve had years to grapple with disturbing questions::  Since Anna’s death, and before, I’ve had years to grapple with disturbing questions: How did this happen to my daughter? Why did I miss what happened? How did we all miss it? What could we have done differently? It takes a village to raise a child:  It takes a village to raise a child I now know it also takes a village to prevent a child’s life from becoming a tragedy. I share with you my journey, my daughter’s Anna’s story and powerful research findings published since her death. I hope that they will help you move past any fear you have of addressing child abuse in your own life, own community, and in your own profession. I hope that together, we can stop the destruction of children’s lives – and thereby heal our own pain, and that of society. Today’s presentation:  Today’s presentation Snapshot of Anna’s life The damaging consequences of childhood trauma: research findings Anna’s early childhood and sexual abuse: Our failure to see or hear her Continuing traumatic events: the making of a broken heart Trauma-informed communities A Snapshot of Anna’s Life:  A Snapshot of Anna’s Life Slide9:  Anna Caroline Jennings (1960–1992) At less than 3 years old, my daughter Anna was sexually abused. The abuse was severe and continued for nearly 4 years None of us recognized what was happening to her For the story of Anna’s institutional years, see www.annafoundation.org Slide10:  Anna Caroline Jennings (1960–1992) Additional family trauma occurred through childhood and adolescence. She “broke at age 13, was diagnosed schizophrenic and at age 15 began psychiatric treatment. Again, no one asked about or recognized what had happened to her. For the story of Anna’s institutional years, see www.TheAnnaInstitute.org Slide11:  Anna Caroline Jennings (1960–1992) For 17 years she was in the mental health system – 11 of those years in mental institutions. For 17 years no psychiatric treatments, alternative therapies, mental health services or medications helped her For 17 years she was retraumatized by violence, toxic institutional environments, forced treatments, and pervasive ignorance of trauma. For the story of Anna’s institutional years, see www.TheAnnaInstitute.org Slide12:  Anna Caroline Jennings (1960–1992) When she attempted to communicate the awful things that had happened to her, there was no one in the system to listen, to understand, or to help her. She took her life October 24, 1992, at the age of 32, on the back ward of a state mental hospital. For the story of Anna’s institutional years, see www.TheAnnaInstitute.org The damaging consequences of childhood trauma: research findings :  The damaging consequences of childhood trauma: research findings Damaging consequences of childhood abuse and trauma: Research findings:  Damaging consequences of childhood abuse and trauma: Research findings The Adverse Childhood Experiences (ACE) Study What is the Adverse Childhood Experiences (ACE) Study?:  What is the Adverse Childhood Experiences (ACE) Study? 17,000 people participated in the largest epidemiological study ever done to examine the health and social effects of adverse childhood experiences over the lifespan Decade-long collaboration between Kaiser Permanente’s Department of Preventive Medicine in San Diego and the Center for Disease Control and Prevention (CDC) ACE Study Findings:  ACE Study Findings Childhood experiences are powerful determinants of who we become as adults ACE Study Findings:  ACE Study Findings Adverse Childhood Experiences are the most BASIC cause of health risk behaviors, morbidity, disability, mortality, and health and behavioral health care costs. Health Risk Behaviors: Symptoms of Illness – or Reactions to Trauma :  Health Risk Behaviors: Symptoms of Illness – or Reactions to Trauma ACE study views health risk behaviors as attempts to cope with impacts and ease pain of prior trauma, NOT as symptoms, bad habits, self-destructive behavior, or public health problems. Existing Practice: :  Existing Practice: Existing practice commonly asks “What is wrong with the person?” vs “what happened to the person?” Existing practice develops diagnoses, and treats symptoms instead of underlying causes. (Smoke vs Fire) This approach misses opportunities for healing and for helping person to develop alternative ways of coping. Adverse Childhood Experiences (ACEs) are Common:  Adverse Childhood Experiences (ACEs) are Common Of 17,000 HMO members: 72% had attended college 77% were white 62% were 50 or older Adverse Childhood Experiences are Common:  Adverse Childhood Experiences are Common Of the 17,000 HMO Members: 22% were sexually abused as children. This is an epidemic. A serious public health issue. One in four was exposed to two categories of abusive experiences One in 16 was exposed to four categories. 66% of the women experienced abuse, violence or family strife in childhood. Adverse Childhood Experiences are Common:  Adverse Childhood Experiences are Common What is uncommon is recognition acknowledgement action Slide24:  health risk behaviors adult diseases disabilities severe social problems severe mental health problems For example: The following information and slides are from September 2003 Presentation at “Snowbird Conference” of the Child Trauma Treatment Network of the Intermountain West, by Vincent J. Felitti, MD. The higher the ACE Score, the greater the likelihood of : Slide25:  Adverse Childhood Experiences vs. Current Smoking % Slide26:  A child with 6 or more categories of adverse childhood experiences is 250% more likely to become an adult smoker than a child with 0 ACEs. A person with 4 categories of adverse childhood experiences is 260% more likely to have Chronic Obstructive Pulmonary Disease (COPD) than is a person with 0 ACEs. Current Smoking Slide27:  Childhood Experiences vs. Adult Alcoholism 0 1 2 3 4+ Adult Alcoholism:  Adult Alcoholism A 500% increase in adult alcoholism is directly related in a strong graded manner to the adverse childhood experiences that person had. 2/3rds of all alcoholism can be attributed to Adverse Childhood Experiences ACE Score vs. Intravenous Drug Use:  ACE Score vs. Intravenous Drug Use N = 8,022 p<0.001 Intravenous Drug Use:  Intravenous Drug Use A male child with an ACE score of 6 has a 4,600% increase in the likelihood that he will become an IV drug user later in life. 78% of drug injection by women can be attributed to ACEs Childhood Experiences Underlie Rape:  Childhood Experiences Underlie Rape 0 1 2 3 4+ Rape:  Rape Women with an ACE score of 4+ are 500% more likely to become victims of domestic violence. They are almost 900% more likely to become victims of rape – compared to women with an ACE score of 0. Slide33:  ACE Score Ever Hallucinated* (%) Abused Alcohol or Drugs *Adjusted for age, sex, race, and education. ACE Score and Hallucinations The making of madness…..:  The making of madness….. There is a significant and graded relationship between a history of multiple childhood traumas (ACE’s) and hallucinations. Slide35:  Childhood Experiences Underlie Chronic Depression Chronic Depression:  Chronic Depression Adults with an ACE score of 4 or more were 460% more likely to be suffering from depression than adults with an ACE score of 0. Slide37:  Childhood Experiences Underlie Suicide 1 2 0 3 4+ Suicide:  Suicide The likelihood of adult suicide attempts increased 30-fold, or 3,000%, with an ACE score of 7 or more. Childhood and adolescent suicide attempts increased 51-fold, or 5,100% with an ACE score of 7 or more. Slide39:  Suicidality is not usually caused by “mental illness”, drugs, rejection by peer groups, school pressure, etc. Rather, it is a coping device – a way to manage or escape from the unbearable impacts of adverse childhood experiences and/or adult trauma. Damaging consequences of childhood abuse and trauma: Research findings:  Damaging consequences of childhood abuse and trauma: Research findings Studies on Childhood Sexual and/or Physical Abuse Slide42:  I believe, based on my experience, that early childhood sexual abuse – if not recognized and addressed early on –can impair resiliency, making it difficult to weather other forms of adverse or traumatic experiences that happen later in life. Sarah Joe, Anna John Mary Slide43:  A number of studies suggest that severe sexual and/or physical abuse early in childhood appear to have the greatest impact and to be associated with the most serious disabilities later in life. Slide44:  2/3rds of men and women in substance abuse treatment report childhood physical and/or sexual abuse. 75% of women in treatment programs for drug and alcohol abuse report having been sexually abused. SAMHSA/CSAT, 2000; SAMHSA, 1994 Adults Slide45:  51 – 98% of public mental health clients with severe mental illness, including schizophrenia and bipolar disorder, have been exposed to childhood physical and sexual abuse. Most have multiple experiences of trauma. Goodman et al, 1999, Mueser et al, 1998; Cusack et al, 2003 Slide46:  There is a significant relationship between childhood sexual abuse and various forms of self-harm later in life, including suicide attempts, cutting, and self-starving. Van der Kolk et al, 1991 One study found childhood sexual abuse to be the single strongest predictor of suicidality regardless of other factors. Read et al, 2001 Children and Adolescents:  Children and Adolescents 1/4th to 1/3rd of all children and as many as 42% of girls are sexually abused before age 18 – with 9% experiencing persistent, genital assault. Saunders et al, 1992; Randall 1995; Epstein, 1998 93% of psychiatrically hospitalized adolescents had histories of physical and/or sexual and emotional trauma. 32% met criteria for PTSD. Lipschitz et al, 1999 Slide48:  Teenagers with alcohol and drug problems are 6 to 12 times more likely to have a history of being physically abused and They are 18 to 21 times more likely to have been sexually abused than those without alcohol and drug problems. Clark et al, 1997 Among juvenile girls identified by the courts as delinquent, more than 75% have been sexually abused. Calhoun et al, 1993 The sexual and physical violation of children results in alterations in self-perception which are immediate, last throughout the life-span, and contribute to suicidality as a way to cope. Judith Herman, 1992 :  The sexual and physical violation of children results in alterations in self-perception which are immediate, last throughout the life-span, and contribute to suicidality as a way to cope. Judith Herman, 1992 Lasting Alterations in Self-Perception Slide50:  Sense of helplessness, paralysis, captivity, inadequacy, powerlessness, danger, fear Continues over the lifespan Slide51:  Sense of Shame, Guilt, Self-Blame, Being Bad Continues over the lifespan Slide52:  Sense of defilement, contamination, spoiled, degraded, debased, despicable, evil Continues over the lifespan Slide53:  Sense of complete difference from others, deviance, utter aloneness, isolation, non-human, specialness, unseen, unheard, belief no other person can ever understand Continues over the lifespan So, and what does the child ask of us?:  So, and what does the child ask of us? There is no trust more sacred than the one the world holds with children. There is no duty more important than ensuring that their rights are respected, that their welfare is protected, that their lives are free from fear and want and that they grow up in peace. Kofi A. Annan Slide55:  “What is the fundamental question one must ask of the world? …. the answer was always the same: “Why is the child crying?” “They do not want to hear what their children suffer. They’ve made the telling of the suffering itself taboo” From Possessing the Secret of Joy, by Alice Walker Anna’s early childhood and sexual abuse: Our failure to see or hear her:  Anna’s early childhood and sexual abuse: Our failure to see or hear her To tell you the following story, I use photographs, Anna’s artwork, her school and medical records, and direct quotes of Anna’s memories, my memories, and the memories of those who knew and interacted with Anna as a young child. Slide58:  Anna’s Early Childhood What happened to her as a child? What clues that she was being abused and traumatized were not recognized? What opportunities for prevention or early intervention and healing were missed? What might we do differently today? Historical Context:  Historical Context One thing I have learned is how important it is to be aware of the context we are raised in and that we are raising our children in. I started thinking of these things as a person trying to look at my own life. Some historical context: the 1950s – 1960s:  Some historical context: the 1950s – 1960s 1950’s-60’s ideal was the single family model, the suburban “white picket fence” home – no family community – no “village” to help in raising children. This resulted in unprecedented isolation, especially for us moms. Gender roles were prescribed: Man- breadwinner, head of household; Woman- wife, mother and housekeeper, subservient and obedient to husband. Racial/other cultural separation; prejudice against Jews, Blacks; white privilege. Class privilege. Rise of consumer culture. Worth measured by possessions, earning power. More historical context:  More historical context Women married young, not encouraged to complete education or pursue career. Women deviating from norm considered suspect, stigmatized, marginalized. Greatest goal to aspire to was that of being wife and mother. Me, Married at Age 19 Slide62:  For Catholic girls, great stress on sexual “purity”, skewed knowledge of sex. Sense of self worth acquired through husband’s success, personal, home, children’s appearances. Motherhood was idealized, but no education in child development and no preparation for parenting. Me, Married at Age 19 Anna’s Parents’ Family Backgrounds:  Anna’s Parents’ Family Backgrounds My family upper class professional; Anna’s father’s working class Anna’s father first of 7 siblings; I was first of 9 siblings We were both raised (Irish) Catholic – attended Catholic grade schools, high schools, and colleges. Slide64:  My father and both Anna’s dad’s parents were Irish Catholic immigrant background traced back to counties Cork and Kerry in Ireland My mother was of German ancestry. Women in her ancestral family not traced back. Intergenerational : substance abuse, depression, Alzheimer’s, physical violence; my great aunt’s suicide at age 16 in Germany; secrets kept in both families of origin. Many things one did not talk about - ever. Spare the Rod, Spoil the Child:  Spare the Rod, Spoil the Child Anna’s dad and I raised in authoritative, punitive parenting model. Blame, shame, criticism, put-down, spanking, “whipping”, and removal of privileges used as discipline. Model same in schools. Anna’s father’s dad physically and emotionally violent to him as a child. My dad occasional intense emotional rage and negative judgment which conveyed sense of innate “wrongness” to us as children. My mother had difficulty nurturing. In both our “families of origin”, wives kept house, kept “peace”, and kept secrets. The model couple:  The model couple Cover for record produced by Cana organization (group of young Catholic married couples led by priest) - of Anna’s parents giving advice in writing to other young married couples Things are not always as they seem:  Things are not always as they seem We continued in the punitive parenting model with our own children. Stress: I felt economic insecurity; fear of husband’s anger; fear of church’s and other’s judgment; dependency; low self-esteem; and lived in “nightly terror of getting pregnant again”. Stress: Anna’s dad had work and money problems, low self-esteem, and released his stress through anger directed toward wife and children, especially oldest son Ignorance: no reality-based knowledge of parenting; child development; sex and sexuality; sexual abuse (did not exist); impacts of smoking and of substance use Anna – pre-natal environment:  Anna – pre-natal environment Anna’s dad and I both smoked and drank. At times I drank to excess . I was prescribed amphetamines during pregnancy to keep weight gain under 20 lbs. Religion forbade us the use of contraceptives: Anna not a planned or wanted child. I attempted to abort my pregnancy by jumping off porch. Anna: Birth to Age 2 ½ - 3:  Anna: Birth to Age 2 ½ - 3 A major city in the Midwest Anna’s Birth: October 20, 1960 :  Anna’s Birth: October 20, 1960 Birth and medical records: Healthy birth; full term, 7 lbs., 14 oz; pregnancy uncomplicated; Pediatric records: no problems; healthy normal baby and toddler Nursing discouraged by medical profession; formula and bottle-feeding seen as preferable. Anna – a few days old:  Anna – a few days old Me, Anna’s mom: “I remember being struck by how exquisitely beautiful she was, even as a tiny new born baby. A perfectly healthy and cuddly little baby girl, Anna snuggled in my arms, took to nursing and then to bottle feeding with ease, napped and slept abundantly, seemed content and trusting of the world.” Slide72:  Anna’s godmother Aunt Genevieve: “I never remembered anything unpleasant. She was a wonderful child. I babysat for her for six weeks after she was born, when you first had her – when she was a little tiny, brand new baby. She was delightful. And I saw her often after that.” Her Aunt Caroline: “I remember her as a tiny baby, being real sweet and quiet, lying in her crib in the dining room next to the kitchen. She was such a little sweetheart, such a quiet, easy going baby.” Slide73:  Her grandmother J: “I remember her as a very pretty and loving little girl, receptive to love and giving it in return. I’m a hugger and she hugged me in return.” Slide74:  Her Aunt Caroline: “She was fun. As a toddler I remember her being very active and outgoing. She was a little girl with a big mouth and big eyes. She would giggle, and that mouth was always open!” Slide75:  Her Aunt Alice: “ I remember feeling she was just the prettiest little girl I’d ever seen in my whole life, kind of sparkly, a big smile, bright eyes. You could really see in her eyes her soul. An incredible kind of spirit would come through in her eyes and smile.” Me, her mom: “…. I remember her gurgling laughter – how much fun she was. She was exuberant, active, assertive, determined and adventurous. I had my hands full with her once she was up and walking!” :  Me, her mom: “…. I remember her gurgling laughter – how much fun she was. She was exuberant, active, assertive, determined and adventurous. I had my hands full with her once she was up and walking!” Sudden intense change occurred in Anna when she was about 2 ½ to 3 years old. :  Sudden intense change occurred in Anna when she was about 2 ½ to 3 years old. All of a sudden, for seemingly no reason, she began to cry and scream inconsolably with unusual intensity and for prolonged periods of time. It was more than “the terrible twos”. She had frequent “temper tantrums”; screamed at her brothers and sisters and other children; expressed extreme terror; withdrew from others; cut off her hair; ate mud; threw her feces at walls; had trouble sleeping; would not obey me…. Self Portrait by Anna in art therapy age 25 Slide78:  Her Grandmother J: “I remember her as a very pretty and loving little girl, and then just all of a sudden, whatever it was crept in and just changed her entire personality.” “For no apparent reason she would have temper tantrums.” “It came on rather suddenly.” Her Aunt Genevieve: “It was when she was about 2 ½ or 3 when I noticed that she, instead of being sociable with other people, would go into hiding, like she did not want to be seen.” “And she would not sing ‘Edelweiss’ anymore, when John and Mary would.” Medical:  Medical Me, Anna’s mom – re Pediatrician: I thought maybe part of why Anna was crying and screaming so much was because she constantly had such a raw sore bottom and what to me looked like a bad diaper rash. But it was unusual compared to the other children. Her pediatrician examined her several times and prescribed Desitin ointment for diaper rash. Emergency Room and dental records: ER records: She became accident prone. Medical records: Between age 2 years 10 months to 3 years four months, was treated surgically on 3 occasions for lacerations on her face and head. Dentist: Dental records cite Anna as “completely unmanageable” – several visits. They could not work on her. Slide80:  Anna: “I fell out of the crib when I was about two and a half or three years old, and I still got this ball on my head where I bumped myself. Then I remember going to the hospital and they put a sheet over my head.” “You were there, and dad, and I was screaming and screaming while they did the stitches.” Slide81:  Housekeeper: “When she was a little girl, if she go outside to play, she’d come back screamin and hollerin, nobody never could figure out why she was cryin. She used to go out your side door and she used to just cry, poor little thing, she used to scream.” “Always thought somethin was gonna get her out there. She used to say “It’s going to get me, it’s gonna get me daddy, it’s gonna get me mommy – it’s going to get me. She was a little girl then, a little bitty child.” Slide82:  Anna: “When I was about 2 ½ or 3 I used to go by the swings in the back yard and eat mud. And I used to throw my shit at the walls when I was in my crib in the bedroom upstairs. I would bump my crib across the floor and throw everything out of the drawers.” Slide83:  Neighborhood mom: “She used to come over to my house and play with the kids – dolls, blocks… but there was something that was a little bit different about her.” “She would grab a toy and run off with it and laugh – a strange laugh for a little kid – kind of crazy, almost like a squeal – more like yelling than laughing.” “And she used to scream, and became difficult for you to handle….” Slide84:  Anna’s dad: “I remember around three or four she became over-reactive, real loud, and particularly angry. Her friend would come over to play with Anna in the sandbox – the slightest thing that would happen, Anna would yell at the top of her voice at her friend – who would then leave. She would literally drive her away.” “She was very stubborn and difficult to discipline compared to the other kids.” Substance Use:  Substance Use Me, Anna’s mom: “I think it was around this time that I began drinking more heavily – always in the evenings. At one point I had 4 children under the age of 6, two in diapers and a 5th child on the way. I had a wringer washer and wire clotheslines in the basement, no diaper service, and tub fulls of dirty diapers.” “I would take a bottle of scotch (my mother’s drink of choice) down with me after the kids were in bed – and wash, wring, and hang hundreds of diapers it seemed. I barely made it back up the stairs.” Slide86:  Me, Anna’s mom: “There were times I could hear Anna upstairs crying to get up from her nap, and I couldn’t get to her with a new baby to take care of – or something with her older brothers and sisters. I got pregnant again and her little brother was asleep and I would want to take a nap –so I would just ignore her cries and leave her there.” “Finally I would drag up the stairs to get her, blurred in fatigue, and there she would be, totally a mess, with tears in her eyes and down her face, sobbing for me to come and pick her up and take her out of her crib where she was all alone. I felt so bad for her. Poor Anna, sobbing to get out of her crib and nobody responding.” Slide87:  Anna: “Spiders. I started to be scared of spiders when I was two or three years old, in a bunk bed on the top bunk. I had thought there were tarantulas creeping along the bed or something. I used to look up spiders in the encyclopedia, spiders, mushrooms and snakes and all that.” “I hated mushrooms, I wouldn’t eat them, from about three years old on.” Slide88:  What happened to Anna? What caused – “all of a sudden, whatever it was – to creep in and just change her entire personality??” Multiple Instances of Childhood Sexual Abuse (revealed to me years later):  Multiple Instances of Childhood Sexual Abuse (revealed to me years later) Age 2 ½ to 3 by teenage male relative Age 3 ½ to 6 by male babysitter Indeterminate age by older neighborhood boy Child without arms – encapsulated – no way out Age 2 ½ to 3: By teenage male relative:  Age 2 ½ to 3: By teenage male relative Revealed to me by housekeeper 27 years later. *(Anna had no memory of this reported abuse). “Somethin happened to her when she was small….. She tried to tell me about the man, she say a man played with her where he wasn’t supposed to. She told me that man hurted her, and that’s what happened to the poor little child.” “That shut her off you know. She seemed like that kept on her mind, you know how little children do. They don’t tell you exactly what’s goin on. They keep on thinkin about it. That’s a shame though, it’s sad you know.” Keepers of Secrets:  Keepers of Secrets Housekeeper goes on to tell me …. “All along I had knowed that was X because that’s why when that child used to go outside she used to scream so hard. She was scared X was gonna come.” “And your mother knowed that. Yep, she sure did. Cause we had discussed it a lot of times, me and her did… she used to talk about that was a shame because X was family…” “And she didn’t want to say nothin.” Age 3 ½ to 6 by male babysitter Revealed to me by Anna 20 years later:  Age 3 ½ to 6 by male babysitter Revealed to me by Anna 20 years later At age 23, Anna described to me fully and in detail the sadistic sexual abuse she experienced as a child. Her disclosure came after she participated in a therapy group at a psychiatric hospital and learned for the first time from the stories of other patients - that she “was not the only one in the world” to have had such experiences… Slide93:  “To do that when I was a little kid was like… uh… I don’t know, I don’t know. It made me feel pretty bad.” “I thought I was the only one in the world. It never happened to Mary or Sarah so I thought I was a bad seed…..” This is what she told me: “(PB) took me upstairs away from Mary and John and Joe and Sarah and told them to go outside and play.” “He tied me up and put my hands over my head so that I couldn’t move, blindfolded me with my little t-shirt, pulled my t-shirt over my head with nothing on below, opened my legs and was examining and sticking things up me. It hurt me. I would cry and he wouldn’t stop.” Slide94:  “I remember after he did that I was walking toward the door out of the room and I was feeling like I was bad. And why not Sarah and Mary, and why just me??” Indeterminate age by older neighborhood boy:  Indeterminate age by older neighborhood boy Me, Anna’s Mom: “The only abuse I remember Anna’s telling me about as a child was of being “fooled with” by a young teenage boy who lived across the street from us. Anna’s dad spoke to his parents and I then took Anna to a doctor for a physical examination.” “I thought of the “fooling” as child’s play, and inadvertently, when I took her to the doctor, I subjected Anna to another invasive procedure…. compounding the abuse.” Physical Examination by doctor: a “re-traumatization”:  Physical Examination by doctor: a “re-traumatization” Anna: “Then I remember the doctor you took me to when I told you. He did things to me that were disgusting (pointing to her genital area).” Me, Anna’s mom: I can see now so many ways in which we retraumatized Anna as a child. The above is just one example of many. This kind of inadvertent re-traumatization continued all through her life. Intergenerational Impacts:  Intergenerational Impacts Me, Anna’s mom: Its possible I was numb to hearing or letting in what Anna may have told me as a child. At the age of about 60 I began having memories and one very severe flashback to an episode of sexual abuse by an aunt when I was around 6 or 7 years old. And I have experienced great discomfort and at times rage with some priests, for no “reason”…. I have always gone “numb” in the face of unexpected sexual aggression, in effect losing my ability to protect myself. So there is the intergenerational impact….. Screams, Tears, “Obstinacy” Met with Discipline – Punishment - Spanking:  Screams, Tears, “Obstinacy” Met with Discipline – Punishment - Spanking Her dad: “I still have guilt feelings. I can still picture me smacking her on the bottom going up the stairs. I was so frustrated that I could not control or communicate or get through to Anna like I could the other kids – that I felt myself out of control Sometimes I would give her a swat and she would just look at me, and wouldn’t even react.” Slide99:  Me, her mom: “I remember her screaming and crying with such piercing intensity and for such long periods of time that I would scream at her and spank her out of total frustration to try to make her stop. Since she had so many accidents, with all the scratches and bruises on her body there were times she looked to me like an abused child.” Slide100:  “I felt helpless – nothing seemed to work. If you wanted her to do something she would do the opposite. I would attribute it to obstinacy. I know now she must have been in terror, but I didn’t see what was happening to her then. I just knew something had to be wrong...” Examination by child psychiatrist:  Examination by child psychiatrist Me, and Anna’s dad: “We finally took Anna to see a well-known child psychiatrist when she was about 4 1/2. He observed her twice in play therapy.” “He said he thought that the heart of her problem was that she was very uncoordinated. She was left handed, left footed and right eyed. He said that she would get coordinated in time and would be OK. To just treat her with lots of love and ease up on the discipline.” “He suggested she needed a more structured environment, such as a nursery school. We were greatly relieved to be informed there was nothing seriously ‘wrong with her’.” Slide102:  Anna – about her visits with the child psychiatrist: “I remember being in a doctor’s office – some doctor with some toys. I was sitting in a room and then he came in to the room and he said “Hi”, and I played with the toys. He said I was ambidextrous or whatever…..” Cana Parents Group:  Cana Parents Group Me, Anna’s mom: “We belonged to a Catholic group for married couples – a peer support group to help each other with our relationships and our children. It was moderated by a priest. We met every month. Most of us were new parents.” “We never talked about child abuse, and certainly not sexual abuse, as it was taboo to talk about sex at all.” Childhood Art:  Childhood Art “Anna’s childhood drawings consistently contained numerous indicators typically seen in the drawings of children who have been sexually abused…..” Director Pediatric Play Therapy Program; Clinical Instructor, Department of Psychiatry UCSF (1991) *Notes accompanying each picture are the art therapist’s. Child without arms – encapsulated – no way out:  Child without arms – encapsulated – no way out Slide106:  Phallic imagery Wedge shapes Rainbow colors Missing eyes Slide107:  Rain in abundance - Disorganization or chaos (purple part) – Tears - Random chaotic scribbling Distorted body parts (short arms) Slide108:  Wedge Shapes Missing arms on all four figures – something overhead figures, theme of need for protection – both pictures have 2nd figure less prominent – wedge shapes - rain:  Missing arms on all four figures – something overhead figures, theme of need for protection – both pictures have 2nd figure less prominent – wedge shapes - rain Slide110:  Phallic images Line penetrates girls genital area Wedge shapes Disorganized/ Chaos Body part distortions Body part omissions Body part exaggeration Bizarre imagery that is very sexualized These pictures are very typical of sexual abuse seen in imagery House colored in – wedge shapes – no windows:  House colored in – wedge shapes – no windows Body parts missing – wedge shapes:  Body parts missing – wedge shapes Red House – Windows filled in:  Red House – Windows filled in No arms – Faces crossed out – Distortions – Figures in big square except one to right - overdrawing abdominal parts:  No arms – Faces crossed out – Distortions – Figures in big square except one to right - overdrawing abdominal parts Body fragmentation – missing body parts – rain – wedge shapes – splitting up torso:  Body fragmentation – missing body parts – rain – wedge shapes – splitting up torso Slide117:  Geometric body shape; overdrawing abdomen; body part distortions Themes of Protection Nursery School Age 4 years 9 months to 5 years 10 months:  Nursery School Age 4 years 9 months to 5 years 10 months Anna, far left in picture Two perspectives of Anna:  Two perspectives of Anna Anna’s Nursery School Teacher: “She was a nice little girl, quiet. Nothing really stands out. She wasn’t a real outgoing little girl, yet she wasn’t withdrawn either, like others who… would not get up and play… or cried when their mother left them…. Basically not a sad child, but a happy child.” “It seemed that things were OK, no problems that we could see on the outside….” Slide120:  Another nursery school mother: “When I took my daughter Stacey and Anna to the zoo, Anna seemed to be a little negative - ‘Stacey has more potato chips than I do’, and when asked to do something would be defiant and do the opposite. When I asked her to stay a certain place, she deliberately turned and walked and stood someplace else, defying me.” Slide121:  “She didn’t cooperate with me and she didn’t cooperate with you. It bothered me that she didn’t seem happier. I remember I thought she was a keen child, bright and intelligent. It was just her attitude.” “I could see that she had a problem, that she was ‘within’ herself, that she was a little against the world.” Slide122:  “On the way home, she got very excited when she saw a car with her (male relatives) in it, they were teenagers, three or four boys in a car.” “Then when we came home to your house, she climbed up on the top of your station wagon and would not get off. Your husband and you had to pull her off.” Slide123:  “She did not mind you. She seemed determined to do what she wanted to do and she was not going to get off that car to come in for dinner.” Anna recalls another car incident: “One day afterwards PB came over with somebody else in a car and pulled up to our house. I screamed and cried and held on to you, then you talked to them and they drove off.” Some positive memories…:  Some positive memories… Anna: “I remember wearing nice clothes. I had a pretty nice life, playing with April-May Smith, going to pre nursery school. The public pools were fun… I was a good swimmer – jumped in the six feet part.” “Once I jumped in the shallow water of 3 feet and bumped my head. The baby pool was fun, and running out in the sprinklers, and getting ice cream cones” Anna, middle of front row Slide125:  Anna: “Happiest time I remember was when we went sleigh riding on Art Hill and I got to have a Baby Ruth candy bar at the end. Then we went to visit Grandma J. She knit me a real beautiful sweater – hand knitted it herself. She said I was her favorite granddaughter…” Phallic imagery; Rain/Snow; Wedge shapes Slide126:  Anna: “I remember playing out in the backyard with the sprinkler. We were all running around in our underwear. I remember thinking ‘Oh god, we’re all running around in our underwear’.” “I was about 5 years old. I thought, “I’m not letting anybody give me a bath anymore. I’m not going to show myself to anybody anymore.” Red house; Scar on Tree Kindergarten: Age 5 years 10 months to 6 years 8 months:  Kindergarten: Age 5 years 10 months to 6 years 8 months Though she continued to be sexually abused, Anna carried on….:  Though she continued to be sexually abused, Anna carried on…. Records show Anna scored in the 99th percentile in the Metropolitan Achievement test Anna’s kindergarten teacher: “The test was given toward the end of the school year to all kindergarten students. Its a national comprehensive standardized and graded assessment of a child’s general strengths and weaknesses in a variety of different areas of aptitude. I can’t recall who Anna was all that many years ago, but I do know if she scored in the 99th percentile, that you can’t get higher than that!” And hope persisted along with love of family celebrations and of artwork:  And hope persisted along with love of family celebrations and of artwork Slide130:  Anna: I was like, “Mommy, mommy, mommy” you know. And Dad, you and him would put all the Christmas presents out and it was so great! We would get up in the morning and all those Christmas presents would be there!! Anna: “What stands out is doing art work. I was drawing all kinds of things. I was learning how to use my favorite materials and colors.”:  Anna: “What stands out is doing art work. I was drawing all kinds of things. I was learning how to use my favorite materials and colors.” Slide132:  Collage of yarn, paper cutouts, drawing Slide133:  Collage flower of colored or painted paper cut outs and yarn Cut out crayoned house with no windows. Her Aunt Jane remembered…..:  Her Aunt Jane remembered….. “Anna drew detailed, I mean beautifully detailed, pictures. I taught kindergarten and I thought, ‘This isn’t ordinary, her ability to draw is not ordinary’.” Slide135:  Anna titled this picture “A four year old Chinese girl next to a bush of bell flowers”. November 1966 Slide136:  Christmas. Created by Anna at her Aunt Dorothy’s house. Age 5 ½- 6 Slide137:  Anna: “I remember how much I loved to draw! I remember drawing something that was kind of like an egg. It was all different colors… It was one of my favorite pictures back then…” Sexual Abuse continued through nursery school and kindergarten:  Sexual Abuse continued through nursery school and kindergarten Sarah, Anna’s younger sister: Anna’s younger sister has one vivid memory of when she was about 2 and Anna was around 6. It was of “going upstairs, “there was a guy baby-sitter there with Anna in her room, and he said to get out, leave us alone, go do something else. Like he was doing something to Anna or something.” Sexual Abuse continued through nursery school and kindergarten:  Sexual Abuse continued through nursery school and kindergarten Sarah, Anna’s younger sister: “I was only about two, but somehow that memory stuck. I was feeling worried for Anna. I felt bad for her. The memory impressed itself on me. It was out of the ordinary, there was something not right about the situation, it was not normal and that’s why somehow I remember that….” Then our family moved to the East Coast :  Then our family moved to the East Coast Anna had a predictive dream…..:  Anna had a predictive dream….. “When we were (driving) on our way to New Jersey, I was looking over at a hill on the side, it was like a black house. Seemed like there were movers picking up the whole house and moving it – it was weird. I have a few dreams back then…walking through houses, and houses that were black and white with black shutters………” The Years Following…:  The Years Following… Slide144:  Continuing traumatic events: the making of a broken heart Slide145:  I share with you now a brief account of what happened to Anna from the time of her move to the east coast at age 6 years 8 months to when she “broke” at the age of about 14, beginning her long slide into an enduring history with the mental health system. Note numerous categories of “adverse childhood experiences” (ACEs) which further overwhelmed her already severely compromised capacity for resiliency. Age 6 years 8 months – to 10 years 8 months New York Suburb:  Age 6 years 8 months – to 10 years 8 months New York Suburb Family relocation – geographic move away from extended family in Midwest to NY suburb Continuation and increase in parents problems Anna’s father’s volatility, explosions of rage My substance use, increasing depression, feeling of being trapped, first realization divorce might be necessary Slide147:  My change, reaction to prescribed roles, determination to become less dependent/more self-sufficient – return to school My shifting childcare responsibilities to oldest daughter My and my husbands relationship disintegrating: My affair. Husband’s discovery and beginning of long-term affair. Determination to change lifestyle, move, enroll children in alternative school setting. Move from suburban to rural area. Age 10 years 8 months – to 13 years 6 months Alternative Schools in rural New Jersey:  Age 10 years 8 months – to 13 years 6 months Alternative Schools in rural New Jersey This period in Anna’s life was a time of massive upheaval and adverse experiences for both Anna and her brothers and sisters. Her brothers and sisters worked through the impacts of their experiences, and although they still struggle from time to time, they today are living full, productive lives blessed with loving relationships, children, friends, and close family ties. It was Anna however, who was re-traumatized by many of these multiple stressors, who broke under their weight, and whose life from that point on was ravaged …… Age 10 years 8 months – to 13 years 6 months Rural New Jersey:  Age 10 years 8 months – to 13 years 6 months Rural New Jersey Multiple geographic moves, shifts in home and school environments for Anna and her brothers and sisters – from traditional to alternative school environments, from traditional to communal living situations Exposure to troubled children and teenagers alcohol and drug use, self-injury sexual harassment by other students sexual permissiveness and promiscuity Slide150:  Witnessing of sadistic physical and sexual abuse by adult male neighbor of 2 year old son Frequent absence of parents: me-school 3 hours away; Anna’s dad- NYC job My continued intermittent depression, use of alcohol, one suicide attempt, increasing withdrawal Both us parents involved in other sexual relationships Our bitter traumatic separation; decision to divorce; disruption of alternative school environment and children’s home. Children go to public schools. Slide151:  My increased absence while I finished education – granting of temporary legal custody of children to Anna’s father. I was given limited right to stay in home with children 3 days a week. Children’s father was present 2 days a week. Abandonment by all trusted adults including teachers, me and children’s father. (Familiar teachers left, I and children’s dad both lived elsewhere part time and with children part time). Father hires new teachers to re-start school. Anna breaks. Hides herself. Withdraws completely. :  Anna breaks. Hides herself. Withdraws completely. Age 13 Years 6 months – to 14 years 8 months Suburb in New Jersey :  Age 13 Years 6 months – to 14 years 8 months Suburb in New Jersey I assume full time legal custody of all my children and establish home in seacoast suburban community in New Jersey Anna cannot handle public school; is put in special education; home tutoring; graduates 8th grade I work full + time. Economic stress. Stress from dealings with mental health and social systems Slide154:  Anna intense, disruptive acting-out at home affecting all in family; complete withdrawal from all others. Many treatments: “Brain-bio”; outpatient psychiatric treatment; medication; counseling. Nothing helped. I struggled to keep Anna out of residential MH settings. Family stress overwhelming. “Family network” intervention results in decision for Anna to move to Midwest to live with aunt, uncle and family. Aunt and uncle are granted temporary custody. Anna moves to Midwest:  Anna moves to Midwest It was here that formal psychiatric treatment began, including 3 hospitalizations; medication; insulin and shock treatments. The story of her 17 years in the mental health system can be seen at: www.TheAnnaInstitute.org Slide156:  The house looks good – lots of open windows – but no foundation. Buffeted by multiple clouds and storms, the house collapses. It cannot withstand the stress. All of what happened to Anna contributed to her breaking. But the core of her vulnerability lay hidden festering within her early childhood years and ate away at her resiliency. Unaddressed early childhood sexual abuse eroded her foundation. She broke. Her brothers and sisters withstood the storms. On Damaged Capacity for Resilience Slide157:  Anna What happened to her as a child? What clues that she was being abused and traumatized were not recognized? What opportunities for prevention or early intervention and healing were missed? What might we do differently today? Slide158:  Trauma-Informed Communities Slide159:  Trauma-Informed Communities We - the adults of the community - must ensure that the rights of children are respected, their welfare is protected, their lives are free from fear and want and they grow up in peace. Anna’s early childhood community:  Anna’s early childhood community Anna’s mom and dad Her extended family Neighbors Housekeeper Priests Couples’ group Obstetrician ER personnel Dentist and assistant Pediatrician Child Psychiatrist Nursery school teacher Kindergarten teacher Slide161:  Any one of the adults in Anna’s early childhood community – had they been trauma-informed – could have saved her life Slide162:  They might have prevented the abuse from occurring They could have recognized the clues that she was being sexually abused They could have intervened early and helped her to heal Slide163:  What can we, as individuals, as organizations and as communities, do differently today? Slide164:  Presentation created by Ann Jennings Ph.D. afj@gwi.net www.TheAnnaInstitute.Org

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