Bessel Van der Kolk
Psychiatrist, author, researcher
and educator
Twenty-five years ago a study by the US Centers for Disease Control and Prevention (CDC) revealed that, in the United States, traumatic life experiences during childhood and adolescence are far more common than was expected. The participants in that study were mostly white, middle-class, well-educated, and in possession of good medical insurance, and yet, only one-third of them reported no serious adverse childhood experiences. In the remaining sample, the vast majority had experienced two or more horrendous childhood events. Subsequent scientific reports from 96 countries have shown that, globally, over half of all children – one billion girls and boys – are exposed to violence each year.
Why is that important? People with childhood histories of trauma are vulnerable to develop a host of problems, including difficulties concentrating, outbursts of anger, panic, depression, and difficulties with food intake, drugs and sleep, as well as higher levels of stress hormones, and reduced or impaired immune responses. Neuroscience research consistently shows that childhood trauma alters brain systems dedicated to evaluating the relative risk of what is happening around us, and causes difficulties regulating emotional responses throughout life.
Despite the World Health Organization’s (WHO) leadership in anchoring violence against children as a global public health priority and the numerous studies over the past 30 years spelling out the devastating effects of childhood trauma on mental and physical health, the effects of exposure to violence remain largely unrecognised, and unresourced, in school systems, childcare agencies, medical clinics and the criminal justice system.
A chance to redress that neglect is on the horizon. In November 2024, the government of Colombia – in partnership with the government of Sweden, the WHO, UNICEF and the Special Representative of the United Nations Secretary General on ending violence against children – will host a Global Ministerial Conference on Ending Violence Against Children. A first-ever bringing together of all 194 countries to recognise the scale, and severity of impact, of childhood violence and to begin to marshal much-needed resources to accelerate action.
The fact that this is a first-ever Global Ministerial on the issue, and that it is largely considered a third-tier policy priority, is startling. A response commensurate with the challenge that preventing childhood violence presents is long overdue.
Long-overdue and short-sighted; the CDC study concluded that childhood violence is the most costly public health issue in the US, calculating that the overall costs exceeded those of cancer or heart disease. It estimated that eradicating childhood violence in the US would reduce the overall rate of depression by more than half, alcoholism by two-thirds, and suicide, serious drug abuse, and domestic violence by three-quarters. Moreover, preventing exposure to violence and abuse would significantly affect job performance, and vastly decrease the need for incarceration. In fact, about 95 percent of violent inmates suffer from childhood experiences with violence and abuse. That, of course, is not limited to the US, but is relevant to children around the world.
When people talk about children’s exposure to violence they tend to focus on what happens outside the home: on the streets, at school, in refugee camps, and in war-torn societies. However, for the majority of children, trauma begins at home, at the hands of their own family members. Both physical and sexual violence by one’s own caregivers have devastating consequences.
In 1987, Frank Putnam and Penelope Trickett at the National Institute of Mental Health started the first longitudinal study of the impact of sexual abuse on girls’ development that now has been ongoing for 35 years. Compared with girls of the same age, race and social conditions, sexually abused girls suffer from a range of profoundly negative effects: difficulties learning, depression, troubled sexual development, high rates of obesity and self-mutilation. They dropped out of school at much higher rates and had more serious medical illnesses. This study, and numerous others like it, underscore the reality that supporting high-quality early caregiving is critically important in preventing physical, social and mental health problems, regardless of traumas that occur outside the family.
Safe and protective early relationships are vital to protect children from long-term problems. If the parents themselves are the source of distress, the child has no one to turn to for comfort and for restoring disrupted biological functioning. Social support is a biological necessity – not an option, and this notion should be the backbone of all prevention and treatment. Early stimulation and sensitive parenting are fundamental to successful growth and development.
John Heckman, winner of the 2000 Nobel Prize in Economics, has shown that quality early childhood programmes that involve parents and promote basic skills in disadvantaged children more than pay for themselves in improved outcomes. Economists have calculated that every dollar invested in high-quality home visiting, daycare, and preschool programmes results in $7 in savings on welfare payments, healthcare costs, substance abuse treatment, and incarceration, plus higher tax revenues due to better-paying jobs.
Following violence, the world is experienced with a different nervous system. The three-decade-long research by Martin Teicher and his colleagues at Harvard has shown that many of the brain abnormalities that were thought to be specific to a variety of psychiatric problems were, in fact, the direct consequence of childhood trauma and abuse.
Labels such as “depression”, “oppositional defiant disorder”, “intermittent explosive disorder” and bipolar disorder, do not begin to address underlying issues.
A mislabelled person is likely to become a mistreated patient. Mental illness is not really like cancer or heart disease: everything about us – our brains, our minds, and our bodies – is geared towards being integrated members of social groups, able to share, nurture and collaborate. This is the key to our success as a species, and this is what breaks down in most forms of mental illness. It is critical to recognise that many of our behaviour patterns are the result of the social conditions and caregiving systems that shape our minds and brains when we are young, and that continue to underpin the fundamental substance and meaning of our lives.
With just six months until the Global Ministerial Conference on Ending Violence Against Children, my hope is that governments recognise the opportunity and necessity to prioritise child protection, as both the right and smart thing to do. The stability and functioning of the societies and citizens of tomorrow depend on the decisions of governments today. No doubt, governments are feeling fiscal pressure but recognising and adequately resourcing childhood violence prevention will prove to be a strategic investment.
The views expressed in this article are the author’s own and do not necessarily reflect Al Jazeera’s editorial stance.
Bessel Van der Kolk MD’s #1 New York Times Science best seller, The Body Keeps the Score: Brain, Mind, and Body in the Treatment of Trauma (translated into 43 languages), transforms our understanding of traumatic stress, revealing how it literally rearranges the brain’s wiring – specifically areas dedicated to pleasure, engagement, control, and trust. He has published over 150 peer reviewed scientific articles on such diverse topics as neuroimaging, self-injury, memory, neurofeedback, Developmental Trauma, yoga, theater, psychedelic therapies, and EMDR. He is founder of the Trauma Research Foundation in Boston, MA; past President of the International Society for Traumatic Stress Studies, and Professor of Psychiatry at Boston University Medical School. He regularly teaches at universities and hospitals around the world.
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