Revealing the Inner World of Traumatised Children and Young People

Citation

Caan, W. (2018), "Revealing the Inner World of Traumatised Children and Young People", Journal of Public Mental Health, Vol. 17 No. 3, pp. 142-143. https://doi.org/10.1108/JPMH-09-2018-074

This book by Christine Bradley (with short contributions by four others) gives much food for thought, at a time when both mental health practitioners and policy-makers are beginning to take adverse childhood experiences seriously. The sort of residential units in which the author once assessed so many traumatised children are much less common now. The reactions of children struggling with adversity, however, are all too familiar today. In the twenty-first century, there is an urgent need to develop more “trauma-informed” mental health services (Rose et al., 2012). Bradley’s formative encounter with the Therapist Donald Winnicott was in 1970, and I doubt anyone developing services now would want to turn back the clock 48 years – but today’s innovators could learn a lot from her generation.

Bradley’s book contains much material around a child’s interior development, attempting to integrate many dimensions of the challenging world in which they participate: “Is that really my song?” At the heart of her practice was a simple commitment: “The primary task in our work is to meet the emotional needs of traumatised children”.

In particular, Bradley maintains an elegant style of writing. For example, describing the importance of “attuned relationships” with adults in the organisation of a young brain, she writes: “If attuned, interactions are like perfectly co-ordinated dances, matched by rhythm and style, whereas chronically misattuned interactions are devastating in their impact and reach, and constitute repeated traumatic experiences. Dancing with a partner who does not see you or sees only what they want to see, or hates dancing with you, is incredibly painful and damaging”.

Myself, I was a Student in the 1970s and so I can recognise terms like “fragile integration”. If this book has a second edition, I would strongly recommend that the publishers Jessica Kingsley include a glossary of its jargon, as readers born after about 1990 may find some of the terminology unfamiliar. In general, though, the recommendations for work with children are clear and to the point: “All good experiences need to have a beginning, a middle and an end to make them into a complete experience”.

In terms of public mental health, I hope future research will work out why some traumas are more overwhelming than others (Myles et al., 2018). Here, I am glad that Bradley gives a voice to some young people. For example, this is the end of a poem by a 14-year-old boy who shortly afterwards committed suicide:

“[…]. And when he lay alone looking at the sky,

It was big and blue and all of everything,

But he wasn’t anymore.

He was square inside

And brown

And his hands were stiff

And he was like everyone else.

And the things inside him that needed

saying didn’t need it anymore.

It had stopped pushing, It was crushed.

Stiff.

Like everything else”.

Future trauma-informed services will need evidence of good outcomes. I was struck by a follow-up study of Bradley’s Cotswold Community. After her service changed to a therapeutic community, the evaluation found the proportion of young residents that moved on to prison or to other costly forms of “care” then “dropped from 85 per cent to 5 per cent”.