Families in Psychiatry

Preventing the intergenerational transmission of trauma


 

Intergenerational trauma often proves to be a prevailing feature of family systems.

The trauma of the Nazi concentration camps, for example, can be re-experienced in the lives of the children of camp survivors. Even the grandchildren of Holocaust survivors have been found to suffer from the effects of trauma. These effects manifest through characteristics such as increased suspiciousness of others, anger, and irritability in these individuals compared with controls (J. Relig. Health 2011;50:321-9).

Such intergenerational trauma has been found among urban American Indian and Alaska Native populations who have been involved in culturally specific sobriety maintenance programs (Am. Indian Alsk. Native Ment. Health Res. 2011;18:17-40). Likewise, a body of research supports the notion that untreated intergenerational trauma tied to generations of slavery in the United States continues to negatively affect many in the black community.

Other kinds of trauma can be passed down through the generations, as well. Take the trauma of a combat soldier; victim of or prisoner of war; survivor of a mass shooting or of child abuse; witness of genocide; or survivor of colonial suppression, slavery, or political totalitarianism. People who have experienced these traumas can pass down the consequences to subsequent generations.

We know that people who suffer trauma firsthand often develop posttraumatic stress disorder symptoms (PTSD) symptoms such as fearfulness, nightmares, flashbacks, sorrow, and difficulty with emotional closeness. However, it also is clear that compared with controls, the children of veterans with PTSD have shown an inability to experience appropriate emotional responses to situations and difficulty in solving problems effectively both within and outside the family unit (Aust. N.Z. J. Psychiatry 2001;35:345-51).

The trauma of childhood abuse also is transmitted down through the influences of the other members of the family, especially their children.

Another group known to suffer from the effects of intergenerational trauma is the children of alcoholics. This is a group that has demonstrated an increased need to care for others and keep secrets. They might use lying as a normal coping style and sometimes experience difficulty being children. Such behaviors are understood as a direct consequence of the experience of the family dysfunction. The question about trauma is: How do the symptoms of PTSD get "passed down" through the next generations, when the younger family members were not exposed to any trauma?

Various mechanisms have been considered, with individual psychological mechanisms and family dynamics being the most commonly cited mechanisms. Other factors have been suggested, such as the role of cultural and societal factors in the perpetuation of symptoms. Children and young adults might develop retaliatory fantasies "to right the wrongs done to their families." These types of beliefs and fantasies fuel many sectarian struggles around the world.

Individual psychological mechanisms commonly considered to be important are projection and identification. The parent with PTSD projects unwanted aspects of himself onto the child, who takes up the projection and identifies with it; this is called projective identification. Fear of the cold or the dark in the father then becomes the child’s fear instead. Children who are closest to the traumatized parent will be most affected.

Other postulated mechanisms focus on affect regulation. Parents who have difficulty with emotional regulation will have difficulty bonding appropriately with their child. On the other hand, emotional numbing might be present, which interferes with the development of a strong bond between parent and child.

One study of male Vietnam veterans found that "emotional numbing" and the quality of their relationship with their children remained significant even after investigators controlled for numerous factors, including the fathers’ family-of-origin stressors, combat exposure, depression, and substance abuse (J. Trauma Stress 2002;15:351-7). In other words, the children then suffer from secondary trauma.

Trauma-affected families also might have difficulty setting appropriate boundaries between parent and child so that the child becomes the caregiver of sorts and protector of the parent. The fears of the parent can become the fears of the child. It might be confusing for the child when a parent says: "Shh! Did you hear that noise," implying that "they" will get us, without really specifying the who and why, thus depriving the child of a rational explanation of his or her own experiences.

However, sometimes, trauma is not transmitted intergenerationally, a series of meta-analyses shows (Attach. Hum. Dev. 2008;10:105-21). Instead, these families are able to develop resilience and adapt well in the face of adversity – and achieve posttraumatic growth. How do we help the families with trauma become these resilient families?

Here is a list of nine points that can help guide the family psychiatrist:

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