Table Of ContentThe Impact of Complex Trauma on
Development
The Impact of Complex Trauma
on Development
Cheryl Arnold and Ralph Fisch
JASON ARONSON
Lanham • Boulder • New York • Toronto • Plymouth, UK
Published by Jason Aronson
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Copyright © 2011 by Jason Aronson
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Arnold, Cheryl, 1947-
The impact of complex trauma on development/ Cheryl Arnold and Ralph Fisch.
p.cm
ISBN 978-0-7657-0882-3 (hardback)
1. Psychic trauma in children. 2. Post-traumatic stress disorder m children. 3. Child
development. I. Fisch, Ralph, 1928- II. Title.
RC552.T7 A76 2011
618.92'8521--dc23
2011031270
9:rw
The paper used in this publication meets tlle minimum requirements of American
National Standard for Information Sciences-Permanence of Paper for Printed Library
Materials, ANSVNISO Z39.48-1992.
Printed in the United States of America
In Memory of
Walter Lee and Violet Arnold
Eternal Love
I dedicate this book to my wife Marjorie Fisch
For her support and encouragement
Preface
Trauma is decidedly not “outside of normal experience.” In fact, an estimated one in six
Americans will be subject to a traumatic experience with lasting psychological consequences
at some point in their lifetime. And those who have endured trauma are not left unchanged by it.
Even a single acute trauma experienced in adulthood can have an indelible impact. Repeated
traumatic experiences in childhood are even more damaging.
Part One of The Impact of Complex Trauma on Development hones in on the
phenomenology of trauma and development—the experience of being traumatized and how
people react to it at specific developmental stages—from the person’s own internal
perspective. It follows the evolution and maturation process as the infant becomes a child, an
adolescent, and an adult, allowing the reader to become more and more aware of the depth and
breadth of the influence of relationships, and especially traumatic relationships, on every
aspect of personality.
After having been traumatized, people struggle to maintain personal meaning and
organization and, consequently, personal regulation. A frequent refrain when they try to tell
about their experiences is the phrase, “You’re going to think I’m crazy, but….” Often, their
worst fear is that they will, indeed, go crazy. However, when you understand the
developmental differences that occur when children are traumatized, you begin to understand
that, far from being crazy, the individual is experiencing a reasonably normal response to an
abnormal (“crazy”) situation.
Historically, psychology has focused on the “nature versus nurture” controversy regarding
human development. This is, however, a simplified notion. A more sophisticated approach is
necessary for understanding trauma—one that begins to describe how trauma affects
development. In normal development, we find a pattern of growth from simple to complex,
through a process of differentiation and integration. When trauma interferes with
development, we find instead a pattern of fusion and fragmentation.
The most intimate experiences and consequences of trauma are not easily reported. The
person who has been traumatized may be able to describe his experience, but the person
listening may lack the background experience (schema) that would allow him to hear and
understand it accurately. While the listener may grasp what happened, he may be totally
unaware of the intensity of the impact on the victim or what the trauma actually means to the
person who has experienced it. Even when someone shares his internal experience, the listener
may be intimidated or frightened by the intensity of the experience and unable to provide
support.
Just as integration is a significant problem for those who suffer from complex trauma, it has
also been a significant problem in psychology. Until recently there has been little effort to
integrate trauma theory with developmental and psychoanalytic theory, or to integrate academic
research with clinical practice. Part Two of The Impact of Complex Trauma on Development
is an integration of theory and practice.
Early in our relationship, Dr. Fisch told me, “If you really want to understand personality
development, working with multiple personality disorder (MPD)> is the way to do it.” Of
course, being an eager student, I wanted to understand everything—cognitively! Little did I
know that through working with Ralph I would come to understand trauma and personality
development not only cognitively, but also emotionally, behaviorally, and throughout my very
being, consciously and unconsciously. Working together with Ralph and my clients, I’ve
learned about the prevalence of trauma in relationships and the significance of interpersonal
trauma in a broad range of psychiatric problems, from the most severe diagnosis of
dissociative identity disorder to some of the subtler relationship problems of people with no
psychiatric diagnoses at all.
The longer I worked with Ralph and clients, the more I understood about trauma, and the
more I felt compelled to share what I had been learning with others. I especially wanted to
share what I had learned about the devastating consequences of developmental trauma over a
person’s lifetime. I wanted people who had experienced trauma in childhood to better
understand themselves—and to understand the symptoms that make them feel “crazy” are
actually normal developmental responses to traumatic experiences. The internal and
developmental consequences of trauma are not only understandable, but also predictable.
Treatment of complex trauma must address these issues, which is the reason for this book.
Unfortunately, our language does not provide a gender-neutral pronoun that is easily used
and understood. Therefore the use of “he” and “she,” “his” and “her,” are interchangeable in
this text when referring to unspecified patients or clinicians. Both girls and boys can be
subjected to complex trauma, and both men and women can be fine clinicians.
When referring to primary caregivers and attachment figures, the term “mother” is used
frequently, largely due to historical precedents. Clearly, both mothers and fathers are capable
of and responsible for being primary caregivers and attachment figures for their children.
The students and patients referred to in the book are real people or in some instances
composites of real people. Their names and other identifying information have been altered to
protect their confidentiality.
It is our hope that this book will assist those in the helping professions understand their
traumatized clients, and that it will help those same clients understand themselves. And realize:
I am not crazy, and I am not alone.
*Now known as dissociative identity disorder (DID).
Acknowledgments
I would like to express my gratitude to my mentor, friend, and co-author Ralph Irving Fisch,
Ph.D., whose insights and ideas have been the inspiration for this book. He has shown great
courage and commitment to the field of psychology both as a clinician and an educator. I am
grateful to Dr. Fisch for introducing me to the richness and power of psychoanalytically-
oriented developmental psychology.
I would also like to thank my clients, past and present, for teaching me about trauma from
the inside out. It has been with great courage that they have shared their pain, their struggles,
and their victories.
Special thanks to our first three readers and encouragers, Minnie Grace (Gay) Hubbard,
Ph.D., Timothy Patrick Dea, Psy.D., and Marjorie Bayes, Ph.D. Thank you to the wonderful
group of women psychologists who have supported me personally and professionally over the
years: Janice Thurn, Bonnie Messer, Emily Lenoue, Rita Vollmer, Judith Dowling, Sue Hamm,
and Karen Gookin.
I would like to acknowledge Gary Peer, Ph.D., at the University of Tulsa, and Karen
Kitchener, Ph.D. and Robert Mines, Ph.D. at the University of Denver, for their contributions to
my professional education. I would also like to acknowledge Julie Silver, director of
“Publishing books, memoirs, and other creative nonfiction” at Harvard Medical School,
Department of Continuing Education; and Eli Gottlieb and Shari Caudron, at the Lighthouse
Writers Workshop in Denver, Colorado, for their support and guidance in the writing and
publishing process.
Dr. Fisch and I are especially grateful to our editor, Phil Waggener, whose attention to
detail has contributed significantly to bringing this volume to fruition. We want to thank Laura
Espinoza and Mirna Araklian, editors at the University Press of America, for their help and
support.
Cheryl L. Arnold
In memoriam, this book is an expression of the enthusiasm and commitment offered in the
past by Lee Silverthorn, Ph.D., my mentor, and my professors Martin Scheerer, Ph.D., Fritz
Heider, Ph.D., Gardner Murphy, Ph.D., John C. Chotlos, Ph.D. I want to underscore their
support and erudition for me through the years. I extend my heartfelt gratitude to Cheryl Arnold,
Ph.D., my co-author for her gracious collaborative efforts to make this book a reality.
Ralph Irving Fisch
Chapter One
What Is Developmental Trauma and Why Does It Matter?
I was excited but apprehensive. Twenty years old, with a 1960s stylish “fall” of long brown
hair and a purple miniskirt, I was starting my new career. I had finished college with all the
required hours of student teaching, and I was finally a certified teacher. In Tulsa, Oklahoma, I
had become the proud proprietor of my own junior high school classroom. The desks were
arranged in the recommended rows, the seating charts were complete, and now—just a few
years older than my prospective seventh, eighth, and ninth grade students—I awaited the bell
that would signal the start of classes. Watching as my new students trickled into the classroom,
I was naively unaware of the impact they would have on my life and on my future. I would
discover that, rather than teaching English, my real job would be to teach children.
I still remember specific students: the pale, blond seventh-grade girl who looked
undernourished and struggled to remember her spelling and vocabulary words; the bright,
diminutive freckle-faced boy who couldn’t stay in his seat and seldom remembered to bring in
his homework; the rather dull ninth-grader to whom I refused permission for a bathroom pass
who later appeared at my desk with a huge glob of disgusting snot on his arm that he somehow
knew would convince me to reconsider. But most of all, I remember Mandy. Mandy was
thirteen years old, with reddish-brown hair, a thickset body, and a timid smile. She was a good
friend of the undernourished blond, and they both liked nothing better than to stop between
class periods to chat with me. Mandy was new to our school, and seemed relieved to have
someone who would spend the few available minutes listening to her. She began to tell me her
story.
Mandy had a baby—an infant only two months old—who had been hospitalized since his
premature birth. The baby had a congenital heart defect and was not expected to live. Mandy
didn’t get to see him much but was intensely focused on his medical progress, of which her
social worker kept her apprised. The baby’s father was… Mandy’s father. This was my
introduction to the incest dilemma, and the beginning of my awareness of how different the
lives of many children were from mine—children who not only weren’t routinely nurtured and
protected, but were repeatedly traumatized by various life circumstances. It would, of course,
be impossible to provide the nurture and protection that were missing from the lives of so
many. But it was clear to me, even as a young teacher, what an important influence for good or
ill I could be for my students. They were hungry for what we all need: understanding and
acceptance, support, and encouragement, and the belief on someone’s part that they were
indeed important, worthwhile, and valuable.
For the last forty years, first as an educator and then a psychologist, I have continued to be
both astonished and appalled at how poorly many of the world’s children are cared for. There
are the AIDS orphans and heads of households in Africa and India; the victims of warfare in
Iraq and Afghanistan; the poverty-stricken children in the slums of urban areas around the
world; and the American children whose faces we see on our television news programs. The
seven-year-old girl who is missing and possibly was murdered by her father; the twelve-year-
old forced by a grandmother to spend his nights in a dog kennel while she reports to work at
the local sheriff’s department; the six-year-old who was starved to death by a stepfather to
whom a court had granted legal guardianship; the innocent babies drowned in the bathtub by
their mothers.
Human development is complex. Every child comes into the world with her own unique
biological makeup and developmental potential, or anlage, which set the parameters of what
her life may become. This fundamental endowment is, however, heavily affected by the sum
total of the child’s experiences—good and bad, positive and negative. It has been said that who
comes into a life is the most significant determinant of what that life will become. On the
positive side of the scale are love and age-appropriate limits. On the negative side is that
pernicious—because it is often invisible—element: trauma. Trauma is not always intentionally
caused; for example, the death of a parent or a serious illness or injury is traumatic. When
trauma is intentional, however, the consequences are even more severe.
For those who manage to survive traumatic experiences in childhood, there are often
lifelong scars. Although not necessarily visible to the naked eye, the scars become subtly
embedded—physiologically, emotionally, and cognitively—within the individual. Left
unaddressed, traumatic consequences continue to affect development as the child evolves into
adolescence, adulthood, and even old age.
WHAT IS TRAUMA?
Classically, trauma is a medical term used to denote serious injury to the human body. But what
is psychological trauma? Before we answer, let’s back up a crucial few steps and talk about
the way a nervous system functions. Typically, according to neurobiologists, about two
thousand bits of information enter our consciousness through our five senses every second.i It’s
easy to see that the mind cannot possibly react in an effective and immediate way to such an
avalanche of stimulation. Some of this incoming information has to be set aside while other
stimulation is directly engaged. Normally, this screening of incoming data is the job of the ego,
as, from a psychoanalytic perspective, the ego is the executor of the personality. When such a
screening maneuver is not possible—as in the case of psychological trauma—it results in
feelings of helplessness and a passivity that leads to emotional dissolution, chaos, and rage.
"Experiencing trauma is an essential part of being human,"ii from which few people, over
the course of a lifetime, are completely spared. However, there are differences in the form it
takes and how frequently it strikes, and what resources are available to deal with it.
Approximately 11 percent of children experience psychological abuse; 30 percent experience
physical abuse; and almost 20 percent experience child sexual abuse.iii
In addition, adverse childhood experiences within the family are widespread. It has been
reported that 23 percent of households are exposed to alcohol abuse, 18 percent to mental
illness, almost 5 percent to drug abuse, 3 percent to criminal behavior. And in 12 percent of
families, the mother is battered.iv The single best predictor of posttraumatic stress disorder
(PTSD) and of the severity of its symptoms in childhood is for the child’s caretaker to be
threatened. The closer the relationship is between victim and perpetrator, the more severe the
