Marianna Jaross
Trigger warning: The following article contains information on the prevalence of abuse. If this content is distressing, please click off this page, and/or reach out to personal or professional supports.
I was recently asked about why I became a psychologist. This is not something I talk – or think about – all that much these days. However, if someone asks me and I trust them enough to know I’ll answer honestly, the question will bring tears to my eyes.
My first foray into the world of psychology occurred through being assessed for court proceedings as a child. At this point, I met my psychologist, who was warm and safe, and let me play with art supplies. I think sometimes our greatest pains and hardships can inform what we gravitate towards or become a part of, and no-doubt this experience impacted me deeply: When I chose the outline of a career a decade later, it was a no-brainer.
Though I experienced abuse and pain in my early life, the reality is that though this is sad, significant, and impacted me; it is, unfortunately and sadly, unremarkable in its prevalence.
The recent Australian Childhood Maltreatment Study (ACMS, Matthews et al., 2023) provided recent data within an Australian sample regarding maltreatment type (as well as multi-maltreatment), and impacts in a population 16-65 years older. Importantly, this study highlights the impacts of childhood maltreatment; including increased likelihood of mental health diagnoses, health risk behaviour(s), and service-sector engagement (see specific sections by Scott et al., 2023; Lawrence et al., 2023; Pacella et al., 2023).
This, both from my perspective through lived experience and as a psychologist for several years has implications for our approach to healing, which I will get to. First, the numbers.
Across the sample Australian population aged 16-65 years and older: 32% experienced physical abuse; 28.5% experienced sexual abuse; 30.9% experienced emotional abuse; 8.9% experienced emotional neglect; and 39.6% experienced exposure to domestic violence. Additionally, 62.2% of the Australian population have experienced at least one type of child maltreatment (Matthews et al., 2023). The ACMS also revealed that child maltreatment is rarely limited to a single type, and highlighted the frequency and ‘combination’ of maltreatment patterns (Higgins et al., 2023), and the increased numbers regarding maltreatment for gender-diverse individuals (Matthews et al., 2023). As important and relevant as these findings are, I won’t detail or be able to cover them all in this span of writing; and will largely refer to the global numbers across the population and its implications for our approach to healing, rather than delving into gender and maltreatment-combination nuances.
The brief report of the ACMS states: “Across the Australian population, 39.4% of people have experienced multi-type treatment, and 23.3% have experienced 3-5 different types. Youth rates are even higher; 40.2% of young people aged 16-24 have experienced multi-type maltreatment.” These highlight that addressing childhood maltreatment – and it’s impacts – needs to be considered as a national emergency requiring a trauma-informed cross-sector collaboration if we’re going to achieve any significant shifts in numbers, and improve mental and physical health outcomes across generations. In short, there is a lot of work to be done.
These numbers, though horrifying, are confirming what I have witnessed working across several sectors; including drug and alcohol, gambling-harm, family violence, oncology, and a brief stint in private practice. Having witnessed the longstanding impacts of abuse, I suspect from a healthcare perspective we are largely operating from a model that is neither ideologically nor practically set up to address the experiences and impacts of childhood trauma that may be present across the life-span in a way that supports requisite deeper and multidimensional healing.
This is a missed opportunity, as though we have the knowledge of both the prevalence and impacts of trauma across the nervous system, brain development, physical health, mental health, identity, sense of self and relationships; our attempts to offer support are largely siloed and fragmented between practitioners alternating between mind and body. This does not accurately represent the interplay of impacts of as they occur within the one person, the fact that these occur across the lifespan, and that healing from trauma is a process and journey spanning beyond 10-session models.
Here are the numbers regarding childhood maltreatment and long-term impacts. Among all survey participants 48% of those who experienced maltreatment met criteria for one of the four mental health disorders investigated. Additionally, the authors were not able to investigate other disorders, such as eating disorders or personality disorders, suggesting that the real impact of maltreatment on mental health may be higher than this data reveals (Matthews et al., 2023). That is, the numbers as high as they are, may still be conservative.
If you had childhood maltreatment, you were:
- 2.8 times more likely to have any mental disorder
- 4.6 times more likely to have current PTSD
- 3.1 times more likely to have anxiety disorder
- 3.2 times more likely to have major depression disorder
- 2.6 times more likely to have severe alcohol use disorder
You were also:
- 6.2 times more likely to be cannabis dependant
- 4.6 times more likely to have attempted suicide in the past 12 months
- 1.9 times more likely to be a current smoker
- 3.9 times more likely to have self-harmed in the past 12 months
- 1.3 times more likely to binge drink at least weekly
- 1.2 times more likely to have obesity
Importantly, the documentation of the long-term impacts of childhood trauma across varied life domains is not new (Felitti et al., 1998). Furthermore, we also know from the research that trauma impacts the brain and brain development, nervous system, ability to connect with others, and sense of identity (Van de Kolk, 2014). As such, it is not a stretch to understand how this can present as symptoms of eligibility for diagnostic criteria and diagnoses, and also increases in health-risk behaviours; which will have impacts on virtually all life areas.
I want to note that having diagnoses, certain symptoms, or behaviours following years of abuse and maltreatment can be a somewhat expected response to adverse life experiences in the form of coping strategies to survive; which later become challenging. This also doesn’t mean that these can’t be changed; healing and recovery is certainly possible with the right systems and supports in place. Importantly, the increased likelihood of mental health diagnoses can help to reveal the lasting impact of childhood trauma, and the understanding of this can frame a much-needed update to our approach.
It is also important to highlight the increase in health service engagement for people who have experienced child maltreatment, which included increased likelihood of; overnight hospital admissions, consulting with a mental health nurse, seeing a psychologist, psychiatrist, and visiting any health practitioner (all within the past 12 months). This means that we have important opportunities to cross-collaborate as people are trying to seek support.
Finally, from a financial perspective there is an economic impact of a system not adequately set up to provide the best support. The brief report for the ACMS states: “In 2020, the Productivity Commission estimated the annual cost of mental health disorders and suicide as $200-220 billion. Child maltreatment contributes substantially to this crippling national burden. Even from a crude economic perspective, we cannot afford not to invest more in child maltreatment prevention. Such investment also promotes a contemporary acknowledgment that federal budgetary policy must not only consider gross domestic product; it must promote the wellbeing of individuals, families and communities.”
Healing is required from both a moral and financial perspective: We have the opportunity to do better.
In short, we can no longer ignore the wide-reaching impacts of trauma. It is a national emergency to create an ideological shift in both healthcare services and practical supports that address these at different levels and sectors in a way that extends beyond capped or 10-session models and siloed community services. Instead, we should incorporate our existing knowledge on the relationship between mind, body, and, if may, soul, identity, relationships, and community; all of which trauma disrupts.
Here is what I think we could work on:
1.) Understanding that a person’s behaviour or surface level diagnosis, as well as their so-called ‘risky’ health-related behaviours can be normal and reasonable responses to their experience of trauma. Understanding this changes the narrative from a diagnosis to be ‘fixed’ into a more humanistic understanding of someone in pain doing the best they can to survive.
2.) Our reliance on private ten-session talk-therapy models is not enough, and nor is our reliance on siloed talk therapy in general; which does not necessarily address all the elements of physical health challenges that people may face. As such, we need to set up systems that are supportive and accessible for people to do the deeper long-term work which addresses the multi-impacted elements of their lives by trauma, including long-term physical health. I suspect this means support and co-ordinated care from an array of clinicians and holistic modalities that can work together in a client-centered way.
3.) As trauma impacts the brain, body, and emotions (as well as relationships); it needs to be widely appreciated that healing also has to address all of these elements. This could encompass a person-centered approach that involves an understanding of the importance of a respectful, warm and understanding therapeutic relationship; tools to support the physiological aspects of the impacts of trauma such as dysregulation and dissociation (such as grounding and mindfulness); access to health services that also incorporate addressing physical health and health-risk behaviours; and incorporating creativity into healing, which has already shown many positive results (Van de Kolk, 2014).
4.) I’m aware that expressive therapists exist within Australia, but I think this significant evidence-base could be better integrated into healthcare; both within the community and privately. I have discussed previously that we are under-utilising clinicians in a great time of need nationally, and would do well to find a way to work together (Jaross, 2023). Renowned therapist Esther Perel revealed that in a conversation with her husband about trauma survivors and when they ‘come back to life’; they agreed that it was when someone can engage in play and creativity. As a survivor myself, I agree that this was an important element of my healing that could not be addressed in talk therapy alone: Active engagement in movement, art, or a creative process restored parts of my soul. From a scientific perspective we know that creativity can help us integrate memories, create new neural pathways, and re-regulate our nervous system.
This is not to say that great work is not already happening. I see there is a move towards holistic practice, such as community services who have begun to incorporate creative and expressive therapies within their repertoire of service offerings alongside nurses and counsellors; clinicians who are becoming trauma-informed in their practice; an understanding of the importance of the therapeutic alliance/relationship. (Just as our relationships may have been a source of pain or damage growing up, so can they be avenues of healing, from a variety of sources).
And yet, I think we can – and need to – do better to have systems that support an integrative long-term model for people in pain. I don’t want this to be the exception; I want this to be the norm.
Overall, I think there is an overdue shift required in our ideological framework to recognise the far-reaching impacts of childhood trauma, concurrently set up systems to support this long-term, deepen the implementation of our knowledge of trauma and physical health, have cross-sector and professional collaboration the norm, and increase the accessibility and integration of body-based and creative modalities to support healing and change.
I will highlight that I am not equipped to present the entirety and details of an elegant solution. I am, however, equipped to provide the intersection of lived experience, research, and clinical experience to highlight that what we’re doing nationally requires an urgent update: Both in ideology and approach, as well as practical systems set up to support the healing of the Australian population long-term.
I would now love to see tangible change; from a moral and humanistic perspective, from a lived experience stand-point, and from a professional one that believes that we have the knowledge to do better for our current – and future – population.
References
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245–258. https://doi.org/10.1016/S0749-3797(98)00017-8
Higgins D.J., Matthews, B., Pacella, R., Scott, J.G., Finkelhor, D., Meinck, F., Erskine, H.E., Thomas H. J., Lawrence D.M., Malacova, E., Dunne, M.P. (2023). The prevalence and nature of multi-type maltreatment in Australia. The Medical Journal of Australia, 218(6), S19-S25. https://doi.org/10.5694/mja2.51868
Lawrence, D.M., Hunt, A., Mathews, B., Haslam, D.M., Malacova, E., Dunne, M.P., Erskine, H.E., Higgins, D.J., Finkelhor, D., Pacella. R.E., Meinck, F., Thomas, H.J., Scott, J.G. (2023). Association between child maltreatment and health risk behaviours and conditions throughout life: The Australian Maltreatment Study. The Medical Journal of Australia, 218(6), S34-S39. https://doi.org/10.5694/mja2.51877
Jaross, M. (2023). Trauma, early interventions, and the issue of access in Australia. Medium. (Republished on mariannajaross.com.au, 2024).
Mathews, B et al. (2023). The Australian Child Maltreatment Study: National prevalence and associated health outcomes of child abuse and neglect. The Medical Journal of Australia, 218(6), S1-S47.
Mathews, B., Pacella R.E., Scott J. G., Finkelhor, D., Meinck, F., Higgins, D. J., Erskine, H.E., Thomas, H.J., Lawrence, D., Haslam, D. M., Malacova, E., Dunne, M, P. (2023). The prevalence of child maltreatment in Australia: Findings from a national survey. The Medical Journal of Australia, 218(6), S13-S18. https://doi.org/10.5694/mja2.51873
Mathews, B., Thomas, H.J., Scott, J.G. (2023). A new era in child maltreatment prevention: Call to Action. Medical Journal of Australia, 218(6), S47-S51. https://doi.org/10.5694/mja2.51872
Pacella, R.E., Nation, A., Mathews, B., Scott, J.G., Higgins D. J., Haslam, D.M., Dunne, M.P., Finkelhor, D., Meinck, F., Erskine, H.E., Thomas H.J., Malacova, E., Lawrence, D.M., Monks, C. Child maltreatment and health service utilisation: Findings from the Australian Child Maltreatment Study. Medical Journal of Australia, 218(6), S40-S46. https://doi.org/10.5694/mja2.51892.
Scott, J.G., Malacova, E., Matthews, B., Haslam, D.M., Pacella, R., Higgins, D.J., Meinck, F., Dunne, M.P, Finkelhor, D., Erskine, H.E., Lawrence, D.M., Thomas, H.J. (2023).The association between child maltreatment and mental disorders in the Australian Child Maltreatment Study. The Medical Journal of Australia, 218(6), S26-S33. https://doi.org/10.5694/mja2.51870
Van de Kolk, B. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking Press.
© Marianna Jaross
Note: This article is independent of my professional association(s) and workplace(s).
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