The neuroscientific agenda and advances in the understanding of trauma and abuse­

In recent years there have been huge advances in our understanding of the effects of trauma, neglect and abuse on a child’s developing brain. These findings have helped confirm what staff in residential settings have been experiencing with such children. Research has shown that the brain of the newborn baby actually grows in response to nurture, love and positive touch and carries on like this well into the second year of life. Chemicals such as the hormone oxytocin are released during these positive interactions promoting loving feelings, reducing the impact of stress and boosting the immune system.

However, the brains of infants like Lucy (in the case study opposite) who experience severe neglect, and physical and sexual abuse can have areas which simply do not develop healthy brain connections. When early experiences are traumatic, different chemicals are released which create unhelpful nerve pathways as well as increasing blood pressure, heart rate and stress levels. It is likely that from early on, perhaps pre-verbally, Lucy became habituated to this agitated, stressed way of being and that this contributed to her insomnia, hyper vigilance and unprovoked outbursts.

Successful adaptation
In the same way we know that environmental risk factors associated with childhood trauma can lead to a lack of attachment and poor outcomes for children. Environmental risk factors that diminish resilience in the personality include: family breakdown, parental drug addiction, major losses such as bereavement, neglect, sexual and physical abuse and domestic violence. These factors often become co-morbid and compound to decrease the chances of the child’s successful adaptation to his or her home, school and community environment:
“the child exposed to chaotic or threatening caregiving develops a sensitized stress-response system that affects arousal, emotional regulation, behavioural reactivity, and even cardiovascular regulation. These children are at risk for stress- induced neuropsychiatric problems in later life” (Perry and Pollard, 1998).

Openness to new theories
Over 70 years the evolution of the school as a therapeutic environment has required an openness to new theories and ideas. Recent advances in neuroscientific research tell us that just as traumatic experiences freeze and dysregulate children’s emotions, over time the experience and delivery of empathic caring relationships can work to ameliorate and modify these psychopathological states.

This understanding supports and complements our intuitive and psychodynamic understanding of building close relationships. Through the provision of empathic and nurturing experiences ‘reflected’ by adults and ‘mirrored’ by the child, we can help children understand that meaningful relationships and social living are possible. It deepens our understanding of how children can internalise adults as caring role models.

For children such as Lucy a fundamental lack of a sense of security and attachment with a primary carer causes them to experience the world as hostile, dangerous and persecutory. A lack of secure attachment undermines the child’s ability to construct self in relation to the primary carer. Rather than developing a coherent personality, their sense of self is fragile and fragmented.

This traumatised state of mind has been referred to as “unthinkable anxiety” and consequently children defend themselves against these unprocessed feelings of anxiety, betrayal, despair and mistrust through chaotic, aggressive and sexualised behaviours. In extreme cases where the attachment experience has been so disrupted, and the child’s “internal working model” becomes “disorganised”(Bowlby, 1969), they can act in violent and aggressive ways, apparently showing little concern or empathy for others.

Safety and attachment
In response to these adverse experiences, children adopt behaviours which appear to be designed to keep adults away. At the school we regard these behaviours as misdirected communications for a need for security and attachment. In this sense, one aspect of our task is to understand behaviour as communication. Such ‘traumatic’ behaviours influence those adults who work closest with them. For these workers these ‘unthinkable’ feelings often reflect the original intensity of feeling in the child.

Working closely with disturbed children is anxiety-provoking. Chaos and aggression are never far from the surface. The effective management of anxiety is a therefore a critical and key concept in providing a safe and nurturing environment. How this anxiety is acknowledged and contained is imperative for successful work with emotionally damaged children.

Neuroscience is, however, just one component of the therapeutic milieu used in the Mulberry Bush School – a therapeutic culture has evolved over 70 years since the founding of the School in 1948. Our model of practice for the care, treatment and education of traumatised children continues to evolve from the synthesis of a number of theory bases, traditions and legacies. I believe it continues to evidence that well-managed, relationship-based residential care really can contribute to the psychological wellbeing of our society’s most emotionally troubled children.