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Hi, welcome to Mental Health Matters. I'm Shannon Eliot. Today we'll be discussing the
role of trauma in mental health. Gena Castro Rodriguez is a licensed Marriage and Family
Therapist and specializes in providing therapy to victims of trauma. She is also the co-founder
of the Youth Justice Institute, a non-profit agency in the Bay Area serving youth in the
juvenile justice system. Gena has written numerous articles in the areas of *** identity
and exploitation of young women. Nicole Plata is the Youth Initiatives Coordinator for the
Mental Health Association of San Francisco. She has overcome a variety of challenges in
her youth, from abuse and street violence to involvement in the criminal justice system
and a traumatic brain injury. A native of East San Jose, Nicole uses her experience
with trauma to advocate for California youth. Welcome, Gina and welcome, Nicole. Thank you
for joining me today.
>>Thank you.
>>Gina, how do you define trauma and how prevalent is it?
>>One of the ways that we think about trauma is that it's when external events overwhelm
a person and their ability to cope and that you have these long-term effects from it,
so there are lasting effects of the trauma. And it's actually quite prevalent. The American
Psychological association says that two-thirds of kids by the time they reach 16 will have
experienced some type of trauma.
>>So to what degree is trauma a cause of mental health issues?
>>I think that it's probably more than we know. There are a lot of symptoms that you
experience with trauma because it is very pervasive that mask or look like other mental
health issues, behavior issues, learning issues. So I think if we get better about assessing
and understanding what's happened for young people, we can get better about linking the
trauma to the behaviors that we see and really identifying what triggered or began those
behaviors for them.
>>And what are some behaviors that you would see and how does trauma influence emotions?
>>It influences your cognitive abilities, your emotions, your relationships, and your
learning; it's very pervasive. So for young kids after an immediate trauma, we see some
behaviors that look fearful. They can have sleep disturbances, physical symptoms. They
can start to avoid situations or develop new fears. And then later it actually affects
they way they relate with other people and the way they walk around in the world and
the way they engage. So you have a trauma and then there are the effects of the trauma,
which are the things that kind of happened to you -- the symptoms that happen to your
body and to your mind and then the reaction is the way that the kids learn how to adapt
to the trauma and the side effects and the different things that they experience and
then they relate to the world differently.
>>So Nicole, I understand that you've had quite a bit of personal experience with trauma,
particularly abuse. What kinds of physical, mental, and *** abuse did you face as a
kid?
>>Well there were just times there was some abuse in the family and at home and physical
abuse, I mean, there were a few times that I some family members tried to rip out my
hair. I was physically hit and I was intimated and told not to talk about it. You know, it's
kind of funny because a lot of a times in it was a reaction to something I did emotionally.
It wasn't actually like I was doing something wrong. It was being corrected in some way.
It was a family member who got hurt by something I did and so emotionally reacted through physical
violence. I had also some molestation that happened when I was younger through just within
the family as well, and also with just different relationships I had at school that were abusive.
>>I remember when we were chatting before you mentioned some stuff at school, particularly
something that happened on your birthday. Tell me about that.
>>At school in general it was very rough because the neighborhood I grew up in there was a
lot of this looming threat of violence. If you didn't personally see a gang fight or
you didn't personally see a shooting, then you heard about it all the time. You heard
about people getting shanked, you heard about so-and-so getting jumped, you heard about
friends knowing friends who passed away and from gang violence. And so that was always
there. And we always had this negative. It was really intense and we just interacted
with each other in intense ways. I remember it was a habit on people's birthdays to go
and actually hit them. You know like on typical birthdays there's this tradition that you
get a spanking, one for every birthday. But at school you basically get jumped for your
birthday. I remember on my thirteenth birthday, I was surrounded by probably about 20 or 30
kids and basically they just punched me over and over 13 times on my birthday. And I had
bruises up and down my arms, you know, coming home. And I had thought it was normal. I had
thought that you know, that's what everyone did. But mine was a little more, other people
got slapped, but I was actually punched.
>>Yours was a little more intense than everyone else's.
>>Yeah, it was really intense. It was really surprising to have. You know, they basically
gave me a hug and pulled back and started wailing on me. That was seventh grade.
>>So how did you deal with that in the moment and how does that affect you to this day?
>>In the moment, I thought it was normal. I thought that's what friendships were. These
were young people that I was obligated to feel cool or look tough around in order to
feel safe, especially what was going on in my environment at the time. I didn't have
family at home. By that time, my closest sibling was incarcerated and my mom separated from
my dad, who was my safety. He was the person that was always there. My mom worked long
hours and I was home alone, so these were the kids that I found.
I was looking for love. I was looking for safety. And so I definitely think it's been
a challenge learning how to redefine my boundaries in relationships, and what is appropriate
in relationships in interacting with people. And also too what's been a challenge is identifying
how to express my needs and how I feel because often I'm very confused with what's ok, especially
in that situation. That was what was socially accepted. And also anytime that I expressed
a need like, "Ow, that hurt, that wasn't cool," then I was putting my safety in jeopardy.
And so there's a lot of this intensity around being vulnerable and saying, "I actually need
this from you," because that would make me look weak. Because I was supposed to be able
to take it. I think that's why I walked about thinking that I was supposed to take it. I
think that's what I walked away with. I was supposed to be able to take it. I walked away
feeling like I didn't cry because they hit me. I felt some shame because I had the bruises
on my arms, but there was also almost like this, "I had to." I don't know. I have a hard
time being in my relationships. Sometimes it's difficult admitting when I have needs
or when I have feelings that are negative. I can get confused whether or not they are
appropriate to express.
>>Sure, especially, when you didn't feel safe being beat up and then you didn't feel safe
saying, "Stop it." What other option do you have in that sense?
>>Gina, how does trauma in youths compare from trauma in adults?
>>So Nicole's story is really kind of a powerful example of what happens to young people who
experience trauma. There is something called developmental trauma, which is trauma that
happens in a developing child. So early in childhood, usually in the caregiving relationship
and what happens is when the people that in your life that were supposed to keep you safe
and were supposed to take care of you and meet your needs and provide for you don't
for a variety of reasons -- because they cant or because they are disturbed themselves or
because they are not able to provide those things -- your attachment and the way you
see the world changes. The way you see relationships and the way you see the world changes. So
for a lot of kids who experience physical abuse or *** abuse or neglect in the family,
they start to learn these really important messages about safety and about who keeps
them safe and about where they need to get the love and attention they need to survive,
where they need to go to get that. And unfortunately when you don't get it in your caregiving system,
you have to reach outside the caregiving system and it puts these kids at great risk for being
exploited or abused further outside of the family. And like Nicole talked about, things
get normalized because if in your family abuse or pain or neglect becomes normalized in the
way you see the world, then when you go out in the world that's what you experience and
you do see it as normal. You do see it as ok or acceptable. Kids who get that that attention
that they need know right away when it's not right and when it shouldn't happen to them.
So unfortunately the childhood experiences and then sort of how those broaden outside
of the home change the way you walk around in the world. And I think that Nicole really
spoke to that. It can be then confusing to know what's ok for me and what's not ok for
me and what do I allow people to do in order to have them in my life and what I don't allow
to happen. We do see a lot of kids that have childhood trauma early in their development,
then seem to be at risk for ongoing trauma. They seem to get into relationships where
they are further abused or further victimized or they are in friendships that may take advantage
of them or exploit them. A lot of that comes from not having that sense of security and
safety in the beginning.
>>Gina, what types of trauma are there and what are some potentially traumatic events?
>>So there are interpersonal traumas and those are the things that happen to us and happened
in relationships. And then there are these external traumas and we can both be affected
by them and we can be affected by helping people who are experiencing them. So interpersonal
traumas are things like abuse neglect, *** abuse, domestic violence, not having your
needs met, having something happen to you interpersonally, some kind of an assault.
And then sort of the external things could be natural disasters or wars or even illnesses
in the family, and those you may have or you may experience them yourself but you also
experience them by working with, living with, or being with people who experience them.
So we're starting to expand the definition to include people who work in trauma and are
affected by the trauma that happens to the people that we work with.
>>Nicole you also experienced physical trauma from a brain tumor. How has that affected
your mental health?
>>That was definitely a new challenge that really was very similar but very different
at the same time. I think with the tumor, just to give a little background, it was the
size of my fist in my brain stem and also in my throat. And because of that I have a
paralyzed vocal chord. But I remember when I first got the diagnosis and I went to one
of the surgeons and even just being 23 and walking into a neuro-oncology department and
having to wait in the neuro-oncology department, it was like, "What? Cancer at 23?" That freaked
me out. And I remember just being in a constant state of panic and I felt a lot of anger at
my body like I'm killing myself, like my body is killing me. And when I went to the doctor,
the surgeon told me that there was the potential -- because the tumor surrounded my carotid
artery -- so I was at risk of a stroke. I was at risk for losing the ability to swallow
and speak. And so they were talking about permanent feeding tubes being placed, permanent
tracheotomies, and I'm like, "What?" I would basically be losing the ability to have sensation
in my mouth, so slobbering all the time. And so I remember being on the bus on my way home
from work and in my mind cursing people out in my head that I see on the bus because I'd
be so mad. I 'd feel like, "You're not even grateful that you can breathe on your own.
You're not even grateful that you can eat." And I mean that was, just the waiting was
really hard. I'm pretty independent, but for awhile I couldn't sleep without having someone
spend the night with me in my room and I never slept with a stuffed animal before. Since
then, I can't sleep without a stuffed animal. I had several panic attacks. One day I felt
like I just couldn't breath and I was going numb and I felt like everything in me wanted
to scream at the top of my lungs. One thing that has really helped me is reading my bible
and praying. I remember going to the beach and there was so much and I couldn't even
focus.
I felt like I was in this fog, in this haze and I felt like no time or space existed.
So I wen to the beach over in Pacifica and I screamed out at the top of my lungs, just
everything that I felt. I was crying and praying and screaming out my everything, like tears,
saliva, everything was coming out. That really helped, but it's been a challenge. You know,
I'm so grateful because I had a ton of support. I had a ridiculous amount of support. I had
about 50 of my family members and church family who prayed for me for 14 hours during the
entire surgery and took care of me. And that definitely has helped. But after it was really
hard, especially when just the physical pain has led to a lot of anxiety. And now I have
a lot of anxiety around flying and being in cars, which is really funny because I have
flown every year of my life since I was 8 months old, but now I start panicking because
I never knew that much pain existed before. And I remember waking up from surgery thinking,
"I feel like I just got hit my a train. I feel like I just got hit by a train." And
then the doctor comes in and says, "So Nicole, you did great. I just want to let you know
the pain you're feeling right now is equivalent to being hit by a bus with a semi-truck following
right behind it." And I'm thinking, "Oh, so being hit by a train in legit." This is real.
>>You weren't making it up.
>>Exactly.
>>So at that point, I think at that point...now when I get into planes and in cars sometimes
I'm afraid of feeling that same physical pain again. I don't ever want to be back there.
And also there is a lot of depression that came after with losing my voice because I
know I don't sound the way I used to. And I used to sing and I can't sing anymore. Even
being able to yell. Sometimes when I'm doing my work and when I'm in certain areas, they
can be kind of sketchy neighborhoods, and I think if I can't yell for help, what will
happen? Or just interacting with my friends in the same way. I used to be a very loud
person. My church is a big important part of my life. When I go to events and there
are hundreds of people, I can't talk or engage with people like I used to because it's so
loud in that environment. So people don't hear me as much. Or even when going out to
dinner with a group of friends, they can't hear me. So I have an iPad now and I write.
But even having to do that, there's kind of this shame and embarrassment. I'm only 25
and I have to do this.
>>Gina, what are some short- and long-term effects of trauma?
>>So short-term, it really affects a child's behavior and how they feel in the world and
how they start to interact with people. And I think Nicole has spoken to that a lot. There
are these certain ways that they have so start adapting in order to either mediate some of
the trauma or hide some of the trauma or try to survive the trauma. But then long-term,
unfortunately there are lots of really pervasive symptoms that we see, even physical health.
There are a lot of diseases that are tied to early childhood trauma, and that ACEs study
really gave us a lot of information about this long-term research about the link between
the number of incidences of trauma and then the correlation to health issues later on
including diabetes and obesity and heart disease and things like that. And then there is, also,
I think pretty important in the relational changes that happen for young people. So when
they experience trauma early in life, they have to learn some important lessons about
how to handle that trauma and those things don't play out as normal relationships later
when they are older. So they either have to protect themselves and stay away from relationships
or they have to cling to relationships because they are trying to get what they didn't get
before. And often they get themselves in these cycles where the abuse continues or repeats
or goes on in their life. They have more of it. So it's a challenge for them.
>>It seems like the role of trauma is often overlooked when it comes to folks that are
acting out or having misbehaviors or harmful behaviors. Why do you think that is?
>>I think it's kind of what Nicole said. If it looks sad and depressed and you need help,
people are more used to that kind of a symptom and you can reach out and things that make
sense like illness, people reach out and help. But when it looks like anger or aggression
or criminal behavior or delinquency or any of those things, we start punishing the behavior
and not looking at where it comes from. So it's really common in the juvenile justice
system for us to see kids exhibiting behavior that's not normal for their age and not ask
where it comes from, but just punish the behavior. So kids that are doing things that are abnormal
like assaulting other people or being involved in really dangerous activities or hurting
themselves with substances or with their activities, there is something behind that. There is something
that is motivating that kind of non-normal behavior, but if we don't ask then we are
only treating the behaviors that they are using to cope with it. We're not dealing with
what drove it.
>>I also think that at least it was true for my family, there's other traumas that occurred
with my parents and also in general throughout my family. And I think what I see is that
there is this uncomfortability. They haven't had an opportunity to get the support they
needed for their traumas. I don't know, I don't have any kids, but I'm assuming that
when you see your kid going through something, it brings up your own stuff. And not being
quite sure, not being taught how to appropriately deal with your own, it could become easy.
And one of my parents, for example. My father -- my biological father -- I didn't grow up
with him as much, but he came in and out of my life. And I remember he lived in the more
wealthy part of town and I lived in East side and he didn't grow up in that environment.
So when he'd see me, he would say, "Cut that gang crap. You're doing that gang crap. You're
acting like this, like those people." But he didn't understand because he wasn't from
that context that I was living in. And also too there were others traumas in the family
that weren't being dealt with. And so I think it was easier to go, "Stop it" rather than
have that conversation because I don't think that he was ever supported in that way to
have that conversation as well. And I don't think that he intended to shut me down, but
I think that's what can happen when you're a service provider or parent, or any caregiver
role for young people. And there's those traumas that I think in general a lot of people feel
that shame, that stigma, that uncomfortability to deal with it and also just the helplessness
like talking about I was abused, now what, what do I do with that.
>>So how does one recover from trauma? How treatable is it?
>>So it's important to know that there are different kinds of trauma because they need
to be treated differently. There are lots of short-term intervention kinds of traumas
that work well with single incidents of trauma, so there are cognitive therapies and there
are immersion therapies. Those tend to work best for people that have pre-trauma safety
and support and structure and they had some internal coping that they can pull for when
they have the trauma. So those short-term treatment models work well in that situation.
Where they don't work well is for a lot of kids that we see in child welfare or delinquency,
or in communities that have violence. These kids have experienced early childhood trauma
-- developmental trauma -- and then it becomes chronic and complex.
So a lot of what Nicole has talked about. It wasn't a single incident or trauma. It's
actually the way that Nicole lived and had to experience both her home and her community
and then she even had the medical trauma later on. So those short-term interventions don't
work very well for someone who has that kind of experience.
And really what you're looking at is long-term trying to change these pathological beliefs
that have developed out of the trauma, so these beliefs about how the world is, about
how the young person is, and about how they have to engage in the world. So some of those
pathological beliefs end up being that the world is not a safe place, or people that
love me aren't going to be there for me or I'm the only person that can take care of
myself and I can't rely on other people or people who love you hurt you. All of those
lead to putting kids in situations where they continue to get hurt. If you believe love
can also be painful and abusive, then you get into relationships that can also be painful
and abusive because that's your experience and that's the way that you see the world.
So the treatment has to be about changing those beliefs and helping people to establish
safety to take back their power, to understand how they can speak for themselves and how
to protect themselves. And anyone can have an impact in that way. So therapy...there's
relational therapies. There's longer term talk therapies that really help sort of change
these ideas that young people developed, but mentors and teachers and service provider
can all play a role in helping change the way young people walk around in the world
by giving them a different experience. So by being safe, by being protective, by being
interested, by worrying about them and helping them and supporting them, you help change
the way the world is for them.
>>Well Gina, thank you for sharing your expertise and Nicole, thank you so much for sharing
your story today. It was a pleasure. Best of luck to both of you.
>>Thank you.
>>For more information on trauma-informed care, visit SAMHSA's website for the National
Center for Trauma Informed Care at: www.samhsa.gov/nctic
To learn more about Gina's upcoming trauma trainings, visit her website at www.castrorodriguez.com
The Trauma Center at the Justice Resource Institute offers education, research, events,
publications, and other resources. Visit their website at www.traumacenter.org.
Thank you so much for watching. We'll see you next time.