Some authorities say that up to 60 percent of psychiatric patients, both in-patient and out-patient, report childhood histories of physical or sexual abuse or both. This estimate excludes emotional abuse and neglect. My experience confirms that very many patients are suffering from PTSD (posttraumatic stress disorder) as a direct result of childhood maltreatment. But they do not know what their real problem is. And worse, they often get the insulting diagnosis of Borderline Personality Disorder!



Psychologists and psychiatrists know what to expect in the way of symptoms with war veterans: PTSD. We know as fact that the experiences of war can produce in even the strongest individual the constellation of symptoms that therapists should recognize as trauma. But for some reason, we have only begun to make this same connection with people whose lives have been a ?war.?

One woman, who spent nearly 20 years in therapy, first with an educational counselor, then three psychiatrists, plus a family therapist, found herself with suicidal feelings right up to the time she entered our group for domestic abuse. One psychiatrist, an analyst, spent two years asking her, ?What do you think?? Another psychiatrist gave her open prescriptions for highly addictive drugs, and the third psychiatrist wanted to use electroconvulsive therapy, probably the worst possible treatment for trauma survivors. The family therapist ordered her to draw a family geneology chart.

None of the above professionals seemed determined to find the cause of her suffering; they just had their favorite ways of treating symptoms. Her real problem had been nightly incest at the hands of her biological father, the rejection by her mother as a result, and constant debasing comments by both parents and both sisters all of her life. Not even her head-banging, a dead giveaway for sexual abuse, was noticed.

Another woman was in treatment for thirty years for depression and a ?borderline personality disorder,? ten of these years with the same psychiatrist. When the decade had

passed, he remarked, ?I really don't think I can help you.? Never was her sadistically violent tormentor, her husband, ever seen or even asked about. She in no way had a borderline personality disorder, but she was indeed suffering from PTSD as a result of life-long abuse.

None of her therapists had been interested in causality. A disinterest in root cause is, in my opinion, the greatest weakness in the mental-health professions. We have clung so closely to the medical model that emotional disturbances of most any kind have historically been seen as free-standing, as though they had arisen from an infection, from a vacuum, or from nowhere. How this mentality has survived is a mystery, when in any other science the principle of cause and effect rules.

Put another way, for every action there is a reaction. Molest, torture, humiliate, or neglect a child severely enough, and PTSD or similar symptoms will be the reaction. For this reason, the treatment of domestic abuse is the treatment of child abuse, and both are the treatment of trauma.