Face to face

As we all know, recognising, safeguarding and pro-actively promoting the needs of children is one mark of a civilised society. We know from an abundance of research that the brains and bodies of children are very sensitive to environmental influences in their broadest sense. The success and quality of this growth process can easily be undermined by a range of factors. Perhaps the most important of these is a lack of safety.

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Feeling safe is essential for normal development. Fear and stress tell a child the world is not a safe place. The Autonomic Nervous System (ANS), designed to respond to love and nurture for survival, amongst other influences, prepares to do battle instead. This is essential in the short term but hugely damaging in the long term. Of course, there are many occasions when the adaptive attachment system focuses on surviving by endlessly trying to please the source of its fear and the authority creating it. “I’ll do anything to ensure you love me and don’t abandon me”. (Stockholm Syndrome) We know that insecure attachment experiences often involve a loss of trust by children in significant adults and that this is driven by fear, lack of safety, neglect, abuse, etc. All undermine normal development. This can lead to a mistrust of all adults and the development of a hypervigilant state. In this case, many are traumatised and do not trust anyone, ever. Why should they? At the heart of all this is persistent stress, identified and described as “toxic” by The School for the Developing Child at Harvard. Fear rewires the brain through a process of “neural plasticity”.

We know the overall effects of this can have damaging consequences for development because the fear response shuts down the child’s evolved learning mechanisms. The learning and survival circuits are intimately related. Children learn effectively when they feel safe. When they do not, it is true, they “can’t think straight”. They stop learning, other than to reinforce the belief that the world is a dangerous place alongside a debilitating reminder that they are not worthy. In the words of some psychiatrists, the lesson is they are not lovable. This so easily becomes a lifelong state that, according to psychiatrist Peter Breggin and others, determines most emotional and mental health difficulties into adulthood. We cannot effectively solve life’s problems if we do not trust anyone and why should anyone help us if we are not worthy?   

Incidentally, one of the main ways a child or young person judges whether an adult is safe to engage with, is by unconsciously interpreting their facial signals. Smiles, warmth, friendly welcoming expressions reassure us. Where a face is covered and therefore displays no emotional expression there will be uncertainty. For the vulnerable child this is likely to translate as fear, especially where there is pre-existing trauma.

From the work of Professors Anders and Felitti, Dr Nadine Burke Harris, California’s Surgeon General, Prof Stephen Porges, Professors Wilkinson and Pickett and Prof Robert Sapolski, we now have abundant evidence that stress and fear in childhood, can not only lead to serious mental health difficulties throughout life, but also chronic physical ill-health, including early death. People who are homeless (for most, read former abused, neglected and fearful children) tend to die in their forties… thirty or forty years before the rest of us. We know why. We now have a pretty good idea that all these influences and responses are not simply affecting the brains and neural circuitry of children but are embodied within the organism via the Autonomic Nervous System (accompanied by continually raised cortisol and adrenalin levels etc). Our hearts and other organs respond with the amygdala influenced stress reaction. Under sustained stress, the consequences relate not just to mental health, but physical health as well. Sustained fear kills.

Research and practice in the field of Adverse Child Experiences (ACEs), explodes the myth that childhood resilience easily overcomes adversity. (See an earlier blog on this website). ACEs refer to those experiences that create extreme stress from living with fear, neglect, abuse, domestic violence, poverty, mental health issues, family unemployment etc. These experiences can lead to sustained worry, trauma or anxiety. This research clearly shows that the more ACEs a child experiences, the more likely he or she will suffer from mental health difficulties, autoimmune illnesses, chronic diseases like heart disease, diabetes (caused by stress as much as diet), poor academic achievement and substance abuse later in life. ACEs are not used as a diagnostic tool but they often corelate with serious illness.

Experiencing ACEs where adult support is minimal can lead to “toxic stress”. This excessive activation of the stress response can lead to long lasting wear and tear on the brain and the body. (The effect is similar to revving a car engine for days or weeks at a time). On a scale of 1-10, relating to the number of ACEs experienced, the higher the score the more likely serious illness may occur. Where a child has supportive adults and carers, described as buffers, serious effects can be mitigated. By definition, vulnerable children often lack this kind of support.   (Profs Anders and Felitti and also Dr Nadine Burke Harris for quick reference).

Prof Stephen Porges’ work focuses on “Polyvagel Theory”. It is also concerned with the way the Autonomic Nervous System works, how it reacts to experiences and regulates responses. It reacts to stories about self, the world and relationships. These are based in the autonomic state.

The ANS is a monitoring and surveillance system. Porges suggests its state is the bedrock of our health and how we relate to the world.

It looks for context, choice and connection in order to find safety and regulation. When one of these is missing, a sense of unease develops and the ANS prepares for protection. When choice and freedoms are restricted, or we experience feelings of being confined or trapped, the ANS senses danger and enacts a survival response. The sympathetic nervous system takes over, which is positive for short term responses but potentially harmful when sustained. For some traumatised children, it can remain switched on permanently: This is toxic.

The theory states that the ANS is shaped by on-going experience. It is constantly searching for cues of safety and danger. It co-regulates, meaning it is regulated through interactions with others. (Where we fear “the other” we reinforce habitual survival patterns). Where children witness constant fear in others, especially in adults, this may be internalised by children.

Two primary experiences exist in the ANS: the biological need for connection and attachment and the wired for survival response process. The latter is activated where the ANS has been shaped in an unsafe environment to the extent that even in a safe environment, the ANS can remain in a habitual hypervigilant, alarmed state with no way back to safety and connection where social engagement, growth restoration and regulation take place.

Simply put, where safety is perceived, we are social, engaged and connected. Where the perception is of danger, we mobilise for fight, flight and action and where we feel seriously threatened, we disconnect from others and ourselves and feel lost. We immobilise, shut down and collapse. We sometimes see these reactions in vulnerable and traumatised children.

Fear and trauma represent a risk to what Polyvagal Theory refers to as The Social Engagement System, also referred to as our face-heart connection. The heart and nerves in the face and head connect to control facial and emotional expression. There are 42 muscles in the human face which have evolved for this purpose. These pathways search for signs of welcome and signals of warning. For example, a face without expression or movement can signal a clear warning, especially for a traumatised individual. It triggers a survival response and with it, a sign that connection may be dangerous. Trauma impacts the autonomic system through acts of commission, (things done to a person) and acts of omission (neglect, unpredictable connections). Connection is a biological and human imperative; chronic disconnection is traumatic.

When opportunities for co-regulation seem risky, dangerous or intermittent, children do not learn the skill of co-regulation and must depend on self-regulation. Instead of feeling safe, the survival or sympathetic state takes over. When the ANS has been shaped by trauma, responses are biased towards protection and survival rather than connection and engagement.

Suffering occurs when we are pulled into survival response and get stuck there. Well-being comes from connecting with resources to return to regulation, but in a state of fear and vulnerability, that very connection struggles to make it and so co-regulation is not available and self-regulation is likely to be inadequate and unsuccessful. This leaves children in a cycle of disconnect - activated distress - disconnect.

The crucial message of Polyvagal Theory is that children and young people (indeed all of us) rely on the social engagement system to learn and function as normal, socially connected human beings. The more vulnerable a child or any of us is, the more problematical such functioning is.

As human beings we need love and connection. We need each other. Where these are lacking, there are significant risks to our mental and physical health. As well as the potential for accumulated ACEs, discussed above. Polyvagal Theory emphasises that it is not necessarily an accumulation of such experiences that can lead to health consequences but also, for some children, just one traumatic event can lead the ANS becoming sympathetic dominant (fight/flight, hypervigilance), leading to the social engagement system being supressed. (ACEs can miss those on the edges). Here, our needs for connection with all its therapeutic benefits, cannot be met.

Perhaps one consequence of this, among many others at present, is that suicide in men under 49 years of age has sky-rocketed and this desperate act of isolation, loneliness and despair is now the highest cause of death in young men.

“The primary factor in recovery from traumatic events is the presence of a supportive, caring adult in a child’s life. Even when a parent is not available, children can benefit greatly from care provided by other adults who can offer them consistent, sensitive care that helps protect them”

Rod Salter

Published: 27th Jan 2021

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