Stopping intergenerational cycles of trauma

Understanding the root of stress and trauma experienced by patients as individuals is a key charge of psychiatry. But patients also can experience psychological distress because of the traumatic experiences of previous generations. The mental health community must be prepared to treat patients who fall into the latter category.

My colleagues and I recently analyzed representative samples of First Nations adults and youth living on a reserve in Canada. We found that the number of previous generations in which families were forced to attend Indian residential schools was cumulatively linked with higher levels of psychological distress and suicidal ideation among those who did not attend themselves (Transcultural Psychiatry. 2014, 51:320-338).

The forced removal of Indigenous children from their homes for the purposes of assimilation occurred over generations in many countries around the world. In Canada, these government-mandated church-run residential schools ran from the mid-1800s until 1996, and resulted in generations of indigenous children being exposed to chronic neglect, abuse, trauma, racism, and cultural shaming (“Honouring the Truth: Reconciling for the Future,” Truth and Reconciliation Commission of Canada, 2015).

Some of our more recent analyses revealed that having a family history of residential school attendance has been linked to a greater likelihood of early-onset mental health symptoms, which in turn, has been tied to an increased risk of suicidality and other unique outcomes that have implications for treatment and prevention. Furthermore, other negative outcomes experienced by indigenous peoples, such as low family income and limited educational opportunities, also appear to be involved in the intergenerational transmission of residential school trauma.

Against this backdrop in Canada, we have a prevailing sense of blaming the victim that is counterproductive to healing. According to a 2014 report by the Royal Canadian Mounted Police (RCMP), 1,017 indigenous women and girls were murdered between 1980 and 2012 across Canada. About one-third of the women died as a result of physical beating, and more than 90% of the victims had a “previous relationship” with the person who killed them, according to the RCMP report. Yet, despite evidence to the contrary, the prime minister of Canada shared his view last year that those staggering numbers should be viewed as a criminal issue and not a “sociological phenomenon” (CBC News, Aug. 21, 2014).

Members of other groups whose previous generations also were exposed indirectly to unspeakable trauma include Americans of African descent, Native Americans, and adult offspring of Holocaust survivors. Rachel Yehuda, Ph.D., has studied the latter group extensively.

In one study, Dr. Yehuda and her associates found significantly reduced cortisol excretion in Holocaust offspring, compared with controls (Psychoneuroendocrinology. 2014 Oct;48:1-10). In another study of the adult offspring of Holocaust survivors, Dr. Yehuda, professor of psychiatry at the Icahn School of Medicine at Mount Sinai in New York, found that “offspring with paternal [posttraumatic stress disorder] showed higher GR-1F promoter methylation, whereas offspring with both maternal and paternal PTSD showed lower methylation.” Furthermore, lower methylation was tied to greater suppression of cortisol (Am J Psychiatry. 2014 Aug;171(8)872-880).

An appreciation for the power of epigenetics, or “soul wounds,” can help us stop blaming indigenous and other traumatized populations, and start tending to their mental health needs. Furthermore, getting individuals to understand these concepts can be yet another step on the path toward healing.

A study of 19 staff members and clients in a Native American healing lodge who began a discourse on the legacy of historical trauma found that counselors understood that their clients carried pain “leading to adult dysfunction, including substance abuse” (J Consult Clin Psychol. 2009 Aug;77(4):751-762). Second, the counselors believed that the pain needed to be confessed. Third, the counselors thought that expressing the pain would help the clients become more introspective. Finally, the process included reclaiming “indigenous heritage, identity, and spirituality that program staff thought would neutralize the pathogenic effects of colonization.”

We do not know the extent to which epigenetics are involved in specific diseases. Epigenetic mechanisms have not yet been tested as pathways involved in the intergenerational transmission of trauma in indigenous peoples. But Dr. Yehuda’s work with the children of Holocaust survivors shows that these mechanisms do indeed exist.

In light of what we do understand and the DSM-5’s emphasis on cultural competency, mental health professionals have a role to play in reversing the negative intergenerational cycles experienced by people across the globe. Only when we start paying attention to the plight of indigenous peoples across the globe will true healing begin.

Dr. Bombay is assistant professor of psychiatry at Dalhousie University, Halifax, N.S.

Understanding the root of stress and trauma experienced by patients as individuals is a key charge of psychiatry. But patients also can experience psychological distress because of the traumatic experiences of previous generations. The mental health community must be prepared to treat patients who fall into the latter category.

My colleagues and I recently analyzed representative samples of First Nations adults and youth living on a reserve in Canada. We found that the number of previous generations in which families were forced to attend Indian residential schools was cumulatively linked with higher levels of psychological distress and suicidal ideation among those who did not attend themselves (Transcultural Psychiatry. 2014, 51:320-338).

The forced removal of Indigenous children from their homes for the purposes of assimilation occurred over generations in many countries around the world. In Canada, these government-mandated church-run residential schools ran from the mid-1800s until 1996, and resulted in generations of indigenous children being exposed to chronic neglect, abuse, trauma, racism, and cultural shaming (“Honouring the Truth: Reconciling for the Future,” Truth and Reconciliation Commission of Canada, 2015).

Some of our more recent analyses revealed that having a family history of residential school attendance has been linked to a greater likelihood of early-onset mental health symptoms, which in turn, has been tied to an increased risk of suicidality and other unique outcomes that have implications for treatment and prevention. Furthermore, other negative outcomes experienced by indigenous peoples, such as low family income and limited educational opportunities, also appear to be involved in the intergenerational transmission of residential school trauma.

Against this backdrop in Canada, we have a prevailing sense of blaming the victim that is counterproductive to healing. According to a 2014 report by the Royal Canadian Mounted Police (RCMP), 1,017 indigenous women and girls were murdered between 1980 and 2012 across Canada. About one-third of the women died as a result of physical beating, and more than 90% of the victims had a “previous relationship” with the person who killed them, according to the RCMP report. Yet, despite evidence to the contrary, the prime minister of Canada shared his view last year that those staggering numbers should be viewed as a criminal issue and not a “sociological phenomenon” (CBC News, Aug. 21, 2014).

Members of other groups whose previous generations also were exposed indirectly to unspeakable trauma include Americans of African descent, Native Americans, and adult offspring of Holocaust survivors. Rachel Yehuda, Ph.D., has studied the latter group extensively.

In one study, Dr. Yehuda and her associates found significantly reduced cortisol excretion in Holocaust offspring, compared with controls (Psychoneuroendocrinology. 2014 Oct;48:1-10). In another study of the adult offspring of Holocaust survivors, Dr. Yehuda, professor of psychiatry at the Icahn School of Medicine at Mount Sinai in New York, found that “offspring with paternal [posttraumatic stress disorder] showed higher GR-1F promoter methylation, whereas offspring with both maternal and paternal PTSD showed lower methylation.” Furthermore, lower methylation was tied to greater suppression of cortisol (Am J Psychiatry. 2014 Aug;171(8)872-880).

An appreciation for the power of epigenetics, or “soul wounds,” can help us stop blaming indigenous and other traumatized populations, and start tending to their mental health needs. Furthermore, getting individuals to understand these concepts can be yet another step on the path toward healing.

A study of 19 staff members and clients in a Native American healing lodge who began a discourse on the legacy of historical trauma found that counselors understood that their clients carried pain “leading to adult dysfunction, including substance abuse” (J Consult Clin Psychol. 2009 Aug;77(4):751-762). Second, the counselors believed that the pain needed to be confessed. Third, the counselors thought that expressing the pain would help the clients become more introspective. Finally, the process included reclaiming “indigenous heritage, identity, and spirituality that program staff thought would neutralize the pathogenic effects of colonization.”

We do not know the extent to which epigenetics are involved in specific diseases. Epigenetic mechanisms have not yet been tested as pathways involved in the intergenerational transmission of trauma in indigenous peoples. But Dr. Yehuda’s work with the children of Holocaust survivors shows that these mechanisms do indeed exist.

In light of what we do understand and the DSM-5’s emphasis on cultural competency, mental health professionals have a role to play in reversing the negative intergenerational cycles experienced by people across the globe. Only when we start paying attention to the plight of indigenous peoples across the globe will true healing begin.

Dr. Bombay is assistant professor of psychiatry at Dalhousie University, Halifax, N.S.

Understanding the root of stress and trauma experienced by patients as individuals is a key charge of psychiatry. But patients also can experience psychological distress because of the traumatic experiences of previous generations. The mental health community must be prepared to treat patients who fall into the latter category.

My colleagues and I recently analyzed representative samples of First Nations adults and youth living on a reserve in Canada. We found that the number of previous generations in which families were forced to attend Indian residential schools was cumulatively linked with higher levels of psychological distress and suicidal ideation among those who did not attend themselves (Transcultural Psychiatry. 2014, 51:320-338).

The forced removal of Indigenous children from their homes for the purposes of assimilation occurred over generations in many countries around the world. In Canada, these government-mandated church-run residential schools ran from the mid-1800s until 1996, and resulted in generations of indigenous children being exposed to chronic neglect, abuse, trauma, racism, and cultural shaming (“Honouring the Truth: Reconciling for the Future,” Truth and Reconciliation Commission of Canada, 2015).

Some of our more recent analyses revealed that having a family history of residential school attendance has been linked to a greater likelihood of early-onset mental health symptoms, which in turn, has been tied to an increased risk of suicidality and other unique outcomes that have implications for treatment and prevention. Furthermore, other negative outcomes experienced by indigenous peoples, such as low family income and limited educational opportunities, also appear to be involved in the intergenerational transmission of residential school trauma.

Against this backdrop in Canada, we have a prevailing sense of blaming the victim that is counterproductive to healing. According to a 2014 report by the Royal Canadian Mounted Police (RCMP), 1,017 indigenous women and girls were murdered between 1980 and 2012 across Canada. About one-third of the women died as a result of physical beating, and more than 90% of the victims had a “previous relationship” with the person who killed them, according to the RCMP report. Yet, despite evidence to the contrary, the prime minister of Canada shared his view last year that those staggering numbers should be viewed as a criminal issue and not a “sociological phenomenon” (CBC News, Aug. 21, 2014).

Members of other groups whose previous generations also were exposed indirectly to unspeakable trauma include Americans of African descent, Native Americans, and adult offspring of Holocaust survivors. Rachel Yehuda, Ph.D., has studied the latter group extensively.

In one study, Dr. Yehuda and her associates found significantly reduced cortisol excretion in Holocaust offspring, compared with controls (Psychoneuroendocrinology. 2014 Oct;48:1-10). In another study of the adult offspring of Holocaust survivors, Dr. Yehuda, professor of psychiatry at the Icahn School of Medicine at Mount Sinai in New York, found that “offspring with paternal [posttraumatic stress disorder] showed higher GR-1F promoter methylation, whereas offspring with both maternal and paternal PTSD showed lower methylation.” Furthermore, lower methylation was tied to greater suppression of cortisol (Am J Psychiatry. 2014 Aug;171(8)872-880).

An appreciation for the power of epigenetics, or “soul wounds,” can help us stop blaming indigenous and other traumatized populations, and start tending to their mental health needs. Furthermore, getting individuals to understand these concepts can be yet another step on the path toward healing.

A study of 19 staff members and clients in a Native American healing lodge who began a discourse on the legacy of historical trauma found that counselors understood that their clients carried pain “leading to adult dysfunction, including substance abuse” (J Consult Clin Psychol. 2009 Aug;77(4):751-762). Second, the counselors believed that the pain needed to be confessed. Third, the counselors thought that expressing the pain would help the clients become more introspective. Finally, the process included reclaiming “indigenous heritage, identity, and spirituality that program staff thought would neutralize the pathogenic effects of colonization.”

We do not know the extent to which epigenetics are involved in specific diseases. Epigenetic mechanisms have not yet been tested as pathways involved in the intergenerational transmission of trauma in indigenous peoples. But Dr. Yehuda’s work with the children of Holocaust survivors shows that these mechanisms do indeed exist.

In light of what we do understand and the DSM-5’s emphasis on cultural competency, mental health professionals have a role to play in reversing the negative intergenerational cycles experienced by people across the globe. Only when we start paying attention to the plight of indigenous peoples across the globe will true healing begin.

Dr. Bombay is assistant professor of psychiatry at Dalhousie University, Halifax, N.S.