Dear Dr Robert,
I am a 21 year old male. Ever since I was a toddler I've suffered from serious anxiety, depression, and sleep disorders, among other things. I would fall out of my bed every night until I was 8, and I wet the bed until I was 11. I was terrified of being alone until I was 10. If I found myself in that situation I would have panic attacks and freak out until I found someone that I knew. I also recently remembered having a recurring nightmare until age 8 where I would be sitting alone in a field on a swing, and a monster-like creature would walk towards me and I would be unable to move from the swing, as much as I wanted to. These days I'm extremely paranoid and anxious, and can't seem to become close with people without hurting them. Putting all of this together, it seems like I might have been abused as a young child. I have no memory of such an event, however. Would it be possible to completely forget abuse and still have it affect me so seriously? Do you have any suggestions on what I should do from here?
Thanks very much for your help.
Thank you for your question. Yes, it is possible that your symptoms are the sequellae (after effects) of child abuse, but those symptoms may have other causes as well. It is true that your symptoms are suggestive of some kind of post-traumatic stress disorder, but the stress may or may not have been abuse of you personally. If you witnessed some kind of violence, particularly directed toward a loved-one, or even if you were exposed to loud and violent sounding arguments between your parents, for example, your young self might have been stressed sufficiently to have become symptomatic in the ways you describe. Witnessing a bloody accident might also produce such post-traumatic stress symptoms, especially if your parents or other care-givers thought it was "wiser" not to discuss it afterwords.
It certainly is possible that you could forget abuse or some other stress and still be suffering the after effects. In fact, the less such events are remembered consciously, the more likely that symptoms such as yours will be produced. One way of looking at this fact is that psyche must find ways of communicating her needs to the conscious personality, and if she cannot do it through remembrance and recollection, then she may resort to symptoms as a way of attracting attention. [I speak of psyche as "she" to honor the Greek myths which are the source of our word "psyche."] This is one reason why self-help approaches to psychological problems, such as the ones advocated by people like "Dr. Phil," or, even worse, Oprah, are useless or even harmful. As we know from physical medicine, treating symptoms without considering the underlying causes is either useless or worse, since the real problem remains buried and must find other, possibly more severe, ways of expressing itself.
I should mention that certain mental health workers, probably due to childhood issues of their own, seem wrongly predisposed to finding child abuse--particularly child sexual abuse--in any patient who complains of the symptoms you have experienced, and, in a kind of foolish circular reasoning, put forth the lack of remembrance as a kind of proof that the abuse really happened. Over time, this kind of psychologist, who really is guilty of malpractice, may convince a patient who has not been abused that abuse took place and is the cause of the symptoms. Therefore, for someone with symptoms such as yours, it is vitally important to work with only the best possible psychologist or other therapist. If anyone even mentions child abuse in the first session, find a new doctor!
In my experience, one of the best approaches to your kind of situation is treatment by a psychologist trained in Kohutian self-psychology. This is a form of psychoanalysis developed in the 1970s by Heinz Kohut who was a Freudian analyst, but found that Freud's theories were not particularly helpful for your kind of problem. In any case, some kind of depth psychoanalysis, and not simply counseling, would be my recommendation. In other words, I recommend that you do not begin with drug treatment for the symptoms, and I also recommend that you do not consider working with anyone who begins by looking for child abuse. If there has been abuse, it will come out naturally in the course of proper treatment. You might be in touch with a local hospital to ask for a list of psychologists who specialize in self-psychology, or perhaps you can consult the internet for a list of self-psychologists in your area.
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