Transgenerational Trauma: A Northern Ireland Perspective

  

The child is born into a family which is the product of the operations of human beings already in this world.  It is a system mediated through sight, sound, taste, smell, touch, pain and pleasure, heat and cold, an ocean in which the child quickly learns to swim.

(R D Laing, 1971, p.11)

 

This essay will critically evaluate the mechanisms involved in the passing of trauma from parent to child using the various theories of the transmission of trauma: with a focus on the Northern Ireland perspective (concentrating on the impact of the ‘Troubles’); as well as international experiences (mainly, the long term effects of the Holocaust). 

Trauma, as a concept, is multicomplex and thus its impact can be experienced in various ways by individuals, by families, by communities, and by societies.  Summerfield (2000, p.232) posits that, ‘[t]here is no such thing as a universal response to highly stressful events’; while Douglass and Vogler (2003, p.10) assert that ‘[…] the pathogenic traumatic experience of one person is an interpretive construct that may not be shared in another, even in identical situations’. 

Herman (2001, p.33) characterises trauma as an affliction of the powerless in which the victim is rendered helpless by an overwhelming force: fundamentally altering the ‘systems of care that give people a sense of control, connection and meaning’.  Auerhahn and Laub (1998, p.22) describe how a ‘massive psychic trauma [can] shape the internal representations of reality’.  This is supported by Van der Kolk and McFarlane (1996, p.6) who state that, ‘[...] the core issue of trauma is reality’ and that the ‘meaning [attached] to the [trauma] is as fundamental as the trauma itself: leading to an inability to ‘integrate the reality’, resulting in a ‘repetitive replaying of the trauma’.  Douglass and Vogler (2003, p.42) summarised Freud’s speculation that in cases where the traumatic event is so extreme one does not in fact experience it - i.e. it is ‘not integrated mentally and emotionally into one’s sense of being’.

There may be positive effects after trauma, such as Post Traumatic Growth, but the majority of trauma literature focuses on the negative (Tedeschi and Calhoun, 1996).  This essay will concentrate on the negative effects and psychopathology of traumatic experiences and how these effects may potentially be ‘passed’ to the offspring of those who were initially affected (Weingarten, 2004, p.45).  There are multiple models put forward to explain transmission but due to space this essay will analyse the psychodynamic, sociocultural and family systems theories.

Research into the sequelae of the Holocaust brought the conceptual framework of Transgenerational Trauma (TGT) transmission to the fore.  Weingarten (2004, p.49) posits that the offspring of traumatised people act as witnesses to their parents experiences while stating that it is not the trauma itself that is passed, but ‘its impact’; or as Lev-Wiesel (2007, p.76) puts it: ‘its contagion’.  Herman (2001, p.2) states that, ‘[w]itnesses as well as victims are subject to the dialectic of trauma’.  The DSM-V-TR (American Psychological Association, 2013, p.271) criteria categorises repeated or extreme indirect exposure to ‘aversive details of the event[s] [as a stressor for PTSD diagnosis, usually in the course of professional duties]’.  This criterion omits offspring, begging the question: Why?  Why are children, who face similar exposure, around the clock, not considered to be affected in the same way as professionals?

Kellerman (2001, p.257), who concentrated on the long term effects of the Holocaust, presents an integrative model to demonstrate how trauma is transmitted and characterises the ‘process’ as a ‘functional relationship’.  This ‘content’ of this relationship can manifest itself in a way that has an adverse pathological effect on the offspring of survivors (Ibid., p.257).  The child is liable to experience problems with: (1) ‘Self’, which would impair ‘self-esteem’ and ‘identity’ development; (2) ‘Cognition’, promoting ‘[c]atastrophic expectancy and ‘stress upon exposure’ [to disturbing] ‘stimuli’; (3) ‘Affectivity’, ‘[a]nnihilation, anxiety, nightmares’ [and] ‘unresolved conflicts around anger complicated by guilt’; and (4) ‘Interpersonal functioning’, involving ‘[e]xaggerated family attachments and dependency or exaggerated independence’ [which may hamper] ‘intimate relationships and the ‘handling [of] interpersonal conflicts’ (Ibid., p.259).  McKenna (2015, p.40) postulates ‘that the children of victims are at an increased risk of experiencing toxic stress’: which has been defined by Shonkoff et al. (2009, p.360) as the ‘strong, frequent, and/or prolonged activation of the body’s stress response’.

Kellerman (2001) puts forward four major theoretical models for the transmission of TGT: Psychodynamic; Sociocultural; Family Systems; and Biological.  Downes et al. (2012, pp. 584-586), who researched families bereaved during the conflict in Northern Ireland, summarise similar approaches including: stress-vulnerability models (in which ‘increased vulnerability to develop psychopathology is [...] transmitted’ [emphasis in the original]); transmission of psychopathology (whereby ‘the parental trauma in itself is not transmitted, but rather that the parental psychopathology is the factor that influences the children’ [emphasis in the original]); genetic and physiological explanations (which posits that the stressor is ‘transmitted physiologically’ to the offspring); social psychological/parenting perspectives (which focuses on ‘social learning and effects on parenting’); psychodynamic theories (through transposition; overidentification; role reversal; and attachment problems); and family system approaches (with a focus on ‘particular interpersonal patterns present in families’).  Hanna et al. (2012) encapsulate a phenomenon of poor psychological functioning in children which may stem from the impact of trauma experienced by their caregivers, leading to a deficit in optimal interactions.

While some of these models may be discrete, others are more intertwined and connected.  Kellerman (2001) argues that any or all of the manifestations of trauma transmission can be determinants.  Weingarten (2004, p.49) echoes this line stating that ‘no mechanism alone is the answer to how trauma passes; none is incontrovertible; and none can be easily separated from the others’ [emphasis in the original].

The psychodynamic model of transmission, according to Kellerman (2001, p. 260), comes from the psychoanalytic tradition where ‘repressed, [unresolved], and insufficiently dealt with’ emotions within the primary victims are passed over to the next generation through unconscious ‘absorption’: which Hesse and Van IJzendoorn (1998, p.304) purport as having the potential to lead to ‘substantial alterations in consciousness’.  According to Volkan (1997, in Kellerman, 2001, p.260) the elder ‘unconsciously externalizes his traumatized self onto the developing child’s personality’: an influence that the child cannot repel; thus it becomes the child’s ‘task, [to] mourn, to reverse the humiliation [and shame]’ [emphasis added].  Lev-Wiesel (2007, p.90) also recognises this dynamic, in that, the 2^nd generation were expected to repay a ‘debt […] for the suffering of the 1^st generation [Holocaust survivors]’: it became their life’s ‘mission’.  A recent full page advertisement from a local victim-centred NGO in one of the main newspapers in Northern Ireland (The Irish News) echoes this mission mentality being placed upon subsequent generations, to perpetually seek truth and justice for human rights violations, by stating that, ‘[The UK] Government is waiting for us to die off but our families will not go away’ (News Letter, 2015).

Rowland-Klein and Dunlop’s (1997, p. 366-367) Holocaust research identifies this ‘intimate, intrapsychic, and unconscious’ process in the form of ‘projective identification’: in which the parents attempt to self-heal through the children, who reciprocate ‘despite the cost to themselves’; and ‘whereby the parent splits off the unwanted part of the self, which is projected into the child, and internalised by it; becoming [Kleinian] ‘containers’ for the parent [emphasis added].  DeGraaf (1998, in Downes et al., 2012, p. 585) describes a ’bad child’ within the parent being externalised through ‘anger, rage, sadness disappointment and grief onto their child’ [emphasis added].  Themes that arose in Rowland-Klein and Dunlop’s (1997, pp. 366-367) research included ‘overidentification’ and ‘re-enactment’ which involved the child placing itself in an analogous situation to the parent where they would try to find meaning and ‘share the suffering’, in a process of ‘introjection’ and ‘transposition’. 

Overidentification and overprotectiveness are evident when children display similar traits to the parents such as hypervigilance and a pervasive mistrust of others; in which the world is a dangerous place and the family is the only safe haven (Danieli, 1985).  Rowland-Klein and Dunlop, (1997, p.367) posit that this can compromise the child’s ‘own sense of security’.  This observation is corroborated by Black’s (2004, p.104) research into the children of police officers in Northern Ireland, in which ‘[the children] may develop anxiety regarding their parent’s or their own safety’.  The child becomes enmeshed in the reality of the parent in a ‘symbiotic’ relationship; boundaries are blurred; role reversal occurs (‘parental child [vs] adult child’); potentially leaving the child with problems around ‘separation’, ‘individuation’ and ‘autonomy’ (Freyberg, 1980, p.90; Rowland-Klein and Dunlop, 1997, p.366; Downes et al., 2012, p.593).  This type of relationship can be detrimental to both parent and child as they may become entwined in what Karpman (1968) has described as ‘The Drama Triangle’.

Kellerman (2001, p.261) shone a light on the ‘sociocultural and socialization models of transmission’ in which it is postulated that social norms and beliefs are passed down from ‘generation to generation’; whereby children ‘form their own images through their parents’ childrearing behaviour’.  This contrasts with psychodynamic theories of the unconscious to more direct and conscious learning.  In Holocaust literature, according to Kellerman (2001, p.261) survivor parents have been described as ‘inadequate’: as their extreme suffering was ‘assumed to create child-rearing problems around both attachment and detachment’.  Difficulties with attachment have been posited as a prominent conceptual framework for the transmission of TGT (Liotti, 1992; Bar-on et al., 1998; Kellerman, 2001; Downes et al., 2012; McKenna, 2015).  Attachment is a psychological model which describes the bonds and interactions between a young child and its primary caregiver and it is believed to be an important determinant of the child’s successful social and emotional development (Commission for Victims and Survivors, 2015, p.23).  Bowlby (1982) describes how we are born with a strong tendency to seek care, help, and comfort in times of danger or when suffering from physical or emotional stress.  Bar-on et al. (1998, p.318) assert that ‘[...] a primary function of attachment relationships is to serve as a source of security [...] in situations that induce fear or anxiety’.  Ideally, in an optimal relationship, the caregiver gives a positive response to the child: problems arise when a negative response is offered.  These problems may manifest in children as ‘disorganised’ or ‘insecure-ambivalent and preoccupied attachment strateg[ies]’, which could lead to an increased vulnerability to ‘dissociative disorders’ (Liotti, 1992, p.196; Bar-on et al., 1998, p.330).

McKenna (2015, p.37) asserts that ‘parental trauma exposures interfere with interaction patterns within families’.  Bar-on et al. (1998, p.319) postulate that ‘parents who are unable to monitor their discourse and thoughts [around traumatic experiences] appear to have children who show a lack of consistent attachment strategy’; adding that it is the ‘lack of successful coping, rather than the loss/trauma per se that contributed to this relation’.  Main and Hesse (1990, in Bar-on et al., 1998, p.320) propose that this ‘lack of resolution [...] is characterised by parental fear [...] perceived by the child as being either a frightened model or as directly frightening the child’; and that the attachment figure is ‘at once the source and the solution of the infant’s alarm, and this leads to a paradox of fright without solution’. 

McKenna (2015) posits that communication within families can be a detrimental determinant of TGT transmission.  McNally (2014, p.32) asserted that traumatic experiences could lead to the development of ‘unhealthy methods of communication’ within the family: ranging ‘from silence to intrusive attempts to discuss the events and imposing their interpretations [onto their children]’.  This type of communication can be either intentional or unintentional: verbal or non-verbal (McNally, 2014).  Bergman and Jucovy (1982) signal the importance of how the narrative of the trauma is relayed to children, in what spirit, or whether the information is used to educate or employed as a threat. 

Danieli (1985, p.298) highlights this ‘Conspiracy of Silence’ as a major factor in the transmission of TGT.  The problems with a frightening narrative explained above are seen in contrast to how silence around trauma can be even more insidious to the next generation.  Many of the families who survived trauma employed silence as a way of coping with their extreme experiences; and also to protect their children.  Their Holocaust experiences were too horrifying to recount; there were no words; they were dealing with feelings of shame and guilt; and at the same time their audience could not or would not listen to or believe them: which led to problems with intrapsychic integration and healing (Ibid.).  Nevertheless, many of their offspring ‘attested to the constant psychological presence of the Holocaust at home, verbally and nonverbally [and] reported having absorbed the omnipresent experience [...] through osmosis’ (Ibid., p.299). 

However, Bar-on et al., (1998, p.331) stress that the conspiracy of silence ‘cannot be total’.  The offspring may hear partial facts and use their imagination to complete the narrative which may result in a more pervasive interpretation; where the ‘made-up story may be even more frightening than the real one’ (Dekel and Goldblatt, 2008, p.285).  They are left with an emotional story without an actual narrative to make sense of it.  Bar-on (1995, in Bar-on et al., 1998, p.326) asserted that, ‘the “untold story” of the past was [transmitted] with greater intensity [...] than the “told” story’; and that the children became sensitive to their parents’ need to keep silent responding with a “double wall”: [t]he parents did not tell and the children did not ask’. 

Danieli (1985, pp.299-304) described four categories of post-Holocaust survivor families to give a sense of the systems they employed: (1) Victim families (characterised by a victim identity, pervasive depression, worry, mistrust, fear of the outside world, and symbiotic clinging); (2) Fighter families (characterised by an ‘intense drive to build and achieve’, mistrust, overinvolvement and overprotectiveness, contemptuous of dependency on others); (3) Numb families (characterised by ‘pervasive silence and depletion of all emotions’, role reversal, children grew up on their own and taught themselves how to live); an observation supported by Becker and Diaz (1998) who argue that such children had to mature rapidly in order to become protectors of their parents; and (4) Families of ‘those who made it’ (characterised by a ‘desire to make it big’, children were emotionally neglected, denial of impact of Holocaust).  All of these families have a commonality in that the past is ‘taboo, excluded from open discussion, [which] cannot then become [an integrated] history (Becker and Weyermann (2006, p.28).

Downes et al. (2012, pp.590-595) located this theme in their research of families affected by the NI conflict: whereby families hid ‘aspects of the traumatic experiences and engage[d] in cognitive and affective avoidance’; where the ‘unspoken’ was prevalent; and the children ‘invented [their] own explanations; a place where the ‘truth [was] dangerous’; where facts were ‘hidden but not hidden’; where the children attempted to ‘block out their feeling for fear of the consequences; upon which one child developed the ‘propensity to be the “good girl” [in] a conscious attempt to avoid causing her own mother any more stress’.  This echoes Dekel and Goldblatt’s (2008, p.285) observations where ‘sensitive subjects are avoided’ to prevent the intensification of stress. 

In conclusion, it becomes clear from the evidence that there is a case to be made for the existence of mechanisms which may pass trauma from one generation to the next; and in certain cases to subsequent unborn generations. However, they are not mutually exclusive and they may not always pass on pathological consequences.  There can be recovery; missions can be accomplished; and growth can occur. 

The main focus of this essay was concerned with transmission inside families however wider society and political responses can have a profound effect on traumatic sequelae (Becker, 2004; McNally, 2014).  From this comes a view that trauma is a biopsychosocial issue that should not be seen through a purely pathological diagnostic lens; ‘in which the basic focus is not so much on the symptoms […] but on the sequential development of the traumatic situation’ (Becker, 2004, p.6).  This point is echoed by McNally (2014) who argues that TGT should not be given a clear diagnostic criterion as this may steer any responses firmly in the direction of the medical model to the detriment of other treatment modalities, and of the individuals and families themselves.  Until the wider issues, that pervade societies affected by protracted conflict, violence, and trauma, are addressed the chances of seriously dealing with the long term legacy of traumatised families are diminished.

 References

American Psychiatric Association. (2013) Diagnostic and Statistical Manual of Mental Disorders. 5th edn. Washington, DC: American Psychiatric Publishing.

Auerhahn, N.C. and Laub, D. (1998) ‘Intergenerational Memory of the Holocaust’, in Danieli, Y. (ed.) International Handbook of Multigenerational Legacies of Trauma. New York: Plenum Press, pp. 21-41.

Bar-On, D. (1995) Fear and Hope: Three Generations of the Holocaust. Cambridge, MA: Harvard University Press.

Bar-On, D., Eland, J., Kleber, R.J., Krell, R., Moore, Y., and Sagi, A. (1998) Multigenerational perspectives on coping with the Holocaust experience: an attachment perspective for understanding the developmental sequalae of trauma across generations’, International Journal of Behavioural Development, 22(2), pp. 315-338.

Becker, D., and Diaz, M. (1998) ‘The Social Process and the Transgenerational Transmission of Trauma in Chile’, in Danieli, Y. (ed.) International Handbook of Multigenerational Legacies of Trauma. New York: Plenum Press, pp. 435- 445.

Becker, D. and Weyermann, B. (2006) Toolkit: Gender, Conflict Transformation and the Psychosocial Approach. Bern: Swiss Development Co-operation.

Bergmann, M.S and Jucovy, M.E. (eds.) (1982) Generations of the Holocaust. New York: Basic Books.

Black, A. (2004) ‘The treatment of psychological problems experienced by the children of police officers in Northern Ireland’, Child Care in Practice, 10(2), pp. 99-106.

Bowlby, J. (1982) Attachment and loss. Vol.1: Attachment. 2nd edn. London: Hogarth Press.

Commission for Victims and Survivors (2015) Towards A Better Future: The Trans-generational Impact of the Troubles on Mental Health. Belfast: Commission for Victims and Survivors.

Danieli, Y. (1985) ‘The Treatment and Prevention of Long-term Effects and Intergenerational Transmission of Victimization: A Lesson From Holocaust Survivors and Their Children’, in Figley, C.R. (ed.) Trauma and its wake. Vol.1, The study and treatment of post-traumatic stress disorder. New York: Brunner/Mazel, pp. 295-313.

DeGraaf, T. (1998) ‘A family therapeutic approach to transgenerational traumatization’, Family Process, 37(2), pp. 233–243.

Dekel, R. and Goldblatt, H. (2008) ‘Is There Intergenerational Transmission of Trauma? The Case of Combat Veterans’ Children’, American Journal of Orthopsychiatry, 78(3), pp. 281–289.

Downes, C., Harrison, E., Curran, D., & Kavanagh, M. (2013) ‘The trauma still goes on...: the multigenerational legacy of Northern Ireland's conflict’, Clinical Child Psychology and Psychiatry, 18(4), pp. 583-603.

Douglass, A. and Vogler, T.A. (eds.) (2003) Witness and Memory: The Discourse of Trauma. Routledge, London.

Freyberg, J.T. (1980) ‘Difficulties in Separation-Individuation as experienced by offspring of Nazi Holocaust Survivors’, American Journal of Orthopsychiatry, 50(1), pp. 87-95.

Hanna, D., Dempster, M., Dyer, K., Lyons, E. and Devaney, L. (2012) Young People's Transgenerational Issues in Northern Ireland. Belfast: Commission for Victims and Survivors.

Herman, J.L. (2001) Trauma and recovery: from domestic abuse to political terror. London: Pandora.

Hesse, E. and Van IJzendoorn, M.H. (1998) ‘Parental loss of close family members and propensities towards absorption in offspring’, Developmental Science, 1(2), pp.299-305.

Karpman, S. (1968) ‘Fairy tales and script drama analysis’, Transactional Analysis Bulletin, 7(26), pp. 39-43.

Kellermann, N.P.F. (2001) ‘Transmission of Holocaust Trauma. An integrative view’, Psychiatry: Interpersonal and Biological Processes, 64, pp.256–267.

Laing, R.D. (1971) The Politics of the Family and Other Essays. London: Tavistock Publications.

Lev-Wiesel, R. (2007) ‘Intergenerational Transmission of Trauma across Three Generations: A Preliminary Study’, Qualitative Social Work, 6(1), pp. 75-94.

Liotti, G. (1992) ‘Disorganized/disoriented attachments in the etiology of the dissociative disorders’, Dissociation, 5, pp. 196-204. Main, M. and Hesse, E. (1990) ‘Parents' unresolved traumatic experiences are related to infant 34 disorganized attachment status: Is frightened and/or frightening parental behavior the linking mechanism?’, in Greenberg, M.T., Cicchetti, D. and E.M. Cummings, E.M. (eds.) Attachment in the preschool years. Chicago: Chicago University Press, pp. 161-182.

McKenna, A. (2015) ‘The impact of the conflict’s legacy on early years’ development of children and young people’, in Commission for Victims and Survivors, Towards A Better Future: The Trans-generational Impact of the Troubles on Mental Health. Belfast: Commission for Victims and Survivors, pp. 36-49.

McNally, D, (2014) Transgenerational Trauma and Dealing with the Past in Northern Ireland. Belfast: WAVE Trauma Centre.

News Letter (2015) ‘Troubles victims use newspaper ad to attack Government over legacy issues’, [Online] Available at: http://www.newsletter.co.uk/news/northern-ireland-news/troubles-victims-use-newspaper-ad-to-attack-goverment-over-legacy-issues-1-7108985 (Accessed: 11 December 2015).

Rowland-Klein and Dunlop’s (1997) ‘The transmission of trauma across generations: Identification with parental trauma in children of Holocaust survivors’, Australian and New Zealand Journal of Psychiatry, 32(3), pp. 358-369.

Shonkoff, J.P. (2010) ‘Building a New Biodevelopmental Framework to Guide the Future of Early Childhood Policy’, Child Development, 81(1), pp.357-367.

Summerfield, D. (2000) ‘Conflict and health - War and mental health: a brief overview’, BMJ, 321, pp. 232–235.

Tedeschi, R.G. & Calhoun, L.G. (1996). ‘The posttraumatic growth inventory: measuring the positive legacy of trauma’, Journal of Traumatic Stress, 9(3), pp. 455-471.

Van der Kolk, B. and McFarlane, A.C. (1996) ‘The Black Hole of Trauma’, in Van der Kolk, B., McFarlane, A.C. and Weisaeth, L. (eds.) Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and Society. New York, NY: Guilford Press, pp. 3-23.

Volkan, V. (1997) Bloodlines: From Ethnic Pride to Ethnic Terrorism. New York: Basic Books.

Weingarten, K. (2004) ‘Witnessing the effects of political violence in families: Mechanisms of intergenerational transmission of trauma and clinical interventions’, Journal of Marital and Family Therapy, 30(1), pp. 45-59. 

‘Trauma is experienced not only by the individual, but by communities and future generations.’

Some more blog for any of you who are interested in how we 'treat' the effects of our troubled 'past'.  For many, the 'Past' is not 'past' it is continuous.  

(Warning) The following is a recent essay I submitted for my Psychological Trauma Studies Degree, so its a bit academic and long-winded.

‘Trauma is experienced not only by the individual, but by communities and future generations.’

This essay will critically analyse the above statement with a focus on the current treatment modalities available to practitioners: taking in the milieu of the period of protracted violent conflict in Northern Ireland, colloquially known as ‘The Troubles’, and the legacy of trauma which has emerged.

In recent years the ‘Peace Process’ in Northern Ireland has been lauded as an international success story (CIPCR, 2015).  With the signing of the ‘Good Friday Agreement’ (GFA), in 1998, the hope was that the violence would finally end and a new political process would flourish.  It could be argued, to a certain extent, that this was achieved, but ‘subsequent years have witnessed continued sporadic violence’ and the political process has been mired in deadlock and recrimination (Bunting et al., 2013, p139; Rowan, 2015).

Another remnant of the Troubles is the long term legacy of unresolved trauma and injustice: its impact or ‘contagion’, as Lev-Wiesel (2007, p.76) puts it.  A pervasive legacy of violent loss and bereavement; of serious injuries; of a perpetual fruitless quest for truth and justice; of socioeconomic deprivation; and the unresolved and unintegrated traumas of individuals, of communities, and of society in general.

This concept of complicated trauma will be the focus of this critical analysis, in how, it has affected the population of Northern Ireland; and what interventions are available in order to prevent it adversely affecting future generations.  Herman (2001, p. 33) characterises trauma as an affliction of the powerless in which the victim is rendered helpless by an overwhelming force: fundamentally altering the ‘systems of care that give people a sense of control, connection and meaning’.  Many of the victims were subjected to this overwhelming force of bombs and bullets which ripped families and bodies apart.  They lost trust in society because society could not protect them nor provide justice.  This is outlined by Kirshner (1994, in Eagle and Kaminer, 2013, p.94) who posits that any damage to the social order can produce ‘numbing, withdrawal, alienation, and disillusionment’.  They had no control as the threat was ‘largely faceless and unpredictable, yet pervasive and substantive’; powerlessness and helplessness were prevalent features in Northern Ireland (Eagle and Kaminer, 2013, p.89).  For many the traumatic event was random and unexpected; finding meaning was problematic.

The violence of the shootings, the bombings and the sectarian strife were common recurrences for certain sections of the population who experienced the conflict with more intensity, and with a more prolonged frequency than others, (Fay et al., Morrissey, Smyth, & Wong, 1999).  Smyth, Morrissey and Hamilton (2004, in Ferry et al., 2010) reveal that ‘40% of the deaths from political violence [occurred] in [Belfast], and 75% of these deaths [occurred] in North and West Belfast’.

Ferry et al. (2010) highlight the aftermath of the conflict by claiming that Northern Ireland has the highest levels of Post-Traumatic Stress Disorder (PTSD) in the world with a 61% adult population lifetime exposure to a traumatic event.  PTSD symptoms include: re-experiencing of the event through intrusive memories; avoidance and numbing; and hyper-vigilance.  The presence of PTSD may bring with it a range of comorbidities such as mood, anxiety or substance abuse disorders according to Shalev and Yehuda (1998).
Due to the nature of the conflict during the Troubles there was an inherent fear of the other (which fed into the poison of prejudice and sectarianism); a fear of entering certain areas; a fear of revealing personal information (which manifested in anxiety, especially among security force families): fears which may or may not have been based in reality (McKenna, 2015; Stewart and Thomson, 2005; Black, 2004).  Van der Kolk and McFarlane (1996, p.6) assert that, ‘[...] the core issue of trauma is reality’.  However, for many, a ‘real’ fear and anxiety still exists in this society.  It is not yet a society that has fully emerged from conflict.

Healey (2004) argues that the term ‘post’ traumatic minimises the effect that such continuous violence has had on individuals and communities: as ‘post’ implies a discrete event, located in the past.  Healey (2004, p.177) describes Northern Ireland as a ‘pre-post-conflict society’.  Straker (1987, in Stewart and Thomson, 2005, p.105) conceptualise a phenomenon of ‘continuous traumatic stress syndrome’; while Eagle and Kaminer (2013, p.85) have expanded upon this with the concept of ‘continuous traumatic stress’ (CTS).

The nature of the violence in Northern Ireland markedly changed after the GFA: from that of daily bombings and shootings to paramilitary and sectarian intimidation in the form of punishment beatings, expulsions, and the targeting of family homes with petrol bombs.  Dissident republican have continued to attack the police and State apparatus (U.tv, 2015).  Eagle and Kaminer (2013, p.90) posit that the symptoms of CTS may be consistent with PTSD but they occur ‘in a context of realistic ongoing threat and therefore cannot be characterized as a maladaptive “false alarm” response to a past event’.This focus on CTS does not, however, take away the severity of how a single event can affect individuals who previously had minimal or no trauma exposure at all.  Summerfield (2000, p. 232) postulates that, ‘[t]here is no such thing as a universal response to highly stressful events’.  Vogler (2003, p. 10) affirms that the ‘traumatic experience of one person is an interpretive construct that may not be shared in another, even in identical situations’.

Nevertheless, it is this pervasive everyday violence still that plagues many communities in Northern Ireland.  It is with this severity, frequency, continuity and proximity to traumatic events in mind that one can envisage how, not only individuals, could be adversely affected, but also how this could ripple out into communities, and even into future generations.  It could be argued that certain sections of the NI population displayed characteristics of collective trauma, in that, hypervigilance and avoidance were common features of daily life responses: primarily utilised as ‘protective’ mechanisms (Stewart and Thomson, 2005, p.105).  Eagle and Kaminer (2013) expand on this observation by affirming that people experiencing CTS are preoccupied with thoughts about potential future traumatic events rather than on the thoughts of a previous unresolved event.

The concept of transgenerational trauma (TGT) has been put forward as a way of explaining how trauma can be experienced by future generations.  There are a number of theoretical models posited in the TGT literature such as: psychodynamic; sociocultural; family systems; and biological (Kellerman, 2001).  Within these models lie transmission mechanisms: with silence considered as being most pervasive.

McKenna (2015) postulates that communication within families has become a determinant of trauma transmission: echoing McNally (2014, p.32) who asserts that traumatic experiences could lead to the development of ‘unhealthy methods of communication’ within the family: ranging ‘from silence to intrusive attempts to discuss the events and imposing their interpretations [onto their children]’.

Danieli (1985, p.298) pinpoints this ‘Conspiracy of Silence’ as a major factor in the transmission of trauma.  An insidious silence within individuals, within families’ within communities: and within the NI statutory sector - which led to a vacuum in services that could have potentially addressed trauma (Healey, 2004).  Silence hinders attempts to employ psychotherapy as a model of treatment.  If the trauma is severe and continuous there may be no words, no narrative based in reality for the client to integrate.  Psychotherapy requires a conversation, one that is ‘co-created, one that enables meaning and understanding to develop, a process [where] a coherent narrative can develop: [where] the hearing and witnessing [is important]; [a virtual impossibility in] a context of silence’ (Healey, 2004, p.168).

The National Institute for Health and Clinical Excellence (2005) guidelines recommend a range of psychotherapeutic treatment models to deal with the pathological effects of PTSD, for example, Trauma Focused Cognitive Behaviour Therapy (TF-CBT).  Most conceptualisations and interventions aimed at treating traumatic stress assume that the experience is firmly rooted in the past yet, as discussed above, for many in Northern Ireland the traumatic stressors are in the present, and potentially in the future.  Eagle and Kaminer (2013, p.92) emphasise that a central facet of CBT interventions is ‘exposure’ to the previous event in an assumed place of safety with the intention of reducing ‘anxiety associated with [...] the past experience, [again assuming] that the danger is now past’.  This essay will now expand upon a selection of models that may be more suited to the ongoing effects of CTS: systemic family therapy; psycho-education; and therapeutic witnessing.

Healey (2004) who worked as a therapist in The Family Trauma Centre, in Belfast, promotes the value of systemic family therapy: a model which takes into account not just the trauma within an individual but one that is culturally sensitive; which pays attention to the whole system within which people exist i.e. their families; their communities; and the socio-political context.  With this in mind, Healey (2004, p.168) attempted to help the parents to find ways to ‘break the silence’ in the hope that this would aid communication and interaction within the family; and also between the therapist and the family.  Healey (2004, p.171) described families ‘at war’ with themselves that needed their own ‘peace agreement’, reflecting the context of the ongoing peace process outside the therapy room at that time.

Healey (2004) posits that psycho-educational material can be useful as a client can develop an understanding of what is happening and can learn some coping mechanisms.  This is in line with Feltham (2000, p. 10) who asserts that psycho-educational guidance can ‘enhance cognitive, behavioural and interpersonal functioning’ by teaching personal skills such as ‘parent effectiveness training, relapse prevention programmes, [and] stress inoculation training’. However, Healey (2004, p.178) concedes that it is ‘difficult to provide effective treatment for continuous trauma by virtue of [it being continuous]; real honesty is required; and the language used must reflect reality and be meaningful.  Straker and Moosa (1994, p.457) highlight these difficulties by asserting: that as the trauma is continuous, ‘the survivors are at great risk of being retraumatized’.  Healey (2004) claims to have witnessed retraumatisation between sessions.

Therapeutic witnessing is another model promoted by Healey (2004, p.180), from her work in the Family Trauma Centre, as being beneficial to ‘families subjected to continuous trauma’: in that, it is ‘important [to] bear witness to the “story lived”’.  Blackwell (1997, p.87) highlights the importance of the therapist in this dyad: as the therapist bears witness ‘to who the client is and what their experience has been [by providing] a recognition of what has happened, how the client’s life has changed and how they come to feel about their lives and themselves’.  Janoff-Bulman (1992, in Eagle and Kaminer, 2013) asserts that trauma shatters the core beliefs, which form our foundations; of what we inherently assume about the world i.e. that it is benign and meaningful.  Blackwell (1997, p.87) posits that recognition helps the client to ‘piece together the shattered parts of [their] subjective continuity and recover [their] sense of integrity as a whole person’; by integrating the ‘past with the present [and the] possibility of the future’.  Furthermore Blackwell (1997, p.87) claims that bearing witness can ‘change the shape of the world in which we all live’ by recognising how organised violence can disorganise and fragment whole communities, cultures, belief systems, and ideas.

Eagle and Kaminer (2013) emphasise that they are not seeking to propose that CTS becomes a new diagnostic category which may colonise a group of individuals as pathological or disordered.  Instead they view CTS from a phenomenological perspective: to be addressed by systemic political and social interventions.  They posit that people who are embroiled in a climate of ongoing political violence and oppression are wise to temporarily employ protective coping mechanisms such as hypervigilance and avoidance in order to survive: citing the work of Martin-Baro (1989); and Samayoa (1987) which points to the need to cling to ‘prejudices’; ‘absolutism’; ‘rigidity’, [and] ‘paranoid defensiveness’.  Lahad and Leykin (2010, p.695) emphasise that constant threat causes permanent arousal leaving such populations with ‘[no] time for respite and are thus constantly governed by [fright or flight responses], or employ avoidance [techniques to dampen these reactions]’.  Nonetheless, Kesebir et al. (2011, in Eagle and Kaminer, 2013, p.96) warn that what may be ‘good for the individual’s control of anxiety […] may sometimes have harmful consequences for society’. 

Eagle and Kaminer (2013, p.96) offer a context-driven ‘idea that trauma-related responses may remit, consequent upon removal from a threatening environment’.  Until the ongoing threat is lifted it may be difficult for conventional treatment models, as recommended by the NICE guidelines, to be efficacious.

In conclusion, this essay has provided a critical analysis of how certain treatment modalities could be utilised, in the context of the impact of the Troubles in Northern Ireland, and the ripple effects of violence and threat that remain to this day: upon which the concept of Continuous Traumatic Stress was explored.  The effect of CTS on society was viewed as being harmful until ongoing threat was removed through political and social intervention.  The transmission of trauma through a culture of silence was given as a possible mechanism.  It is within this context that one can claim that ‘trauma is experienced not only by the individual, but by communities and future generations.’

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