National Partnership to End Interpersonal Violence: ACEs Project

Charlie Pacello, William Robertson, Pearl Berman, Rachel Posner LeMay

Reliving Trauma: The Relationship between Post-Traumatic Stress Disorder and Child Abuse

“Undeservedly you will atone for the sins of your fathers.”

Undeservedly we are atoning for the sins of our fathers.  We’re here, so many of us in trauma, so many of us in this space.  You’re here because we don’t have peace in the world.  We don’t have peace in our hearts, we don’t have peace consistently.  We have glimpses of it at times, we have visions of what could be, but we’re not there yet.

I have a great story that really speaks to that point.  My grandfather, possibly like many of your grandfathers, was in WWII.  He came back with ‘battle fatigue’ or ‘shell shock’; this is how he was with my grandmother, with my father.  My father went and fought his own war in Vietnam; this is how he was with us, even more than my grandfather.  By the time it came to me, my war was the nuclear war.  It was even more extreme, epic.  I had it in the pregnancy phase, just like when my mom was pregnant with me; I had fear coursing through every cell, cortisol overstimulated, ready to fight, ready to flee.  When my mother was eight months pregnant with me, in a moment of shear madness, caused by the intolerable pain, fear, and terror she felt on the inside because of the volatile, threatening, and sometimes violent episodes with my father who suffered from combat PTSD and was drowning out the pain with alcohol, brought a butcher’s knife to her belly and tried to murder me.  My paternal grandmother reached across my mother’s body and stopped her hand from committing the act just in time.  I was programmed for war, trauma, and PTSD before I even had a chance to take my first breath.

When I was born, my father was still experiencing PTSD on such an extreme level that it scarred my parents’ relationship from the very beginning.  Not only did I experience fear and terror during her pregnancy phase, but as an infant and toddler, I experienced it on a regular occurrence.  I can remember my mom being thrown into the snow by my dad.  I can remember hearing the screaming and hollering in the other room as my parents’ were fighting each other.  I remember vividly going to my mother when she was weeping by her bed after a night of violence and going up to her and saying, ‘Mama, please don’t cry.”  I ended up filling an emotional void left by my father for my mother, and I would end up taking on the role as the mediator in the family, the one who would hold the ship together, the peacemaker.  One of the worst nights I can remember was when my father had been drinking, we had been at a company party all day, and we got into the cab of his truck to return home.   My father was drunk and he was driving; occasionally he slammed my mother’s head against the window as he yelled at her; my mother screamed, ‘Watch Out!’ ‘Please, Oh, God, Please’; I was petrified, terrified for my life, and holding on to my mom as tightly as I could.  My father had blacked out.  He almost killed us that night.  I was 2 ½ years old.

-Charlie Pacello

Charlie’s father is just one individual who has endured trauma and developed PTSD. The Center for Disease Control and Prevention defines PTSD or post-traumatic stress disorder as a condition that is developed following a traumatic event where the effects persist long-term and affect an individual’s life. Most of the information regarding PTSD is directed in the general public to soldiers who have been in combat, despite individuals developing the disorder through other traumatic events. These include enduring physical, sexual, or emotional maltreatment, being a victim or witness to violence, and even witnessing a loved one being seriously ill or die.   The common symptoms of the disorder include the individual reliving the event over and over and being easily startled. They can have problems sleeping, suffer from nightmares, and be quick to anger. However, not every individual who has experienced trauma will develop PTSD. According to the National Center for PTSD, based off the U.S. population, 7-8 out of every 100 people will have experienced PTSD, with women more likely to develop the disorder than men.

If trauma itself is not what leads to PTSD, then what does? Several factors play a part as they can increase the risk of developing the disorder. The National Institute of Mental Health reports that risk factors include: 1) being hurt during this trauma, 2) seeing another person hurt or killed, 3) experiencing trauma during childhood, 4) having little to no social support following the traumatic event, and 5) having more stressful events occur following the trauma including loss of loved ones, losing your job, or being injured.

Like many cases involving a family member with PTSD, Charlie Pacello’s did not have to suffer as it did. Charlie’s father developed combat-related PTSD and was coping with alcohol – this alcohol use only exacerbated his condition leading to violent outbursts within the home. This behavior effected every family member. Charlie’s mother nearly stabbed herself with a knife due to the stress brought on by this volatile situation. The family was nearly killed in a car accident while his father was driving drunk and angry. Charlie’s father was like many other men with combat-related PTSD. Research by Price in 2016 demonstrated that individuals with PTSD are at an increased risk of becoming violent. This is detrimental to the children who are witnessing these outbursts. They may become extremely fearful and withdrawn or they might become angry and aggressive themselves. It may lead to the children having difficulty maintaining positive relationships not only with their family but with outside social groups as well. There is also increased risk for unintentional neglect from the parent who doesn’t have PTSD. Charlie’s mother, fearful of her husband, put herself and 2 11/2 year old Charlie into a car although she knew it would be driven by her drunken husband. During the course of these dramatic events, Mrs. Pacello sought out help from the VA. Unfortunately, these events unfolder in the late 1970’s when there was not enough expertise or help to draw on.

In addition to being at increased risk for violence, some individuals with PTSD try to withdraw from situations that they fear could cause them to relive the traumatic event. For example, refusal to go to a movie about warfare. Children may misinterpret their parents’ actions as a rejection. Reasoning incorrectly that, “the reason my dad doesn’t take me to the movies is because he doesn’t like me.” In reality, the father was afraid that an explosion would occur during the film that would cause flashbacks.

Fortunately the National center for PTSD had found that just as there are factors that increase the risk of developing PTSD, or making symptoms of it get worse, there are also factors that can help decrease painful symptoms. These include seeking support from loved ones, joining a support group, and developing positive coping strategies for dealing with past trauma.

If you know anyone who has PTSD or you suspect that they might, be there for them by offering emotional support and letting them know they aren’t alone. Try and be patient with them as recovering from a trauma does not involve quick fixes. Rather, recovery may include bumps in the road as the individual faces the complex issues that resulted in the trauma.  Do not try to be the only one helping this individual recover. Someone with PTSD has complex needs; help them gain access to needed resources rather than being the sole resource. If there are children involved, learn the warning signs of violence and find a safe space for children to come if danger threatens. Help however you can, even if it is the smallest act; don’t underestimate the power that a variety of small acts of kindness may have on an individual in need of help.

If you believe that someone you know is suffering from PTSD and may be abusing their partner or children, do not ignore it. Contact the local Veterans Affairs office and Child Services agencies to take action. Unlike in the 1970’s, there now are special services available to help combat veterans both within the traditional VA system as well as through private resources.

Charlie and his mother needed support getting his father help before he endangered himself or them. This didn’t happen. They might have died in a car crash. Don’t ignore the signs of trouble and let tragedy strike someone you know. Be the one to end that cycle of violence – see the resources listed at the end of the document to learn about how you can contribute.

Intergenerational Impact: Impact of Dad’s PTSD on Charlie & Mom: The Effect of Violence across the Lifespan 

Charlie Pacello began his story of growing up with a father who suffered from PTSD and the effects that it had on his family. Due to his condition, Charlie’s father was emotionally and physically abusive towards them and used alcohol to cope which only exacerbated the situation. In this next installment, Charlie gives insight into how the trauma he experienced during his childhood has affected his life even into adulthood. 

“PTSD and the story of what causes it always concern more than just the survivor.  Until properly addressed, it reverberates through our relationships, and down the generations, harming everyone it touches.” 

– Dr. Edward Tick

My story continues.  I joined the service; I received an appointment to the US Air Force Academy, following the same warrior path, the same warrior wounding path as my father.  I know one of the primary reasons for doing it was to connect with my dad.  I graduated from the Air Force Academy, was commissioned an officer, and stationed at Los Angeles AFB, where I served as the Chief, for the US Nuclear Detonation/Detection Systems Mission Processing for the GPS/NDS program.  I was responsible in part for the operational readiness and mission processing capability of the ground survivable mobile units called GNT (Ground NDS Terminal), which would only be used for these missions: Integrated Tactical Warning/Attack Assessment and Nuclear Force Management.  End-to-end nuclear war.  You can find this stuff in my officer performance reports.  I remember very clearly as a young Lieutenant when I started doing this job, feeling a great tightening within my soul, saying, to myself, “This is not what I signed up for.  I wanted to preserve, protect, and defend life, not participate in the plans for the destruction and annihilation of mankind.”  But like most officers, I did my job, and I did it with aplomb, I was the #4 Lieutenant out of 30 in the office.  Techno-war increases our sense of culpability and I didn’t like the work that I was doing.  The word trauma comes to us from the Greeks.  It means a ‘piercing wound’.  With PTSD, the wound is in the heart.  It’s in the soul.  It is a moral wound.  The traumatic wound is a reversal of the right way and our hearts and spirits are broken.  See, the ancients didn’t separate the body and the soul like we do today.  If you were wounded, your soul was too.  And, if one of us was wounded, we all were wounded, and this would pollute everyone, not just the individual who carried the wound.  It’s an encounter with the Beast, the part of us that has a will to survive that is so strong it will do anything to get what it wants; it is the power over life and death.  It’s the encounter with our own darkness, our shadow, the destructive power of our humanity, and it can shred the innocence of our youth.  It did mine.  My innocence got hijacked, and suddenly, I couldn’t separate the good guys from the bad guys anymore.

I slowly got distracted.  Life didn’t make sense to me.  I turned away from God, I turned away from all that I knew before, and took the Epicurean idea of ‘Eat, drink, and be merry, for tomorrow we may indeed die” to the extreme.  I drank alcohol to anesthetize myself, and then drugs.  I just wanted to feel good.  Yet, underneath all that was the shame, the deep, buried pain, and I was numbing it based on this idea.  My operating system was ‘I was guilty, I was shameful, I was undeserving, I was unworthy.’  These were deep unconscious beliefs that I carried with me from childhood.  There existed this unconsciousness of guilt, shame, and unworthiness, and the inner knowing I must make peace with this.  Everyone can relate to this.  If I just eat enough, the pain will go away.  If I just drink enough, or do enough drugs, the pain will go away.  The problem is we are born into a world of trauma; we have a deep rooted sense about this.  I did.  And I tried numbing it away.  You may have felt like this too.  I wanted to make nuclear annihilation go away.  I was having nuclear war going off inside of me.  I had numerous nightmares of a futuristic apocalyptic destruction of the human race that I had played an instrumental part in causing.  I’d wake up with night sweats, sometimes completely paralyzed in my bed.  Life lost all meaning and purpose, everything seemed pointless, and nothing made any sense to me.  I had no hope for a future.  I wanted to numb it.  Maybe if I just ‘Eat, drink, and be merry’ the terrible thoughts, feelings, and nightmares of it would go away.  That didn’t work.  What ultimately worked was the program I created.

Things took a turn for the worse.  There is a strong sense of brotherhood in the military, especially the guys you trained with, who went through the same stuff you did.  I had that brotherhood with some of the officers there, many of whom were Academy grads.  A handful of them were engaged in some illegal activity.  I was seeking for excitement to numb out, from the moral trauma I was experiencing at that time.  Thrill seeking and high-risk taking is a common symptom of someone who is experiencing PTSD.  My life no longer held any meaning in my mind, I was filled with hopelessness and despair, and my depression was swallowing up my joy for living, and when this happened, it was very easy not to be protective of my own existence.  This self-destructive behavior – engaging in reckless activities, drugs and alcohol abuse, being around dangerous groups or people, putting myself in dangerous situations – were subconsciously done in an attempt to destroy myself.

Most of my life I carried with me this sense of guilt and depression, I was marked with a sadness that was inexplicable.  Despite this low level of guilt, sadness and depression, I still had great times.  I still created good times.  High school was one of them.  I could wear different masks.  I could play different roles.  But deep in my core was always this.  I thought my way back to wholeness would be if I could just keep the family together.  I had made it my responsibility at a very young age to keep the family together.  I was searching for peace, searching for wholeness, searching for connection, searching for healing, and my thought was ‘keep the family together’, then I could get that healing, I could get that wholeness.

PTSD is not just limited to the person who has it.  This stuff gets passed down generationally.  It spreads within the family and down the generations when it is not healed within the individual who has it, and every generation suffers because of that.  What is not contained in one generation, the pain, the suffering, the trauma, will get unconsciously passed down to the next generation, and they will unconsciously play it out in their own lives.  Not knowing where it came from, not knowing how it happened.  Many of you may have experienced this same thing.  Where you find yourself in a relationship that is abusive, or violent, because that is what you experienced as a child.

I had terrible nightmares.  Most of the time I couldn’t sleep, and when I did sleep, they were terrible.  I was comatose at work, people would wave their hands in front of my face to see if anyone was home; I would come into the apartment and relive the trauma in its intensity over and over again; I would stare at the walls of my apartment for hours on end and break down into uncontrollable sobs, so deep, so heavy, so painful.  I had this extreme vulnerability, I wanted and needed to feel loved and connected to someone, but I was so afraid of getting hurt, I wanted to keep this part of me protected, and at the same time, I had this extraordinary rage, I wanted to destroy, I wanted to hurt, I wanted to seek revenge.  On everyone.  But something inside of me said you’ve got to keep going, you can do it, face what is in you that needs to be faced.  I prayed like I never prayed in all my life.  I got on my hands and knees; I knew I was in trouble.  I happened to be practicing A Course in Miracles, and I hung onto it like a life line, meditating on each thought for each day as best I could, trying to find my way out.  There was this big gaping hole on the inside of me where my soul should have been.  There was this painful hole where everything was being sucked into, and it was the most excruciating, unendurable pain that I had ever felt in my whole life and it followed me everywhere. It felt like I was fighting the pain of the world.  And in the deepest and darkest moments, I wanted to commit suicide.

-Charlie Pacello

Although the acts of violence that Charlie experienced during childhood had ended, the effects of the trauma carried over into his adult life and shaped various aspects of his identity. He had developed PTSD just like his father before him. He faced bouts of depression to the point that he states it interfered with his work and that he would break down into sobbing. He even contemplated suicide at times to end the pain he felt. The effects of violence do not end when the abuse ends, as the survivor now has to find a way to cope with their past and prevent it from overwhelming them and possibly being revictimized or becoming a perpetrator of violence themselves.

When discussing violence, it is often categorized into various forms: physical, emotional, sexual, neglect. This is done to recognize what signs to look for when suspecting violence. The problem with this though is that it ignores polyvictimization. This refers to having experienced multiple forms of violence either at the same time of the violent act or at different points in a person’s life. When different forms of violence happen within one another, it is referred to as co-occurrence. In most cases, a violent act is not limited to one form. Using Charlie’s story as an example, he stated how his father was emotionally and physically abusive to Charlie’s mother. With more than one type of violence occurring at once, the effect is increased as a survivor may not only be physically hurt but can be terrified that their abuser will react the same way again.

According to the Center for Disease Control and Prevention, 1 in 4 children have been victims of abuse at some point in their life, with an estimated 702,000 children having been victimized in 2014 alone and 1,580 dying from being abused or neglected. In a long-term study conducted, 80% of children who were victims of abuse met the criteria of at least one psychological disorder by the time they were 21. Some of the consequences of being a victim of violence include improper brain development, impaired cognitive, social, and emotional skills, being at a higher risk for developing diseases such as heart, lung, and liver disease, more likely to suffer from obesity, high blood pressure, and high cholesterol, have problems with anxiety, and be more likely to smoke, excessively drink, and abuse drugs. From this list of symptoms, Charlie matches with developing anxiety and problems with drinking and drug use. Often, drugs and alcohol are used as coping mechanism, but they only make the situation worse. Along with using illicit drugs, individuals who were abused as children are more likely to engage in risky sexual behavior. They are also at least 25% more likely to become pregnant as a teenager, drop out of high school, and to engage in delinquent acts.

Studies have been conducted to examine the effects of violence in childhood across the lifespan with much coming from the research known as Adverse Childhood Experiences (ACEs). The original ACEs survey listed statements about whether an individual had ever experienced this act of abusive behavior during childhood and to either mark “0” for no or “1” for yes. At the end of the survey, the participant would count up their score and the higher your score, the higher your risk was for developing these symptoms. If you wish to score yourself, look for the ACEs study online and see where you rank.

Charlie Pacello had a difficult childhood that has greatly affected his life. Unfortunately, this did not have to happen and yet it is still happening to people around the world every day. Let this be the end of it. If you know someone who you believe is a victim of violence or even a perpetrator of violence, don’t be a bystander. Take action and report these acts to a Child Advocacy Service in the event you suspect child abuse. Please know that you do not have to be 100% certain that abuse is going on. If you suspect abuse, call these services and they will determine if there is a case. Outside of this, be a safety net for your friends and family who are experiencing violence or were victims in the past. Listen to their problems and be there to provide emotional support. Even the smallest act, may be all that it takes for a survivor of violence step back from the edge of the dark abyss that Charlie Pacello says he was close to taking. And one of the most important things to do when interacting with a survivor of violence is to believe them. You may be the only one who does. For more information about how you could do this, see the end of the document.

Surviving Violence: Trauma Informed Treatment: The Effects of Violence Prevention Programs

Charlie Pacello grew up in a violent household and experienced the fear and trauma associated with it to the point that he began to repeat the cycle. However, Charlie was able to find a way to begin recovering from this trauma. Here is the conclusion to his story:

At a conference I attended in March 2015, I had the opportunity to present my story and the work that I do with Gail Soffer, Founder and Executive Director of the non-profit ‘The Mindful Warrior Project’.  One of the presenters before us, Dr. Bob Geffner, focused on the neuropsychology of trauma in children and showed in one of his slides the MRI scan of a child’s brain that had experienced the same or similar kind of violence in the home that I had.  This six-year-old’s brain scanned exactly the same as a soldier whose experienced severe combat.  I almost fell out of my chair when I saw that slide and knew that was my brain too.  I started to shake, and tears filled up my eyes.  I always knew from a very young age there was something wrong in me.  And there it was, clearly marked on the slide.  My brain was just like my dad’s when I was six.  A few months later, on Father’s Day 2015, I showed the slide of the six-year-old’s brain to my combat veteran dad.  He stood there frozen for nearly a minute, as the tears started to come down his cheeks.  He said, “Wow.  There it is.  Son, my war was for 4 years.  Your war was for 42 years.  How in the world did you come back?”  “Love, dad, plain and simple.  Love for you, my family, and all the men and women who’ve ever been touched by the horrors of war”, I said to him, holding back the tears.  It was a moment where the warrior in me was recognized and seen by the warrior in him.  He understood unequivocally the war I had been fighting all my life.  But, I digress.  It’s important to know the full story, and how these early life traumas in childhood detrimentally affect a person’s quality of life when they become adults.

Most of my life I carried with me this sense of guilt and depression, I was marked with a sadness that was inexplicable.  Despite this low level of guilt, sadness and depression, I still had great times.  I still created good times.  High school was one of them.  I could wear different masks.  I could play different roles.  But deep in my core was always this.  I thought my way back to wholeness would be if I could just keep the family together.  I had made it my responsibility at a very young age to keep the family together.  I was searching for peace, searching for wholeness, searching for connection, searching for healing, and my thought was ‘keep the family together’, then I could get that healing, I could get that wholeness.

There was something wrong with my dad, I knew it.  And, there was something wrong with my mom.  And, as children, we make the erroneous assumption it must be because of me.  It’s my fault.  So, I took on the role as the mediator, the one who held the bonds together.

-Charlie Pacello

Charlie’s journey of trauma began even before he was born. As an adult, he was able to embrace the part of this journey that included healing and recovery. Recovery looks different for every person impacted by trauma. Judith Herman (2015) describes three stages of recovery: Safety, Remembrance/Mourning, and Reconnection. The first stage focuses on regaining a sense of safety, from within oneself and in one’s environment. The second stage involves telling one’s story, mourning one’s losses, and creating new meaning from the trauma. Finally, the third stage allows one to focus on reestablishing a sense of self as well as relationships with others, including friends, family, and the greater community. These tasks of healing are a core component to various types of evidence-based, trauma-informed treatment.

PTSD is treatable. There are a variety of types of interventions that are shown to be effective in the healing of those impacted by trauma and PTSD. The Department of Veteran’s Affairs (VA) identifies several of these therapeutic treatments, including cognitive-behavioral therapy (CBT), cognitive processing therapy (CPT), and prolonged exposure (PE) (Cook & Stirman, 2015). These approaches are based on cognitive theories of psychology. Some studies also show that people with PTSD benefit from a relational/psychodynamic approach to therapy (Spermon, Darlington, and Gibney, 2010). Medication treatment is another option. Addressing levels of neurotransmitters in your brain through use of medication can provide relief and also help make your therapy experience more effective. To consult about this option, it is important to schedule an evaluation with a psychiatrist.

Let’s also consider this question: What if the pain and trauma that Charlie and his family endured could have been prevented? Whereas treatment is an important modality for supporting survivors of trauma, it is also crucial to put efforts toward violence prevention, a movement which strives to reduce the overall exposure to and impact of trauma. Organizations like the National Partnership to End Interpersonal Violence (NPEIV) work toward the goal of ending all interpersonal violence by joining research, practice, policy, and advocacy. Any person can get involved.

To become more involved in violence prevention, you must commit to no longer being a passive bystander. If you see something happening that feels wrong, try to do something to intervene. For example, if you see a man yelling at a woman outside of a restaurant, you could try walking over and asking them for directions – this could help deescalate a tense situation. Another way to help is to learn calming techniques and teach these to others – this will help people gain control of intense emotions and related urges. Most importantly, we must look out for each other – forming positive relationships fosters ongoing healthy attachment and feelings of support.

Many prevention programs have been implemented across the country. Several of these have been assessed for efficacy and effectiveness. The Green Dot bystander program, a program directed at college students, focuses on encouraging students to take action versus being a passive bystander. Research shows that schools that implement this program had significantly lower violent victimization rates and fewer male perpetrators than comparison campuses (Coker et al., 2015). In a review of violence prevention programs targeting children ages 7-14, 25 programs were found to be effective in improving attitudes toward violence and reducing delinquency rates and aggressive behavior (Cooper, Lutenbacher, & Faccia, 2000). Effectiveness of these programs is closely related to program quality (Finkelhor et al., 2014), and it is important to continue to build and assess excellent prevention programs for people of all ages.

Those who have endured trauma show great resilience. The American Psychological Association defines resilience as, “the process of adapting well in the face of adversity, trauma, tragedy, threats, of significant sources of stress…it means ‘bouncing back’ from difficult experiences.” There are specific factors that contribute to a person’s resilience, such as good relationships, and strong problem-solving skills. There are ways to build resilience, such as self-care practice and making positive connections with others. Remember that humans are strong and there is hope for those who have experienced trauma to recover and find peace.

Did you want to take some action steps to help yourself or others? See the resources below that are divided by issue:

Learning more about the Signs of Trauma and Abuse:

Go to the Center for Disease Control: http://www.cdc.gov/childrensmentalhealth/ptsd.html

Go to the U.S. Department of Veterans Affairs:

http://www.ptsd.va.gov/public/PTSD-overview/basics/how-common-is-ptsd.asp

Go to the National Institute of Mental Health:

http://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml

Learning more Information about Violence and PTSD 

Go to the U.S. Department of Veterans Affairs: http://www.ptsd.va.gov/professional/treatment/children/pro_child_parent_ptsd.asp and at http://www.ptsd.va.gov/professional/treatment/family/partners_of_vets_research_findings.asp

For more resources for you as an individual or community, see the award-winning non-governmental organizations committed to veterans and healing PTSD, violence, and the invisible wounds of abuse at http://www.mindfulwarrierproject.org; http://www.soldiersheart.net and http://www.charliepacello.com

Learning more about Child Abuse:

Go to The Center for Disease Control and Prevention:

http://www.cdc.gov/violenceprevention/childmaltreatment/consequences.html , and at Safe Horizon at http://www.safehorizon.org/page/signs-of-child-abuse-58.html.

Learning more about Treatment:

Veterans who are interested in seeking treatment can find information about the services offered at their local VA. http://www.va.gov/directory/guide/PTSD.asp

Those interested in therapy treatment may contact their primary care physician for a referral to a local provider within their insurance network, or visit  https://findtreatment.samhsa.gov/

Learning more about Prevention: 

If you are interested in taking a stand to prevent violence, you can get involved with or donate to the Center for Violence Prevention. http://mscvp.org/get-involved/

You can also visit https://www.cdc.gov/violenceprevention/youthviolence/opportunities-for-action.html for information about opportunities to take action against interpersonal violence.

Read more about international efforts toward violence prevention.  http://www.who.int/violenceprevention/en/

ACT, supported by the APA violence prevention office, is a program to promote positive practices in parenting and caregiving. http://www.apa.org/act/