An influential period of many “firsts,” human childhood creates lifelong memories that shape our sense of identity and our perceptions about life. A child’s mind is molded by their vulnerability to new experiences. Wide-eyed at every encounter, they subconsciously draw conclusions about life, whether or not their conclusions are healthy. As children gather impressions to create fundamental knowledge, they spend adolescence drawing from these memories to navigate their social environments.
Healthy childhood experiences provide strong social guidelines, but sadly, childhood trauma is detrimental to adolescent mental health. Abuse, whether physical, sexual or mental, occurs more often than one might think; in fact, the Substance Abuse and Mental Health Services Administration found that over two-thirds of children in the US have experienced at least one traumatic event by age sixteen.
Though not all cases are severe enough to manifest later as significant mental health disorders, the presence of co-occurring disorders in abuse victims is common among adolescents. Poor coping mechanisms like substance abuse only worsen their mental health, pushing them further into social isolation and dissociation from reality. Analysis of Charlie’s character from Stephen Chbosky’s Perks of a Wallflower shines a spotlight on the overlooked “forgotten relationship” between substance abuse and mental health disorders. Adolescent substance abuse remains the largest public health issue in America; as such, its underlying causes require examination, as do medical perspectives that advocate for therapeutic practices like family-based intervention.
CHILDHOOD TRAUMA BACKGROUND
Childhood trauma is one of the most significant risk factors for the development of adolescent mental health conditions. More specifically, trauma load during a child’s formative years compromises neural structure and function, leaving children susceptible to later cognitive deficits and psychiatric illnesses including schizophrenia, depression, bipolar disorder, Post-Traumatic Stress Disorder (PTSD), and substance abuse. Indeed, the National Survey of Adolescents found that teens who had experienced physical or sexual abuse were three times more likely to struggle with substance abuse than those who had not. Unfortunately, these kinds of traumatic life experiences occur at alarmingly high rates across the country. By undermining a child’s perceived sense of safety in their attachment figures, trauma directly compromises their innate human need for security. The emotional attachment bond is necessary for children to create a solid foundational identity; it serves as a psychological template to inform their ability to form healthy attachments throughout their lives. However, when these initial bonds are marked by abuse, especially at the hand of guardians, the results profoundly damage children’s outlook on future interpersonal relationships. Feelings of associated terror, helplessness, and fear become imprinted into their memories, manifesting in extensive ways long after the traumatic event(s). As they become closed off to human connection, choosing self-reliance over potential disappointment from others, the most common symptom is difficulty forming fulfilling relationships.
CASE STUDY – PERKS OF BEING A WALLFLOWER by STEPHEN CHBOSKY
Stephen Chbosky’s coming-of-age novel provides an example of the devastating impacts of abuse on adolescents’ daily lives. The novel’s protagonist, Charlie, is deeply troubled and emotionally scarred from two traumatic childhood experiences: 1) recurring sexual abuse, and 2) witnessing the death of his Aunt Helen. These events distort Charlie’s perception of romance and even friendship, manifesting in the forms of social anxiety, awkwardness, and a severe lack of self-esteem and identity. His deep-rooted, intrinsic sense of shame and guilt prevent him from forming close relationships, especially romantic ones. This inability is evident in his relationship with Sam, when he is unable to trust or become intimate with her. Every attempt at romance only forces him deeper into his haunting past. His prior trauma disrupted healthy relationships in his formative years, leading to his subconscious decision to detach from others altogether. On the surface, this mindset is driven by his inability to trust others. However, on a psychological level, he distances himself from relationships due to his extreme sense of self-reliance, which he was forced to develop for survival. In adolescence, this independence translates to social avoidance and the formation of distant relationships, like his relationship with Sam. He is unresponsive to others’ needs, often appearing “tone-deaf” and awkward; but in reality, he has dissociated from all attachment bonds with other people as a subconscious way of removing all possibility of future abuse.
Charlie’s dissociation from his reality is apparent throughout the novel. In efforts to maintain a sense of normalcy and avoid confronting his trauma head-on, he represses memories of his aunt’s abuse, choosing to remember her as his “favorite aunt” after her death. His memory suppression is a common trauma response; it allows him to prevent experiences of pain and discomfort from integrating into his psyche. However, over time, this repression morphs from a natural coping mechanism into severe psychological instability and distance from reality. He develops a tendency to detach physically, mentally, and emotionally when he becomes overwhelmed. For example, upon witnessing his sister’s boyfriend physically abusing her, he disconnects and is completely unable to move or intervene. With this scene, Chbosky emphasizes how Charlie’s desperation to escape stressful situations and further trauma outweighs even his basic human value to protect those he loves.
DISSOCIATIVE DISORDERS AND ADOLESCENT SUBSTANCE ABUSE
Considering Charlie’s state of mind, the fact that he eventually turns to substance abuse to temporarily numb his psychological distress is no surprise; however, drugs and alcohol only further exacerbate his emotional instability and push him toward risky behaviors. Charlie’s case evidences how dissociation is a major psychological factor in substance disorder development. “Dissociation” refers to a mental process of disconnecting from emotion, memory, or identity. Sometimes described as “spacing out,” “losing time,” and “going blank,” this form of detachment from current reality can protect victims against overwhelming trauma-related feelings or memories. However, the practice degenerates into a “dissociative disorder” when it causes significant interference with daily mental functioning and forms memory and identity lapses.
Unfortunately, as it is an internal process, dissociation disorder is extremely difficult to recognize and often goes undiagnosed. As a result, individuals with dissociative disorders frequently do not receive necessary treatment early enough; when their disorder does not provide adequate relief, they turn to substances as a means of further escape. It is very common for the two to exacerbate each other, or for one to mask the other. The complex relationship between substance abuse and dissociation culminates in a “co-occurring disorder.”
Such disorders impact areas of the brain involved with decision-making, impulse-control, and emotion. They also interfere with neurotransmitters like dopamine and serotonin. Due to this wide range of vulnerabilities, co-occurring disorders can coincide with several other disorders as well, including anxiety, ADHD, and bipolar disorder. Uninformed healthcare professionals may likely miss one of these illnesses, which is why treatment and intervention must be sought as soon as possible.
MEDICAL PERSPECTIVES ON TRAUMA-INFORMED CARE
Currently, medical perspectives informed by how childhood trauma impacts lifelong psychological progress advocate for patient-centered efforts to dissect the dissociation’s source. In his book The Body Keeps the Score, researcher and psychiatrist Bessel van der Kolk discusses how a lack of patient collaboration is not only ineffective to a patient’s health, it is harmful. He recollects his time working in a psychiatric hospital’s research ward as an attendant under a project investigating treatment options for adolescents with schizophrenia. His role was to keep the patients—college students like him—engaged in normal adolescent activities. Because he spent so much time in the unit, including weekends and nights, he was exposed to many things the doctors never saw during their brief visits. For example, when he would engage in conversations with the patients during late hours, they often opened up to him about their previous trauma. Yet during rounds, Van der Kolk was surprised when none of the doctors mentioned any of the patients’ traumatic stories about rape, childhood violence, or other abuse. He recalls the “dispassionate” way doctors discussed patients’ symptoms, and that they spent more time trying to manage the patients’ suicidal thoughts and self-destructive behaviors than they did on unearthing the underlying causes. They paid little attention to the “ecology of their lives,” as Van der Kolk states, and rarely showed empathy.
While a variety of available treatment approaches are used in trauma-based care, many focus on treating individuals through cognitive behavior therapy, motivation enhancement, and one-on-one drug counseling support. However, individual treatment may not be sufficient in the case of dissociation from childhood family trauma of any kind. In these cases, family-based treatment is recommended for a dissociated adolescent, as it can provide them with the sense of security they missed during their childhood and assist in replacing traumatic memories with new feelings of peace. Additionally, family-based interventions can offer previously negligent guardians an opportunity to rectify their mistakes and reconnect families with one another. Because children create their first sense of identity out of their family’s developmental ecology, by reconstructing an unstable family life into a strong support system, family-based therapy allows adolescents to battle addiction with a newfound and stronger foundation for their sense of self. While individual personality and cognitive factors are important in understanding adolescent behavior, this ecodevelopmental approach emphasizes contextual factors over individual factors. Considering a family precedes and sets the framework for every aspect of an individual’s identity, this context must be addressed and improved first.
CONCLUSION
Those who experience childhood trauma become vulnerable to mental health disorders that compromise emotional and behavioral stability throughout their lives. They require careful, consistent, trauma-informed care by practitioners who value empathetic understanding of their patients’ unique experiences. Chbosky’s portrayal of Charlie’s character underscores the persistence of trauma, demonstrating its impacts on Charlie’s ability to participate in stable, mutually satisfying relationships. His deep-rooted feelings of guilt and shame distort his perception of romantic relationships and diminish his sense of self, causing him to withdraw emotionally from those around him. He often dissociates from his reality, suppressing memories regarding the abuse he faced and seeking comfort from substances when dissociation does not suffice. Sadly, his story is representative of many adolescents struggling with co-occurring disorders as they attempt to heal from their formative trauma.
Though the idea of invoking painful memories can make abuse survivors reluctant to seek professional support, the therapeutic process is a necessary landmark on the road to recovery. More specifically, family-based interventions can offer a holistic approach to reconstructing individuals’ foundational identity and help them cultivate a much stronger support system to face their addiction(s). Indeed, therapy allows people to rewrite their scarring memories in a new light and helps them face those traumas through repeated conversation and discussion until the need for suppression is replaced by newfound introspection, acceptance, and ultimately peace.
Works Cited
“Dissociative Disorders and Drug Abuse.” American Addiction Centers, 10 Nov. 2022, https://americanaddictioncenters.org/dissociative-disorders.
Horigian, Viviana E et al. “Family-Based Treatments for Adolescent Substance Use.” Child and adolescent psychiatric clinics of North America vol. 25,4 (2016): 603-28. doi:10.1016/j.chc.2016.06.001
Khoury, Lamya et al. “Substance use, childhood traumatic experience, and Posttraumatic Stress Disorder in an urban civilian population.” Depression and anxiety vol. 27,12 (2010): 1077-86. doi:10.1002/da.20751
“Mental Health and Substance Use Co-Occurring Disorders.” SAMHSA, 24 Apr. 23AD, https://www.samhsa.gov/mental-health/mental-health-substance-use-co-occurring-disorders.
Najavits, Lisa M, and Marybeth Walsh. “Dissociation, PTSD, and substance abuse: an empirical study.” Journal of trauma & dissociation : the official journal of the International Society for the Study of Dissociation (ISSD) vol. 13,1 (2012): 115-26. doi:10.1080/15299732.2011.608781