Violence and Trauma: The Thorn in our South African Flesh

Violence and Trauma: The Thorn in our South African Flesh

The lifelong and debilitating impacts of trauma, especially childhood trauma, are increasingly starting to enter popular media and dinner table discussions. I recently listened to at least two good podcast discussions on the topic, but there are many, many more available. Good books, too.

In October, South Africa’s mental health awareness month, the impact of trauma on people’s lives deserves some consideration.

After the seminal paper by Dr Bongani Mayosi and colleagues in the Lancet in 2009, violence and accidents continue to be identified as one of South Africa’s big four health burdens. They can both cause trauma, but there are many life traumas not captured by this category.

A short while ago, Prof Linda Richter released the results of the Birth to Thirty study. Together with other researchers, she has been following the lives of a group of South African children since their births in 1990. Originally, the study was conceptualised as the Birth to Twenty study. Over time, however, funding has extended the study timeline.

The results of the Birth to Thirty study, which followed the lives of 3,200 children, born between 23 April and 8 June 1990, were recently released in the form of a book (you can order it via this link).

In the Daily Maverick piece written on the launch of the book and the study’s core results, there was a focus on the immense impact violence has had on the lives of the children, who eventually became adults. An academic article on the extent of violent events in children’s lives is also available.

By the age of 18, only 1% of children who were followed had not witnessed or experienced some type of violence, while about half had experienced or witnessed violence in some context of their own lives.

The nature of younger children’s lives provides some protection, but by high school, their greater level of movement to and from school, as well as activities with peer groups, mean they have a much greater chance to experience or witness violence. Among adolescents, 96% had already had a personal experience of violence (more than just witnessing, but personally experiencing).

There is significant evidence showing that trauma experienced during childhood is associated with physical, mental and emotional symptoms that can endure into adulthood. Childhood adversity is now identified environmental risk factor for non-communicable disease.

A question that economists often grapple with is one of association versus causation. It is possible that people who have experienced childhood traumas also lived in certain circumstances, or in certain ways that contributed to poor later-life outcomes. Were these outcomes simply associated with trauma, and actually caused by other factors?

It will never be ethically possible to run experiments to determine identify trauma as a root cause of other outcomes. We therefore turn towards the natural experiments provided by historical events better understand trauma’s impacts in a causal way. Wars and the circumstances associated with them provide a source of historical data to start answering the question of causality.

The Second World War and the traumas caused by this war have had many later-life physical manifestations. In one study focusing on children born in Helsinki between 1934 and 1944, it was found that a traumatic separation from parents during childhood was associated with less than ideal (in the social context) later-life reproductive health outcomes. Many of these children were evacuated from Helsinki during the war and sent (unaccompanied) to live with temporary foster families in Sweden and Denmark. The group also had many children who were not separated, allowing for causal analysis on the impacts of this type of childhood trauma.

For the children who were separated, their trauma impact had clear biological manifestations. There is evidence that childhood traumas can manifest in changes in brain structure, leading to physical, mental and emotional symptoms later in life.

The lives of child soldiers also provide a context for understanding how extreme childhood traumas can play out later in life, but potentially also how the consequences of these early-life events can be prevented, or softened. In Liberia, a country which experienced an extreme civil war, providing young men who were recruited as child soldiers with cognitive-based therapy sessions reduced their later-life participation in crime and violent events.

South Africa’s population experiences extremely high levels of trauma, whether through violence and accidents, familial separation, or the myriad of other possible traumas. If we believe theories on trauma and epigenetics, previous generations’ trauma also affects the health of our current population.

Yet we have extremely low numbers of psychologist and psychiatrists to help address this underlying trauma. This means that we need to start moving towards experimentation and innovation in the way we offer our population access to therapy.

Technology is one tool that can be utilised. However, we may also need different models of in-person therapy. And we need to start recognising that trauma’s impact extends far, far beyond only mental health, into physical illness.

Once we have a clear understand of how trauma’s costs are evident everywhere in society, there may be a greater willingness to start supporting those who have suffered traumas they never should have been exposed to.

Views expressed are the reader’s own.

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