Treatment Offers Hope for Imprisoned California Siblings
The California case in which 13 siblings were found imprisoned at home earlier this week is shocking, but not without precedent. Lurid cases have come to light over the years of children locked in closets and basements, held captive by parents who have crumbled under the weight of drugs, extreme religious conviction, personality disorders or their own abusive backgrounds.
The good news, trauma experts say, is that recovery is indeed possible. Victims can reclaim their lives.
“The clinical data is encouraging,” said John A. Fairbank, co-director of the National Center for Child Traumatic Stress. “There are good treatments available for children seriously abused and traumatized.”
“临床数据是乐观的，”美国国家儿童创伤应激中心(National Center for Child Traumatic Stress)联席主任约翰・A・费尔班克(John A. Fairbank)说。“对受到了严重虐待和创伤的儿童有很好的治疗方法。”
In particular, said Dr. Fairbank, a professor of psychiatry and behavioral sciences at Duke, good results have been shown with a relatively short-term cognitive behavioral therapy tailored for trauma patients, an approach developed in the early 1990s but widely disseminated in the last 15 years.
A significant hurdle to recovery for the California siblings and children in analogous situations, said psychologists, is that their captors were not stranger-kidnappers but their parents.
“In doing the healing work, you look at what the patient’s support systems are, “ said Priscilla Dass-Brailsford, a trauma psychologist and an adjunct professor in the department of psychiatry at Georgetown University. “The biggest supports are parents and family. These kids don’t have that. The parents were the aggressors.”
“在进行康复工作时，要找出病人的支持系统是什么，”乔治城大学(Georgetown University)精神病学系副教授、精神创伤心理学家普利西拉・达斯-布雷斯福德(Priscilla Dass-Brailsford)说。“父母和家庭是最重要的支持。但那些孩子们没有这些。他们的父母就是侵犯者。”
Experts interviewed for this article, who underscored that they had no direct knowledge of the California case, said that because the siblings’ primal assurance of unconditional love and safety had been ripped away, they would almost certainly struggle to trust and attach to future supportive figures.
“The notion that this was done by parents increases a child’s helplessness and hopelessness,” said Nora J. Baladerian, a Los Angeles psychologist who often treats traumatized individuals.
“知道这是父母的行为这一点增加了孩子的无助和绝望，”洛杉矶一名经常治疗精神创伤病人的心理学家诺拉・J・贝拉戴里安(Nora J. Baladerian)说道。
Dr. Dass-Brailsford compared the 13 siblings’ situation to that of prisoners of war, who have been deprived of food, freedom and sufficient nurturing.
“One glimmer of hope is that they did not go through this alone,” she said. “Prisoners of war are isolated as part of their torture. These children at least had each other.”
Before formal therapy can begin, the siblings must be placed in a safe, nurturing environment where kind treatment will be a positive constant they can rely upon, experts said. They added that keeping as many siblings together as possible would be important, to sustain their bonds.
Daniel L. Davis, a forensic psychologist in Columbus, Ohio who has treated victims and perpetrators and evaluates children for juvenile court, said that there is not one behavioral model that adequately describes a typical parent perpetrator.
一位在俄亥俄州哥伦布市少年法庭治疗受害者和施害者的司法心理学家丹尼尔・L・戴维斯(Daniel L. Davis)表示，没有哪一种行为模型可以完全概括出典型的父母施害者。
“There are risk factors, certainly,” he said. A list might include a prior history of abuse, domestic violence, and a cluster of personality disorders such as antisocial personality disorder, borderline personality disorder and narcissistic personality disorder. Such people, he said, might be overly emotional, unpredictable, manipulative and exploitative.
But like other trauma experts, Dr. Davis emphasized that children can be remarkably resilient. He treated an elementary school-age boy whose parents had kept him locked away for such a long period that the child showed significant developmental delays. “But with intensive treatment and real effort by a support team, his growth was impressive,” said Dr. Davis. “His parents were sent to prison.”
Other examples of children locked away from society by parents do occasionally emerge. A documentary “The Wolfpack” tells the story of seven siblings isolated in a Lower East Side apartment by their father. In 2015, three siblings were found locked by their parents in a urine-and-feces infested room in Spotsylvania County, Virginia. That same year, a teenage girl in Murfreesboro, Tenn., was also discovered having been locked in her bedroom for months by her parents, who had allowed her three siblings to travel at will.
Dr. Davis said that while poverty is an element in many cases, it is certainly not a signature characteristic; indeed in the California case, the family lived in a middle-class neighborhood and the father, David Allen Turpin, had reportedly once been employed as an engineer. But poverty-afflicted situations may come to light more often, Dr. Davis noted, “because the perpetrators don’t have the resources to keep shielding from public scrutiny.”
戴维斯博士表示，虽然贫穷是很多案例中的一个因素，但它肯定不是标志性特征。事实上，在加州的这个案例中，这家人住在一个中产阶级社区，据说父亲戴维・艾伦・特平(David Allen Turpin)曾做过工程师。但是，戴维斯博士指出，贫困导致的情况可能更容易被发现，“因为犯罪者没有足够的资源来避免公众监督”。
Formal treatment begins after children are placed in a secure home and assessed for trauma-related symptoms, including post-traumatic stress disorder. They may be unwilling or unable to describe their experience. Nightmares may roil them. The slightest trigger ― the rattle of keys, for example ― might send them into a hysterical tantrum. They may seem hyper-aroused or vigilant, ever alert and cringing, braced to flee or fight. Younger children may act out the trauma as they play; for others, the emotional pain may be so overwhelming that they seem numb.
“But the majority of these children can bounce back, “ said Anthony P. Mannarino, director of the Center for Traumatic Stress in Children and Adolescents at Allegheny General Hospital in Pittsburgh. “I’m not saying they’ll forget it but they can find a way to go forward.”
“不过，大多数孩子都能恢复过来，”匹兹堡阿勒格尼医院(Allegheny General Hospital)儿童和青少年心理创伤中心(Center for Traumatic Stress in Children and Adolescents)的主任安东尼・P・曼纳里诺(Anthony P. Mannarino)说，“我不是说他们会忘记，但他们能找到前进的道路。”
Dr. Mannarino is a co-developer of trauma-focused cognitive behavioral therapy (TF-CBT). The typical treatment, he said, is 12 to 16 sessions.
First, a therapist works with a child to manage terrifying thoughts and feelings about the experience. Next a therapist helps the child gradually discuss the trauma.
“Those memories are really scary,” Dr. Mannarino said. ”Maybe the parents said, ‘You deserve what you’re getting, it’s your fault,’ and the child may have internalized shame. Helping them talk and processing that distortion gives them a chance to understand that they are not to blame.”
Finally, TF-CBT involves the child’s new caregivers. “We work with them to understand that the child’s behavior expresses what happened to the child, as opposed to who they really are,” said Dr. Mannarino.
Of numerous therapies developed to address traumatized patients, TF-CBT is one of the most studied. In a 2004 randomized, multisite study published in the Journal of the American Academy of Child and Adolescent Psychiatry, 203 children between eight and 14 who had symptoms of PTSD related to sex abuse, and their caretakers, were randomly assigned to TF-CBT or “child-centered” therapy ― a talk therapy model often use in rape-crisis or sex-abuse treatment centers. TF-CBT patients showed significantly more improvement in markers such as PTSD, depression and behavior.
在治疗创伤患者的诸多疗法中，TF-CBT是最受关注的一种。在《美国儿童和青少年精神病学会期刊》(Journal of the American Academy of Child and Adolescent Psychiatry)2004年发表的一项多地点随机研究中，203名8至14岁具有性虐待创伤后应激障碍症状的孩子和他们的看护人被随机分配采用TF-CBT疗法或“以儿童为中心”的疗法――后者是强奸危机中心或性虐待治疗中心经常使用的一种谈话疗法。采用TF-CBT疗法的患者在创伤后应激障碍、抑郁和行为等指标上的改善更为明显。
Dr. Baladerian hoped that not only would the California family receive sufficient services, but that “the attention will also help other victims whose cases might not have been attended to with such alacrity.”