When we think of mental health problems, it’s easy for many of us to envision obvious symptoms – anxiety, depression, and rage. However, mental health issues present challenges precisely because it can be almost impossible to detect or observe. It is not binary or exclusive, but something that is complex and universal. Despite progress in recent years, not many people understand the full scope of mental illness, especially concerning the role of psychological trauma in the cause and treatment of anxiety and depressive disorders.

Trauma, including one-time, multiple, or long-lasting repetitive events, affects everyone differently. Some individuals may clearly display criteria associated with post-traumatic stress disorder (PTSD), but many more individuals will exhibit resilient responses or brief subclinical symptoms or consequences that fall outside of diagnostic criteria. The impact of trauma can be subtle, insidious, or outright destructive. How an event affects an individual depends on many factors, including characteristics of the individual, the type and characteristics of the event(s), developmental processes, the meaning of the trauma, and sociocultural factors.

It is strongly speculated in psychology and neurobiology that many mental illnesses may bear their roots in childhood and adult trauma. To reiterate this claim, such a journal written by C.B. Nemeroff, an American psychiatrist who received his PhD in neurobiology and his M.D. from the University of North Carolina at Chapel Hill, mentions the following: “There is considerable evidence to suggest that adverse early-life experiences have a profound effect on the developing brain. Neurobiological changes that occur in response to untoward early-life stress can lead to lifelong psychiatric sequelae.” 

He added, “Children who are exposed to sexual or physical abuse or the death of a parent are at higher risk for development of depressive and anxiety disorders later in life. Preclinical and clinical studies have shown that repeated early-life stress leads to alterations in central neurobiological systems, particularly in the corticotropin-releasing factor system, leading to increased responsiveness to stress. Clearly, exposure to early-life stressors leads to neurobiological changes that increase the risk of psychopathology in both children and adults.”

If trauma is left untreated, the effects of trauma become multigenerational through repeated psychological dysfunctions. The new science of epigenetics is identifying the mechanisms that even affect gene functioning. The children of Holocaust survivors, for example, have altered genetic mechanisms leading to abnormal stress hormone levels. Animal studies are showing that the physiological effects of trauma can be passed on even to the third generation.

As the old saying goes, prevention is better than cure. In essence, the key to fighting stigma surrounding psychological trauma as well as its effects is education. Most of us know the differences between physical ailments such as a cold, a sprain, cancer. We don’t refer to them under a singular “physical illness” umbrella. Similarly, there are many different mental illnesses, each with their own unique symptoms and behaviours. By constantly educating ourselves about mental illness, we can help eliminate misconceptions that contribute to stigma.  

Until we better recognise the impact trauma has on individuals, society will be limited in their ability to support human dignity, well-being, and resilience. Indeed, we must better understand trauma, discuss it, and integrate awareness of it into the culture of social change if we are to effectively address issues in which trauma and intergenerational trauma are factors. Recently, we gathered the dedicated women of ABRI Integrated Mental Health – Faith Foo, Cathie Wu, and Sudha Kudva – to speak on the record about the intricate link between mental health illness and psychological trauma.


The Art Of Understanding: A Roundtable Discussion On Mental Health
Faith Foo

Faith Foo is the Founder and Director of ABRI Integrated Mental Health and Faith Foo Counseling. Clinically, she is a licensed counsellor, a certified EMDR Therapist, a certified coach, and an author. Her practice specialises in treating depression, anxiety, relationship issues, divorce, infidelity, stress, traumas, PTSD, anger issues, grief, executive coaching, and more.

Mental health, like physical health, affects all our lives; however, we may talk or think about it differently. Can you share what mental health means to you?

Mental health includes our emotional, psychological, and social well-being. It affects how we think, how we act, and how we behave. It also helps determine how we perceive our own lives. Like physical health, it’s essential to be mindful of the condition of our mental health. For instance, you’d exercise to ensure that you’re physically healthy. Likewise, there are steps that we can take to improve our mental health. Often, symptoms will start showing up when our mental health is neglected.  

Mental health is important at every stage of life, from childhood and adolescence through adulthood. Biological factors can contribute to the development or progression of mental disorders. However, the clients that I’ve treated are usually not under this category. They come to sessions due to issues that are caused by psychological and environmental factors. These factors include a variety of causes including trauma, abuse, and dysfunctional family history. Most of my clients were exposed to some form of traumatic event at some point in their lives, or even their childhood. 

Is being mentally healthy the same as being happy?

Not necessarily. Being mentally healthy means that one is resilient and able to mentally cope with the uncertainty, challenges, and adversity of life. They have strength, the capacity to do things well, and contribute to society.  When somebody is whole, they’re resilient, and they’re able to cope with stresses more easily. 

How does one recognise the early signs of mental illness?

Usually, if someone grew up in a toxic environment, they’d have difficulty recognising the signs.  I have a client in his 20s, and he did not know the significance of what he’d experienced in life. He was going through severe anxiety issues as a result of his upbringing. In essence, his childhood had normalised feelings of anxiety and paranoia that extended well into his adulthood. It was only until he started to connect with people that he realised that what he’d experienced was out of the ordinary. Fortunately, he had a high level of self-awareness which prompted him to come for therapy.  

I think teachers play an important role. A child would not know that they’re experiencing something that is out of the ordinary, and parents would often be blindsided, considering how often these things are caused by familial environments. Instead, the teachers can pick up on the signs by observing the child, considering that they’re well informed on the importance of childhood in a person’s mental health development. That’s why it’s so important for our society to educate people about mental health. Often, people don’t even know that they’re struggling because of their upbringing. 

Are there any self-help techniques for coping with mental illness?

Deep breathing. It’s simple, but how many people are really practicing it? Deep breathing is one of the best ways to lower stress in the body. Anxiety floods your body with stress targeting hormones, utilising deep breathing as a grounding technique can help relieve anxiety. When you breathe deeply, it sends a message to your brain to calm down and relax. 

Another technique that one could utilise is to ground yourself using each of the five senses – sight, touch, hearing, smell, and taste. The idea is to ground yourself by using your senses as soon as you’re experiencing strong emotions or a difficult mood. For people struggling with mental illness, it’s easy to dwell on negative thoughts. The grounding technique brings them back to the present through the senses.

Collectively, what can we do to support mental health? 

I think it’s about constantly creating awareness; a lot of information must be talked about. For instance, there has been a significant growth of environmental awareness in recent years, and that’s because the public is aware of the consequences of environmental damage. Likewise, we need to do the same for people who are struggling with mental health issues. We need to focus on developing more projects, more campaigns. Yes, it’s important that we save our planet, but wouldn’t it be better if the inhabitants were healthy as well? 


The Art Of Understanding: A Roundtable Discussion On Mental Health
Cathie Wu

Cathie Wu is the Director and Counselling Psychologist of ABRI Integrated Mental Health. Having worked with a diverse mix of clientele in USA and Malaysia including US army veterans, international expatriates, and patients with psychiatric conditions, Cathie specialises in treating clients with mood disorders, anxiety disorders, life adjustment difficulties, grief, bereavement and loss, chemical and non-chemical addictions, gender identity disorders, schizophrenia, and delusional disorders, as well as personality disorders. She also conducts various psychological screenings for mood disorders, as well as for dementia and progressive neurocognitive decline.

What is complex trauma and how does it develop?

Let’s define complex trauma. If trauma is first understood as intense emotions over a very distressed, distressing experience. Intense emotions over distressing experience. Then, complex trauma can be seen as exposure to multiple traumatic sources— often of a repeated, prolonged nature — and the wide-ranging, long-term effects of this exposure.  

Unfortunately, we do see cases where there’s complex trauma in individuals who arise from a dysfunctional family. In many cases, we’re talking about a child who spent almost two decades in a dysfunctional environment. Complex trauma may arise from different origins.  All these formative years that’s shaped by abuse, types of abuse that are repeated and prolonged over the course of decades.  These events are severe and pervasive, such as abuse or profound neglect. 

Can you tell us about the impact of trauma on a person’s wellbeing and behaviour?

Historically, we understand trauma within the context of post-traumatic stress disorder (PTSD), and it develops after a single stressful, frightening, or distressing event. With PTSD, traumas were understood to have features such as somatic, physical arousal, and anxiety. The fight or flight mechanism, flashbacks, and avoidance of trauma-related stimuli, these were features understood to be associated with PTSD. 

On the other hand, complex post-traumatic stress disorder (CPTSD) is understood to affect a person in a multifactorial way. Because of its multiple origins as well as prolonged duration, we learned that the effects from complex trauma are way more complicated. Studies have shown that trauma can change the structure of the brain. The effects of trauma on the brain impact three areas of the brain that are impacted the most are the amygdala, hippocampus, and prefrontal cortex. And these changes play a part in regulating emotions and responding to fear. 

In essence, complex trauma affects a person mentally, even physiologically in the brain structure. Therefore, emotion regulation is disrupted, which leads to change in behavior.  So really, the person is wired to experience anxiety later in life. In many instances, whenever I meet clients who are experiencing anxiety disorders or depression, we link it back to trauma. 

What happens if trauma goes untreated?

If complex trauma is left untreated, the person starts to internalise negativity – self-blame, shame, doubt, guilt. These are all very defining features of internalising behaviour. Furthermore, one may even experience externalised behaviours – aggression, anger, further abuse of others. It’s very common for people who grew up with abuse to get into toxic relationships. In many instances, the cycle repeats itself.  

Is it possible for people to heal from complex trauma?

Recovery is possible because the brain is very malleable. Although recovery is a possibility, it’s important to stress that one cannot overcome this only on their own. 

There are methods developed in our mental health multidisciplinary areas to help the person overcome, heal, or recover from these complex traumas. One very effective strategy is a recall-based therapy modality called EMDR (Eye Movement Desensitisation and Reprocessing). Clinically, we use it for a lot of conditions under the umbrella of anxiety disorders which includes PTSD, CPTSD, phobias, obsessive compulsive disorder (OCD), and more.  


The Art Of Understanding: A Roundtable Discussion On Mental Health
Sudha Kudva

Sudha Kudva is the Director and Partner of ABRI Integrated Mental Health. Through her experience as a mental health professional, Sudha understands that our childhood has a major developmental impact on our lives as adults. She has worked with individuals, couples, and families through complex and unique relationship dynamics. Some of these include issues stemming from childhood wounds (implicit or explicit), infidelity, and expatriation stress, to name a few. 

What is the definition of child abuse and neglect?

First off, what is the definition of a child? The definition of a child is anyone who is younger than 18 years of age. In the USA, child abuse and child neglect are defined as at minimum, any recent act of failure to act on the part of a parent or a caregiver which results in death, serious physical, or emotional harm. It includes sexual abuse, exploitation, or an act of failure to act which presents an imminent risk of serious harm. It’s complicated, but that’s the definition.

I’d like to simplify it for parents and caregivers. When a child is repeatedly made to feel worthless, unloved, alone or scared, they’re experiencing emotional abuse. Often, children have difficulty dealing with negative emotions because adults have the tendency to shift the responsibility onto them. Once we’ve pushed the responsibility to the child, we deny the child’s voice to be heard. So, what was traumatic for the child has now become an adverse life experience for the child. Abuse can come in simplistic, subtle forms, and we need to be aware of creating a space where children can speak up. 

Child neglect represents acts of omission. It’s the failure to provide for a child’s basic physical, emotional, or educational needs. Undoubtedly, child neglect causes low self-esteem by making it hard to perceive yourself accurately, and that doesn’t end when an emotionally neglected child grows up.

What are the signs of a dysfunctional family?

When parents label their kids, that’s a sign of a dysfunctional family. When we label a child without really understanding that behaviour is merely a symptom of an internal state, we’re refusing the opportunity to learn more about our children. In essence, you’re seeing the child through the label, and you’re not seeing the whole child. Furthermore, when cell phone usage dominates family time, it’s usually a telltale sign that something is wrong within the family. I mean, why doesn’t the child want to share? Or have intimacy with their parents?   

To be fair, I’m a parent as well, and I acknowledge that I’ve made some mistakes. Ultimately, we want the best for our children. Instead of hearing the child, parents have the tendency to shut them down and go into advice giving mode. As parents, we tend to be overly protective of our children, without knowing that our actions are keeping the child from wanting to interact with us.

Can you walk us through the stages of recovery for survivors of child abuse?

Thank you for your question. I have someone who’s having sessions provide their answer, I’m going to read it to you:  

“In my own experience as someone who’s currently doing trauma work with a therapist. I think the first step to recovery is building back the person’s confidence. What does this entail? It entails one’s ability to trust in themselves, in their confidence, as well as their ability to deal with challenging situations and stressors. It’s about tackling unhelpful beliefs and the capacity to accept one’s own thoughts, feelings, and internal experiences fully.” 

“Also, it’s about finding ways to soothe oneself when threatening sensations arise in one’s body. After that, once we have the ability to navigate in threatening situations, the person can start to process past instances of childhood abuse, which then allows recontextualising them, reprocessing them, and working with the inner child.”

ABRI Integrated Mental Health is the product of a passionate group of mental health clinicians who share a common vision for mental health. Uniting over three decades of multidisciplinary practices, the clinicians at ABRI offer a variety of psychological, emotional, and relational health services to individuals, couples, children, and families.

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