A shared trauma legacy, two brothers, two trajectories
Journal of Psychiatry Reform vol. 11 #2, February 2024
Caroline Giroux, MD, FRCPC
Professor of Psychiatry, Psychiatrist, University of California, Davis Medical Center, Department of Psychiatry and Behavioral Sciences, Sacramento, California, USA. [email protected]
Suffering is a fact of existence. Trauma, a form of suffering that is often preventable, is more the norm than the exception in our Native populations. My heart sinks even more deeply when I encounter children and teenagers who share their narrative connecting the dots of oppression, colonialism, genocide, addictions, suicide and ongoing discrimination. These themes remain salient regardless of the age. Yet, the intake process and the nature and formulation of the questions slightly differ from patients who had a longer lifespan. Conversely, the youth teach me over and over again about the importance of spending more time exploring perinatal history. The impact is so wounding at times that the dig must take place through the chart or collateral information.
This was the case with a 16-yo teenage boy recently. He had a fairly common American name, so I will call him Peter. The chart review revealed that he was adopted, and that he had attempted suicide a few months before our meeting. He apparently didn’t talk much and refused to think or talk about the past. The chart was more verbose than this young man, whose affect appeared flat, not reactive. He barely moved, was avoiding eye contact, and seemed to hide behind his visage taken over by acne. To the question “do you have friends?”, he replied “no”. He didn’t know what he wanted to do in life. The intake process was like pulling teeth. I pieced together that he had just changed schools because he failed classes, and he failed classes because he was “not smart”. Even though he had no immediate suicidal intention, he didn’t care whether he died. My team of med students tried to engage him the best they could, doing a beautiful job in trying to connect with him as a person, exploring his interests, which didn’t go beyond weight-lifting, maybe as a symbolic, Sisyphean gesture of playing judo with what life threw at him even before he was born. His monosyllabic answers, his very brief sentences indicated anhedonia, learned helplessness, lack of aliveness. His adoptive caregiver, who also looked downcast, provided additional info. Peter’s father died by suicide before Peter was born. He had gone into foster care and was adopted about 3 years previously. The anti-depressant medication he was taking didn’t seem effective. He was almost at a maximum dose since 5 days prior. I asked if he had tried a different class of antidepressant before. When I gave an example, his aunt said this medication made his brother, who was diagnosed with schizoaffective disorder, suicidal. My heart sank a bit more. His brother was scheduled for an assessment right after him that morning…
I was so concerned about Peter, I scheduled him for a follow-up 2 weeks later, to give some time for the medication increase to kick in. With warmth and compassion, I also reiterated a few times that school grades were not equated with someone’s worth, that he should say he failed classes because he was going through challenges in his life (which can happen to anyone), not because of lack of intelligence.
I was preparing myself and my students for likely another, if not challenging, heavy session with his brother. I had just read in his chart that it was actually both their parents who had died by suicide (the dad died when he was only 1-yo, and the mother, 6 years later). There was polypharmacy to dance with the plethora of diagnostic labels, ranging from social phobia to ADHD, daily alcohol use, bipolar disorder and schizophrenia. Like Peter, he had also tried to commit suicide within the previous year, and had even experienced a bike accident that resulted in a head trauma with skull fracture and brain hemorrhage.
Unlike his younger brother, his name, which I was hearing for the first time, sounded Native. I will call him Ada-Hy. Even from the zoom space, I could almost perceive the vibrant color of his eyes: blue. At 17, there was a light pervading his whole being. His dark, shoulder-length hair added some chi, prana, life energy to his aura. Defying my pessimistic expectations, Ada-Hy was refreshingly open, engaged and answered our questions eagerly. He shared goals for the future. He told us he loves fishing. He had already had dating experiences, and shared that he had been respectful towards all his girlfriends when asked about how he navigated intimacy. He admitted he had used then had quit cannabis. He even had a lovely sense of humor. One could never guess the collection of diagnostic labels upon hearing this very teenagerly narrative. With his younger brother’s image fresh in mind, I couldn’t help but think it was like night and day. I felt bad for Peter, for immediately comparing him to Ada-Hy. I was struck once again by the duality we often see in families. Despite sharing an era, two parents and living conditions, two siblings can evolve quite differently. I think of a friend, who has a son who was incarcerated and another one who was a PhD. Another one has fraternal twins, one of which is successful in sports and in social life, while the other one struggles with mental suffering, depression, school avoidance and autism. I think about my own experience as the oldest of three, which often made me reflect on this polarization that children from the same families are cast into. My spirited sister, Isabelle, younger than me by almost 4 years, was the active, athletic one, the “clown”, while I was referred to as the intellectual, calm, serious, responsible one. Our younger brother, Jean-Pierre, shared characteristics with both of us while having his own (like performing well in school with minimal preparation!).
I took the opportunity of his eagerness to answer questions to ask how things were going with his brother, if they were getting along and doing activities together. I was grateful to hear that Ada-Hy was supportive of Peter and able to spend time with him by exercising for instance. Despite the apparent polarities, there was a bond that could help them both. After all, sibling relationships have the potential to be the longest bond ever in a lifetime.
I wanted to draw upon my own experience and countless observations of sibling dynamics to give Ada-Hy’s younger brother also a chance. In their family myth, maybe Peter was the bearer of the family’s suffering and legacy of tragedies. One can only imagine the impact of a father’s suicide on a yet-to-be-born child’s self-representation throughout life. Even under more optimal conditions, siblings might be compelled to enact some patterns, or different polarities, receiving the projections and splitting of parental figures or even deceased ancestors who didn’t free themselves from their own trauma. Under his apparent depression, I believe Peter is suffering from PTSD with dissociation. By cutting himself from painful memories, he is also severing his bond to joy. Therefore, he appears numb, flat, absent.
Over the years, my sister and I developed a strong connection and mutual support and admiration. I comforted her when she was going through a challenging situation as a teenager. She was there for me in the same way as we became adults. We were able to find some of each other’s traits and abilities within ourselves. As such, I overcame my own self-defeating or internalized narratives and I allowed myself to express other aspects of me: I became more physically active, starting to jog in my twenties, and I accessed and developed my own sense of humor. Conversely, Isabelle liked joining me in cultural events and became more interested in reading books which nourished our exchanges.
The trajectories of these two brothers I recently assessed started with many similarities but their current clinical presentations are antipodal. I want to believe that all beings are not to be defined by their starting point nor characteristics imposed on by the environment they grew up in. I want to believe that everyone should be given a chance to integrate their own polarities to become more complete, just like my sister and me.
Also, we should adapt our therapeutic approaches to foster healthy sibling relationships and enhance the advantages that come into specific birth order: various studies provided evidence that led to the conclusion that older siblings can be a source of security for last-borns, which may contribute to the prevention of mental health problems . We can only hope that Ada-Hy will continue to help improve Peter’s prognosis by providing a positive attachment experience through his support, modeling and guidance.
If there is something the story of this family can teach us, it is that we need to look at every human potential multidimensionally. Many factors beyond the genetic aspect can contribute to the risk of developing mental illness (in utero exposure, chaotic upbringing, trauma), and at least as many factors, many of them still unknown, can help change the trajectory towards healing and resilience.
And working for the Native populations in California for over a year now taught me that connecting to nature and rituals can be a way to reclaim power over one’s destiny. Maybe having a Native name and being connected to Mother Earth by fishing is more effective than many medications. Maybe Peter will want to discover the story of his own name, or even dig, reclaim or “fish” another unused name, and connect with his cultural heritage in his own way, if not by renaming himself, at least by no longer sacrificing his life bearing the distress of his parents, not clinging onto that weight, letting this burden go, and finally releasing the life energy stuck somewhere in him, like we all deserve to have access to.
1. Fukuya Y, Fujiwara T, Isumi A, Ochi M. Association of birth order with mental health problems, self-esteem, resilience, and happiness among children: results from a-child study. Frontiers in psychiatry. 2021 Apr 14;12:638088.