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Understanding the behaviours of people with intellectual disabilities experiencing trauma

Valerie Sinason and helping to understand trauma in the lives of people who have an intellectual disability

Valerie Sinason and helping to understand trauma in the lives of people who have an intellectual disability

I recently met with a young woman with Downs syndrome, Miss A, for a psychotherapy assessment. While going through her history it was clear she had witnessed some disturbing incidents. She had been in a taxi accident, had seen someone drown in a swimming pool and her mother had died in front of her, unexpectedly.

In many ways, Miss A was a typical young person who has Downss syndrome, smiling, joking, and curious about me. She told me she was doing 'okay, but when I met her carer, I heard a different story. The carer talked about her concern for Miss A who, following her recent loss, screamed at night, and often

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Valerie Sinason and helping to understand trauma in the lives of people who have an intellectual disability

I recently met with a young woman with Down’s syndrome, Miss A, for a psychotherapy assessment. While going through her history it was clear she had witnessed some disturbing incidents. She had been in a taxi accident, had seen someone drown in a swimming pool and her mother had died in front of her, unexpectedly. 


Often in patients who have intellectual disabilities, they can hide away from traumas. Picture: Alamy

In many ways, Miss A was a typical young person who has Downs’s syndrome, smiling, joking, and curious about me. She told me she was doing 'okay’, but when I met her carer, I heard a different story. The carer talked about her concern for Miss A who, following her recent loss, screamed at night, and often talked to herself in an agitated manner. Miss A was also focused on emulating her dead mother’s life, for example watching her favourite shows, wearing her clothes, and talking as if she was still alive. Miss A appeared to be suffering psychological trauma. 

Traumatic symptoms are significantly under-recognised in people who have intellectual disabilities. As a psychotherapist working in the NHS for many years, I can only think of a few referrals featuring some reference to trauma, let alone any referrals that indicated it as a diagnostic feature.

Sigmund Freud

The psychiatric ‘bible’, the Diagnostic and Statistical Manual of Mental Disorders, defines a psychological trauma as being when: ‘A person must have experienced an event outside the range of usual human experience, and that would be markedly distressing to almost anyone, such as a serious threat, or harm, to one's life or physical integrity.’

The main thinker for me, in pondering this is Sigmund Freud, who described the presence of past trauma in the present as a ‘foreign body which, long after its entry, must continue to be regarded as an agent that is still at work’. 

Freud compared trauma to having a needle inserted into your arm, most of the time you forget about it and carry on with your normal activities, then suddenly you are reminded of it and its associated pain.

Psychoanalyst Valerie Sinason described how disability can vary greatly in individuals throughout the day, and how emotions affect their state of mind greatly, and levels of competence. It may not always be clear which behaviours are connected to the organic disability, and which are linked to trauma. So, often trauma is behind what we term ‘challenging behaviour’. 

'Fixed' behaviours

Sinason noticed that people who are close to grief and trauma cannot bear to hear about it. I see this a lot in services where people are talk about ‘looking forward’, or ‘on the positive side’. Sinason described the effects of this on this on people with a learning disability. Many had a fixed grin, but she noticed it was false, and that the person was hiding their more painful feelings. She called this the ‘handicapped smile.’ Sinason also noticed how people exaggerated their disability as a way of protecting themselves from the original traumatic event, which she termed ‘secondary handicap’. 

I believe that Freud’s and Sinason’s insights will significantly increase the likelihood of helping Miss A. 

Reference

Sinason V (1992) Mental Handicap and the Human Condition. An Analytic Approach to Intellectual Disability. Free Association Press, London.  


About the author

 David O’Driscoll is a visiting research fellow at the University of Hertfordshire, Hatfield

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