What becomes of infantile traumatic memories? An adult "wild child" is asked to remember.

A severely traumatized child, acting like a wild animal, was removed from her parents at thirteen months of age when her three-week-old sister was found, bitten and shaken to death. (Her father was later convicted of manslaughter and imprisoned.) The older child was also covered with bite marks. When she was twenty-nine months old, this child, whom I call "Cammie," was brought to me from miles away by herfoster parents for once-monthly psychotherapy. I have treated her, stressing abreaction, context, and correction, once a month ever since. When she was five years old Cammie's foster family adopted her. She is now twenty-two. I call her the "wild child" because of the growly voice, vomiting at will, grabbing at the genitalia of strangers, and cruelties to animals that she exhibited after her rescue. Presently she attends college and is training to be a preschool teacher or an aide to pediatricians. I have taken notes on what Cammie says and does during the twenty years she has come to me. In the spring of 2011, I was asked to speak later that year about infantile memories at the Margaret Mahler Symposium, Columbia University, New York. With the organizing committee's approval, I accompanied Cammie and her adoptive mother to the October 1, 2011, meeting and asked her in front of the psychoanalytic audience to recount her oldest remembrances. She, her mother, and I spoke about the nonverbal manifestations of her memory as well. I had briefly prepared Cammie and her mother for our presentation at the Mahler Symposium, but for the most part, it was spontaneous and unrehearsed. Their comments are quoted in this article. At twenty-two the "wild child" reports no verbal memory from her first year. On the other hand, her behaviors, attitudes, and perceptions over the years have reflected what occurred to her and indicate very active nonverbal memories of the traumatic experiences. Fragments of verbal memory that she recounted in therapy between ages two and three have entirely slipped away. Several kinds of behavioral reenactments of the abuses she received as an infant have been reversed into altruism. Other attitudes and behaviors have remained unaltered, however. Under the influence of street drugs or anesthetics, her infantile memories have been reawakened in the form of illusions, delusions, and condensation. Following a disaster in Japan, a shard of infantile memory was retrieved in the form of a repeated nightmare. Single cases like Cammie's inform us about the course of traumatic memories through childhood. Such cases may lead us to follow larger groups of infants for extended periods of time. We must try to further understand the effects of early trauma on the brains and minds of young children. This is of crucial importance to the future of psychiatry and psychoanalysis and to our duties to society.

Treating childhood trauma.

This review begins with the question "What is childhood trauma?" Diagnosis is discussed next, and then the article focuses on treatment, using 3 basic principles-abreaction, context, and correction. Treatment modalities and complications are discussed, with case vignettes presented throughout to illustrate. Suggestions are provided for the psychiatrist to manage countertransference as trauma therapy proceeds.

Five analogies between a King's Speech treatment and contemporary play therapies.

OBJECTIVE: Psychiatric patients frequently respond positively to play therapy, which may rely on psychoanalytic, Jungian, cognitive-behavioral, familial, school-based, or other theories. I wished to determine if there were unifying principles that tie together these various types of play treatments. METHODS: The fact-based film, The King's Speech, vividly illustrates play utilized by Lionel Logue in his speech treatment (1926-1939) of the future King of England. In the film I found five analogies to the play therapy I employ in office practice. RESULTS: The play scenes in The King's Speech point to five unifying principles among contemporary play therapies: (1) the crucial nature of the relationship, (2) the centrality of having fun, (3) the occasional reliance on others, (4) the interjection of pithy talk, and (5) the usefulness of a little drama. CONCLUSION: No matter what theory a play therapist ascribes to, these five unifying principles should be kept in mind during treatment.

Using context to treat traumatized children.

When treating childhood psychic trauma, context means "putting a perspective to the terrifying experience"--"seeing it in a new light", one might say, or understanding its magnitude and meaning. Of three essential mechanisms behind a young person's psychological recovery from a stress disorder--abreaction, context, and correction-context is the most reflective, cognitive, and conscious of these processes; while abreaction is primarily emotive, and correction is primarily behavioral (involving real or fantasied action). Because context, newly introduced by this author to the psychiatric literature (Terr, 2003), is the most recent and the least well understood of the three mechanisms, it will be the sole focus here.

Children's turn-arounds in psychotherapy: the doctor's gesture.

UNLABELLED: Over the past year, a number of us have been examining the organizing principles behind dramatic turning points in the psychotherapies of children. We wondered whether any particular techniques or occurrences in therapy promoted childhood change. METHOD: One of us (L. T) asked the health care professionals on the UCSF child psychiatry grand rounds email list and 50 colleagues across the United States and Canada to select key "moments," or turning points, in their treatments of young people. No organizing principles were suggested in the request letters. Over 3 months, 21 vignettes telling of major changes in children and adolescents arrived in San Francisco. Some of them came from psychotherapies-others, from consultations or very brief therapies. Eleven are included in this paper. RESULTS: Gestures from the psychotherapist were shown to effect dramatic turn-arounds in some young people. These shifts in the doctor's emphasis or behavior included: (1) making an entirely unexpected statement; (2) advocating strongly for the youngster; (3) confessing personal flaws and/or frustrations to the patient; (4) feeding or rewarding the young patient; and (5) inquiring deeply into something personal with the child. A gesture never given--in this instance, an undelivered inquiry into incest--is shown to have left an adolescent patient unchanged. The young people described in this report suffered from anxiety, trauma, neglect, cancer; anorexia, bulimia, and personality disorders. Two were institutionalized at the time of their dramatic changes. One had been previously hospitalized 4 times. Another small child had suffered a double amputation. These children came with a far broader spectrum of problems than the relatively mild disorders for which child-psychodynamic psychotherapy was originally tailored. Although we were not primarily concerned with the "ground" on which the doctor's gesture fell, in 5 of our cases there had been little to no therapeutic relationship prior to the gesture; in 4, the relationship had been primarily positive; and, in 2, it had been negative. CONCLUSIONS: Doctors' gestures are usually given on impulse and unexpectedly during psychotherapy. To the child, these gestures appear counter-intuitive and surprising. From the therapist's perspective, they first generate a brief sense of confusion in the patient, and then a strong sense of connection between the young person and the adult. In the cases we report, the physicians'gestures created a new alliance. The tone of the therapy switched, leading to a noticeable psychic shift in the child. SUMMARY: A doctor's gesture may elicit a dramatic turn-around in a young patient. This therapeutic climax is implicitly understood between the two parties and then may be converted to consciousness and worked with explicitly. Therapeutic "moments" occur in a broad range of disorders, that in many cases are also being treated simultaneously with medications, and with family or institutional counseling.

"Wild Child": how three principles of healing organized 12 years of psychotherapy.

Methods of conducting psychotherapy in the most severe forms of childhood posttraumatic stress disorder (PTSD), especially in those traumas discovered very early in life, are rarely reported. This paper presents such a report and in the process emphasizes three elements of treatment: abreaction (full emotional expression of the traumatic experience), context (understanding and gaining perspective on the experience), and correction (finding ways personally or through society to prevent or repair such experiences). With traumatized children, all three elements may be inserted into their therapeutic play, art, and/or talk. An overarching mood of light humor helps the transference stay positive and the child interested. The case of "Cammie," an infant who was bitten, shaken, and sexually abused, and whose 25-day-old sister was discovered at home, murdered, is the subject of this report. This little girl, upon removal at 13 months of age from her home of origin, growled, bit, sniffed sexual organs, rarely spoke, and behaved like the "feral children" described in the classic psychiatric literature. Two respected professionals diagnosed her as mentally retarded. A year in an outstanding foster home did little to improve her. At 29 months of age she was brought to the author, who saw enough imagination and pithy language to believe the child to be intelligent but severely traumatized. The author had begun to conceptualize three principles of PTSD treatment after a study of normal schoolchildren's reactions to the 1986 Challenger disaster. These three principles were used with varying emphases at different phases throughout the "wild child's" 12-year course of once-monthly therapy. Improvement beyond anyone's expectations ensued.