Complex PTSD in relatives of people with ID: an illustrative clinical case study from South Africa

Abstract

The debilitating impact of trauma on people with learning disabilities is increasingly recognised in research. Sinason’s influential psychoanalytic writing has drawn direct links between the presence of an opportunistic secondary handicap and pervasive exposure to trauma. Traumatic events often occur within families, implying that more than one family member may be exposed to the same traumatic stressor(s). Because adults with learning disabilities require additional support from caregivers to live socially valorised lives with optimal degrees of self-direction, in the context of home living, a parent’s experience of severe trauma could have a deleterious impact on her caregiving capacity to meet her child with learning disabilities’ support needs in an equitable manner. This paper contains a case study that describes how a mother’s experience of earlier trauma, which resulted in complex post-traumatic stress, had a profound influence on her object-relations and object-relatedness with both of her children, including her daughter who had mild learning disabilities and severe behavioural difficulties. While the mother’s own experience of trauma deserves attention in its own right, her defences against traumatic recollection also affected her responsiveness to her daughter’s high behavioural support needs.

Keywords:

• learning disability
• trauma
• complex post-traumatic stress disorder
• families
• South Africa
• psychotherapy

Acknowledgements

I would like to thank Prof Colleen Adnams and Prof Leslie Swartz for all their support and expert advice during my PhD research, which led to the writing of this case study.

This research was made possible by the Western Cape Forum for Intellectual Disabilities.

Disclosure statement

No potential conflict of interest was reported by the author.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Human Research Ethics Committee of the University of Cape Town’s Health Sciences Faculty and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Statement of originality

This paper is the author’s own original work and has not been published or submitted elsewhere.

Notes

1. Many contemporary writers in the field of disability studies reject the term ‘handicap’ as discriminatory and disablist. I use this term in this article because it was used by Sinason (2010), whose work forms a starting-point for my argument. Sinason (2010) provides an instructive discussion of the politics of language regarding disability.

2. Real names were not used to ensure anonymity.

3. In South Africa, there is no formal registration process for psychotherapists. Clinical psychologists are fully licensed to conduct psychotherapy as part of their scope of professional practice.

Additional information

Funding

This work is based on the research supported in part by the National Research Foundation of South Africa (grant specific unique reference number (UID) 85423). The Grandholder (LS) acknowledges that opinions, findings and conclusions or recommendations expressed in any publication generated by NRF supported research are that of the author, and that the NRF accepts no liability whatsoever in this regard.