In important ways, an experience does not really exist until it can be named and placed into larger categories.

If a mother cannot meet her baby’s impulses and needs, [quoting Donald Winnicott] ‘the baby learns to become the mother’s idea of what the baby is.’ Having to discount its inner sensations, and trying to adjust it its caregiver’s needs, means the child perceives that ‘something is wrong’ with the way it is. Children who lack physical attunement are vulnerable to shutting down the direct feedback from their bodies, the seat of pleasure, purpose, and direction.

While reliving trauma is dramatic, frightening, and potentially self-destructive, over time a lack of presence can be even more damaging. This is a particular problem with traumatized children. The acting-out kids tend to get attention; the blanked-out ones don’t bother anybody and are left to lose their future bit by bit.

Feeling listened to and understood changes our physiology. Being able to articulate a complex feeling and having our feelings recognised lights up our Limbic brain, and creates an ‘ah-ha’ moment. In contrast, being met by silence and incomprehension kills the spirit.

When people are compulsively and constantly pulled back into the past, to the last time they felt intense involvement and deep emotions, they suffer from a failure of the imagination, a loss of the mental flexibility. Without imagination there is no hope, no chance to envision a better future, no place to go, no goal to reach.

Rage that has nowhere to go is redirected against the self, in the form of depression, self-hatred, and self-destructive actions. One of my patients told me, ‘It is like hating your home, your kitchen and pots and pans, your bed, your chairs, your table, your rugs.’ Nothing feels safe – least of all your own body.

Freud had a word for such reenactments: ‘The compulsion to repeat.

The social environment interacts with brain chemistry. Manipulating a monkey into a lower position in the dominance hierarchy made his serotonin drop, while chemically enhancing serotonin elevated the rank of former subordinates.

To my amazement, staff discussions on the unit rarely mentioned the horrific real-life experiences of the children and the impact of those traumas on their feelings, thinking, and self-regulation. Instead, their medical records were filled with diagnostic labels: “conduct disorder” or “oppositional defiant disorder” for the angry and rebellious kids; or “bipolar disorder.” ADHD was a “comorbid” diagnosis for almost all. Was the underlying trauma being obscured by this blizzard of diagnoses?