Holistic Treatment For Trauma In Children

Episode Transcript

Dr. Nicole Beurkens

Hi everyone, welcome to the show. I’m Dr. Nicole, and today we are going to be looking at the topic of child development and mental health through a bit of a different lens. We are going to explore how insights from older adolescents and adults in both acute inpatient psychiatric settings and the prison system can help us understand what’s most important for supporting kids who are struggling. The lived experiences and stories of people whom our systems have failed can teach us a lot about what we should be thinking about and doing instead. I’ve invited my colleague Tara Bixby on the show to discuss this with us based on her career of supporting people with mental health challenges in some of the most difficult settings a therapist can work in. Let me tell you a bit about her.

She’s an anxiety coach, licensed therapist, and everyday girl on a mission to change the mental health narrative. After years of struggling alone in silence, Tara broke free from the beliefs and behaviors that were keeping her stuck. Now she helps other women heal their anxiety, regulate their nervous systems, and find freedom from their symptoms through one-on-one coaching. She’s also the host of the Courageously.u podcast, where she has casual, yet introspective conversations with guests covering topics from mental health, hormonal health, body image, holistic wellness, trauma, substance abuse, and much more. Tara, welcome to the show. Thanks for spending time with us today.

Tara Bixby

Yes, thanks for having me. I’m so excited.

Dr. Nicole Beurkens

You and I had the opportunity to have a really great conversation for your show a couple of weeks ago, and I was excited to have you on this show to really just give people a different perspective, based on your work experience with some really unique populations. And it’s a perspective that I think most people aren’t really aware of unless they do work with people in those systems. But, as I mentioned in the intro, I think it’s kind of a way of looking at people who the system has failed, and then seeing “What could have, should have, needed to happen there to better support these people?” So I think it’s just such an interesting perspective. I would actually love to start by having you share how you got into the field of mental health in the first place, because we all have a story around that. So what’s yours?

Tara Bixby

Yeah, it’s so funny because I get asked this a lot, and honestly, it’s not a cool story. I was just somebody who went into cosmetology, I used to do hair. And my clients just really opened up to me. And I remember one time a client told me she was raped, and I’m like, “Ooh, that’s really heavy. I don’t even know what to do with this.” And so that’s kind of what got me into psychology. And so then I went back to school for psychology. And then I moved to California for a boy and I got into 911 dispatching. I started to hear crisis stories, and I would have people calling in who were suicidal. That just kind of furthered that interest of working with people. And then when I moved back to Idaho, I was still finishing up my undergrad in psych, no clue what I wanted to do with it. And one of my friends, I was asking her, I was like, “Well, what are you going to do with your degree?” And she’s like, “Well, I’m going to go get my Master’s in counseling.” And I’m like, “Cool. Sounds fun. I’ll do it too.” So no future planning. I was like, “That’s a cool idea. I’ll do it.” And then when I graduated, somebody sent me a message and was like, “Hey, the prisons are hiring for a psych tech, you should apply for it.” And I was like, “Okay.” I’m obviously one of those people. It’s like, “Okay, cool. I’ll do that.” And so I went and did it, and it changed my life. Nobody thought I was going to be able to do it. They were like, “Dude, you can’t hack the prisons. You are too nice. You are too sensitive.” And it changed my life. And so I did. The day I started grad school was the day I started there as a psych tech, and I worked with civil commitments in an acute mental health unit inside a maximum-security prison. And I did that for two and a half years. And then when I graduated, naturally, I was like, “Well, I want to be a clinician here.” So that’s kind of what got me there. It’s no cool story other than I kind of feel it’s my purpose and doors were presented to me at the moments that they were supposed to, and I just sort of stepped through them.

Dr. Nicole Beurkens

I actually think that’s a very cool story. I think it’s a very unique story. I think many people have sort of boring or typical stories of “Oh, well I did my undergrad and then went and got my graduate degree and then became a therapist.” And you are like, “No, actually, I got to know people by having them in the chair at my salon”, which is a form of counseling. I mean, honestly, many people, I think women and men would say that that was sort of their first sort of dipping their toe in the water experience of, obviously, that’s not a therapeutic relationship, but it is a relationship that a lot of people use for talking about the realities and the struggles of what’s going on in their life. So you used that experience then to springboard into learning more, and then working with what we can all agree are some of the most difficult cases in one of the most difficult environments you can work in. I think it’s a very cool story, and so I think you should reframe that when you tell it. It’s a very cool story, and kudos to you. And I think it’s interesting, because this idea, and we will probably circle back to this in our conversation later, but this idea that you are too sensitive, attuned, kind, caring to make it in the prison system: Let’s just put a pin in that because I would argue that’s one of the biggest problems with how our prison system works is that there’s this idea that you can’t be kind, empathic, understanding, and caring, and make a difference there. So, yeah, kudos to you for doing it. I think it’s great. And as you and I talked about previously, it’s really shaped a lot of how you understand what mental illness is, what the needs of these individuals actually are, and how much our systems fail people. So on that note, I would actually like to dive in a little bit to your work in these environments because I know you have done both acute inpatient psychiatric settings, as well as the prison settings. What has that shown you about what we are getting right, but also what we are getting wrong about kids and adults and mental health?

Tara Bixby

I think the biggest thing for me, speaking just on the prisons, is I get so many people in who are now adults, they are incarcerated. And I always ask people, “Tell me your story. What was going on?” We have this thing called RDU. I joke that it’s like the Ellis Island for the prisons. This is where they come in, and we do all of the stuff we need to do for them to go to other prisons in Idaho. And I just always ask them because one of the questions is, “Are you currently struggling with symptoms related to your trauma?” And they all tell me “No.” And I’m like, “Really? Really? You are accessing meds right now through me, and you are wanting mental health services, but you are denying that your symptoms are related to past trauma.” And so even just last week, I had a guy who told me “No”, and I said, “Hear me out.” And I unpacked what he had already told me. And he told me that his dad used to lock him in a shed and that he would be starved and he’d be like, “My dad would literally pick me up from school just to physically abuse me.” And I said, “Okay”, and I told him about the nervous system and the role that it plays in it. He’s currently incarcerated for domestic battery, which is not okay. However, he had that anger and agitation. And so I wanted him to see the role that his trauma was playing in that anger and agitation, and he just started crying. And he’s like, “Nobody has told me that, you answered a question for me that I’ve always wondered.” And so people think these are just men who are incarcerated because they made poor choices, but the reality is: These are a lot of little kids that the system essentially failed. Some of them had horrible homes. He was actually put in foster care for a little bit. And they are not addressing the mental health component of it. They are just treating the symptoms. They are just giving them diagnoses, and they are just medicating them without ever helping them get to the root of what’s driving their behaviors. And then they grow up, some of them self-medicate, and then they end up incarcerated. And so I don’t know if I’m answering your question, but pretty much, I just feel we are going wrong in that sense of, we could really stop our incarceration rates if we could redirect the resources and attention to the kiddos when they are young to help them navigate what they are going through, so that as they get older, they have a better understanding of what they are engaging in.

Dr. Nicole Beurkens

Beautifully said. Yeah, we are missing the boat on connecting what happens in the lives of children with their key attachment relationships, their lived experience growing up, all of the various levels of trauma that happened to them. We’re failing to address those in childhood. And then when they become adults, we are failing to address those underpinnings and just treating them like “You are violent because you are violent”, or “You are a felon because you made poor choices,” or whatever, without recognizing that there’s this whole history of things that I think you said so beautifully: This once was a child who did not get what they needed to develop a brain and a nervous system and a way of processing and understanding the world that allows them to function well in adulthood. And it really begs the question of when do we stop seeing them as kids? Because I think one of the things that happens is there’s a lot of empathy around kids. “Oh, kids with trauma, we need to help them.” But these kids grow up. Shouldn’t we have as much empathy for them when it’s the middle aged, or however old adult sitting across from you who is still that hurting child? But at some point, we stop having empathy for that, right? And yet, the nervous system underpinnings of that are still so very real.

Tara Bixby

Yeah. It’s really hard, because obviously, I work with a population where it’s sometimes tough. I work with sex offenders, and it’s really hard for me to know what they did and still show up empathetically, or murderers. But I always just kind of have to step backwards and just be like, “Okay, when I look at this person, I’m looking at a younger version. What led to them engaging in those behaviors? What did they go through where their nervous system might have become? dysregulated? Why were they self-medicating?” And I just think we are so quick to diagnose and we are so quick to over medicate. There’s a time and place for all of that, but at the end of the day, from being a child to being incarcerated, what’s happening in between? Where are those resources and how can we better support them? Because we do have a high incarceration rate, and the worst part about it is we have a high recidivism rate, which means that they come to prison, they get out, and they come back. And so obviously medicating them and just purely diagnosing them isn’t addressing the problem, because they keep coming back.

Dr. Nicole Beurkens

Yeah, it’s so true. And to be clear, neither of us is saying that the behaviors that these people engage in or the crimes that they commit are acceptable. Clearly, they are not. This is about unpacking this and understanding why these things are happening, getting to the root of that, not only so that we can help these individuals who are already adults and currently in the system, but I think it really does inform our understanding and practice of children and adolescents where we are able to be more proactive about this, right?

Tara Bixby

Yeah. And I think it kind of came full circle for me when I was working after I temporarily left the prisons to go try inpatient psych with adolescents, and it came full circle for me because a reason I wanted to do it was because I would ask the guys that I worked with that were incarcerated, I would say, “What did you guys need that you didn’t get?” They’re like “We needed somebody to intervene when I was a kid.” And so I was like, okay, cool, I’m going to go work with kiddos in an inpatient psych hospital. And I realized that’s kind of when they fall into the water. If you think of a river, that’s where they are starting to fall in is when they are in inpatient psych as a kid. And then I saw them all being overmedicated. I don’t feel there was any trauma work. It was a really tough pill for me to swallow, because I was like, “Man, this is where it’s starting.” And then instead of trying to figure out how we can pull them out of the water, I want to go back to how we can keep them from falling into the water. I had a kiddo that was diagnosed with, I think it was RAD, and I couldn’t get him into an inpatient or an outpatient psych facility after because of that diagnosis. And I’m like, this is where we fail these kids. We give them a diagnosis, and then nobody wants to work with them, and then a large majority end up incarcerated as adults. So it was kind of a full circle moment where it was like, “Oh, man, I can really see the bigger picture right now.”

Dr. Nicole Beurkens

Yeah. It’s such a unique perspective that most people don’t have. But right, looking at that and going, “Here are kids who are still minors, who we have an opportunity to understand what’s going on for them at a root level, not just address the symptoms, which is unfortunately what the mainstay of mental health care is, especially in acute care. They end up at an inpatient facility or hospital for whatever the reason is, and the approach is, “Let’s get them diagnosed, let’s get them medicated, and let’s put them in a week or two of some group treatment and make sure that they have contact with a talk therapist when they get out”, and it’s so clear that that does not even begin to address the issues, because it’s not getting to the root of why they are there in the first place. And I’ve worked in inpatient settings too, and what always baffled me is all of the focus is on the minor child. Where is the focus on the adults in the life of the minor child, because that is where we actually get the traction and make a difference. But no, it’s all about this acute model of “Subdue the behaviors, sedate, send this kid right back into whatever environment without doing anything to change the system”, and to your point, not only do they end up then potentially in a life of crime and things where the recidivism rates are high and they just keep circling through that system, but we see that even in children, teens, and young adults in the inpatient and the acute care system, that they become frequent flyers in that system, and nobody stops and goes, “Wait a minute, what do we need to be doing here to prevent this kid from being back in this situation? Because clearly how we are handling it is not working.”

Tara Bixby

Yeah, it’s really tough, because you take these kids, it’s the same with inpatient psych with adolescents, and it is with incarcerated adults. You take them out of their environment, and you are treating them as a sole person. And then you throw them back in the environment, and it’s like throwing them back into a toxic sea. How do you expect them to be successful when they are back home if nothing has changed in their environments? Their nervous systems become accustomed to a different environment, and then it just goes down the whole nervous system trigger thing, but we have to address what’s going on outside also, that is presenting this feeling of them not feeling safe, and their nervous system is responding. And so we did do some family work when I was inpatient, but we had some families that didn’t want to engage, and it was very much so, “My kid is the problem.” And me being a therapist is partly why I left. It was like “I can’t do this, I’m not going to enable the parents and keep their kids here because they are unwilling to address their own role within this problem.”

Dr. Nicole Beurkens

Which, for all of you listening, you know no matter what topic we cover on this show, we cover it through the lens of a systems framework, and what as parents do we and other key adults in the child’s life, have control over? How can we change ourselves? How do we need to be changing ourselves to support our children? Which does not mean it’s our fault, that our kids are having issues, but Tara, to your point, saying, “Well, my kid’s here because there’s something wrong with them, and don’t look at me and try to get me to do anything”, that represents a fundamental misunderstanding of why kids have these patterns of behavior and challenges in the first place. It’s very much an issue of needing to look at parents and caregivers. And I would even extend it beyond that as kids get older, and you have probably heard this certainly from talking to adults in the prison system: It’s not just parents and caregivers, it’s teachers and other people interfacing with them in school settings, in community settings. It’s adults in their life, period.

Tara Bixby

Yeah, they need the opportunity to just regulate. They need that coregulation. It’s not the fault of the parents. I think when parents can’t regulate themselves, it’s because they were never taught to regulate, and kiddos need a caregiver in their life that can help them coregulate, that can help them regulate their own nervous systems, and I see that a lot, especially in incarceration. I work with the worst of the worst population, so I know when I talk about it, I don’t want people to think I’m generalizing it to everybody, but I noticed with the population I work with is they lacked that caregiver role where they could coregulate, and their nervous system just never felt safe. And so going forward with kiddos, if we could have somebody in their life where they could regulate with it, whether it be a teacher, a daycare provider, a doctor, just somebody that is that safe space for them, where their nervous system can feel safe and it can kind of shut down and go back into ventral, where it can discharge all that stored stress, and it can minimize or prevent future mental health symptoms.

Dr. Nicole Beurkens

Let’s dig into the nervous system piece a little more because I know you are so passionate about this based on the work that you are doing. When we talk about regulating the nervous system, when we talk about helping, whether it’s offenders in the prison system, or kids in an acute inpatient setting, or just kids in general or adults in general who are struggling, what are we talking about when we are talking about the nervous system and regulation, and why is that so important?

Tara Bixby

So I kind of have married two theories together. So I took polyvagal, and then I took the window of tolerance, and I kind of just created an idea of something based on what I was seeing with the population I worked with. I believe that everybody has a window of tolerance of how much stress they can tolerate before their nervous system becomes dysregulated. And the reason the nervous system is so important to me is because you could take 100 people and put them on a line, and their window of tolerance is all going to be different based on factors in their life that could have made it shorter or smaller or bigger. And if they had parents who had a small window of tolerance, then they are more likely to have a small window of tolerance. And so I think it’s just really important, because kiddos, from the moment they are in the womb, they can be impacted by stressors. And if they are not discharging that stored stress from their body, I think of it like a cup. I actually have a cup of water right here. You are going to start to fill up your cup with stress arousal, and then it’s going to overflow. With kids, and I’m kind of blending kids in the incarcerated population, but I’ve noticed that a lot of people who are incarcerated have really bad agitation and anger and they don’t know why. They are like, “I don’t know why I just snap.” And I’m like, “You are outside your window of tolerance. You have moved out of ventral, where there is that safety and connection, and you have moved into sympathetic, which is fight or flight, and your body is responding with action, it’s saying ‘We are going to fight’, and that’s why you are showing up the way you are.” And so that’s just why I’m so passionate about it, it’s because they think something’s wrong with them. They are like, “I’m in here for an aggravated assault or a battery, or it’s domestic.” And I’m like, “Okay, what you did is not okay. I want you to recognize the role your nervous system played in that. And while I’m not going to let you use it as a scapegoat, it gives you the ability to reregulate your nervous system, discharge that stored stress, and to start rewiring and reshaping your nervous system to respond in a different way.

Dr. Nicole Beurkens

Which is why it’s so important for all of us parenting and working with children, that we use strategies and approaches and treatments that help expand that window of tolerance and give them tools for discharging that and regulating their nervous system when they are young. Whether you have a child right now who’s been diagnosed with a neurodevelopmental or behavioral or mental health issue, or you just have a child who snaps easily, or you feel very challenged by maybe their agitation or how angry or anxious they get, this is why it’s so fundamentally important to understand from a brain perspective what’s going on there. Because I think what you are sharing about how these adults say to you, “Well, I just figured something’s wrong with me”, many of them have gotten various diagnoses, whatever, to understand why this is actually a normal human response to being outside our window of tolerance, right? For any of us, if you give us enough stressors thrown at us for long enough, and we have only so much capacity to handle it, we are all going to react in unhealthy, inappropriate ways. For some people, that’s that acting out in aggressive, hostile kinds of ways. It’s a normal human response, and I think it’s recognizing that some people, because of their history and trauma and everything that’s happened to them, have a much smaller window of tolerance. And so we have to look at it through another person’s shoes, right? I can’t look at what happens with a child, for example, where they snap at the slightest thing, through my own perspective, and I’ve got a pretty big window of tolerance. That’s not going to be helpful, because I’m assuming that they should be able to regulate that in a way they can’t. So we have to understand that people are operating with different amounts that they can tolerate.

Tara Bixby

Yeah, and I have a million reasons, but a reason I’m just so passionate about this and why I want to create the conversation so we can redirect our resources to kids, is I have so many people who come to me and they tell me these horrific trauma stories from their childhood. They were sexually abused by grandpas, dads, brothers, babysitters. I’ve had a guy tell me that he was chained to a fence when he was a kid in nothing but his little boy little whitey underwear that little boys wear, in the middle of winter. He was forced to pee in a cat litter box. I had one person tell me recently that as a 13-year-old, he was still wetting the bed, and one day his mom made him wear the wet underwear on his head out in front of everybody. And so I hear these stories, and I’m like, okay, these were all little kids. All these little kids, what they went through, their nervous system became dysregulated, their window of tolerance shrunk, their amygdala created these emotional memories, and now they are navigating life. And all these cues in the environment that resemble those past emotional memories, they are igniting. And I want people, instead of looking at the kid like, “Oh my gosh, this kid has a behavioral issue, what is going on?” Just get curious and be like, “What did this kid experience that led to the shrinkage of his window, of how much tolerance he can have for stress?” And instead of being so quick to give them an oppositional defiant disorder, RAD, or whatever those diagnoses that they want to put on little kids who have some behavioral issues, just get curious. Especially teachers, because a lot of these kids, home is not a safe space for them. And so when they are in school and they can’t sit still, and they are agitated, instead of getting frustrated with that kid, maybe schools can incorporate tools to help them feel a little bit more regulated. What can this kiddo do when he’s in class, and he’s being triggered? Instead of being like, “Oh, my gosh, this is such an angry little kid”, be like, “Oh, he is in a sympathetic state right now. There’s a stressor that is causing these behaviors. How can we help his amygdala feel safe so that it can move back into that ventral state of safety and connection?”

And I think the other thing, too, is that a lot of people get frustrated that their kid is having angry outbursts, and the parents are trying to use words to calm the kid down. And if I can tell anybody anything, it’s that when that kid is in that sympathetic state, there is no verbal language that is going to help them just regulate and move back into ventral, because when they are in sympathetic, their amygdala has essentially shut off the cortex. So no cognitive thought can communicate with it, and it all becomes a survival response until that amygdala feels safe again.

Dr. Nicole Beurkens

I want to touch on something that maybe some listeners are thinking about right now, because we’re talking about the population of children and adults that you have worked with that have what I think we would all consider very obvious, significant trauma. And by the way, I will comment with my own experience of years of working in hospital, and inpatient, and all kinds of settings: I have yet, in my 25-year career, to meet a person who has major issues with being in and out of the prison system, who has committed terrible crimes, or children who are exhibiting very, very inappropriate and even violent behavior, who do not have some significant form of trauma in their past history. I have yet to encounter it. If they exist, I have not met them. Tara, I don’t know if you have met them, but that’s how connected these things are. But I also want to touch on, because some of you maybe are thinking, “Well, I have a child who exhibits really aggressive or violent behavior”, or “I have a child, who now is a young adult, who is very, very challenged around regulating their behavior in various ways, and my child does not have a history of abuse, of sexual trauma, of some of the things that you’re sharing the stories about from your clients.” Can we just talk about that for a minute, about how those are the obvious extreme cases, but trauma is a spectrum right?

Tara Bixby

With a lot of people, I always ask, “Have you experienced trauma?” And a lot of them tell me “No”, and I’m like, “Okay, let me tell you what trauma looks to me.” And I always say the trauma is any stressor, I mean, it could be stubbing your toe. If you have a very small window of tolerance and you stub your toe, that could be a massive stressor for you. So trauma is any stressor that is too much for your nervous system to handle. It is when you feel powerless, helpless, or you are lacking control, when your amygdala perceives you to be those three things, you can move into the zone of trauma. And so I think as a kiddo, divorce can be traumatic, bullying at school can be traumatic, asking a girl on a date or a boy on a date and they say “No”, that can be traumatic. So it’s just any stressor that’s just too much for your nervous system to process. I also just think it’s really important to recognize that a lot of people don’t think it’s traumatic, but I think right now with COVID, kiddos not being in school, the fear of school shootings, there’s just so many stressors that are going on, it’s just individualized to that little kid whether or not their nervous system can handle what’s going on in that moment to keep them within their window of tolerance.

Dr. Nicole Beurkens

Such important points. And I would add to that: If you have a child with what we might call a neurodivergent brain, or a child who’s been diagnosed with something Autism Spectrum Disorder or ADHD, or even learning disabilities, anxiety, those types of things, those kids are inherently going to have a smaller window of tolerance because their brain already struggles with processing just any input. And so it’s important to realize that, for example, some of the most intractably challenging kids that we work with at our clinic, who really do struggle with significant behavioral challenges, safety issues, those kinds of things, school, their experience of school, their neurodivergent brain and the expectations of school have been so far outside their window of tolerance and their ability to process for so long, that that becomes a hugely traumatic thing, and can lead to a lot of these issues. And that’s just one example. Another example would be some of the kids that I see who have had a history of a lot of medical trauma. Maybe they have needed a lot of surgeries, a lot of procedures, maybe they have had conditions that have been very mismanaged, and now their window of tolerance, in general, for any kind of stress is so small because of the buildup of all of that. So I think we just need to think in a more flexible way about how these kinds of inputs, experiences, genetic predispositions, and processing problems can narrow that window of tolerance and then create these nervous system issues.

Tara Bixby

Yeah, I had two thoughts pop up when you said that. One is, I didn’t even know this, but when you go in for surgery and you get put under, your nervous system, your amygdala essentially thinks that that’s the freeze state, and your body essentially moves into a freeze state and that is still stress arousal in your body. So for a lot of people who come out of a surgery, it’s really important to allow your body that rest and relaxation so you can discharge that stress arousal and move back into that ventral state. But then the other thing that I’m really passionate about, and I get really fired up with kiddos, is the foods they are consuming. School lunches, all the vending machines in school, kids who eat really sugary cereals. When your gut is inflamed or your gut microbiome is off, your vagus nerve communicates with your amygdala. With what’s going on in your gut, it will send a message up your vagus to your amygdala, it’s like, “Hey, things are not okay down here, we need you to activate,” and you move into that sympathetic state. And so you had made the comment about, “Well, my kids have never been through anything traumatic”, well, maybe get curious about what foods are consuming or what beverages they are consuming or what’s going on that could be causing that internal stressor, because that can also activate your sympathetic nervous system and move you into that fight flight response.

Dr. Nicole Beurkens

Perfect. And yes, you know I’m so on board with that. And for all of you interested in more, if you haven’t already listened to all the past 200 and something episodes of the show, go back and do that now, because we cover all those topics on many episodes. Tara, you and I can talk about this for hours. The stories that you have about the people you have worked with are just really profound and incredible, and are stories that the world needs to hear. I do know we are going to have to wrap it up at some point, but I want to touch on this because I really want the parents and professionals listening to hear your perspective on this, because as I mentioned earlier, there’s this thought process that “Well, if we just get these people mental health treatment, which consists primarily of some type of counseling or behavioral therapy and psychiatric medication, then we have done the job of dealing with their mental health issues.” You and I both know how incredibly false that is, and you are seeing people in the prison system, and you saw kids in the inpatient system every single day who had those things were in place for them at some point. Can you talk about why it is that this idea that medication is what needs to happen for these people to treat their behaviors, their mental health, Why that’s so misguided?

Tara Bixby

Oh, man, I could literally talk a whole hour just on this topic. I used to believe in the medication model, I worked with individuals who are civilly committed, who were the most acute with mental health, and I would tell them, “Hey, take your meds, this is going to give you quality of life.” And when I started to see nothing’s changing, they are coming back, or they are just so zombied or over medicated, and then I went and worked with somebody who wasn’t at such a high level of acuity, and they were like, “I started taking meds”, and they give me this laundry list of meds, and they are like, “Nothing’s helping” or “It helped for a short period of time”, I started to get curious. I was like, obviously, this isn’t working. And then I went back and I worked with the kiddos. I was like, “You guys are over medicating these kids.” I would have a psychiatrist give a kid an injectable for an antipsychotic that’s not even FDA approved for a kid, and in my mind, I was like, “What are we doing?” And so, while medication can help some people, for the most part, it helps less people than people think. And I see people start to struggle with side effects, and then they get prescribed medication for their side effects. And then just the whole rewiring it does in the brain, and the bodies become used to it, or people get put on benzodiazepines, and then their amygdala essentially has to get stronger and stronger, because your amygdala is your survival response. It’s what keeps you out of danger when you are in danger. It gives you the ability to fight. And if you are constantly sedating it, it’s trying to break free of a straightjacket. People don’t understand that. I’m trying to shorten this, it’s not a very short response, but I get a lot of push-back from people who think I’m perpetuating the problem and I’m furthering the stigma, and I think at the end of the day, I have just seen so many people medicated who never had the root cause issue addressed and they are still unhappy, they are still depressed, they are still anxious, they are struggling. The disability rates are skyrocketing right now. That’s not a life worth living. That’s not quality of life. If you need medications temporarily, and I say temporarily, that’s fine. But you need to do the work of healing too. Figure out what’s igniting your symptoms, what can you do to change? Lifestyle factors, diet, and then when you feel you are in a better place, you can start to titrate off your medications. And so I think at the end of the day, it’s just that if medications were helping people, we wouldn’t be seeing such a high disability rate, we wouldn’t see so many people incarcerated. And I think kiddos would be able to best navigate their mental health when they are younger.

Dr. Nicole Beurkens

Yeah, it’s so true. And even in the cases where medication is helpful in the short or the long term, it does not remove the fact that we still have to get in there and do this root level work around supporting nervous system development and expanding that window of tolerance, learning healthy behaviors, coping skills, lifestyle, developing those healthy relational attachments. Whether or not medication helps, those things all need to happen. And this idea that the solution to these kinds of problems, especially these kinds of very serious issues in children and adults, is to make sure they are taking their prescriptions every day — Listen, I would be the first in line to advocate for that if it actually worked, but I anecdotally in 25 years, have seen that that does not work. And beyond just anecdotal experience, the data, the research on this shows that this does not work. It can be helpful to reduce symptoms, to make them more tolerable, to help people do the work, but this alone is not the solution. And, I think actually, the prison system is one of the most interesting places, or inpatient settings where we can see this in action, because here are populations of people who literally are being forced to take their medications every day. They do not have a choice. They are inpatients or they incarcerated, they are taking them, and they are not substantially changing, and that alone should be enough for us to say, “Okay, whatever your views on medication are good, bad or otherwise, clearly, there is something else that needs to happen here to help these people.”

Tara Bixby

Yeah. And I think it’s important, because I think for people incarcerated, they can give consent whether they want meds or not. Luckily, if they land on my caseload, they are not going to like it, because I’m like, “No, I’m not referring you right now.” But there’s people also who are harbored or civilly committed by the state, and those ones are force medicated, and that crushes my soul because they don’t even get a say. And you have to realize: I didn’t just one day flip the switch and was like, “Okay, I’m not a fan of meds”, because I used to take Xanax. I was prescribed Lexapro and Wellbutrin. I drink the Kool Aid. But when you see what I see, it’s like “What are we doing?” It’s hard in the prison system too, because they don’t have the environment that supports their mental health. The food, let’s be real, it’s not organic. It’s not veggies and lean proteins. They aren’t getting the vitamin D.

Dr. Nicole Beurkens

Forget not organic, most of it’s not even real food, period. Which, by the way, is not that much different than what our kids are consuming in the cafeteria, but that’s for a different episode.

Tara Bixby

Yeah. I started to read books and I started to hear stories. I couldn’t do it anymore. It made me sick. I was like “I can’t support this anymore.” And while I still work in the prison system, I am a very loud voice of “Let’s get to the trauma. Let’s address what’s going on.” And I tell everybody that comes through RDU, which is where they all come from the county jails, I tell them “Your medications aren’t designed for long term”, some of them have been on them for so many years, I would never tell them to get off of them. But if they are not on meds and they are requesting meds because they are anxious or depressed, first, I tell them “You are having a normal response to coming to prison. If you are not anxious and depressed, I’m worried about you.” And then I just educate them. I could go on forever, but at the end of the day, I just want people to know, I, too, drank the Kool Aid. I saw that it wasn’t working, so I started to dive into the research. And I was like, “Oh my gosh, I was kind of fed one narrative, and it’s a narrative that doesn’t actually support people’s healing.”

Dr. Nicole Beurkens

Yeah. I think you’re right, that idea that we need to be open to a variety of experiences with this, and for every one person who says “I took X, Y, or Z medication for this diagnosis, and it helped me and changed my life in a positive direction”, there are many people who would say something different or the complete opposite of that. And none of those perspectives are right or wrong. It’s recognizing that there are so many root causes and underpinnings to these symptoms that we put labels on and that we then medicate, that of course, people are going to have a broad range of response and experience with that, and we need to be open to and understand that broad range of experiences, especially when we are looking at children and adults who are continuing to struggle. And I so admire the work that you are doing. It takes a unique person and professional to be willing to swim upstream, especially in an environment like the prison system, teaching this stuff, supporting people in this way. It’s a very unique thing. We need more people in the field who are willing to do it. And so I appreciate that you are doing that work.

Tara Bixby

Yeah, I appreciate it. I don’t know why I went this direction, but the more I get into it, I really feel it’s more of my calling and I’m just leaning into it. it just feels right.

Dr. Nicole Beurkens

It’s awesome. I want to make sure that people know where they can find out more about you and the work you are doing, because you also do this work outside the prison system, and your podcast is great. So where can people find out more?

Tara Bixby

Yeah, I’m the most active over on Instagram at courageously.u, and then I also have a podcast, it’s the Courageously.u podcast. Those are pretty much the two places where I’m the most active.

Dr. Nicole Beurkens

Awesome. Tara, thank you so much, again, for the work that you are doing and for sharing it with us today. I know that this conversation and stories that you shared are helping parents and professionals who listen to this show expand their own understanding of these things. And so we really appreciate you being here. Thank you.

Tara Bixby

Yes, thank you.

Dr. Nicole Beurkens

And thanks, as always, to all of you for being here and for listening. We will catch you back here next time.