Mental Illness Is Not Always ‘Visible Sadness’

School of Nursing assistant professor Lem Scott discusses how trauma in childhood translates into mental health conditions in adulthood. Early intervention is key.

This is a summary of a story by Jessica Covil-Manset on School of Nursing.

Duke Assistant Professor of Nursing Lem Scott examines how adverse childhood experiences and early trauma translate into mental health and substance use conditions in adulthood and how those adult conditions frequently generate new trauma for the next generation of children.

Scott, the new director of the Psychiatric-Mental Health major, said his research was influenced by his experience as a military veteran.

“Service placed me among people who were managing things they had been conditioned not to discuss,” he said. “I did not yet have the vocabulary of adverse childhood experiences or trauma-informed care, but I was watching what happens when trauma goes unnamed. It surfaces as substance use, as irritability, as withdrawal from the people who could help, as almost anything other than a direct request for support. That observation is the throughline to my scholarship today.”

Scott said he wants to “steward what already works” in his new directorship but that the program curriculum should “keep pace with practice.”

“Psychiatric prescribing, regulatory expectations, and the substances patients actually present with all shift faster than curricula typically do. Closing that gap is ongoing rather than something you finish,” he said.

Scott added that mental illness does not always present as “visible sadness.”

“What actually presents is irritability, exhaustion, somatic complaints, a shortened fuse with one’s children, a quiet decline in work performance. Because those signs do not match the expected picture, the people closest to someone are often the last to name what they are seeing.”

As such, Scott views early treatment as a family intervention. “Untreated mental illness in a parent frequently becomes an adverse childhood experience for that parent’s child, which is precisely how one generation’s trauma becomes the next generation’s diagnosis.”

For the full Q&A with Lem Scott, go to School of Nursing.