Scarlett starting seeing a psychologist at 3. It took 19 years for professionals to join the dots.

Content note: The following deals with abuse, sexual assault and self-harm. For 24-hour mental health crisis support, please contact Lifeline on 13 11 14.

For most of Scarlett Franks’ life, she didn’t make sense to herself. That’s the way the 26-year-old puts it; her way of describing what it was like to grapple with the consequences of the trauma she experienced as a child.

Since infancy, the Sydney woman had endured sustained physical and emotional abuse and neglect at the hands of someone close to her.

She’s not in a position to go into details of precisely what she went through, suffice to say it was “horrific”. But this initial violence was compounded by a profound misunderstanding of the nature of trauma, how it had affected her, and how she could recover from it.

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The term ‘complex trauma’ refers to exposure to multiple traumas and the impacts of that exposure. In Australia, it’s conservatively estimated that as many as one in four adults have experienced complex trauma from childhood, stemming from situations like abuse, neglect and family violence.

The impacts of those experiences can be both physical and psychological, and vary in their severity.

In Scarlett’s case, they emerged as early as three, when she started tearing out her hair in her sleep. It was then she was first referred to a psychologist, and again at the age of eight. On and on it went throughout her teens.

“I was receiving labels like anxiety, severe depression, mood disorders, eating disorders and self-harming disorders. All these disparate issues were being labeled and tackled in isolation,” she told Mamamia. “And I was experiencing all these somatic symptoms like non-epileptic seizures, random unexplained vomiting, unexplained fainting, unexplained chronic pain.

“The dots were just not being connected.”

And the diagnoses kept coming. Dissociative identity disorder, borderline personality disorder, post-traumatic stress disorder. Collecting them burdened Scarlett with a sense of helplessness; they located the problem within her, rather than the trauma she’d experienced.

Over the years, she tried to take her own life nine times, and was sectioned (involuntarily admitted under the mental health act) to public psychiatric hospitals on a dozen different occasions.

It also left her homeless. She was kicked out by her family at the age of 16, forced to rely on the kindness of friends and teachers.

“I remember it was pretty surreal. I had run away to a friend’s place, and I was very fortunate that my friend’s mother was a solicitor and a bad-arse woman, and she had no qualms about my decision to remain out of home.”

Liaising with police and her school’s welfare officers, she pursued legal independence from her parents and completed her schooling while staying with different families over the course of 18 months.

Asked what it was like to be out of home, she paused.

“I don't know. It was a mixed experience, because there was both a sense of grief and fear, but also a sense of relief. And then there was guilt about that sense of relief. Because my siblings were still at home. I feel I had been protector of them, to an extent, as the eldest child.

“But also there has been nothing that has induced more self-loathing in me, in my life, than the sense of burdening other people — families, friends and teachers — by sleeping on their couch or by living in their homes.

“[Adolescence] is already a time when people are unsure of themselves, and to feel like you are imposing upon people, when you've already been told that your entire existence is an imposition on your family… it’s like an existential crisis. It's a great sense of dread.”

But Scarlett still believes she did the right thing. By leaning on those in her life, she avoided becoming entangled in the child protection system, being bounced around youth refuges and potentially having to move schools in her final year.

They also provided her with the emotional support and practical support that she desperately needed. There was understanding about her lack of concentration in class, her inability to meet deadlines or afford basic supplies or activities.

“I had some of my teachers pay for my school excursions and my formal ticket and my school uniforms, even have me over at their houses occasionally, just so I could be in a safe place,” she said. “It meant the world to me then, and as I've met more people who've been through these experiences, I don't think it can be overstated how crucial that has been to my survival.”

Especially, considering what happened when she was 18.

"It really rocked our entire community."

Eight days before Scarlett was due to sit her first HSC exam — English Paper 1 — she was sexually assaulted by four male peers. Again, she can’t go into detail here because the resulting court case was sealed due to the age of the offenders.

“It really rocked our entire community — the schools that I attended and the offenders attended and the families that were already supporting me,” she said.

“I tried to sit the HSC; I attended every exam. But I couldn't string two sentences together out loud, let alone on paper.”

Instead, Scarlett was given an estimate grade.

While people rallied around her once again, she said the formal/institutional response was woefully inadequate, insensitive, even re-traumatising; from the interrogative court process, to the six years it took to process her victim compensation claim (partly a result of a change in NSW compensation law shortly after her case).

“It was a horrific process involving lots of retelling my experience in gruesome detail in a context outside of my choosing, outside of my control, and being treated like I was a criminal a lot of the time by members of the justice system,” she said.

Critically, Scarlett believes that much of the healthcare system and many mental health services aren't equipped to deal with cases like hers.

She was bounced from doctor to doctor, therapist to therapist, service to service, until at the age of 22, she’d saved enough money to get into a private outpatient care program.

There, she started to receive psychiatric explanations for what was happening to her, the full story of her mental health, and how her brain had adapted to her traumatic upbringing.

It’s called 'structural dissociation'.

“When you've had to grow up with disorganised, chaotic caregivers, where your survival depends upon submerging yourself and trying to anticipate what they will do next, those parts of self become siloed, partitioned,” she said. “This is a neurophysiological mechanism; it's not a metaphor.”

In other words, the personality exists in parts: a part that's focused on avoiding or escaping traumatic events; and a part that's focused on daily activities and getting on with life. One result of this, for example, is that Scarlett can find it hard to express emotions, particularly anger.

“People like me learn that expressing anger gets you nowhere. It gets you nowhere with the people upon whom you must rely to survive but who are abusive or unpredictable,” she said. “So anger is quite a difficult part of myself to access, because it feels so dangerous. My experience is that when people express anger, they are out of control and their anger is sort of like a tsunami that just crashes over everybody around them.”

Dr Cathy Kezelman AM, president of Blue Knot Foundation National Centre of Excellence for Complex Trauma, explained that when complex trauma occurs during crucial developmental years (as in Scarlett's case) the impacts can be profound.

“It can really affect that very core formation of your sense of self and your ability to relate to yourself and to others,” she said.

It’s about what happens to the brain and the body when it’s exposed to repeated, extreme stress.

“We all have physiological responses when we're under threat or perception of threat. So we all go into a fight, flight or freeze response. And obviously when you’re a young child, you can't fight, you can't leave,” she said. “So often children and young people get stuck in a loop of hypervigilance, waiting for the next danger to come.”

The impact of that will depend on the person and their experience.

“Sometimes, the coping strategies they adopt, which may be things like avoidance and withdrawal or self-harm or substance abuse, don't appear very constructive and often aren’t,” she said, “yet they’ve allowed someone to survive.”

For Scarlett, having that knowledge meant she was able to begin making sense to herself.

“Just learning that there are neurophysiological and relational reasons for why I was suffering in particular ways or why I couldn't shake certain compulsive self-harming behaviours, the way it felt like traumatic things continuing to happen to me… that was really the key,” she said.

“Once you learn a little bit about how trauma works, you realise that the problem can be relocated from your personal failing to the way that society and our culture let people down. Let children down, let women down.”

She's since been able to move forward with meaningful healing. At the moment, that means seeing her therapist three times a week, plus group therapy, art therapy, peer support, yoga and acupuncture.

But it’s something she’s had to fight for.

“It's not easy in this country to figure out what's out there [to help] people with trauma history. But I've done that work, and I've fought hard to get the funding. I've fought hard to get the pension and in my NDIS applications and in applications for suicide prevention funding and inpatient programs,” she said. “That’s the sort of slow administrative violence, the bureaucratic obstacles to basic daily safety, let alone therapeutic treatment, [that survivors face].”

And she acknowledges she’s in a privileged position; she’s from a post-graduate educated family, lives in a metropolitan area, is white, able-bodied. She has access to and can comprehend the literature about what she’s experiencing, she can grapple with the complex paperwork necessary to get formal help.

“Everybody needs access to this kind of information. Everybody needs access, at the very least, to an alternate narrative, to the idea that certain people and certain communities are simply doomed to poor mental health, rather than looking at where these poor mental health symptoms come from. And that, yes, they can actually be prevented,” she said.

It’s why Scarlett has devoted her career to precisely that goal. She works alongside academics at the University of Sydney’s Faculty of Medicine and Health, which involves survivors in designing, conducting and analysing research on dissociative disorders and complex trauma.

It’s also why she shares her story. To improve understanding about complex trauma among the public, health professionals, and the legal and child protection systems. But most of all, to help other survivors feel less isolated.

It was by sharing her experience in her own 'survivor community' that helped her feel able to regain a sense of agency over her narrative, to dispel the shame that was holding her in self-destructive patterns.

“There’s vicarious resilience, because I have my own resilience reflected back at me and I am also able to draw strength from what other survivors are experiencing. And just be able to have a little bit of anger on their behalf that, maybe, is a little hard for me to have on my own behalf.”

It’s that resilience that saw her navigate her way through a broken system to a place where she can begin healing, to recognise that she’s part of a bigger picture, one she can help others like her interpret.

“If people are being turned away and feeling like, ‘Oh, the system's just not set up for me; I must be so beyond help, I must be so damaged’,” she said, “I want them to know that it's the systems failing to manage complexity, rather than it being [individuals] who are too much.”

Dr Kezelman, herself a childhood trauma survivor, echoes that message and urges that others like her find hope in it, because it means that there’s space for culture, institutions and policies to improve.

The Blue Knot Foundation, for example, is today releasing practice guidelines to help healthcare professionals build their understanding of how to work safely with people who have experienced complex trauma; from understanding the depths of the shame they’ve experienced, to the fact that their so-called ‘symptoms’ are actually coping strategies.

Only then can they help in their patient’s healing. Something that Dr Kezelman stresses is entirely possible, even though it may not always feel that way for them.

“There are many times when survivors lose their sense of hope; it's bleak. Having someone who can help you hold onto a thread of hope when you can't feel it yourself is really critical,” she said.

“It's not just the neuroscience that shows us that people can recover; it's people like Scarlett that show us that absolutely can happen and does happen.”

Lifeline: 13 11 14

1800 RESPECT (National Sexual Assault and Domestic Violence Counselling Service): 1800 737 732

Blue Knot Foundation: 1300 657 380