The Origins of Addiction - from Dr. Vincent Felitti and the Adverse Childhood Study

In this film,  Dr Vincent Felitti, from Kaiser Permanente presents information from the ongoing 17,000 person Adverse Childhood Experiences (ACE) Study to challenge the conventional view that certain chemicals are intrinsically addicting.  He presents the evidence gathered in the ACE study to show that “addiction is not a disease, but is an unconsciously attempted response to minimize the effects of abnormal life experiences. Addiction can be seen as the unconscious, compulsive use of psychoactive materials in response to the stress of life experiences, typically dating back to childhood.”

Dr. Felitti discusses patients, including the woman who was the first person to draw his attention to the issue of using substances (in her case food), who are engaging in behaviors normally considered harmful in order to alleviate and protect from the pain of childhood experiences.  He primarily addresses food, alcohol, nicotine, methamphetamines and heroin addiction.  They are a few of the things that may be seen as public health problems but may often be “personal solutions to long-concealed adverse childhood experiences.  Describing bad habits as self-destructive behaviors hides their functionality in the life of a trauma survivor.”

As I think about how we try to address substance abuse, the heroin crisis, and human trafficking, I am drawn to the conclusion that we will fail in our attempts to resolve the crises until we begin to talk about the long held private conditions that lead to the public problems.  “These life experiences are very likely to be lost in time, and protected by shame, by secrecy, and by social taboos against exploring certain aspects of human experience.”  So many of us were raised in families and cultures where we did not discuss shameful family secrets.  As we grew up we were seen as the problem when the legacy of adverse childhood experiences presented as addictions and mental illness.

At this point in time treatment options are few and far between and minimally address the origins of the addiction.  By failing to address the adversity experience in childhood by so many people, we fail in our attempts to treat.  When treatment fails, we blame the person instead of recognizing that by “treating someone’s attempted solution, we may be threatening and causing flight from treatment” or forcing them to find another, possibly life-threatening, solution.

When these childhood experiences are named and validated as the source of long term difficulties in adolescence and adulthood we are removing the stigma and helping persons understand that it is not about having something wrong with them, but that something was done to them.  The next steps are to assist in finding healthier solutions and recognizing the strength and resiliency that helped them find solutions in the first place and survive in the midst of extremely adverse experiences. 

http://www.albertafamilywellness.org/resources/video/origins-addiction

This is an excellent blog post by Laura Kerr Ph.D. on trauma and mental illness.  Just click on the title below.

Want to reduce mental illness? Address trauma. Want to save the world? Address trauma.

Abraham Lincoln – A Case Study in Depression, Trauma and Resiliency

 I have recently been interested in reading about Abraham Lincoln and the depression that significantly affected his life to the point of being a defining characteristic of who he was. 

I started by reading (yes, I will admit this) Abraham Lincoln, Vampire Hunter by Seth Grahame-Smith.  I doubt it was Mr. Grahame-Smith’s intent, but in knowing that Lincoln suffered from depression I found the novel to be an allegorical representation of Lincoln’s struggle against the demons of depression (and slavery).  This fight strengthened him and led to the heroic acts that defined his presidency. 

The book, Lincoln’s Melancholy, How Depression Challenged a President and Fueled His Greatest by Joshua Wolf Shenk is definitely a more serious and enlightening depiction of the life of Abraham Lincoln.  I invite you to read the first chapter and listen to the podcast at http://www.npr.org/templates/story/story.php?storyId=4976127

Mr. Shenk does an excellent job in outlining the struggles that the president experienced in his life and is able to do research that delineates the genetic heritage of depression in the Lincoln family.  Although he makes a great amount of mention to the struggles in Lincoln’s earlier life, Mr. Shenk does not seem to make the connect between these early traumatic experiences and the depth of Lincoln’s depression.

According to historians (including Mr. Shenk and James Swanson in Manhunt: The 12 Day Search for Lincoln’s Killer) Lincoln experienced the following traumatic experiences in early life:

· the death of his mother when he was nine
· frequent moves due to poor business decisions on the part of Thomas Lincoln, his father
· the death of his older sister who had been his primary caretaker after the death of his mother until his father remarried.
· raised by a distant and abusive father who had witnessed his own father being killed in an Indian raid
· Living in neglect and poverty
· The death of two children before his assassination.
· Marriage to a woman with her own trauma and mental health issues.

If we used today’s ACE (Adverse Childhood Experiences) score see http://opendoorsnh.blogspot.com/2010/07/adverse-childhood-experiences.html , Lincoln would probably score 5 or above, well within the range that leads to risky and negative consequences in life.

Lincoln also experienced two strong characteristics of many trauma survivors. After the death of a woman with whom he may or may not have had a serious relationship in his twenties, Lincoln’s friends organized themselves into a suicide watch. Lincoln himself reported that he was fearful of carrying a knife for fear of following through on his desire to end his life.

In a letter to John T. Stuart, his first law partner, Lincoln wrote:

“I am now the most miserable man living. If what I feel were equally distributed to the whole human family, there would not be one cheerful face on the earth. Whether I shall ever be better I cannot tell; I awfully forebode I shall not. To remain as I am is impossible; I must die or be better, it appears to me.”

Secondly, Lincoln had what is known as a ‘foreshortened sense of future,’ which in hind sight was definitely prophetic. He often commented having a sense or dreams of his impending assassination. Given the politics of the time and his position, it is understandable that he may be fearful but this started much earlier than his rise to the national political stage.

Abraham Lincoln had tremendous resiliency. He was able to take each negative experience and eventually turn it to his advantage. Even his backwoods poverty served him well in connecting to the constituency that eventually elected him to office. Lincoln also was able to attract people into his life that enhanced his abilities and balanced his deficits.

In understanding Lincoln’s history and theories of attachment, it can be seen that four people nurtured Lincoln’s innate resilient nature: his mother, Nancy; his sister, Sarah; his stepmother, Sarah Bush Johnston; and his friend, Joshua Speed. I encourage you to read more about these relationships, but I wish to particularly note that it was his stepmother who encouraged his love of learning even in opposition to a father who believed that reading anything other than the Bible was frivolous and lazy. It is my opinion that this relationship was the most stabilizing influence of his life and greatly offset the mercurial relationship he had with his abusive and distant father.

It is very apparent that Lincoln was a great politician with high ideals. His desire to be of service and to make meaning of his life was a component of his strength and resiliency. Abraham Lincoln was a man of conscience who was determined to leave this world better for his being in it and he succeeded, not in spite of his depression, but because he was able to use his struggles to his advantage. Unfortunately, a person with the same history of mental illness would probably be unable to rise to the status that Abraham Lincoln did due to stigma. However, I think that those of us who struggle with depression and the effects of childhood and adult trauma can find Lincoln’s story enlightening and inspiring.

Book Review - Fried: Why You Burn Out and How to Revive by Joan Borysenko, Ph.D.

I have been under the weather the past couple of days and was fortunate to have Fried by Joan Borysenko at the top of my reading pile.  Dr. Borysenko used the social network, Facebook, to gather input from her Facebook Friends (FBFs) to write about people’s experiences with burnout.  By combining the input of her FBFs with research about burnout she was able to give a comprehensive view of the experience of burnout and the possibilities that come with surviving the experience.  The information she provides would be extremely helpful to anyone working in the field of domestic violence and sexual assault. 

Dr. Borysenko uses the allegory of Dante’s Inferno to map the progression of burnout from the descent into hell to the rise to Paradise.  In the first chapter she provides the stages of burnout with the first stage being “Driven by the Ideal” and the last stage as “Physical and Mental Collapse.”  I was extremely affected by the quote she provided from Thomas Merton’s Letter to an Activist which I think is very applicable to the work we do in our work to end violence against women and children.

“Do not depend on the hope of results.  When you are doing the sort of work you have taken on, essentially apostiolic work, you may have to face the fact that your work will be apparently worthless and even achieve no result at all, if not perhaps results opposite to what you expect.  As you get used to this idea you start more and more to concentrate not on the results but on the value, the rightness, the truth of the work itself.”

In this first section on the stages of burnout, Joan Borysenko provides writing exercises to help determine where a person may be on the continuum.  In other chapters she addresses the “depression industry” that fails to recognize the effects one’s life history and prefers to medicate symptoms rather than address trauma and grief and may have actually done more harm than good.  I found this section particularly interesting.

Dr. Borysenko also discusses the Adverse Childhood Experience studies of Dr. Vincent J. Filletti  and outlines how childhood experience effects out ability to maintain our physical and mental health.  She also encourages the use of McClelland’s Thematic Apperception Test and the Meyer’s Briggs to determine temperament and how one responds to stress.  It was not necessary for me to take the TAT to know where I would fall and I found it helpful in validating the work I currently do.  Dr. Borysenko recommends the use of such tests as a means of finding out whether or not one is working in a situation that will lead to increased risk of burnout. 

Dr. Borysenko’s wisdom and stories from her own life are beautifully intertwined with the wisdom of the FBFs that she invited to participate in discussion regarding burnout and the revival that occur once a person makes the journey from Hell to Paradise and the recognition that we can let go and move one to a new life with even greater excitement and productivity. 

I hope readers will find this book as wonderful as I did.  I plan to refer to it often

I will end with a quote Dr. Borysenko  included by John Milton (from Paradise Lost):  “The mind is its own place, and in itself I can make Heaven of Hell, a Hell of Heaven.”

.