I am really starting to pay attention to Gabor Maté, a Canadian physician who has worked for many years with the most vulnerable drug-addicted population in a part of downtown Vancouver, which he characterizes as the most densely populated area of addicts in all of North America. His assertion is that all addiction is a result of early childhood trauma. Actually investigating his work is new to me, so this is just some early reflection on material that I see potentially significantly informing my practice. I also reflect on some treatments that are either already part of my toolbox, or rapidly becoming so.
Having worked with people who have had significant early childhood trauma, Maté’s observations and assertions ring deeply true. His insight on the impact of childhood trauma include the following:
- The major contributing factor to all illnesses, psychological, addictive AND physical originates in infancy and childhood in the form of attachment disorder – insecure, intermittent or abusive caregiving in the earliest years.
- As the brain develops under these adverse conditions, attachment trauma results in weak executive function. The lack of guidance by a loving caregiver in ways to soothe negative emotions results in a “narrow window of tolerance – the inability to tolerate peaks or valleys of emotion. In adulthood, and a client thus effected will spend much of their time either scared and angry, shut down and listless, or in escape mode – in the latter often where addictive behavior is found
- Attachment rupture inhibits neurobiological development: the circuits that produce positive neurotransmitters such as dopamine, serotonin and oxytocin are not working optimally. Therefore, the client will substitute with drugs, alcohol, workaholism, eating, shopping etc., all of which provide a pleasurable chemical “kick” that brains who don’t get enough soothing and pleasurable neurotransmitter activity crave.
- Maté sees the “genetic” explanations as “nonsense”. He characterizes this popular explanation as a convenient way to pass off responsibility for the problem rather than address it at its root. Mate asserts that by “passing the buck” to the unchangeable genetics, society can justify a go-go world of success, profit and power where women’s maternal leave is a fraction of the 2 years he recommends, and caregiving is passed off to surrogates like daycare, nannies, video games and smartphones
The discovery the now well-known concept of neuroplasticity, the capacity of the brain to re-wire in accordance with new experience, appears to justify time-honored methods of cultivating attachment, and is prompting many of the new trauma paradigms of trauma treatment, now that there is hope of cultivating neurologically healthier brains in adulthood. At the bottom of these methods is some type of way to give the children the attunement and and capacity for self-soothing that they never had; the treatment goal of these new methods is “earned secure attachment”.
Besides a complete reassessment by society of the importance of long term and frequent mother-to-child connection, Maté envisions the remedy for these deep seated attachment issues in adulthood in the realm of rediscovery of Authenticity – of who we really are mirroring D.W. Winnicott, the an early pioneer in the study of attachment, who famously drew our attention to what he termed the True/False self (p 140). As an infant involves itself in hard-wired attachment to the mother, her acceptance cultivates the burgeoning personality.
The more of the baby’s true self expressions the mother accepts and encourages, the more likely the child will grow up feeling “authentic”. However, when the mother responds to the baby’s efforts with anger or neglect, the baby learns to suppress those offensive “authentic gestures” that trigger the mother’s ire, or devise strategies to get attention that otherwise would not have emerged naturally. With time, these messages create a self that is True, based on acceptance of spontaneous gestures, or partially or completely False, based on suppression and the inauthentic responses necessary to maintain the critical survival bond.
But how do we cultivate this often forgotten and elusive “True Self”? .
Much of psychodynamic therapy is based in the healing and reparative relationship of therapist and client in a thoroughly confidential environment. Winnicott, as do all psychodynamically trained therapists, felt that if people can be fully accepted as themselves, as they are in the therapy room, they could gradually develop a secure attachment with the therapist. This incremental re-wiring of the brain to learn the inner meaning of secure attachment could lead to the client accepting and finally embracing her “true self.”
Anyone who has seen the “Gloria” films knows that Carl Rogers had an iconically personal way with clients. By helping the client express verbally their true emotions, he could work toward an alignment with what was verbalized and what was felt fully within the body. By mirroring the narrative expressed in therapy back to the client as best he understood, and as the client agreed or corrected his interpretation, they eventually would arrived at a felt sense of “congruence” in which themselves as a living being aligned with what they expressed.
But what of severe trauma? What happens when one’s childhood has been traumatic and filled with abuse, neglect or worse?
Besides the necessity of a safe and warm therapeutic alliance, and within the framework of psychodynamic therapy, I turn, as an adjunct, to Janina Fisher for additional help. Fisher who worked for many years in the clinic of famous trauma expert Bessel Van der Kolk has created what she calls a “new paradigm” for trauma treatment. Her method, which draws heavily on the neuroscience of attachment, as well as other established methods, breaks down each defense against or in compliance with the “scary” behavior of caregivers manifests in “parts”, each one arrested at the age in which it was forced to emerge. By seeing the parts as individual entities of various ages, the client can be gently guided to use the high functioning parts of themselves to slowly get to know and learn to welcome these parts with the love and security they still perceive is lacking.
For many decades, the concept of attachment has been identified and elaborated. With thousands and thousands of studies to its credit, it is about as well researched a psychological concept that exists. Virtually every therapist in practice today is familiar with the concept, knows the damage that insecure or traumatic attachment can cause in adulthood, and incorporates this knowledge into their work. What Maté is proposing takes attachment to the true forefront of virtually all human maladies. His implication brings the realization that healthy attachment is not a luxury; it needs to be seen as a necessity. This makes the notion of earning a secure attachment all the more vital for a healthy life, society and world.
Sevilla King, LICSW 