Dropped Stitches
By Judith S. Freilich, MD

I am a psychiatrist thinking about knitting – about dropped stitches, in particular. Knitters know that a dropped stitch weakens the whole cloth, disrupts the garment’s integrity and leaves a hole that may not even show until there is a stretch or stress on it. Then, the fabric is likely to begin unraveling from the hole, no matter how carefully the rest is knitted.

I wonder about this in my life. In the fabric of my life, there were many dropped stitches – emotions suppressed, voices blocked, roads not taken, losses not grieved before moving on, trauma endured. Life.

My way was to keep moving forward with determination, compassion and courage. I loved, worked hard, accomplished, learned and helped others along my way. On the surface, my efforts seemed of strong cloth. As time went on, those invisible holes – the dropped stitches – began to show and unravel.

“The body is the mind’s subconscious,” says respected neuroscientist Candace Pert, PhD. That which our minds can’t absorb is held for us in our bodies. Dropped stitches remain in our garment, a part of us. They do not just disappear.

What to do about my dropped stitches? Do I leave the past untouched and continue pressing forward? What would that mean for the whole cloth? Does it end up in the trash that way? Do I choose the difficult task of repairing my garment, so it has more integrity for the future?

When a knitter discovers a dropped stitch, she repairs it. She unknits back to it, picks up the dropped stitch and then knits forward again. Knitters call this “tinking” – “tink” being “knit” spelled backwards.

I think I will “tink.” Many of my dropped stitches are losses not fully grieved. There are trauma-made holes, too. The largest is from when my daughters died in a tragic car accident in 1985. Then, I had no ability to grieve. I might have died or gone crazy had I not become frozen and dissociated.

I did not consciously make a decision to freeze. Perhaps my soul did, in order to preserve my life. And by doing so, the memories and grief were frozen and stored in my body – until the time came to unfreeze and release them. And, yes, it left dropped stitches. I think this was preferable to having no garment at all.

There are many ways to “tink.” Each begins with recognizing a hole. We can complete a grief left undone. We may reconnect with an attenuated relationship. There is repair that is spiritual in nature, such as gratitude and forgiveness in their many forms.

There is trauma work. Effective trauma release is “tinking” at its best. Sometimes it involves finding memory pictures, then developing them to bring buried treasure to light or frozen emotions to life. Sometimes, tracking body sensations is the way to find and release them. Or we might return to an old physical environment, restoring an emotional state that was left behind before it was time.

The purpose is to transform trauma. It helps to think about chemistry and alchemy. Like knitting, these are transformational processes. They turn one thing into another. If a single step in the process is missed, the whole thing won’t go to completion. It just doesn’t work.

Tinking is precise, too. It begins with intention – and some resistance, as undoing is unpleasant. The knitted strand is carefully pulled apart, all the way back to the hole. The yarn is neither lost nor cut. It remains an integral part of the garment. When reknitted forward, it becomes part of a stronger garment.

Knitting creates links. A bridge is a link. To pick up a dropped stitch is to build a new bridge, make a strong link where one was weak or not even there. Building a strong bridge requires first building good foundations at each end of the span.

Not long after my girls died, a friend talked to me of bridges. She said that when your child dies, the foundation of your life collapses. For a while, you must go forward, building a new foundation. At some point, you then can build a bridge back to the past. Healing happens then. Connecting past and future makes a stronger whole.

With thanks to Descartes: “I ‘tink,’ therefore I am.”

— Judith S. Freilich, MD, is a psychiatrist at The Meadows who is board-certified in psychiatry and neurology.

By Debra L. Kaplan, MA, LAC, LISAC

Not too long ago, a client who I was treating for prescription drug abuse, looked at me and said, “It’s my desperate need to silence my feelings that drives me to want to use.” She went on to describe what it felt like to live in her skin. “It’s as if the people in my life are at the controls of this rollercoaster called my life and I’m trapped and I can’t get off. I like or hate the ride based on how I feel about them at that moment; in my mind you’re either with me or against me. But I can’t fire them from the controls!”

Unbeknownst to this woman, she was verbalizing her underlying issue: Complex Post-Traumatic Stress Disorder (CPTSD). For the uninitiated, CPTSD is classified as a long-term traumatic stress disorder that may impact a healthy person’s self-concept and adaptation. Exhibited symptoms include mood disorders (depression, manic-depression, anxiety); fear of real or imagined rejection or abandonment; and addictive, self-defeating behaviors including bulimia, anorexia, compulsive spending, sexual compulsivity, and perhaps self-injury.

In an effort to differentiate between psychosis and neurosis, the condition first was branded Borderline Personality Disorder (BPD). New research and advances in studying chronic trauma’s effects on self-concept and psychological organization have yielded a more accurate approach to characterize exhibited symptoms.

Recurring bouts of emotional instability wreak havoc on the life of an individual struggling with this issue. Along with the ups and downs of the emotional roller coaster comes confusion about one’s identity. An individual with CPTSD often wrestles with a persistently unstable self-image; like in a house of mirrors, one’s identity is rendered illusive and distorted.

Those who are familiar with CPTSD know all too well the chaos and havoc brought to bear upon relationships. In working with trauma complicated by emotional dysregulation, I have often likened the displays of impulsive rage to a cluster bomb. From one furious mass come multiple smaller submunitions. These emotional explosions neutralize any threat of real or imagined relational rejection, abandonment or disapproval. Loved ones who are idealized one day are devalued and rejected the next, relegated to the role of enemy – perhaps simply because an act of parting was interpreted as an act of betrayal. Some who struggle with CPTSD have co-occurring mood disorders that exacerbate internal stressors to the point of brief psychotic episodes.

Individuals with CPTSD often verbalize feeling wronged, misunderstood and empty. As is often the case, the trigger – be it internal or external – prompts attempts to self-medicate overwhelming emotions with alcohol or chemical dependence, acts of self- mutilation (cutting, burning, wrist-slashing), and even suicide attempts.

Historically speaking, the prognosis for CPTSD has been poor. Within the therapeutic community, clients who present with these symptoms have been branded unmotivated, hard to treat or, worse, noncompliant. The current belief – and one that I genuinely embrace – posits that a consistently supportive therapeutic relationship can become a healthy foundation that allows a client to begin to experience trust and safety. Much is still unknown about the post-traumatic condition, but continued advances in neurobiological, genetic, and social research have led to new treatments and psychopharmacological interventions that have proven successful in generating enduring, positive change.

The path out of the CPTSD maze begins with a gradual acknowledgement of the problem and a willingness to accept oneself. But what happens when one does not acknowledge the presence of a problem? Clearly, such denial undermines progress toward positive change. An individual’s need to shield himself from unacknowledged and overwhelming feelings exists until he is psychologically ready to see himself as he really is – and not who he wants to be.

Support for an individual’s attempts to break through denial is necessary for enduring progress to be made. The presence of a psychological struggle does not designate a bad or defective person. He’s done nothing to deserve it, much like a child does nothing to deserve the onset of juvenile diabetes. However, the individual is now living a reality of roller coaster emotions, unstable relationships, addictions, and feelings of emptiness. The cold, harsh fact is that the self-defeating behaviors and unstable self-worth are not likely to change until the person changes.

As with all physical and emotional distresses, there comes a moment when the status quo is no longer acceptable. The chaos or unmanageability of a situation necessitates asking for help and taking action. Perhaps the adage “being brought to one’s knees” applies here. An ensuing adjustment period, in which one comes to terms with a new reality, may not be immediate. However, a new perspective might arrive with a sobering blow to the denial – or with the quiet realization that life is eroding beyond one’s grasp. Self-acceptance can be attained perhaps only through small, sometimes imperceptible steps. In recovery speak, it is progress rather than perfection that guides us: “I am not a problem, but my behavior has become problematic!” I ask my clients, “Which would you prefer to be: resolutely right or resolutely happy?”

When one is living a life that, despite great efforts, no longer results in satisfying outcomes, it is time to look inward and ask the hard questions: “What am I doing that is no longer working? Harder yet, what am I prepared to do about it?”

Until that moment of introspection and committed motivation, little if any enduring change will occur. But the path out of the house of mirrors, and away from the emotional roller coaster, is the path to a new life.

This article originally appeared in the Spring/Summer 2009 edition of The Cutting Edge.

Author’s note: Nearly a decade ago, I began to work with women confronting sexual betrayal. It was this professional experience that inspired me to write Deceived: Facing Sexual Betrayal, Lies and Secrets, a book for female partners of sex addicts. Much of this article is excerpted from that book, published by Hazelden in April 2009.

Most couples, whether married or not, have both spoken and unspoken commitments that sex stays within the relationship; they communicate and respect each other’s personal needs and boundaries. Their expectation is for unconditional love, but they know that relationships have conditions that need to be negotiated openly. Unfortunately these commitments and expectations are often a façade in many relationships.

Many people are in coupleships riddled with deception, lies, and false perceptions as a result of their partners’ compulsive sexual acting out. Today in every neighborhood throughout every community, these people are being challenged by the addictive nature of their partners’ sexual behavior. It may be the wife who just discovered her husband was with another woman within days of their wedding. It could be the mother of two young children whose boyfriend has just lost his job due to engaging in Internet sex during work hours, or the partner who has masked her shame and confusion about her husband’s chronic pornographic activity, and is now horrified at the thought that her children are going to find out about their father’s voyeurism. It may be the man who recently discovered hidden computer files of sexually explicit photos his girlfriend has been emailing to a great number of men. It could be the wife of 40 years, her husband soon to retire, who has known about his affairs from the beginning of their marriage. There’s nothing particularly different about the current affair that she just discovered; it’s just the “straw that broke the camel’s back.”

The Coaddict Didn’t Get Here by Accident

Influenced by both culture and family, a coaddict learns coaddictive behavior long before a partner comes into his or her life. As much as the socialization and empowerment of women in Western industrialized culture has changed, women are still more apt to:

• defer to men by giving them the benefit of the doubt
• take on false guilt
• believe they need a partner in order to be okay
• prioritize men’s needs over their own
• acquiesce
• be polite
• refrain from showing anger
• feel inadequate about their sexuality
• have a distorted and shame-based body image

Yet this socialization of women is not the strongest factor driving a person to couple with a sex addict. Far more influential, for both men and women, is family history. While they may not have thought of their childhood as being significant to what is happening now, and while there are no perfect parents or perfect families, looking at family history and dynamics will be significant in healing. It’s critical to examine the beliefs they developed about themselves and others, the ways they learned to experience connection and/or protect themselves, and the behaviors that helped them garner esteem.

The behaviors and belief systems of both coaddicts and sex addicts are strongly influenced by individual childhood experiences. For the coaddict and the addict, it is common that one or both parents were addicts – alcoholics or sex addicts in particular.

It may not have been called “addiction,” but coaddicts and addicts often say their fathers were womanizers or their mothers had lots of affairs, drank a lot, etc. There may have been a history of extreme parental rigidity, strict all-or-nothing parental codes. Messages about sex were shaming or distorted, creating confusion in the child.

In essence, both the coaddict and addict were raised in very similar family systems in which they experienced a range of emotional and physical abandonment.

The Coaddict: Trauma Repetition

Kate is an example. She was raised in an alcoholic and violent family. She is divorced from two different alcoholic men and is now married to an active sex addict. Her husband has had multiple relationships with other women, and now he is flagrantly acting out in a manner that she cannot deny. She knows he visits pornographic bookstores, and on a recent visit, he had their 4-year-old son with him. Yet she still had the ability to rationalize. He is stressed by our two young children. He wouldn’t do this if he wasn’t on drugs. She would deliberately not ask questions. If she didn’t ask, then she wouldn’t have to know. She wouldn’t ask for help, because as she said, I just need him to stop. She wouldn’t assert any limits because her fear is him leaving her. In ultimate desperation, she found herself left alone in a hotel room with a baby just a few weeks old, a 4-year-old, no car, no food, and no money – while he went to get more drugs and meet up with a girlfriend. And Kate just wanted him back.

Kate didn’t get to this place overnight. Her childhood history was her training ground long before she entered her three addictive relationships. As with most partners of addicts, dysfunction ruled her original family. As a child, she learned to:

• Overlook (deny, rationalize, minimize) behavior that hurt her deeply
• Appear cheerful when she was hurting
• Make excuses for the hurtful behavior
• Avoid conflict to minimize further anger
• Tolerate inappropriate and hurtful behavior
• Prioritize the needs of others over her own
• Caretake others
• Fault herself for her family’s problems
• Discount her own perceptions and give others the benefit of the doubt
• Believe she had no options
• Believe she is at fault and it is her job to find the answers
• Not ask for help
• Accommodate

She was reared to be the perfect candidate for partnering with an addict. This is a natural consequence of being raised in a shame-based family, which is very often an abusive or addictive family. The child grows up to be an ideal partner for the addict, one whose codependent traits enable him to act out his addiction with little disruption.

While the names change, the stories of repetitively partnering with an addict are common and span generations. What Kate and other coaddicts experience is referred to as trauma repetition. Although Kate repeated it many times in her own life, others simply repeat it generationally. Trauma repetition means creating behaviors and situations similar to those experienced earlier in life – reliving a story out of one’s painful history. When these individuals find themselves in the same situation with the same type of person over and over again, they seldom link the behavior to their original betrayal and trauma.  Reenactment is living in the irreconcilable past. They may have been raised with addiction and may even be aware of this, but that doesn’t necessarily keep them from marrying addictive and/or abusive men. Replaying past trauma often involves repeating what they know, the familiar, or what they believe they deserve.

Utilizing Resources

Addressing sexual betrayal that has become addictive requires special assistance, and that help is available today from professionals and 12 Step programs. While individual therapy is often where the coaddict begins recovery, I cannot overemphasize the healing power of a group, whether it’s self-help or a therapy group with others who have similar experiences. It is within the group experience that many coaddicts heal to a degree they never imagined possible. It is in the group that they come to realize their healing journey is a gift to themselves that will take them through life and its ultimate challenges.

The Possibilities

Recovery is a process that offers no guarantees about relationships, but it does guarantee a journey to self-love and self-care. A woman in recovery can learn to trust herself and listen to her inner wisdom. It is her opportunity to learn about healthy boundaries, who is responsible for what, and what provides a sense of safety. She can give voice to her reality, moving forward in truth. Secrets disappear, leaving potential for connectedness with self, others and the universe. She deserves to believe in her preciousness and to have it honored from within and by those she invites into her life. Her recovery is a journey of honoring and respecting herself. It is moving from immobilization or reactivity to a life of hope, greater esteem and greater choices.

Resources

Society for the Advancement of Sexual Health (SASH) -www.sash.net

S-Anon – www.sanon.org

Co-Sex Addicts Anonymous (COSA) -www.cosa-recovery.org

Co-Sex & Love Addicts Anonymous (COSLAA) -www.coslaa.org

Recovering Couples Anonymous (RCA) -www.recovering-couples.org

Note that the above material is an excerpt of Claudia’s book, Deceived, in which she addresses issues such as:

• In The Face of Truth
• His Behavior is Not About You
• Learning the News
• Your Time to Heal
• Finding Your Serenity

ABOUT THE AUTHOR

CLAUDIA BLACK, PHD, MSW

Claudia Black, Clinical Consultant for The Meadows, is a lecturer, author and trainer internationally recognized for her pioneering and contemporary work with family systems and addictive disorders. Since the 1970s, Dr. Black’s work has encompassed the impact of addiction on young and adult children. She serves on the Advisory Board for the National Association of Children of Alcoholics and the Advisory Council of the Moyer Foundation. Claudia is the author of 15 books; her newest title is Deceived: Facing Sexual Betrayal, Lies and Secrets, released in April 2009 by Hazelden Publishing. She has produced several audio CDs, the newest of which is Triggers, and more than 20 DVDs, most recently The Triggering Effect. All of Claudia’s products are available at www.claudiablack.com.

Child Abuse, Neglect, and Character Defects
by John Bradshaw

One of the most insidious effects of child abuse and neglect is their impact on “character” foundation.

Addiction (any form of obsessive/compulsive behavior) and the codependency that fuels it can be understood as being rooted in a complex of “character defects.” We now have good evidence of a chemical imbalance that predisposes certain persons to addiction. (AA has, since its inception, pointed to a chemical imbalance in alcoholics.) Current research points to missing strands of DNA in the neurotransmitter dopamine. But missing DNA strands of dopamine do not mean that a person will necessarily become codependent or develop an addiction.

I do not hold the opinion that addiction and codependency are diseases in the medical sense of the word. They are certainly diseases in the psychological sense. They wreak havoc in a person’s life and lead to moral and spiritual bankruptcy. Moral bankruptcy is my focus in this article.

Not all character defects come from child abuse and neglect. In the world of human freedom, anyone can choose to act in an immoral way. My concern in this article is to understand the role of child abuse and neglect in the formation of character defects.

Codependency is a disease of the developing self that is fully manifested in adult relationships. The primary symptoms of codependency, in relation to moral character, are:

• A lack of a solid sense of self-identity, which is rooted in toxic shame (“carried shame,” as described by Pia Mellody).
• A shame-based identity that manifests itself in polarized extremes, either as a character-disordered “more-than-human” (inhuman) personality exhibiting grandiosity, perfectionism and blame; or a neurotic “less-than-human” (dehumanized) personality exhibiting a sense of worthlessness. A person can be stuck in either polarized extreme or may switch back and forth, as in the more-than-human anorexic eating disorder that is transferred to the less-than-human bulimic eating disorder. Pia Mellody has suggested that these polarizations are the product of two types of abuse: a falsely empowering abuse and a disempowering abuse. Both types are rooted in toxic (i.e. carried) shame.
• Distorted ego boundaries, both external and internal. This character disorder tends to set up walled boundaries, and the neurotic personality tends to have weak and broken boundaries.
• Emotional illiteracy, which is characterized by extremes of rigid emotional numbness or the inability to regulate the intensity of one’s feelings.
• Difficulty in recognizing what one wants and needs.

These behavioral symptoms make up the essential “character defects” of codependency, which I refer to as “disabled will” in my book, Bradshaw: On the Family. Codependents do not choose well and seldom make virtuous choices. Virtue has to do with choosing the appropriate mean between two extremes. Codependents and addicts choose in ways that are all or nothing, black or white.

Moral action is concerned with choosing well in the ever-changing singular circumstances that make up our lives. Necessary to a strong ethical character is a specific virtue called prudence – the refined ability to “know how” to choose well in the changing circumstances of one’s life.

The disabled will is the reason codependency has been described as the disease of addiction. Addicts of any kind have serious defects when it comes to choosing well. I chose to drink as a solution to the problems caused by my drinking. I chose to act out sexually and commit adultery to assuage the guilt I felt for repeatedly betraying my wife by committing adultery. Words like “adultery” have a sting that is worse than simply saying “acting out sexually.”

The will depends on reason, conscience, and that which the ancient philosophers Aristotle and Thomas Aquinas called a habituated or “right appetite.” The will, they believed, has to be educated in such a way that a person experiences and tastes goodness. Aristotle believed we become brave by being brave, just by being just. The more we experience virtuous behavior, the more we learn how to choose to be virtuous. Aristotle and Aquinas referred to this knowledge to choose expertly as the virtue of prudence. Their formal definition of prudence involved right practical reasoning, which is based on right desire and a passion for goodness.

When we examine the symptoms of codependency, we find that they are the results of developmental dependency deficits, which are the consequences of abuse and neglect.

Developmental deficits refer to unmet developmental dependency needs. These needs must be met in order for a person to develop a solid sense of self and emotional literacy; these needs depend on source figures for their fulfillment. A child’s needs cannot be met without reliance on a functional adult. Solid selfhood and emotional literacy are two essential foundations for the development of moral intelligence and ethical character. Psychologist Erich Fromm defines ethical character as “the relatively permanent form in which our moral energy is channeled in the developmental stages of our life…. Our ethical character is who we are as expressed in our actions, how consistently we live, what we believe in and how we actualize those beliefs.” People often say that a certain behavior is “true to character” or “out of character.” Codependent and addictive behaviors are “out of character” for any healthy adult human being. Toxic shame creates inhuman and dehumanized behavior.

Solid selfhood and emotional literacy are the fruits of an educated will. With a solid sense of self, a person has good boundaries and will power. Emotional literacy is characterized by the ability to think about and contain feelings, using them for self-soothing and expressing them with appropriate intensity.

The primary pillars of solid self-hood and emotional literacy are:

a) The development of one’s own innate healthy or natural shame.
b) The achievement of “empathic mutuality” through the actualizing of the innate need for secure attachment.

Let me briefly discuss both of these pillars, and how child abuse and neglect damages them.

Healthy or natural shame is an innate human effect. It marks our natural human boundary and is a root of the natural moral law. Someone once described healthy shame as “the permission to be human.” Natural shame is an auxiliary feeling that signals limits and monitors our pleasure, excitement and interest. Natural shame lets us know we are limited and imperfect beings. As such, it gives us permission to make mistakes and ask for help when we need it. Natural shame grounds us in our finitude and lets us know that there is a higher power. This is why the philosopher Nietzsche called shame “the source of spirituality.” Natural shame is absolutely essential to the development of a moral life. When natural shame is nurtured in a healthy way, it develops into guilt (i.e., moral shame). Guilt is the guardian of conscience.

Natural shame becomes toxic when children interact with source figures who are immature (developmentally arrested) and morally shameless. The caretaker’s shamelessness may take the form of the more-than-human, character-disordered control freak or perfectionist who chronically judges, blames, criticizes, beats, punishes or sexually uses his or her children. Or it may come from the neurotic character type who feels worthless and less-than-human, who treats his or her child as superior or worthless. In either polarized character form, the caretaker acts shamelessly and immorally.

Shameless caretakers were themselves the recipients of falsely empowering or disempowering abuse. Their grandiosity or worthlessness is a defense against their own toxic shame. Shameless caretakers also use a primitive unconscious defense mechanism called “projective identification.” In projective identification, the projector, by means of interaction with the recipient (i.e. through acts of neglect or abuse), unconsciously induces feeling states in the recipient that are congruent with the projector’s own rejected feelings (in this case, his or her own carried shame). A shameless caregiver’s defensive projective identification causes those in his or her care to feel the shame being rejected.

Pia Mellody has described the dynamics of the transfer of shame as “carried or induced” shame. Carried or induced shame is toxic shame. Toxic shame results in the breaking of the interpersonal bridge between the child and his or her caretaking source figure. This has disastrous moral consequences, as the empathic mutuality between mothering source figure and child result from their secure bonding or attachment. Erik Erikson has repeatedly shown this secure attachment (along with natural shame) to be the earliest and primal root of moral life. The golden rule is embodied in empathic mutuality.

Years ago, pioneering psychologist John Bowlby stated that attachment behavior is “vital to the survival of the species.” The earliest years of life are the most significant for attaining secure attachment. Secure attachment can be defined as the biological synchronicity between organisms. Secure attachment is the dyadic (interactive) regulation of emotion and has its foundations in the right hemisphere of the brain (or the nondominant, if you are left-handed). The known functions of the right brain, or right hemisphere, (RH) are:

• It is crucial to our sense of bodily and emotional self.
• It recalls autobiographical information.
• It relates the self to the environment and to social groups.
• It maintains a coherent, continuous and unified sense of self.
• It is the source of resiliency and manages stress.

Secure attachment is a form of resonance, which can be defined as a shared feeling or sense. Emotional information is intensified in resonant contexts. Secure attachments allow a child to develop resilience in the face of stress. Resilience is an ultimate indicator of attachment capacity and an infant’s mental health.

The key to secure attachment is the source figure’s capacity to monitor and regulate his or her own emotions, especially negative ones. This kind of regulation is one of the fruits of emotional literacy.

In infancy, the relationship between the mothering source figure and the infant exhibits the most intense emotions. Communication is right brain to right brain. It will take some three and a half years for the left brain (the seat of verbal language and logical thinking) to emerge. In the beginning, the interaction takes place within a context of facial expressions, posture, tone of voice, tempo of movement and incipient action. The infant’s emotions are initially regulated by the mothering source. When this interaction is sufficient, the infant toddler is able to increasingly self-regulate and cope with stress. Our earliest emotional experience directly influences the maturation of the right brain’s early regulator system.

Emotional dysregulation and the disorders of the self are the effects of early relational trauma, abuse and neglect, and are imprinted on the amygdala of the right brain (the nonverbal unconscious). As leading neuroscientist Dr. Allan N. Schore writes, “Emotional dysregulation is a fundamental mechanism of all psychotic disorders.”

Most abused and neglected children were poorly attached as infants for the simple reason that most abusing and neglecting source figures were shameless, immature and dysfunctional. It is illogical to assume that they were mature during their children’s infancy and became immature later on.

Because the achievement of secure attachment establishes empathic mutuality, trust and hope, most codependents and addicts began their lives without a moral foundation. Abuse and neglect continue unless source figure caretakers get help and begin their own recovery processes. This is happening more and more as we grasp the dynamics of this whole sordid mess.

While I do not like the connotation of words such as “pride,” “gluttony” and “adultery,” I have to face the fact that my alcoholic addiction and sexual compulsiveness resulted in immoral behaviors.

I have had to confront my “better-than” belief in my own specialness and face up to making amends, owning my healthy shame and accepting responsibility for my moral life. Steps 4 through 10 of the 12-Step Program are crucial for rebuilding character, establishing a platform for virtue and deepening spirituality. I know these are suggested steps, but I see them as an essential bridge to repairing character defects. If you do not choose to do these steps, you will need to do the recommended work in some other therapeutic context.

Therapists have wisely shied away from moralistic rhetoric, but I see no way to mollify my character defects, other than to see them as immoral behaviors.

We are essentially moral beings. Our innate shame and innate need for attachment are the developmental roots of the natural law. Attachment and shame are the developmental motors of moral development and the virtuous life.

Aristotle believed that human happiness is synonymous with living a virtuous life. Happiness and virtue go hand-in-hand. Those who have walked a long way down the road to recovery know this. The tenets of AA promise it.

The cores of virtue are balance, polarity and moderation. Thomas Aquinas, the Medieval philosopher and theologian, believed that virtue is arduous, that it takes time and hard work to develop. He believed that virtue is a habitus of soul. A habitus is more than a habit. It is an integral quality of a person’s inner life, something that has been so internalized that it is a part of the person’s very being. When a person has such a quality, he or she does not have to think about things very deeply; he or she simply does good, because good is good to do. Not bribed by heaven or threatened by hell, this person does good because he or she has tasted it and wants it. It is good will.

Character defects are like holes in the conscience that distort our ability to make sound judgments. This is why recovering addicts and codependents are urged to get sponsors or to consult with therapists. It is why addicts and codependents in early recovery are urged to avoid making any major decisions for an extended period of time. The disabled will is as severe a moral problem as a person can have without being psychopathic.

I know of no better ideal or better gauge of a person’s recovery than the degree to which he or she lives a balanced and moderate life and makes sound and virtuous choices.

About the Author

John Bradshaw, MA, has, for the past four decades, combined his exceptional skills as counselor, author, theologian and public speaker, to become a world renowned figure in the fields of addictions, recovery, family systems and the concept of toxic shame. Mr. Bradshaw has written three New York Times best-selling books: Homecoming: Reclaiming and Championing Your Inner Child, Creating Love, and Healing the Shame That Binds You.

Primacy of the Affect System: A Support for The Meadows’ Model

by John Bradshaw, MA

Almost a half century ago, research psychologist Sylvan Tompkins (referred to by some as “the American Einstein”) wrote:

“I see affect or feeling as the primary innate biological motivating mechanism, more urgent than drive, deprivation and pleasure and more urgent than physical pain. Without its amplification, nothing else matters, and with its amplification anything can matter.”

This statement summarizes Tompkins’ long-term research, verified by cross-cultural studies with five literate and two pre-literate cultures (Eckman, 1971). Tompkins isolated nine innate affects and showed that they compose “the affect system,” which operates like other human systems (endocrine, nervous, immune, etc). Tompkins supplanted Freud’s libidinal energy theory with the energy of affect as the primary motivator of human behavior.

During the 1990s, often called “the decade of the brain,” neuroscientists such as Joseph LeDoux, Allan N. Schore, Antonio Damasio, and Daniel Siegel offered extensive clinical evidence supporting and expanding Tompkins’ works.

Following are a few significant ideas from these researchers, each clearly identifying affect regulation as the critical factor in the organization of a functional human. I believe that the work by Tompkins and many contemporary neuroscientists supports, validates, and offers new depth to the “feeling work” being done at The Meadows.

Joseph LeDoux is the Henry and Lucy Moses Professor of Science in the Center for Neuroscience at New York University. He has presented strong clinical evidence that there is no single part of the brain that houses a separate limbic, or emotional, brain. He has shown how emotion is involved in most aspects of human behavior, and he has done pioneering work on the Amygdala, a primitive part of the brain that operates much like home alarm systems. Our right-brain Amygdala records traumatic events. Whenever a situation bears a resemblance to a past traumatic event, the alarm goes off.  Amygdale reactivity can bypass and greatly distort rational thinking, but it has survival value and is a right-brain form of intelligence. Tompkins concluded that affect is the right brain’s form of cognition, an intuitive intelligence.

LeDoux supports this position: “Subjective emotional states, like all other consciousness, are best viewed as the end result of information processing occurring unconsciously. The activity goes on in the right brain, which is intuitive, nonverbal, and non-logically analytic.” It is, however, deeply intelligent. Parts of the emotional system are involved in cognition and choice. Feelings involve “conscious content,” says LeDoux.

Antonio Damasio, in his book Descartes’ Error, presents a severe blow to the ratio-logical bias that has dominated Western philosophy for several hundred years, from René Descartes’ “I think, therefore I am” to Hegel’s Phenomenology of Mind. Many of us grew up under the umbrella of Descartes’ rationalism, hearing our parents say things like “Don’t be so emotional” and “Emotions are weak.” Our parents also stuffed their own feelings, both conscious and unconscious. This set us up to “carry their feelings,” as Pia Mellody has pointed out. The shaming of our feelings caused us to numb our feelings and set up codependency, which is the core of addictiveness.

Damasio presented the case of Mr. X, who has suffered damage to a part of his brain that has cut off his ability to experience feelings. Mr. X can think logically and abstractly, but he cannot make simple decisions, such as where to eat. Damasio shows that, without feelings, we are unable to make real decisions. It is no wonder that the severely co-dependent make such bad decisions.

In my forthcoming book Bradshaw On: Calling Forth the Better Angles of Your Nature (due in September 2008), I offer plentiful evidence that moral and spiritual choices depend on emotional literacy. Since the time of Aristotle, we’ve known that the last act of any moral or spiritual judgment is dependent on affective (feeling) inclination governed by good will (right appetite). It is no wonder that co-dependents and addicts are morally and spiritually bankrupt.

In his book The Developing Mind, Daniel Siegel shows us the social nature of the brain, i.e., how relationships and the brain interact to shape who we are. For Siegel, the interpersonal bridge of the secure attachment bond is critical to a healthy emotional life and healthy sense of shame. Healthy shame is the affect that most determines and guards our sense of self, honor and dignity. The breaking of the interpersonal bridge is the root of toxic shame and the first step in forming a shame-based self.

Siegel asks, “Why does a child require emotional communication, attunement and alignment of emotional states in order to develop a solid sense of self?”

Emotion is how the mind establishes meaning and places value on an experience. Both meaning and value are integrally linked to social interactions. Following his colleague Allan N. Schore at UCLA, Siegel posits that self-regulation with reality is fundamentally rooted in the education of the emotions, or emotional literacy.

Schore, in his three poignant books Affect Regulation and the Organization of the Self, Affect Dysregulation and the Disorders of the Self, and Affect Regulation and the Repair of the Self, stresses the importance of affect regulation, especially the relationship between infant attachment, affect regulation, and the organization of a healthy functional self. Following the pioneering work of John Bowlby and his student Mary Ainsworth, Schore uses the growing body of evidence showing that the neural circuitry of the stress system is locked in the early development of the right brain. The right brain is dominant in the control of vital functions that manage stress, regulate emotion, and preserve a consistent sense of self.

Schore quotes copious studies that cite trauma as having significant negative impact on early bonding and maturation of the right brain during its most crucial period of growth. The most serious damage of early relational trauma is a lack of the capacity for emotional regulation. This adverse experience results in an increased sensitivity to later stresses. The Meadows’ Senior Fellow Bessel van der Kolk reiterated this conclusion in 1996 (see Proceedings of the National Academy of the U.S. of America, 1996).

Schore suggests that these neuroscientific findings call for a greater affective bond with our clients, who must disclose personal issues around shame. Schore makes it clear, as did Tompkins, that we can’t take our shame-based clients further than we are willing to go. As the great psychotherapist Milton Erickson modeled, we must meet our clients at their map of the world. By mirroring and utilizing another’s meaning systems, we can lead him to a larger view of the world. This requires that we have done our own feeling work.

During the eight years of my PBS show and workshops, an estimated 300,000 people did the “Inner Child” and “Healing Shame” workshops. Among the thousands of volunteer therapists at these events, many had difficulty handling the deep feeling work. It was common to find professionals reticent to work with participants who went into an age regression. The work can be frightening, as I am sure many of us experienced in our early professional careers. But it is paramount that, as professionals, we not hide behind talk therapy or prescription giving, when what would most help the client is feeling work.

New insights in neuroscience point to “affect” as the primary motivating energy of life. Affect work has been a missing piece in many therapeutic models, and I am sure this will change in the coming years.

About the Author
John Bradshaw, Fellow of The Meadows, has combined his exceptional skills as counselor, author, theologian and public speaker for the past four decades to become a world-renowned figure in the fields of addictions, recovery, family systems and the concept of toxic shame. John has written three New York Times best-selling books: Homecoming: Reclaiming and Championing Your Inner Child, Creating Love, and Healing the Shame That Binds You.

In Terror’s Grip: Healing the Ravages of Trauma
By Bessel A. van der Kolk, MD

From research on trauma’s impact on various victim populations, we have learned that the great majority of people not affected immediately and personally by a terrible tragedy sustain no lasting damage. Most of those who witness devastating events are able, in the long term, to find ways of going on with their lives with little change in their capacity to experience love, trust, and hope for the future.

The critical difference between a stressful but normal event and trauma is a feeling of helplessness to change the outcome. This is obvious when people are trapped physically, or their cries for help go unheeded. A nightmarish example is the experience of waking up during anesthesia, which is thought to happen to some 30,000 people a year undergoing surgical procedures in the United States. If this were to happen to you, you would be conscious and aware of where you were and what was happening but, because of muscle relaxants and other drugs, you would be unable to move or speak. Psychological trauma is a frequent result.

As long as people can imagine having some control over what is happening to them, they usually can keep their wits about them. Only when they are faced with inevitable catastrophe do victims experience intense fear and feelings of loss and desertion. Hearing unanswered screams for help or witnessing mutilated human bodies, as happened to some survivors of the September 11th attacks in Manhattan and Washington D.C., is particularly disturbing. In addition, many trauma survivors, including rape and torture victims, have come face-to-face with human evil, witnessing people taking pleasure in inflicting humiliation and suffering.

Feeling helpless against a dire threat, people may experience numbness, withdrawal, confusion, shock, or speechless terror. Staying focused on problem solving, on doing something, however small, about the situation—rather than concentrating on one’s distress—reduces the chances of developing post-traumatic  stress disorder (PTSD). In contrast, spacing out (dissociating) during a traumatic event often predicts the development of subsequent PTSD. The longer the traumatic experience lasts, the more likely the victim is to react by dissociating. Once a person dissociates, he becomes incapable of goal-directed action.

People’s responses to the traumatic event change as time passes. Usually, there is an initial outcry, seeking of help and attempt to re-establish social connections. Once victims have regained a sense of physical safety, they can assess the damage and begin to adjust or assimilate—a process that may take months or years. It is primarily their social context that re-establishes the feeling of safety vital for successful recovery. This initial social response will shape the way the victim comes to perceive the safety of the world and the benevolence or malevolence of others. If people in the social environment refuse to step in when a person’s own resources are exhausted, this may become as great a source of devastation as the original trauma itself, seeding further helplessness, rage, and shame. Many people who feel powerless to change the outcome of events resort to “emotion-focused” coping; they try to alter their emotional state instead of the circumstances giving rise to it. About one-third of traumatized people eventually turn to alcohol or drugs in a (usually ill-fated) search for relief. This coping behavior is often a prelude to developing PTSD.

Failing to reset their equilibrium after a traumatic experience, people are prone to develop the cluster of symptoms that we diagnose as PTSD. At the core of PTSD is the concept that the imprint of the traumatic event comes to dominate how victims organize their lives. People with PTSD perceive most subsequent stressful life events in the light of their prior trauma. This focus on the past gradually robs their lives of meaning and pleasure.

People who merely remember a specific event usually do not also relive the images, smells, physical sensations, or sounds associated with that event. Instead, the remembered aspects of the experience coalesce into a story that captures the essence of what happened. As people tell others the story, the narrative gradually changes, and the event is understood as something belonging to the past.

Thus, the core pathology of PTSD is that certain sensations or emotions related to traumatic experiences are dissociated, keep returning in unbidden ways, and do not fade with time. It is normal to distort one’s memories over the years, but people with PTSD seem unable to put an event behind them or minimize its impact.

Traumatized people rarely realize that their intense feelings and reactions are based on past experience. They blame their present surroundings for the way they feel and thereby rationalize their feelings. The almost infinite capacity to rationalize in this way keeps them from having to confront the helplessness and horror of their past; they are protected from becoming aware of the true meaning of the messages they receive from the brain areas that specialize in self-preservation and detection of danger.

If the problem with PTSD is dissociation, treatment should consist of association. Freud wrote in Remembering, Repeating and Working Through that “While the patient lives it through as something real and actual, we have to accomplish the therapeutic task, which consists chiefly of translating it back again in terms of the past.” Thus, psychotherapy has emphasized helping patients to give a full account of their trauma in words, pictures, or some other symbolic form, such as theater or poetry. For traditional therapy, this has meant focusing on the construction of a narrative that explains why a person feels a particular way, the expectation being that, by understanding the context of the feelings, the symptoms (sensations, perceptions, and emotional and physical reactions) will disappear. Unfortunately, there is little evidence that simply creating a narrative, without the added process of association, succeeds.

Under ordinary conditions, the brain structures involved in interpreting what is going on around us function in harmony. The subcortical areas of the brain represent past experience differently than the more recently evolved parts of the brain, which are located in the prefrontal cortex. These higher cortical structures create language and symbols that enable us to communicate about our personal past. When people are frightened or aroused, the frontal areas of the brain, which analyze an experience and associate it with other knowledge, are deactivated.

In people with PTSD, specific deactivation of the dorsolateral prefrontal cortex (which is responsible for executive function) interferes with the ability to formulate a measured response to a threat. At the same time, high levels of arousal interfere with the adequate functioning of the brain region necessary to put one’s feelings into words: Broca’s area. Traumatized people suffer speechless terror.

Under conditions of intense arousal, the more primitive areas of the brain—the limbic system and brain stem—may generate sensations and emotions that contradict one’s conscious attitudes and beliefs. Sensations of fear and anxiety coming from the subcortex can cause traumatized people to behave irrationally in response to stimuli that are objectively neutral, or merely stressful.

The usual regulatory system of adults is a kind of top-down processing based on cognition and operated by the brain’s neocortex. This allows for high-level executive functioning: observing, monitoring, integrating, and planning. The system can function effectively only if it succeeds in inhibiting the input from lower brain levels. However, top-down processing techniques relied upon by traditional psychotherapy inhibit rather than process (or integrate) unpleasant sensations and emotions. A prime characteristic of both children and adults with PTSD is that, in the face of a threat, they cannot inhibit emotional states that originate in physical sensations.

When asked to put their trauma into words, many people respond physically—as if they were traumatized all over again— and so do not gain any relief. In fact, reliving the trauma without being firmly anchored in the present often leaves PTSD sufferers more traumatized. Because recalling the trauma can be so painful, many people with PTSD choose not to expose themselves to situations, including psychotherapy, in which they are asked to do so. A challenge in treating PTSD is to help people process and integrate their traumatic experiences without feeling retraumatized—to process trauma so that it is quenched, not kindled.

Above all, treatment should seek to decondition people from their trauma-based physical responses. Medications such as selective serotonin reuptake inhibitors can alleviate the distress of PTSD, but survivors still need to find ways to put the traumatic event into perspective—as an element of their personal history that happened at a particular time, in a particular place.

In summary, there are three critical steps in treating PTSD: safety, management of anxiety, and emotional processing.

When people’s own resources prove inadequate to deal with a threat, they need to rely on others for safety and care. It is critical that trauma victims re-establish contact with their natural social support system. If that system is inadequate to ensure one’s safety, the help of institutional resources will be needed.

After safety is assured, psychological intervention may be needed. People have to learn to put words to the problems they face, to name them, and to formulate appropriate solutions. Victims of assault must learn to distinguish between real threats and the haunting, irrational fears that are part of the disorder. If anxiety dominates, victims need help to strengthen their coping skills. Practical anxiety management skills may include training in deep muscle relaxation, control of breathing, role-playing, and yoga.

Trauma victims must gain enough distance from their sensory imprints and trauma-related emotions to observe and analyze them without becoming hyper-aroused or engaging in avoidance maneuvers. One tool for this is serotonin reuptake blockers, which can help PTSD patients gain the necessary emotional distance from traumatic stimuli to make sense of what is happening to them.

After alleviating the most distressing symptoms, it is important to help people with PTSD find a language for understanding and communicating their experiences. To put the traumatic event in perspective, the victim needs to relive it without feeling helpless. Traditionally, following Freud’s notion that words can substitute for action to resolve a trauma, victims are asked to articulate, in detail, what happened and what led up to it, their own contributions to what happened, their thoughts and fantasies during the event, the worst part of it, and their reactions to the event, including how it has affected their perceptions of themselves and others. This exposure therapy is thought to reduce symptoms by allowing patients to realize both that remembering the trauma is not equivalent to experiencing it again, and that the experience had a beginning, middle, and end. It belongs to their personal history—to the past, not the present.

The study of trauma has been perhaps the most fertile area within psychiatry and psychology in terms of promoting deeper understanding of how emotional, cognitive, social, and biological forces interact in human development. Trauma study has yielded entirely new insights into the way extreme experiences may profoundly affect our memory, how our bodies as well as our minds respond to stress, our ability to regulate our emotions, and our relationships to other people. Now, it promises to shed light on the fundamental question of how the mind integrates experience to prepare itself for future threats, even as it distinguishes between what belongs to the present and what belongs to the past. These discoveries, together with a range of new therapy approaches, are opening entirely new perspectives on how people who have been traumatized—whether by an individual in a private act of violence or by a disaster affecting an entire society—can be helped to overcome the tyranny of the past.

About the Author
Bessel A. van der Kolk, Clinical Consultant for The Meadows and Mellody House, is one of the world’s foremost authorities in the area of posttraumatic stress and related phenomena. His research work has ranged from the psychobiology of trauma to traumatic memory, and from the effectiveness of EMDR to the effects of trauma on human development. He is professor of psychiatry at Boston University School of Medicine and medical director of the Trauma Center in Boston, a Community Practice site of the National Child Traumatic Stress Network. The Trauma Center is one of the foremost training sites in the country for psychologists and psychiatrists specializing in the treatment of traumatized children and adults.

Preventing and Healing the Sacred Wound of Sexual Molestation
By Peter A. Levine & Maggie Kline

Unless you have personally experienced the deep wound of childhood sexual trauma, it may be difficult to imagine how complex, confusing, and varied the long-term effects can be. This is especially true when the molestation was perpetrated by someone the child trusted, or even loved. When a child’s   innocence is stolen, it affects his or her self-worth, personality development, socialization, achievement and, later, intimacy in adolescent and adult relationships. In addition, these children are prone to somatic symptoms – such as physical rigidity, awkwardness, or excessive weight gain/loss – born of a conscious or unconscious attempt to “lock out” others and not be in one’s own body. Also common are tendencies to live in a fantasy world, to have problems with attention (spacing out and daydreaming) and to dissociate in order to compartmentalize the awful experiences.

Sexual trauma varies widely, from overt sexual assault to covert desires that frighten and confuse a child by invading his or her delicate boundaries with unbounded adult sexual energies. When parents have experienced unresolved sexual violations themselves, or were lacked models for healthy adult sexuality in their families of origin, they may have difficulties protecting children without conveying a sense of fear and rigidity around issues of touch, affection, boundaries, and sensuality. Or conversely, parents might avoid offering either discussion or protection due to their own lack of experience in sensing, within themselves, the difference between potentially safe and dangerous situations and people.

Are Some Children More Vulnerable Than Others?

The majority of parents, communities, and school programs warn children to avoid “dangerous strangers.” Sadly, strangers are seldom the problem. Other myths persist as well, such as the beliefs that only girls are vulnerable and that most assaults happen at or after puberty. Although statistics vary, the numbers of preschoolers and school-age children reporting sexual assault are astonishing. Approximately 10 percent of sexual violations happen to children younger than 5 years old , more children between 8 and 12 report molestation than do teenagers, and 30 to 46 percent of all children are sexually violated in some way before they reach the age of 18.

Sexual trauma is pervasive – it prevails no matter one’s culture, socio-economic status, or religion. It is not uncommon even within the “perfect” family.

In other words, all children are vulnerable, and most sex offenders are “nice” people whom you already know! If you have been putting off talking with your children about sexual molestation until they are older, or because you are uncomfortable with the topic, we hope that what you learn here will bolster your confidence to begin these discussions sooner rather than later.

The Twin Dilemmas of Secrecy and Shame

The sexual molestation of children is further complicated by the added shroud of secrecy. Since 85 to 90 percent of sexual violations and inappropriate “boundary crossings” are committed by someone the victim knows and trusts, the symptoms are layered with the complexity of betrayal. Even if not admonished (or threatened) to keep the assault secret, children often do not tell due to embarrassment, shame, and guilt. In their naiveté, they mistakenly assume that they themselves are “bad.” They carry the shame that belongs to the molester.

In addition, children fear punishment and reprisal. They frequently anguish over “betraying” someone who is part of their family or social circle, and they fantasize about what might happen to the perpetrator. This is especially true if he or she is a family member on whom they depend. If not a family member, the violator is usually someone well-known. Neighbors, older children, babysitters, a parent’s boyfriend, and other friends of the family or step-family are frequently the offenders. Or it may be someone who has prestige and social
status or who serves as a mentor, such as a religious leader, teacher, or athletic coach. How can children know – unless you teach them – that they are not to blame when the perpetrator is not only someone
known, but someone revered?  Parents can pave the way to safety by teaching their children to trust and act on their own instincts, rather than submitting to an older child or adult who is using status for his or her own gratification.

What is Sexual Violation?

If sexual violation doesn’t typically involve a “dirty old man” using candy to lure a child into his car, what is it? Simply put, it is any instance of anyone taking advantage of a position of trust, age, or status to lead a child into a situation of real or perceived powerlessness around issues of sex and humiliation. In other words, when children must passively submit to the will of another, rather than having the choice to defend themselves or tell someone – whether or not they are “forced” – it constitutes sexual violation or assault.
This can range from being shown pornography by a teenage babysitter, to an insensitive medical examination of a child’s private parts, to being forced to have sexual intercourse with a parent or other adult. While actual rape by a parent or step-parent is less common, exposure to pornographic material or being asked to strip, look at, or handle exposed genitals, as well as rough handling during medical procedures, are far too common.

Steps Caregivers Can Take (and that adult survivors can learn) to Decrease Children’s Susceptibility

1. Model Healthy Boundaries: No one gets to touch, handle, or look at me in a way that feels uncomfortable.
2. Help Children Develop Good Sensory Awareness: Teach children to trust the felt sense of “uh-oh” they may feel as dread in the gut or rapid heartbeat, which lets them know something is wrong and they need to leave and get help.
3. Teach Children What Sexual Violation Is, Who Might Approach Them, and How to Avoid Being Lured: Teach children how to use their “sense detectors” as an early warning sign.
4. Offer Opportunities for Children to Practice their Right to Say “No.”
5. Teach Children What to Say and Do: Also, let them know that they should always tell you what has happened so that you can keep them safe and help them deal with their feelings.

In summary, let’s look further at boundary development:

Model Healthy Boundaries

There is a delightful children’s picture book by James Marshall about two hippopotami who are good friends. One’s name is George, the other Martha. They visit and play together and have dinner at each other’s houses. One day Martha is soaking in her bathtub and is shocked to see George peeking through the window, looking right at her! George was surprised at her outrage, and his feelings got hurt. He thought that this meant Martha didn’t like him anymore. Martha reassured George that she was very fond of him. She explained, in a kind manner, “Just because we are good friends, George, doesn’t mean that I don’t need privacy when I’m in the bathroom!” George understood.

This little George and Martha story models setting boundaries, communicating them clearly, and honoring the boundaries of others. Parents need to show good boundaries themselves, respect children’s need for privacy (especially between the ages of five to seven), and support them when they are in unappealing situations and are defenseless to help themselves.  This begins in infancy. The following illustration will help you understand how to offer this protection:

Little baby Arthur fussed and arched his back each time Auntie Jane tried to hold him. His
mother, not wanting to offend her sister, said, “Now, now, Arthur, it’s OK, this is your Auntie
Jane. She’s not going to hurt you!”

Ask yourself what message this sends to Arthur. He is already learning that his feelings aren’t important, and that adult needs take precedence over a dependent’s needs. Babies show us their feelings by vocal protests and body language. They are exquisitely attuned to the vocalizations and facial expressions of their parents. Their brain circuits are being formed by these very interactions that deal with respect for feelings and boundaries around touch.

For whatever reasons, Arthur did not feel safe or comfortable in Aunt Jane’s arms. Had his “right of refusal” been respected, he would have learned that his feelings do make a difference, that he does have choices, and that there are adults (in this case his mother) who will protect him from other adults whose touch he does not want. A few tactful words to Jane, such as, “Maybe later, Jane — Arthur’s not ready for you to hold him yet,” would leave an imprint impacting the baby’s newly developing sense of self. And if his mother’s appropriate protection continues, Arthur’s brain is more likely to forge pathways that promote self-protective responses that may safeguard him from an intrusion and assault later in his life. Although not in his conscious awareness, these unconscious body boundaries formed in the tender years of infancy will serve him well.

Trauma is a breach of energetic and personal boundaries. Sexual trauma, however, is a sacred wound – an intrusion into our deepest, most delicate and private parts. Children, therefore, need to be protected by honoring their rights to personal space, privacy, and control of their own bodies. As different situations develop at various ages and stages, children need to know that they do not have to subject themselves to “sloppy kisses,” lap sitting, and other forms of unwanted attention to please the adults in their lives.

Other Areas in Which Children Need Respect and the Protection of Boundaries

Children instinctively imitate their parents. Adults can capitalize on this favorable attribute when it comes to toileting behavior. A lot of power struggles and unpleasantness for toddlers and parents can be avoided altogether. By respecting your child’s timetable, you will encourage her to joyfully model mom’s behavior and toilet “train” herself. Take the “train” out of toileting, and your little boy will proudly do it like “Daddy does,” at his own pace.

Prevent unnecessary trauma in this major developmental area by following your child’s lead rather than by listening to the “experts” who believe in timetables. Forcing a child who is not ready to use the toilet disrespects his right to control his own bodily functions and sets a lifelong pattern of expecting to be dominated by someone else. By encouraging rather than pushing, you will be assisting your child to develop healthy self-regulatory habits and a natural curiosity about his or her own body. In some cases, you may even help to prevent eating disorders, digestive problems, constipation, and related difficulties. And, as a side effect, you’ll produce happy, spontaneous children.

Sharing the Disease
by Claudia Black, PhD, MSW

It has long been known by addiction professionals that, for every person addicted, approximately another four persons, usually immediate family members, are directly affected— husbands, wives, committed partners, mothers, fathers, siblings, and young and adult children.

Would the impact of addiction be reduced if four times the number of family members took part
in recovery programs? Would the impact be reduced if educational and treatment programs addressed the confusion, fear and pain suffered by families and children when the addicted person enters treatment? How might the lives of family members be altered if interventions were directed to them?

As the addict deserves his or her recovery, so do codependent family members. When family members recognize their codependency and its similarities to the addict’s addiction, they can recognize the mutuality of their recovery processes.

The following, excerpted from my recently published Family Strategies: Practical Tools for Professionals Treating Families Impacted by Addiction, helps therapists working with family members to link the addict’s behaviors with similar behaviors experienced by the family. This approach allows family members to realize they also have issues from which to recover.

The following provides examples of each disease symptom as experienced by the addict and by the family member (codependent).

In conclusion, it is important to continue to talk about disease-related behaviors such as lying, sneaking, etc. and the many feelings related to living with addiction. To understand the addict’s process and then consider the family’s similar experiences helps family members understand that they are in need of recovery as well. Family Strategies offers a wide variety of tools to assist families in their healing processes.

As family members share in the disease, they may now share in the recovery.

About the Author
Claudia Black, PhD, MSW, Clinical Consultant for The Meadows, is a lecturer, author and trainer internationally recognized for her pioneering and contemporary work with family systems and addictive disorders. She serves on the Advisory Board for the National Association of Children of Alcoholics, and has been a keynote speaker on Capitol Hill in Washington,DC. Claudia has been featured in numerous publications, appeared on many national television shows, and written several well-known books, including Changing Course, It Will Never Happen to Me, A Hole in the Sidewalk, Depression Strategies, Straight Talk, Relapse Toolkit, The Stamp Game: A Game of Feelings, and her latest book, Family Strategies.

The Therapeutic Genius of Pia Mellody

By John Bradshaw, MA

Pia Mellody joins the company of those who have created highly effective therapeutic models and who can put their theories into practice with unusual skill. Pia’s approach is phenomenological, resulting from her own painful struggle with codependency, as well as from thousands of hours spent interviewing and working out healing strategies with patients at The Meadows.

Pia began her unique journey as the head of nursing at The Meadows. In her early days, she suffered from low self-esteem, unhealthy shame, and a hyper-vigilance that accompanied her need to be perfect in every aspect of her work and life. She lived in that lonely place of non-intimacy, polarization and silent anger that most codependents experience.

Pia decided to get some help for her problems at another treatment facility, where she found the experience not only frustrating, but ineffective. Her problems did not seem to fit into any consistent category of the Diagnostic Manual. When she completed treatment, she continued to try to make sense of her raw pain and confusion, reaching out to others to try to get assistance in alleviating the distress. She was grappling with an inner distress exacerbated by a sense of defectiveness, the inability to engage in really good self-care, and living in reaction to other people. Thanks greatly to her, this condition is now called “codependence.” At that time, there was no coherent theory or therapy for the problem.

Early Roots of Codependency
Prior to Pia’s work, some relevant work had been done concerning the reality of codependence. Ludwig von Bertalanffy’s work titled General Systems Theory had filtered its way into several arenas of psychotherapy, notably Ronald Laing, Virginia Satir, and The Palo Alto Group (Gregory Bateson, Don Jackson, Paul Watzlawick and John Weakland).

In 1957 in Ipswich, England, John Howell concluded that the entire family itself was the problem, rather than just the symptom-bearing individuals. Dr. Murray Bowen developed “The Bowen System” of family therapy. He clearly posited the whole family as the problem, maintaining that the most distressed and under-functioning person in the family triggered the rest of the family into over-functioning behaviors. The more the family members over-functioned, the more the distressed person under-functioned. Thus, the more the family tried to change, the more it stayed the same. Bowen was convinced that the whole family was in need of therapy. Bowen did not use the word “codependency,” but he emphasized that, like a mobile, every member of a diseased family was dependent on his or her other family members.

Dr. Claudia Black, currently a Senior Fellow at The Meadows, wrote a now classic book called It Will Never Happen To Me. In it, she described the symptoms she carried as an adult that stemmed from living with an alcoholic father and a co-alcoholic mother. Dr. Black made it clear that her whole alcoholic family was diseased, and that each member was codependent on the alcoholic father.

Soon hands-on clinicians like Dr. Bob Akerman and Sharon Wegscheider Cruse (a protégée of Virginia Satir) were describing the symptoms of the adult children of alcoholic families as “codependent,” although no one knows who first used the term “codependency.”

I did a 10-part series on PBS in April 1985 that met with a huge public response. In it, I used a mobile to describe the family system, moving it energetically to show how the whole family is affected in dysfunction, and allowing the mobile a lightly moving homeostasis to show its functional state. I devoted two parts of this TV series to issues I called “codependency,” although my grasp of the concept was still vague and lacked a consistent theory of explanation.

Outside the recovery field, which deals with addictions of all kinds, was the work of Karen Horney and Theodore Millon. Horney’s Neurosis and Human Growth presented many descriptions of a dependent personality. Horney’s description touched upon many of the primary symptoms of codependency, which Pia Mellody later organized into a coherent theory. According to Horney, those lacking healthy adult autonomy and interconnectedness sought their fulfillment and a sense of self from other people. For these people, relating to other people became compulsive and took the form of blind dependency. Horney used the phrase “morbid dependency.”

In the International Encyclopedia of Psychiatry, Psychology and Neurology, John Masters wrote: “I think that mainline academic psychology has not done enough extensive work on dependency as it relates to codependency as an identifiable personality disorder. Codependency is now seen by many to constitute a painful problem for certain clusters in our society. We are on a primitive frontier with regard to understanding codependence.”

Psychiatrist Dr. Timmon Cermak, in Diagnosing and Treating Codependence, argued that codependency was on par with other personality disorders. “To be useful though,” wrote Cermak, “codependency needs to be unified and described with consistency. It needs a substantive framework and, until this is done, the psychological community will not recognize codependence as a disease.”

Enter Pia Mellody
It was at this point that a young nurse stepped onto the arena of modern psychology and made an extraordinary contribution.

One day, Pia Mellody walked around the corner of a building and had a moment of clarity. She thought of AA and how alcoholics start recovery by simply telling the stories of their troubled drinking. They share their experiences and strength in embracing their shame and their first glimmers of hope.

Pia realized that hundreds of people had passed through her office at The Meadows with stories very similar to her own. For one thing, a large majority had been abandoned, abused and neglected as children. Pia had long suspected that her own symptoms stemmed from her traumatic childhood and severely dysfunctional family system.

At this point, Pia began interviewing the many people who came to The Meadows with stories of abandonment, neglect, abuse of all kinds, and enmeshment with a parent, the parent’s marriage or the whole family system.

As Pia interviewed person after person, a unique and clear pattern emerged. All had five similar symptoms:

• They had little to no self-esteem, often manifested in the carried shame of their primary caregivers;
• They had severe boundary issues;
• They were unsure of their own reality;
• They were unable to identify their needs and wants;
• They had difficulty with moderation.

These symptoms together marked an extreme level of immaturity and a level of moral and spiritual emptiness or bankruptcy. Patients shared their sense of relief in just being able to identify and talk about the distress they were in.

With an interviewing approach fueled by her intuition, Pia Mellody had discovered what she called codependency.” She had come to understand the word “abuse” in a much broader context than clinicians had previously understood it. Pia also showed how codependents carry their abusive caretakers’ feelings. Our natural feelings can never hurt or overwhelm us; their purpose is to aid our wholeness. Our anger is our strength, a boundary that guards us. Our fear is our discernment, warning us of real danger. Our interest pushes us to expand and grow; our sadness helps us complete things (life is a profound farewell). Our shame lets us know the limits of our curiosity and pleasure; it becomes the core of modesty and humility. And our joy is the marker of fulfillment and celebration. “Carried” feelings lead to rage, panic, unboundaried curiosity, dire depression, shame as worthlessness or shamelessness, and joy as irresponsible childishness.

Pia later saw the five core symptoms as leading to secondary symptoms: negative control, resentment, impaired spirituality, addictions, mental or physical illness, and difficulty with intimacy.

Pia believed that alcohol and drug addiction, sex addiction, gambling addiction and eating disorders must be treated before the core underlying codependency can be treated.

Understanding that addiction is rooted in codependence is another contribution that Pia helped to clarify. Years ago, Dr. Tibot, an expert on alcoholism, saw that there was an emotional core to alcoholism that he called the “disease of the disease.” Pia’s work has certainly corroborated that intuitive insight.

Pia Mellody’s most important contribution may be how she and her groups of suffering codependents worked out strategies of healing. They did this through trial and error. The results were so striking that The Meadows encouraged Pia to develop a workshop titled “Permission to be Precious.” It was an instant success, and Pia began to take it to different cities around the U.S. Soon she wrote a book, Facing Codependence, with Andrea Wells Miller and J. Keith Miller. Later she developed a powerful approach to treating love addicts and their counterparts’ avoidant addictions. Her most recent book, The Intimacy Factor, is the only relationship book that treats the core “grief feeling work” around early abuse, neglect and abandonment. I believe that other self-help relationship books fail because they do not address these fundamental issues. “Feeling work” involves exposure, vulnerability and what Carl Jung called “legitimate suffering.” Pia has done her share of that and has the know-how to gently nurture others through this work.

Pia’s work has become the core model in treating addictions of all kinds and the core of codependence they rest upon. She has personally led hundreds, probably thousands, of people suffering from codependency into recovery and wholeness.

Pia answered Dr. Timmon Cermak’s challenge to do the work that established codependency as a treatment issue. She not only found a consistent way to conceptualize this source of suffering, but she found the know-how to address it.

The time has come for a broader recognition of Pia’s art and genius.

Inner-Child Work: Some Evolutionary and Neuroscientific Reflections

By John Bradshaw, MA

For the last 27 years, I’ve reflected on the power and efficacy of inner-child work. Recently I found two areas of knowledge quite interesting and enlightening: the evolutionary theory of neoteny and the neuroscientific study of the brain.

Neoteny

In 1988, I was presenting my inner-child workshop to a group of holistically oriented dentists. I arrived the day before I was to begin and discovered that one of my most revered mentors, Dr. Ashley Montagu, an anthropologist at Princeton, was giving the keynote address.

When I began my workshop the next day, Dr. Montagu, 84 years young, was in the audience. He participated in the entire two-day workshop, doing all the experiential exercises. At the end of the workshop, he gave me a manuscript copy of a book he had written that was to be published later that year. The book was called Growing Young. It presented an extremely complex argument for the theory of neoteny, an evolutionary theory that many biologists, ethnologists and anthropologists believe is a necessary complement to Darwin’s theory of evolution. Montagu told me that what he had experienced in the workshop mirrored what his book outlined as a major focus for psychotherapy.

Neoteny is defined in biology as “the retention of fetal or juvenile traits by the retardation of developmental processes.” The prolonged childhood of humans is unique among all life forms. Since humans are the apex of evolution, there must be some evolutionary reason for our prolonged childhood.

Montagu cites a number of renowned scientists who believe that Darwin’s theory of natural selection is not fully sufficient to account for human evolution. There is, they believe, another mechanism at work in evolution, first noted by Edwin Drinker Cope in 1870. Cope discovered what he called the law of acceleration and retardation.

While I’m not qualified to present the scientific argument for the theory of neoteny, I’ll tell you what excites me about it in terms of inner-child work.

Retardation of development allows us humans to avoid limiting our brain development to the specialized focus of survival.

The juvenile chimpanzee is quite humanlike compared to the adult chimpanzee. The adult’s head and jaws are elongated and no longer round. The elongation is due to the fact that chimps must focus all their attention on survival. The early need for specialization forces the ape’s brain into an elongated pattern. The vast number of neurons in the chimp’s brain are pruned to a relative few concerned only with survival.

For us humans, our prolonged childhood (from birth to 14 years) opens the door to many experiences that allow our brains to expand. This non-specialized use of our brain offers us enormous possibilities for creativity and freedom.

Montagu quotes from the Journal of Auroville, which recounts communication from a flying saucer. The alien says, “The trouble with earthlings is their early adulthood. As long as they are young, they are loveable, openhearted, tolerant, eager to learn and eager to cooperate with others. By the time of adulthood, most human adults are mortal enemies.” I’m not prone to believe this statement came from an alien. However, the human race says it wants peace more than anything, yet we keep having wars.

For Montagu and his biological colleagues, the goal of human maturity is not adulthood as we now conceive it, but adulthood as actualizing our childlike traits, such as openness, tolerance, docility, spontaneity, love for others and willingness to cooperate.

To sum up neoteny, Montagu asserts that “we are designed to grow in ways that emphasize rather than minimize childhood traits.” Montague asserts that the understanding of neoteny is urgent in terms of human survival. History teaches us “that only the races with the longest childhood were able to stay in the cultural mainstream.”

A century of clinical psychology and psychotherapy has helped us understand that we are by nature open, curious, tolerant, loving, playful and joyful. Life is not an ongoing warfare, as philosopher Thomas Hobbes and others have believed. All humans have a deep and persistent desire for wholeness and, when we are emotionally dis-eased, we deeply desire recovery. We intuitively know that being violent to ourselves and/or others and hating ourselves and/or others are not what our nature intended and will not bring us happiness.

Psychotherapy helps us clearly see that violence and hatred of ourselves and others are primarily reactions to childhood, trauma, abandonment, neglect and chronic abuse of one kind or another.

The inner child is a symbolic metaphor for the natural child’s preciousness, as well as the natural child’s adaptation to trauma, abuse, abandonment, neglect and enmeshment (the wounded child).

Inner-child work aims at helping us re-own the natural child within us (the precious child). In order to reconnect with the primal energy of our natural child, we need to grieve the wounds resulting from our abandonment, neglect and abuse. Once we’ve grieved our early losses, we can learn the things we needed to learn at each of our developmental dependency stages. These learnings create the self-esteem and the safe boundaries that we need in order to be open, tolerant, non-judgmental, spontaneous (rather than forever on guard), loving and cooperative. It seems clear that our neotenous nature demands that we do “inner-child” work when we have been traumatically abused, abandoned, neglected or enmeshed.

When I was actively addicted, I used my addiction to feel my childlike aliveness. Without my addiction, I felt dead. Addictions are abortive ways we choose in order to be restored to the natural childlike traits of our beginnings. Ultimately, addictions result in irresponsible childish behaviors. Healing the wounded inner child is necessitated by the theory of neoteny.

Recent Development in Neuroscience

Recently, Thomas Hedlund, the supervising clinician in more than 35 of my recent inner-child workshops, excitedly told me that he had just finished a workshop with Dr. Allan N. Schore, a clinical faculty member of the U.C.L.A. David Geften School of Medicine and an internationally recognized expert in the neuroscience of the brain. In the workshop, Dr. Schore had presented a complete neuroscientific explanation for the effectiveness of inner-child work in general and my inner-child workshops in particular.

Dr. Schore is one of the major pioneers of a paradigm shift in understanding psychopathogensis and therapeutic change. This paradigm shift that directly affects clinical practice focuses on the centrality of emotional processes and the role of the self in human function and dysfunction.

What Dr. Schore has made clear is that childhood abuse, abandonment, neglect and enmeshment damage a child’s need for healthy attachment, i.e. secure bonding. Attachment disorders damage the functionality of the right (or non-dominant hemisphere) of the brain.

With a “good enough” early attachment, a person can learn to handle stress without overreacting. Because they have been loved, touched and given appropriate space, they feel loveable and can be loveable to others. The empathic mutuality of “good enough” bonding is the foundation of a unified sense of self.

Dysfunctional Attachment and the Non-dominant Hemisphere

Dysfunctional attachment impacts the nondominant hemisphere in any or all of the following ways:

• Loss of ability to cope with stress
• Post Traumatic Stress Disorder (P.T.S.D.), which reflects a severe dysfunction of the right hemisphere system
• Since early trauma is usually cumulative and chronic, there is evidence that longterm autonomic reactivity can lead to “neuronal” structural changes, involving atrophy, shrinkage and permanent damage
• Since the right hemisphere has an adaptive capacity to regulate affect – the most significant consequence of the stressor of early relational trauma is the loss of the ability to regulate the intensity and duration of affect – (REACTIVITY)
• Loss of the capacity to assimilate new experiences – the personality cannot enlarge
• Tendency to disengage socially
• Dissociation and defensive projective identification.

I invite the reader to explore Dr. Schore’s work in his two volumes, Affect, Dysregulation and the Disorders of the Self and Affect, Regulation and the Repair of the Self. In my ”inner-child” workshop, I work on the first three childhood developmental stages. I place great emphasis on the attachment bond and our early  developmental dependency needs (the needs that can be met only by depending on another person). Codependency is the major outcome of attachment disorder because its primary symptomology is the result of a failure to get our developmental dependency needs met.

Most inner-child work is aimed at the nondominant hemisphere of the brain. I use a lot of imagery  meditations and age regressive techniques (so that a person can grieve his wounds at the age-appropriate stage at which his attachment rupture took place). I use music to stimulate the ”felt thought” intelligence of the right brain. I divide participants into groups of six or eight, and let the group members become non-shaming “benevolent witness.” They serve as mirroring faces who offer validating feedback, which legitimizes the pain of the person sharing a story or scene of shameful abuse. The group work helps the sharing person reduce his dissociation and own his prospective identifications. Being reconnected with his own feelings, a person can begin his grief process.

“Inner-child” work is thus conceived as grieving and redoing each developmental stage of early and middle childhood.

The new relationship that emerges is the relationship with one’s functional adult and inner child (the reconnection of the self with the self). The inner child is understood as a metaphor for our natural child of the past, whose feelings, needs and wants were bound in toxic shame.

Dr. Allan Schore expresses his conception of the paradigm shift in treating attachment disorder as follows: “The treatment of attachment pathologies is currently conceptualized to be directed toward the mobilization of fundamental modes of development and the completion of interrupted developmental processes.”

Happily, many of us have been using this model for quite some time.

I could write a lot more about the neuroscientific basis of inner-child work as a paradigm shift in understanding psychopatho-gensis and therapeutic change, but the limits of this short article do not allow it.

I hope this modest presentation has been stimulating for the reader. I invite those interested to read the work of Joseph Le Deux, Diane Foshe and Antonio Damasio, along with the work of Ashley Montague and Dr. Allan S. Schore.

About the Author
John Bradshaw, Fellow of The Meadows, has combined his exceptional skills as counselor, author, theologian and public speaker for the past four decades to become a world renowned figure in the fields of addictions, recovery, family systems and the concept of toxic shame. John has written three New York Times best-selling books: Homecoming: Reclaiming and Championing Your Inner Child; Creating Love; and Healing the Shame That Binds You.