Trauma is Caused by the Absence of Tribal Affiliation
In the mid 1980s physicians at Kaiser Permanente’s Department for Preventative Medicine in San Diego made a startling discovery: they found that members of their weight loss programme prematurely dropped out as soon as they started successfully losing weight. This counter-intuitive finding led the clinicians to speculate as to why their obese patients were seemingly unwilling to let go of their excess weight? Could overeating have been a coping behaviour for their obese patients? Could it be that these patients had put on excess weight as a protective mechanism in response to a traumatic childhood? If so, how could overeating and subsequent weight gain have ameliorated the effects of those childhood adversities? For example, could a child who had been sexually abused have learnt that excess weight made them less attractive to a sexual predator? Or did comfort eating self-medicate trauma symptoms due to the release of feel good neurotransmitters like dopamine and endorphins, which temporarily blotted out the effects of emotional abuse, stress, and abandonment? Was there indeed, a link between obesity and childhood trauma?
In the mid 1990s the Kaiser hospital group teamed up with the Center for Disease Control and designed the Adverse Childhood Experiences Study (also known as the ACE Study). The study intended to find a link, if any, between ten common types of childhood adversity and a number of adult health concerns including; overeating, nicotine use, alcohol use and the use of injectable drugs. The following things were outlined by the ACE study to be the most defining characteristics of an adverse childhood.
Respondents were asked a variety of questions pertinent to these criteria in order to determine the levels of abuse, neglect and household dysfunction they had been exposed to. The results were stark. This study (and further studies) found a high degree of correlation between adverse childhood experiences and poor behavioural health in adulthood (such as drug addiction, alcoholism, overeating and smoking). And this was not the only link. High rates of ACE also predicted a much higher prevalence of chronic and non-communicable diseases such as bronchitis and emphysema, than in those who were not exposed to such experiences. In fact, the study revealed an overall ‘dose-response’ relationship between ACE and addictive behaviours. This means that the more a person used illicit drugs, alcohol, nicotine or food to self-medicate, the higher the rate of adversity in childhood was likely to be.
For example, imagine that a hard-core intravenous heroin user who has hepatitis C and works in the sex trade, might have ten out of ten of these ACE’s. A cocaine addicted, heavy drinking lawyer with a history of convictions for driving under the influence but an otherwise functioning life, might have five. And a cannabis addled student failing in his grades — maybe two. This is an over-generalization of course, but you get the picture.
It is worth noting in passing that household dysfunction and adverse childhood experiences do not seem to be the sole preserve of the ghetto underclass, but are rather more evenly distributed across socio-economic groups than we might like to think. After all, the ACE study was researched using data from over 17,000 predominantly middle-class Americans of various ethnicities.
The criteria used to define abuse may also come as something of a surprise. Below are some of the questions that were used by the ACE study to determine emotional and physical abuse.
Answers of “sometimes,” “often,” or “very often” defined some level of emotional or physical abuse during childhood. Not exactly big traumatic stuff is it! “Par for the course for every child” I hear you say. “Surely worse traumas than these have existed for millennia?” And they have.
This developmental view of addiction is very compelling. The ACE model shows us that adverse childhood experiences are more common than we think, that they go unrecognized as a cause of physical and mental ill health by both the individual and wider society, and that they are still having pronounced effects on the victims’ decades later. It also shows us that many of the diseases that cause early death — both addiction itself, and the chronic diseases that arise out of it, such as lung cancer, heart disease, HIV and liver disease — most likely have significant roots in the childhood environment. In sum, there appears to be an undeniable link between childhood adversity and poor health outcomes in adults, particularly via the emotionally protective, but ultimately self-destructive behaviours that we think of as addictions (smoking, overeating, sexual impulsivity, and heavy drug and alcohol use).
On the other hand — we are quite possibly the least traumatized generation that has ever lived. There are no children in the western world (where addiction is most prevalent) who are currently being predated on by wolves or pythons. There are no bombs raining down on London today. So why are addiction rates so high? The answer, lies in what kind of trauma human beings are adapted to.
Humans are actually quite well adapted to trauma and adversity in general. We wouldn’t be here if we weren’t. But while humans are well adapted to the adversities we faced in the ancestral environment — like inter-group conflict and natural disasters — we are not so well adapted to facing them alone. To put it in other words — isolation is the worst adversity of all. Having ineffectual, discombobulated parents is the same thing as having to face the world alone, especially in a society where it is the nuclear family rather than the clan, that has become the pre-dominant protective unit. Humans beings can deal with floods, and they can deal with hurricanes. But they can’t cope with being cocooned in a closed social system with emotionally unwell people. Whilst in our past, tribesmen with batty parents must surely have existed, their progress was not impeded as it is now, because they were not marooned exclusively with those individuals within the emotional hothouse of the nuclear family or single parent family.
For this reason, whilst exposure to violence and other traumatic events does pose a risk factor for both PTSD and addiction, it is not necessarily predictive of psychopathology. It’s something else that’s doing the damage. PTSD, addiction, and other stress related conditions, arise most commonly from a breakdown in the platforms that used to provide us with the psychological support we needed to offset stress. This support was of course, the tribe, the extended family, the clan and the community. These social structures provided resilience to adversity and trauma of all kinds, and what’s more, they neutralized the disabling effects of being brought up by physically, mentally or emotionally under-par parents. Being well integrated into a wide social network with multiple surrogate parents, grandparents and siblings served as a ‘protective factor’ against overwhelming and inescapable stress.
This makes sense when we think about the fact that post-traumatic-stress is not caused by any lack of individual durability. PTSD (and even the symptoms of what we might call small ‘t’ traumas) do not happen to ‘weak people’. Some of our toughest infantrymen and special forces soldiers are currently struggling under the weight of the ongoing symptoms of traumatic stress. I know, because I’ve treated a number of them from both the US and UK armed forces with regard to their addictive behaviours and PTSD. The fact is, PTSD is caused by the unstoppable battering ram of horror, which drives roughshod over the toughest of human beings. Addictive behaviours are a form of self-medication for that unrelenting stress.
What we are starting to realize is that addiction and trauma are not caused so much by the presence of risk factors, as by the absence of protective factors. These protective factors are well described in the literature on trauma. Resilience to trauma comes by way of various psycho-social factors. It comes from having cognitive flexibility (the ability to see things positively); having a moral compass (the ability to discern a sense of meaning and purpose in life); and from having self-efficacy (the ability to problem solve and make the best out of a bad situation). Obviously children who have been socialized by highly anxious, personality-disordered, substance-abusing parents, are less likely to be imbued with these skills — and all the more so when access to other elders is limited by the breakdown of communities and the dispersal of the extended family unit.
Perhaps the most important protective factor of all in providing resilience to trauma (before, during and after the traumatic event) is the presence of a strong community with a strong social fabric. A strong community with a strong social fabric transcends the potential weaknesses of an individual nuclear family. It is held together by common values, beliefs systems, and best of all, by a driving need for mutual survival. This strong community, or ‘clan’ need not be ethnically or religiously homogeneous (although in our evolutionary past it certainly would have been).
In his book Tribe the journalist Sebastian Junger explains how military units are good examples (and perhaps the only modern examples) of this type of group. During war, they are bonded together by altruism and self-sacrifice. They place the groups welfare above their own. This type of loyalty to one another has a tonic effect. In fact, it is difficult to live in this type of sacrificial, altruistic zone and still remain depressed. In short, placing your own needs as secondary to the group is extremely good for your mental health.
By way of example, imagine asking our grandparents generation which were the most meaningful years of their lives. There is a fair chance they would have answered resoundingly, “the war.” In the midst of carpet bombs and death they found an almost steroidal sense of meaning. No-one was having an existential crisis. No-one asked “where is my life going?” There was no effete whining about “how unfair” life is. They were driven by the all-consuming need to survive — and to survive together.
Human beings can tolerate almost any amount of adversity if they are given the ‘how’ and the ‘why’ of it. If they are imbued with a sense of purpose and thereby understand the meaning behind their suffering. Humans can and do tolerate suffering and remain mentally healthy if they are placed solidly within the wall of human community. In such situations, adversity is a strengthening agent, not a disability.
The real problems come when this need to survive is removed. Ironically, our real problems come WHEN WE NO LONGER HAVE ANY REAL PROBLEMS. A sense of belonging is crucial for our mental health because we are highly social primates, and yet it seems we need a certain level of calamity to bring that cooperative tendency to the fore, at which point it overrides our other all-consuming tendency — which is to look after number one. This latter mind-set, contrary to popular belief, is a mental and emotional catastrophe.
In sum, we all have a need to bond and belong. Not just to our nuclear family but to the wider pack. Above all else, placing the group’s needs above our own appears to be extremely good for us. However, this is not something we automatically do unless the circumstances warrant it. This is why 12 step fellowships and other mutual aid groups which focus on ‘service’ to others are so effective. It is also why all-out war, somewhat amazingly, seems to have the counter-intuitive effect of lowering rates of depression, suicide and addiction. Perhaps the complete removal of traditional forms hardship and adversity are a double-edged sword.
So now just think about how many people you know in modern society who grew up with in a strong community with a strong social fabric, or with the types of adversity that are likely to bond them rather than isolate them, and then you will have a good idea of why addiction is more prevalent in the developed world than it is in the developing world, where despite widespread absolute poverty, there is still a large amount of emotional sustenance available due to relatively intact extended family structures, a strong national or tribal sense of identity, and a deeper connection with traditional culture.
So let us not ask not if the child is a product of a traumatic environment, but rather, let us enquire as to the cultural catastrophes that have caused it. Let us look to the social and emotional poverty of our fragmented societies. Because it is not adverse childhood experiences and trauma in and of themselves which have caused addiction — but our eviscerated communities. Post-traumatic stress is a symptom of what happens when people face adversity but are no longer supported by the tribe (including all its attendant belief systems and rituals). Addiction, by extension, is an understandable and yet tragically botched attempt to deal with that evolutionary anomaly.