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Posts from the ‘The Meadows Model’ Category

Feb 28

Recovering From Early Social Adversity: Valuable Lessons from Adopted Orphans

During my first meeting with Rebecca (as I will call her), I asked about her family history of mental and emotional difficulties, which can tell me something about her genetic susceptibilities, and about her early life experience with caregivers.  These two elements of the evaluation often provide critical information about the unique way in which nature and nurture contribute to human development (see my previous article on this topic).

When I asked Rebecca these questions, an unforgettable look flashed across her face that was part shame and part longing as she explained to me that she was adopted and had no “valuable information” to offer on these topics.  All she knew was that she had been adopted by an American family from a Romanian orphanage at the age of two.  In fact, to her surprise, this little bit of information proved to be extremely valuable as we tried to better understand how her challenges in adulthood were related to her early childhood experiences. Read more

Aug 6

Behind the Mask

Facing the Truth Behind the Mask

“Recovery is about living more in truth than in lies… it’s about facing reality and growing up.”

 –  Pia Mellody

 Over 2,500 years ago, in Athens Greece, playwrights like Sophocles introduced a form of theatrical art known as the tragedy.  Greek tragedies typically dealt with weighty themes such as betrayal, loss, pride, jealousy, rage, love, courage, honor, life and death.  Often these dance-dramas also explored man’s relationship with God and the existential challenges that are part the human condition.  Actors wore elaborate masks with exaggerated facial expressions so that their character’s role, emotional state, and intentions might be accessible to the audience.  Commonly, one actor played several characters during the course of the theatrical performance, changing masks for each character and sometimes for each scene.

Fast-forward to our lives today and the Greek tragedy might be used as a metaphor for some of the key aspects of recovery from trauma and addiction.  Like an actor in a play, often we are reacting to life’s existential challenges according to a script.  This script can influence how we move about on the stage of life; it can spell out our roles in relation to others, how we think and feel, and how we act in various situations.  From the first moments of conception and throughout development, by way of ongoing interactions between ourselves, others, and the environment, this narrative is written into our psychobiology – it becomes an implicit script in the mind-body system.

Moreover, similar to actors in Greek tragedies, our implicit scripts encourage the use of certain masks or personas.  In many ways, this is completely natural and necessary for a life in which we play many different roles.  For most of us, the scenes on life’s stage are constantly changing; we may transition from a family mask to a work mask, then to a friend mask, and back to a family mask, all within the course of one day.  However, unlike the actors in a Greek tragedy, for us these personas are not distinct, separate people – they are aspects of a single being, linked together by the person behind the masks.

For some of us, our own life resembles a Greek tragedy, with painful experiences of betrayal, loss, abandonment, and trauma.  These experiences are written into the mind-body script that tacitly flavors our thoughts, feelings, and behavior.  Some of these life events can be so traumatic that we don’t even want to look at the script – we would rather not face the reality of our situation, it’s just too painful.  Yet, our bodies and minds still play the part, even when we don’t pay attention to the script; something happens on the stage of life and we just react according to our past experiences, maybe without even being aware of the script. Read more

Apr 17

The Twists and Turns of Recovery Treatment – A Case History

In my third year of medical school, I was mentored by a brilliant surgeon who routinely pontificated about the virtues of his profession, with clear intent to dissuade me from entering psychiatry.  On one such occasion, he disrupted my tense and halting approach at a long abdominal incision with the question: “Do you know what makes a surgeon great?”  I looked up from the patient’s pale, still body – scalpel still poised.  “It’s not the suturing; you can teach any monkey how to sew.”  (That didn’t boost my fledgling surgical confidence.)  He went on to say, “When you open someone up, it rarely looks like the textbook.  It’s messy, unpredictable.  Great surgeons effectively respond to each new situation as it arises… they adapt.”

Although this gifted surgeon didn’t dissuade me from the practice of psychiatry, I was persuaded to believe that effective treatment of the body and the mind requires an ability to adapt to each new situation as it arises.  Most people enter The Meadows with some idea of their underlying problems and what they want to accomplish in treatment.  However, as people give themselves to the recovery process, often the mental and emotional landscape changes in unpredictable ways, presenting new challenges and new opportunities for healing and growth.  The following case history highlights the dynamic unfolding of one patient’s experience at The Meadows and some of the treatment modalities that were adaptively employed on the patient’s behalf. Read more

Jan 27

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Attachment Theory and the Developmental Consequences of Relational Trauma

As Humans, we are intensely social creatures.  Close relationships with other people are often the source of our greatest joy in life, but they can also be associated with tremendous pain and suffering.  Early relationships with caregivers, siblings, and extended family are not merely a static backdrop to a mechanistic unfolding of human development – these relational experiences have profound effects on biological and psychological processes, for better or for worse.  We now know that children come into the world with sophisticated neurobiological systems that are keenly attuned to the social environment and in turn these systems are shaped by the social milieu.  This means that the narrative of the early social experience is written into the biology of the developing child, or in other words, nurture actually becomes nature.

Unfortunately, overt forms of childhood abuse and neglect are all too common and can result in serious long-term physical and psychological consequences.  In fact, large research studies have shown that adverse childhood experiences can lead to serious health risks, including many forms of chronic illness and even shortened length of life.  However, it is increasingly recognized that covert forms of relational trauma and emotional abuse can also lead to deleterious outcomes, particularly in the area of social-emotional development.

While the term “relational trauma” often connotes overt forms of maltreatment such as physical and sexual abuse, it can also be used to describe covert forms of maltreatment such as abandonment, enmeshment, parent-child role reversal, verbal abuse, love-withdrawal, and many other forms of emotional abuse.  Relational trauma can be difficult for children, caregivers and outside observers to recognize, which means it can persist throughout much of childhood and even into adulthood.  For this reason, relational trauma can have insidious effects on development through persistent, maladaptive interaction patterns.  These social interaction patterns occur while the brain is developing and can therefore shape the way that individuals think and feel about themselves, others, and the world around them.

Attachment theory is a very useful framework for understanding how differences in the quality of close interpersonal relationships, particularly parent-child bonds and adult romantic bonds, influence health and well-being throughout the lifespan.  In the mid-nineteen hundreds, John Bowlby proposed that an attachment behavioral system evolved in humans (and other animals) because it improved the chances of offspring survival and successful reproduction by fostering proximity to caregivers, protection and safety, and sense of security for the developing child.  Bowlby argued that a secure attachment relationship between a parent and child doesn’t lead to dependency, which was the contention of his psychoanalytic colleagues at the time, but instead creates a secure base for the child.  In fact, he postulated that attachment security, and specifically a secure base, actually facilitates exploration and learning in childhood and ultimately leads to greater autonomy and social competence later in life. Read more