Blog | Dr. Jon Caldwell

Jul 24

Political Mindfulness: Casting a Vote While Maintaining Serenity

One of the most desirable fruits of the recovery process is a greater sense of serenity and peace. Yet, for those who are recovering from addiction and trauma, each day can bring challenges, both large and small, to one’s sense of serenity. Encountering opinions that are different from our own, especially when they bring our own values and beliefs into question, can certainly stir powerful emotions and threaten our serenity.

In the United States, we are nearing the end of a long political season, yet the grueling presidential election process is bound to bring even more opportunities for personal and interpersonal friction. Nevertheless, it is important that we remain involved in the political process and take part in civic duties. The question is do we let politics rob us of our serenity? And if our intention is to maintain serenity, how do we go about doing that?

Recently, I was faced with this very question when I received a politically charged email from an acquaintance. Fortunately, in that moment, I found just enough space and serenity to write my feelings down (instead of shooting off my mouth). My own political views and those of the email’s author are not important, no matter where we stand on the political spectrum we will face moments when our serenity is challenged. Here is my written response in the moment that my serenity was on the line:

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Jun 25

The Rings and Springs of Recovery: Facing Imperfection with Courage and Patience

Nearly four-hundred years ago, St. Francis de Sales wrote the following pearl of wisdom for those in recovery today: “Have patience with all things, but chiefly have patience with yourself. Do not lose courage in considering your own imperfections…” As the fog of trauma, addiction, and emotional challenges begins to lift, one thing becomes clear: our imperfections! Even when we muster the courage to consider these imperfections, it can be disheartening to realize that some of our imperfections are terribly persistent, requiring repeated doses of courage and “an ocean of patience” (another quote by St. Francis de Sales).

On the pathway of recovery, it can be hard to see our own progress – especially when we keep running into the same old character defects. It’s like courageously cutting a path through a dense thicket while hiking, only to reencounter the same thicket hours later, with the path already overgrown. In those discouraging moments, it can feel like the recovery path has circled back on itself, leaving us stuck on a ring, destined to repeatedly stumble on our imperfections. Our previously-mustered courage can get pushed aside by anger, frustration, resentment, doubt, and shame. As for that ocean of patience… forget about it – sometimes we are lucky to find a puddle of patience!

May 24

Finding Resiliency in Vulnerability: Shifting Perspectives on Genes and Environment

Clients frequently ask me if their mental and emotional struggles are a result of their genes or their environment. My answer is always the same – “yes”. Of course, my simplistic response refers to the interaction between genes and environment that characterizes nearly all mental health conditions, but it clearly belies the centuries of debate on this fundamental and contentious topic. In recent decades, the Cartesian dualism that has traditionally dominated the nature-nurture debate has given way to scientific theories that describe complex, bi-directional relations between genes and environment. These theories of human development have also furthered our understanding of “neural plasticity” – the exciting notion that our brains are more malleable and open to change than we once thought.

First, a brief historical regression may be helpful. In the early part of the twentieth century, psychoanalysis was the dominant perspective in psychology and its guardians were particularly keen on environmental influences. In fact, parents of the baby-boomer generation were likely told that schizophrenia was entirely caused by cold, unresponsive mothering (i.e., so-called “schizophrenigenic mothers”). Behaviorism, which rose to prominence in the early-to-middle part of the century, saw human development as a process of learning based on stimulus-response interactions between an organism and its environment. By the nineteen-sixties, the “cognitive-revolution”, with its emphasis on internal mental states and the promise of neuroscience advances, largely eclipsed these theories, but still had relatively little to say about the role of genetics.

In the second half of the twentieth century, geneticists began conducting large twin and adoption studies and found that a number of psychiatric conditions showed evidence of genetic heritability. For example, studies showed that schizophrenia occurs in 1% of the general population, but this increases to 6% if a parent is affected and 48% if an identical twin is affected. Findings such as these clearly showed that genetics play a role in many forms of mental illness. However, by the end of the twentieth century, the pendulum had swung too far in the direction of genetic influence, with some researchers claiming that single genes could be wholly responsible for complex phenomena like depression, violence and even suicide (e.g., one research group claimed to have found “the suicide gene”). Read more

May 8

Attachment, Emotion Regulation, and Resiliency

Often, during the first week of treatment at The Meadows, people will skeptically inquire, “Do experiences in childhood really continue to affect my life as an adult?” While social scientists and mental health clinicians have been exploring this question for decades, other fields of science and medicine have been slow to recognize the effects of childhood adversity on adult health and wellbeing. However, this trend may be changing, in part due to a very influential study by a group of researchers at the Centers for Disease Control and Prevention that are examining the long-term effects of adverse childhood experiences (ACE) on various health outcomes in over 17,000 members of a managed healthcare organization in California.

In general, the results of the ACE study¹ show that adverse childhood experiences (e.g., abuse, neglect, abandonment) are relatively common and are associated with higher rates of early initiation of tobacco use and sexual activity, adolescent pregnancy, multiple sexual partners and STD’s, intimate partner violence, alcoholism, illicit drug use, depression, and suicide attempts. Of course, this resonates completely with our clinical experience and treatment model at The Meadows. However, these investigators also found that adverse childhood experiences are related to elevated rates of liver disease, autoimmune disease, chronic obstructive pulmonary disease, ischemic heart disease, and lower levels of health-related quality of life.

These compelling data suggest that childhood maltreatment is associated with a variety of mental, emotional, social, and physical health problems in adulthood. In fact, results such as these have led some people to elevate childhood maltreatment to the level of a “public health threat”. Yet, as indicated by the conceptual model used in the ACE study (see Figure 1), there are considerable gaps in our scientific understanding of the mechanisms and mediating pathways connecting adverse childhood experiences to the host of deleterious outcomes mentioned above.

Attachment theory has proven to be a useful framework for understanding how early relational experiences influence developmental pathways and adult functioning (see earlier article on attachment). Over fifty years ago, John Bowlby (the “father” of attachment theory) studied adverse childhood experiences in delinquent and homeless children and found that a warm, continuous, and secure attachment relationship between caregiver and child was of critical importance, not only because this biologically-driven bond enhances survival and reproductive fitness, but also because it establishes the foundation for successful social-emotional development and resiliency throughout the lifespan.

Apr 24

Living in the Present – One Moment at a Time

Recovery programs are replete with catchy little quotes and sage-like sayings, but perhaps none of them are used more often than the time-honored phrase: “One day at a time.” Have you ever wondered why people struggling with addictive behaviors find it necessary to remind each other to take recovery one day at a time? (Some go as far as saying: “One moment at time.”) Wouldn’t it make more sense to actually use our highly evolved neocortex to construct a comprehensive, future-oriented plan for recovery and healing? After all, how can a person reach a desired destination or accomplish a goal without considering several days, weeks, or even years at a time?

As it turns out, people recovering from addiction aren’t the only ones who need to be reminded to take life one moment at a time. By in large, modern humans are addicted to “future-tripping” (one of those catchy little terms used in our recovery program). Most of us spend large swaths of our days, stuck in our thoughts, trying to plan, control, and manage our lives. The human brain naturally fixates on what is wrong, both in ourselves and others, and then ruminates and perseverates on how to avoid the unpleasant what-ifs that haven’t yet materialized. This unrelenting mental chatter is often coupled with a pervasive sense of discontent, as if we are waiting for something else to happen so that we can finally be fulfilled. We habitually lean into the future, hoping that the next moment will contain what this moment does not.

This is not to say that we should all get lobotomies and retreat to the nearest cave to live in solitary present-momentness. After all, critical thinking and future planning are important survival skills in this complex, fast-paced world. Our rational, thinking mind is not the enemy, but if left untrained, it can be a demanding taskmaster instead of a loyal servant. Through various contemplative practices, we discover that the brain is also capable of deep, non-conceptual awareness of the mind and body, other living creatures (including people), and the natural world around us. Many have found that this present-moment awareness can bring a profound sense of contentment and joy. 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

Mar 14

Attachment Theory in Action: Feeling Attachment Security in the Body

Several months ago, as I sat waiting to board a flight, my attention was captivated by an active toddler sitting (for the most part) on her mother’s lap. Beneath naturally curly locks of hair, her eyes, bright and curious, darted about the busy terminal, feasting on the smorgasbord of novel stimuli. When a scruffy-looking man passed by in a wheelchair and offered a gnarled hand to the young child, she fearfully buried her face in her mother’s loose-fitting sweater. The girl’s mother instinctively pulled her close and whispered softly in her ear while giving the grizzled man an apologetic smile. As the man pushed on, his course laugh still lingering in the air, the girl gingerly emerged from her safe, sweater-cocoon to survey the scene. Still within her mother’s secure embrace, the girl stood-up and ventured an inquisitive glance in the direction of the retreating man. Her fear had been down-regulated and she was able to explore the environment once again.

Interactions like this between a parent and child are repeated on a regular basis throughout early development. From the perspective of attachment theory, these dyadic experiences are the foundation for all social-emotional development. It is noteworthy that, from the earliest moments of life, attachment experiences are interactions between two minds and two bodies. As illustrated by the example above, the mother sensitively responded to the nonverbal intentions and emotions of the child by communicating safety and security through an embodied interaction with her child. In this way, attachment experiences, whether secure or insecure (as in the case of relational trauma and abuse), are incorporated into the body’s self-regulatory systems, and as a result, can play an important role in how the body reacts and responds in close relationships later in life.

This article is part of a series on attachment theory and relational trauma (see the first article for an overview) and is meant to illustrate how attachment theory can guide a therapeutic approach that incorporates working with emotions and the body. To ensure patient confidentiality and anonymity, the clinical example in this article is a fictional account based on many different patient histories and various treatment experiences. Although the following clinical information isn’t associated with one particular person, it is representative of many people who have experienced relational trauma. Read more

Feb 10

Allowing the Unbreakable to Bloom from Broken Trauma Defenses

Long before I was a psychiatrist, I worked at a golf course rummaging through thorny shrubbery and dense pockets of oak trees to find golf balls that had strayed from their masters. As an eight-year-old boy, this hardly seemed like work – it was more like a treasure hunting adventure, complete with the threat of poison ivy and villainous snakes. After a couple of cycles in the ball-cleaner, a relatively unscathed Titleist could fetch a dime, and a bucket of similar balls could finance an extravagant trip to the candy store.

Occasionally I would come across a ball that looked as though it had been mauled by a wild animal (or, more likely, a large lawnmower); the ball’s hard shell filleted open, allowing the mangled elastics to protrude through the untidy gash. Such a ball had no monetary value at the time – but these many years later, the image of the ruptured golf ball has become a meaningful metaphor in my work with individuals who have experienced trauma.

For humans, trauma can take a myriad of forms, yet the immediate response is surprisingly predictable. Like most animals, trauma in humans evokes an automatic and primitive instinct to survive. The traumatic stress response has little need for logic or reason, but instead relies on the unconscious reflexes of fight, flight and freeze. Therefore, out of necessity, the tender and vulnerable aspects of trauma are often swallowed up and pushed away. Survival is the goal. 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

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