The Meadows Blog

By: Jon G. Caldwell, D.O.

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.

In the last several decades, as geographic and political borders began to break down, the deplorable conditions of many orphanages around the world came to light, including those in Romania. In some cases this exposure led to policy changes, gradual improvements in orphanage conditions and a wave of adoptions by people from other countries. It also offered scientists a rare opportunity to study children who had experienced early deprivation and adversity and to follow these children as their environmental conditions changed after adoption.

Research of this kind has confirmed that early social experience plays a critically important role in human development. Indeed, we come into the world with a brain that has evolved to capitalize on the social environment, which under favorable conditions is full of rich opportunities for learning and completely embedded in a milieu of meaningful social relationships. Unfortunately, this doesn’t describe many orphanages around the world, where children are kept in cribs or cots for long periods with little access to toys or books and caregiver-to-child ratios can be as high as one caregiver for twenty children. This issue is terribly important because, for better or for worse, the early social environment appears to lay the foundation for cognitive, emotional and social development.

In fact, there appears to be sensitive periods early in life, during which time the brain has an overabundance of neurons that are just waiting to capture information from the outside world. During these sensitive periods, certain brain circuits are more easily shaped by environmental input and may also be more susceptible to environmental insult. After the sensitive period has ended, the brain actually “prunes” or cuts back those neural connections that aren’t necessary for success in the environment of upbringing.

However, as you might expect, children raised in deprived circumstances may not receive adequate brain stimulation during sensitive periods of development, and this is bound to negatively affect the neural pruning process as well. Fortunately, the brain’s mechanisms of neural pruning are balanced with its incredible capacity for “neural plasticity” – which is the brain’s ability to continually change in response to environmental demands. Thus, even when environmental conditions are suboptimal during a particular sensitive period, it doesn't mean that development can't or won't take place, but it can mean that development might proceed along a somewhat atypical trajectory, bringing with it some challenges for the child and the child's caregivers.

Early social experiences with caregivers and family members are important for the development of adaptive emotional and behavioral regulation (i.e., self-regulation). Children everywhere encounter stressful situations on a daily basis and typically they must rely on caregivers to help them resolve these situations and to aide them in regulating their nervous system so that the toxic effects of stress are ameliorated in a timely fashion. In typical rearing environments, children experience repeated cycles of nervous system activation and caregiver-facilitated deactivation and these cycles get written into the child’s neurobiology until it becomes a natural, self-regulatory response pattern for the developing child.

Individuals like Rebecca who were raised in adverse environments often do not receive the short- and long-term benefits that come with this kind of nervous system regulation and organization. Often, these children are forced into a sort of social hibernation where they must shut-down their natural impulses to seek closeness and security from caregivers. Some of these children will learn to sooth themselves, but these make-shift measures are by no means optimal and it is likely that many of these children do not experience the much-needed social-emotional brain development that comes through interacting with sensitive and responsive caregivers.

Despite these concerns, the research on Romanian orphans illustrates the power of neural plasticity and provides some degree of hope because many of these orphans show significant developmental gains in certain areas after they are adopted. The first area of development to show progress after adoption is often physical health; these children can rather quickly experience improvements in weight, height and fine and gross motor skills. In fact, many these children may not be physically different from their peers by the time they start school.

Somewhat surprisingly, these children often make gains in the cognitive domain too – they seem to catch up in terms of reading and writing, and general intelligence is often similar to their school-aged peers. Yet, a proportion of children who were in an orphanage have some lasting problems with attention, concentration, focus, distractibility, impulsivity, and poor organizational skills. It seems as though the neural circuits involved in “executive function” (i.e., attention, cognitive flexibility, planning, goal-directed behavior, etc.) are very sensitive to suboptimal rearing environments.

Of interest, the areas that seem to be most affected by early deprivation are the social and emotional domains. Children raised in orphanages frequently have challenges in terms of regulating their emotions, calming themselves, coping with difficulties, initiating and maintaining friendships, and negotiating close relationships. Because these children often make noticeable physical and cognitive gains after adoption, the lingering social-emotional issues can be confusing to the child and caregivers. Of course, these social-emotional issues can be compounded if the adoptive home environment is less-than-nurturing or if the child encounters any form of trauma later in childhood.

Even after leaving the orphanage, some of these children have difficulty learning to trust caregivers and to make their attachment needs known in adaptive ways. There can be a tendency on the part of these children to avoid showing vulnerable emotions and outward displays of affection and they may seem indifferent to, or afraid of, intimacy and closeness. On the other hand, some of these children may show signs of heightened separation anxiety, clingy and anxious behavior, and they might have strong fears of abandonment. Some children display signs of both of these extremes in their relationships with caregivers – the so-called “push-pull” pattern where they desperately want companionship but at the same time seem to fear closeness or fear that it won’t last. This sort of picture is sometimes referred to as “reactive attachment”.

That being said, it is important to stress that a warm and nurturing home environment will go a long way to buffering many of the social-emotional difficulties associated with early adversity. Over time, sensitive and responsive parenting practices, coupled with consistent and caring limit-setting, can gradually establish a sense of trust and security. Within the safety and security of the caregiver-child attachment relationship, the child’s nervous system can be re-organized in a way that supports greater self-regulation. This socially enriched environment can stimulate new brain pathways in the adopted child that will eventually underpin a greater capacity to regulate emotions and maintain close relationships.

Like Rebecca, some individuals who have experienced early social deprivation require additional support and treatment later in life. This may come as a result of ongoing issues from early childhood that were never quite resolved or previously resolved issues that resurface due to subsequent experiences of loss/death, abandonment, betrayal or traumatic experiences. While the resurfaced issues can usually be handled by traditional treatment methods, it can be very helpful if the treatment providers also have an understanding of how early social deprivation and trauma can influence social-emotional functioning late in life.

The Meadows treatment model is designed to specifically address the core developmental issues related to early childhood neglect and abuse. Treatment at The Meadow also helps individuals to understand how these core developmental issues are related to secondary symptoms, like shame, anger, low self-esteem, co-dependency, love addiction/avoidance, anxiety, depression and addictive behaviors of all kinds. Through various forms of expertly delivered treatment, individuals at The Meadows build on these insights by gaining actual experience in learning to esteem themselves from within and regulate their own nervous systems more effectively. Gradually, as individuals at The Meadows feel more comfortable with themselves, they are aided in forming safe and meaningful relationships with family members and significant others.

For many individuals who come to The Meadows, the experience of early social adversity starts to become a vital part of a broader life story that no longer carries with it the pain of the past, but instead offers the promise of a brighter future.

Jon G. Caldwell, D.O., is a board certified psychiatrist who specializes in the treatment of adults with relational trauma histories and addictive behaviors. Dr. Caldwell currently works full-time as a psychiatrist at The Meadows treatment center in Wickenburg, Arizona. For many years he has been teaching students, interns, residents, and professionals in medicine and mental health about how childhood adversity influences health and wellbeing. His theoretical perspective is heavily influenced by his PhD graduate work at the University of California at Davis where he has been researching how early childhood maltreatment and insecure attachment relationships affect cognitive, emotional, and social functioning later in life. Dr. Caldwell’s clinical approach has become increasingly flavored by the timeless teachings of the contemplative traditions and the practice of mindfulness meditation.

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By: Joyce Willis, MC, LPC

The Model of the Developmental Immaturity was developed by Pia Mellody. In the 1970s, Pia was working at The Meadows, a trauma and addiction Inpatient Treatment Facility. Pia found that she was encountering an increasing number of patients who identified less than nurturing, abusive family systems in their childhood - leading to adulthood behaviors of codependency. The codependency patterns translated into addictions, mood disorders and physical illness. Pia's continued work with patients led to the conclusion that people with codependence wind up in despair and actually die from the effects of codependence. Thus, the model was "born" to help patients understand the Family of Origin issues that brought them to the symptoms of their addictions, mood disorders and relationship struggles.

The Model of Developmental Immaturity
NATURE OF THE CHILDCORE ISSUESSECONDARY SYMPTOMSRELATIONAL PROBLEMS
Valuable Self-esteem Issues Control Relational
Esteem
Vulnerable Boundary Issues Resentment Enmeshment
Avoidance
Imperfect Reality Issues Spirituality Dishonesty
Dependent Dependency Issues Addiction
Depression
Interdependence
Spontaneous Moderation Intimacy Intensity

The Model of Developmental Immaturity is incorporated into every facet of treatment at The Meadows; from the week-long workshops to the intensive inpatient program.  At each level, patients receive education on The Model and learn how to identify the childhood roots of their adult behaviors. Therapists at The Meadows lead patients through understanding how their core issues, secondary symptoms and relational problems were set up in childhood, leading to codependence in adulthood. The biggest understanding that we want patients to leave treatment with is the belief in the Nature of the Child - which is the Nature of the Functional Adult; that we are inherently valuable and perfectly imperfect. We will further explore The Model in stages, beginning with understanding the primary symptoms of codependency and understanding The Nature of the Child.

The Model of Developmental Immaturity is a model that has to do with codependency. Codependency is defined as a disorder of immaturity caused by relational problems.  Understanding codependency is imperative to understanding The Model. There are five primary symptoms of codependency. These are:

1. We have trouble esteeming ourselves from the idea of inherent worth.
2. We have trouble protecting and nurturing ourselves.
3. We have trouble being real.
4. We have trouble attending to our needs and wants.
5. We have trouble living life with an attitude of moderation in all things.

The Model of Developmental Immaturity Issues is a model used at The Meadows to treat the effects of childhood trauma and issues of developmental immaturity. Childhood trauma and developmental immaturity can lead to addiction issues, mood disorders and physical issues.

To further understand the model, we will examine each column. The first column is the Nature of the Child. The Nature of the Child is the Precious Child Ego State.  Our precious child is the reality of who we are:

  • We are precious and valuable just as we are.
  • We are vulnerable and can expect protection.
  • We are human and make mistakes. We are perfectly imperfect.
  • We are dependent on others for our needs and wants.
  • We are spontaneous and open.


As children, we get relationally traumatized by enmeshment, neglect or abandonment in the “Nature of the Child” areas. Let's explore each of these terms:

  • Enmeshment is the inappropriate closeness of family members. In an enmeshed and overinvolved relationship, individuals get lost in the relationship. There is a lack of clear boundaries, thus each individual has difficulty having a clear sense of self. Examples of phrases that demonstrate enmeshment are, "You're my everything," "Without you, my life would not be worth living," or "You complete me."

  • Neglect happens when a child's basic dependency needs were not met. Dependency needs are our basic needs for food, clothing, shelter, safety and medical attention. Either the parent did not know how to meet these needs or the parent did not meet these needs well enough.  Neglect in childhood may lead to depression, anxiety, eating disorders, anger issues, or alcohol and drug abuse in adulthood.

  • Abandonment happens when the loss of one both parents occurs physically or emotionally. If the parent was not present in the child's life or the parent withheld affection or nurturing, the child was abandoned. Abandonment in childhood can result in adulthood difficulties with expressing and managing emotions, trust issues or a need to be in control.


Any behavior exacted upon us as children that was less than nurturing is defined as trauma in this model. Childhood trauma causes immaturity in the Core Issues (Column II of the model).

We will examine the Core Issues in Part II of "Breaking Down the Model."

Joyce Willis is a Licensed Professional Counselor and is currently a therapist at The Meadows. She earned her Bachelor of Education degree from the University of Akron. After teaching for several years, Joyce earned a Master's degree in counseling from the University of Phoenix. She has been in the counseling profession since 1996 and in that time has worked extensively in the addictions field. Her specialties include treatment for addictions, bereavement, trauma, depression and anxiety. Joyce has a special interest in mindfulness and helping people connect their emotional, spiritual, mindful and physiological selves with compassion and respect

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The Meadows Proudly Participates in UKESAD 2011 - London, England

What a tremendous experience we had in London! The Meadows Senior Staff spent the week of May 16th at the 8th Annual UK/EUROPEAN SYMPOSIUM ON ADDICTIVE DISORDERS - better known as the UKESAD 2011 Conference. The conference brought together some of the top minds in the world of addiction treatment and provided an opportunity to network and exchange national and international knowledge with more than 500 attendees.

On Friday, May 20, 2011 Meadows Senior Fellows; Pia Mellody, RN and Shelley Uram, MD co-presented the Plenary Session. The presentation titled "FACING CODEPENDENCE: WHAT IT IS, WHERE IT COMES FROM AND HOW IT SABOTAGES OUR LIVES" addressed the effects of childhood boundary violations on adult behaviors, including codependent adults lacking skills to mature or enjoy healthy relationships - personal or professional. Dr. Uram discussed the effects of Childhood Trauma on the Brain and further how those early traumas are stored to negatively affect our developmental maturity leading to co-dependent behaviors and addictions.

In addition to our Senior Fellows, our CEO, Jim Dredge, was on hand to meet and greet attendees throughout the conference. People lined up to a book signing by Pia Mellody of her best selling work. Dr. Shelley Uram hosted an Alumni Lecture titled: Understanding Trauma and the Brain, which attracted a standing only crowd! Another very popular event was The Meadows Raffle; to which a lucky winner - Alistar Richardson of London - received an I Pad Generation 2 with 32G.

There were some newsworthy issues addressed, including a review of the "Payment by Results" plan proposed by the British Government. This plan would overhaul the reimbursement to alcohol and drug programs by basing reimbursement on treatment effectiveness. This is an issue the U.S. is also debating right now so the U.K outcomes will be interesting to watch.

The experience we had at UKESAD was stimulating and thought provoking. We are already looking forward to next years’ conference.

Published in Blog

The Meadows is pleased to present its ongoing series of videos on addiction and trauma; the series features some of the most influential figures in the mental health field, including Maureen Canning, John Bradshaw, and Dr. Jerry Boriskin, among others.
In the second video of her series, Maureen Canning, MA, LMFT, clinical consultant and senior fellow at The Meadows, discusses the nature of sexual addiction and trauma in women.

"Sexual addiction, unlike other addictions, is based in shame," she explains. "Sex addicts have a sense of self that is very diminished. They feel worthless at the core of who they are. The feel as if they don't deserve love."

She goes on to explain that most sexual addictions are rooted in childhood trauma - and that trauma causes disruptions in psychosexual development.

"When the child grows up, they want to undo that original trauma, and so they start to act out," Ms. Canning says. "And when they act out, they re-create the original behavior."

In addition to her role as senior fellow at The Meadows, Ms. Canning is a clinical consultant at Dakota, an extended-care facility dedicated exclusively to the treatment of sexual addiction and trauma. Her extensive clinical experience includes individual, couples, and family counseling; workshops; lectures; educational trainings; and interventions. She is the author of Lust, Anger, Love: Understanding Sexual Addiction and The Road to Healthy Intimacy.

In other videos in the series, Ms. Canning discusses such topics as the nature of healthy sexuality, how sexual addiction can kill, and what partners of sex addicts need to know. View the entire series of The Meadows' videos at www.youtube.com/themeadowswickenburg. For more information about The Meadows' innovative treatment program for addictions and trauma, see www.themeadows.org or call The Meadows at 888-888-8888.

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Note: This article was originally published in the Summer 2005 issue of The Meadows‘ alumni magazine, MeadowLark.

Dissolving Fear and Nurturing Joy: the Personal Story of a Recovering Agoraphobic with Panic Disorder

By Charles Atkinson, MA, MSW, LCSW

Hello, my name is Charles Atkinson. I am a 55- year-old recovering agoraphobic with panic disorder. The term "agoraphobia" derives from the Greek language. The interpretation of "agora" is marketplace, and a "phobos" is defined as flight. Hence, agoraphobia literally means "flight from the marketplace." Further examination of the word agora reveals it was not only a place of intense commerce where goods were sold and bartered, but also the social hub of town for the exchange of exciting new ideas and concepts. Consequently, an agoraphobic could not venture into the marketplace for fear of overstimulation in unpredictable and chaotic surroundings. Therefore, at an unconscious level, the marketplace represented to the agoraphobic a mirror image of his childhood environment.

Today, the definition of agoraphobia has been refined to include an avoidance of a specific place or situation in which one feels trapped and may experience embarrassment. The terms "panic attack" and "anxiety attack" can be applied interchangeably. Panic attacks occur when the sympathetic nervous system goes into overdrive and generates a cognitive distortion of second-order fear, or "fear of fear." This emotion of fear is felt on both the conscious (physical) and unconscious (emotional) levels. The results are panic attacks that feel as if the sufferer is going to lose control, go crazy or die.

It is not fully understood if agoraphobia with panic disorder has its fundamental inception in biology or is a learned behavior. I believe this disorder has its roots in both theoretical paradigms. However, additional schools of thought can be applied.

Dr. Shelley Uram, a Harvard-trained psychiatrist at The Meadows, helps articulate a layperson's perspective of how the neuropsychiatry model of the mind and body adapts to stress and trauma. She explains that our amygdala is located in the limbic system of the brain. The limbic system is located in the midbrain, where our emotions originate. Constant stresses, such as childhood traumas, rattle and sensitize our amygdala, which is also referred to as the "smoke detector," a moniker indicative of its function. It does not gradually activate the sympathetic nervous system for the fight or flight response. It spontaneously stimulates the adrenal glands to flood the body with adrenaline. This results in a state of arousal for the body and mind. If the brain continually perceives the message of an external threat, whether real or imagined, it will create an internal state of perpetual hypervigilance and angst. It is analogous to revving your car's engine to the highest RPMs while in park.

Pia Mellody's longtime work in the area of trauma and addictions has resulted in a behavioral model called "Developmental Immaturity." This model addresses the problems of being relational and achieving intimacy. To gain a better understanding of Pia's model, imagine a tree.

The roots of the tree are the childhood traumas, including physical, sexual and emotional abuse. The trunk of the tree allows the core issues of immaturity to fester and impede personal growth. These core issues include problems with self-esteem, boundaries, reality, dependency and containment. The branch of the tree denotes the secondary symptoms of unmanageability. This is the stage when addictions, depression, fear and panic disorders appear. The leaves of the tree represent the final outcome of all of the dysfunctional stages and an inability to establish and maintain healthy intimate relationships.

My first panic attack occurred at age 27, six weeks after I was married. It as if I were losing control, going crazy and having an emotional breakdown. A visit to the emergency room ensued. The hospital medical staff said I was having an anxiety attack, gave me a tranquilizer and sent me home. Not only did I feel emotionally trapped and ill-equipped to engage in an intimate relationship, but the sense of overwhelming fear and impending doom was ever-present. I tentatively speculated that marriage was the problem. It was too incomprehensible to think that the problem was endogenous to me. So began my journey through life, filled with hidden shame, fear and depression spanning the next three decades.

After two years of visiting a myriad of psychotherapists and experimenting with numerous psychotropic drugs, I was still battling depression, fear and anxiety. Fortunately, at 29, I found a psychologist who diagnosed my condition as agoraphobia with panic disorder. He explained that my disorder stemmed not from my perception of marriage, but from the cognitive distortions and childhood trauma embedded in my psyche due to physical abuse. Recalling the physical abuse experience was so powerful that it felt as if my heart and soul were being suffocated. I could not address my childhood abuse issues.

However, as I developed more psychological ego strength and better coping skills, I gradually reflected back to my childhood. I was physically battered multiple times between the ages of 5 and 13. I tried unsuccessfully to stave off my father’s abuse with my feeble attempts to express anger. My retaliation was met with scorn, disdain and an escalation of violence. This violence would trigger my body to mobilize and prepare my internal milieu for the most primitive response: survival.

Today, my father would be labeled a "rage-aholic." His impulsivity and inability to contain his rage were equivalent to a ticking time bomb, ready to explode at any time, for no reason. Since I was the oldest male child in the family, I was the focal point of his outbursts. This dysfunctional
behavior perpetuated the male rite of passage in our family. The sins of the father were being passed to the next generation as an acceptable form of discipline.

After decades of therapy, I found that the model that helped me grasp and understand my problems most clearly was Pia Mellody's. Her approach illustrated that my father had an extreme failure in maintaining his boundaries, contributing to my feelings of being exceedingly vulnerable and without boundaries. His constant verbal and physical abuse was an edict to our family; he was the boss. If he was in the perennial position of one-up, we were always one-down. Being one-down all the time obviously had a negative impact on my self-esteem. Also, he emphatically and without question demanded obedience, putting himself in a position of omnipotence. This eventually distorted my reality, dislodging me from the spiritual path to my higher power. My father was continually on the verge of being out of control. His lack of control influenced my behavior, as I always tried to be in control and perfect.

As a survival technique, especially during the physical battering, I dissociated my emotions from my body. If I felt any feelings, I cognitively appraised them as anxious feelings. This psychological tactic of turning my anger at my father into anxiety within myself allowed me to function in a chaotic and unpredictable home.

Consequently, after decades of dissociating from my feelings, convoluting and twisting my emotions, I was unable to identify and appropriately express emotions. Therefore, every time I had a feeling, I assessed it as anxiety - and only anxiety. This increasing accumulation of stress and inappropriate processing of emotions provided a fertile environment for the onset of panic attacks. Pia Mellody would call this psychological process "carried feelings" or "carried shame." More pointedly, during my father's rage attacks, I felt shame, and he was shameless. As a vulnerable child, I symbolically swallowed all of his emotional frailties and inadequacies. The psychological process of feeling my shame, fear and anger, plus my father's feelings, was too overwhelming. A panic attack was the result of the carried fear and shame.

Healing the sins of the father is a Herculean effort. Many therapists employ traditional talk psychotherapies, which are extremely helpful. However, traditional talk therapies primarily engage the higher cortical portions of the brain. Some research indicates that childhood trauma seems to be locked in the more primitive limbic system. One of the most effective ways to access the limbic system of the brain is through modalities that stimulate the midbrain, or our seat of emotions. An example of this modality is guided imagery used to re-experience the childhood trauma as an adult. Pia Mellody uses this technique and others that bridge both portions of the brain, the frontal cortex (thinking) and the limbic system (feeling).

In closing, the abatement of the carried feelings is not the end; it is the beginning of one's spiritual path. Ironically, recovery is not only achieved with the dissolution of fear, but with the nurturing of joy.

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