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").
At the turn of the twenty-first century, genetic theories relying on simple one-to-one relations between a single gene and a psychiatric condition were supplanted by "diathesis-stress" models, which posited that genetic diatheses or "vulnerabilities" could interact with environmental stressors to produce deleterious outcomes. The most prominent study of this genre was published by Caspi et al. in 2002 and showed that the relation between childhood maltreatment and later-occurring antisocial behavior was much stronger for individuals who had the less efficient form of the MAOA gene (a gene that improves the function of nerve transmission in the brain). In other words, genetics alone didn't predict poor outcomes; it was the combination of a genetic predisposition and the stress of childhood maltreatment that led to an increase in antisocial behavior.
Although this particular gene-environment interaction has been replicated a number of times, some researchers have questioned whether the diathesis-stress model tells the whole story. In the last decade, researchers began noticing that when individuals with a genetic "vulnerability" experienced lower levels of environmental stress, they often fared better than those with individuals with the "favorable" form of the gene. For example, in the graph from the Caspi (2002) study (see above), under conditions of no childhood maltreatment, individuals with the "inefficient" form of the gene (red line) actually had lower levels of antisocial behavior than individuals with the "efficient" form of the gene (blue line). In the Caspi study, this difference wasn't statistically significant, but it raised questions about whether it could be a significant finding if studies were designed to see the phenomenon more clearly.
Jay Belsky, a professor of mine at the University of California at Davis, was one of the first to propose that particular genes (like MAOA) may confer risk or benefit, depending on the environment. Instead of thinking of certain genes as merely a liability, he argued that these genes might increase susceptibility to environmental conditions, "for better or for worse". Belsky and colleagues" theory of "Differential Susceptibility" is rooted in an evolutionary argument that, under circumstances where the future is uncertain, it makes sense to have some offspring that are less sensitive, and other offspring that are more sensitive, to environmental conditions. Like a well-diversified financial portfolio with some money in conservative, robust holdings and some money in high-risk stocks that can respond dramatically to market swings (too close to home for some of us), differential susceptibility posits that some people have a more "fixed" genetic makeup that is less vulnerable to environmental conditions, while others have a more plastic or malleable genetic makeup that is more susceptible to the environment, whether it be positive or negative.
Of course, this theory comes with the exciting possibility that reducing environmental stress (e.g., child maltreatment and relational trauma) may be particularly meaningful for individuals with genetic susceptibilities. In a study published in 2008, Bakermans-Kranenburg and her colleagues tested this hypothesis by investigating 157 families with toddlers who showed elevated levels of externalizing problems (e.g., hyperactivity, oppositional behavior, aggression, etc.) They found that their Positive Parenting and Sensitive Discipline intervention program was most effective in reducing externalizing behaviors in those children who had a version of the dopamine gene (DRD4) that has been linked to externalizing behavior and attention-deficit hyperactivity disorder. That is, children who would have traditionally been thought of as carrying a dopamine-related genetic "vulnerability" were in fact most responsive to the positive environmental changes associated with the parenting intervention program.
The results of this study, and many others like it, suggest that improving environmental conditions during childhood can drastically enhance developmental outcomes, especially for those children who are genetically susceptible to environmental influences. However, these findings might also apply to adults - especially considering recent research showing that the brain remains plastic or malleable well into adulthood. For adults with adverse life experiences who are recovering from conditions like depression, addiction, and post-traumatic stress, the genetic susceptibilities that previously contributed to their sensitivity to adverse environmental conditions may also facilitate their responsiveness to the positive changes associated with recovery treatment. In other words, by improving environmental conditions, what was once considered a vulnerability may actually become the very means for plasticity and growth.
As the Serenity Prayer suggests, it takes courage to improve our environmental conditions and there is much of our day-to-day circumstances that remains beyond our control. However, even when we cannot change our external environment, we can always alter our perspective of it. Approaching ourselves, our fellow beings, and the world with a greater measure of acceptance and compassion can literally change the subjective experience of our environment, and in many cases it can also lead to objective changes in the environment. This shift in perspective is bound to feed back into the biology of our being, perhaps most noticeably for those individuals who at one time may have been considered genetically vulnerable, but who might actually be predisposed to resiliency, especially if the right environmental conditions are established.
The Meadows is pleased to announce that Sean Walsh has joined The Meadows as Executive Director. An extensive search was conducted to find a leader that would honor the trauma and addiction treatment work that is done at The Meadows.
For the last 16 years Walsh has committed his work towards giving back and helping people heal, including positions as CEO and COO for two treatment programs. Prior to his executive leadership roles, Sean has worked in several clinical service and leadership positions, including launching two successful programs specifically designed to meet the unique needs of young adults. Walsh retains a post as an adjunct faculty member at Rio Salado College in Tempe, Arizona, teaching two different chemical dependency seminars on street drugs and adolescent substance abuse. His industry experience and passion for the field make him uniquely qualified to assume day-to-day leadership of The Meadows Wickenburg campus and improve The Meadows services to meet the growing demand from the young adult patient population.
"Sean is the right person for this position because of his experience, clinical expertise and personal passion to lead a quality organization that is committed to changing lives," said Jim Dredge, The Meadows CEO.
Dredge created the Executive Director position to allow him to focus time and attention to the growth plans for The Meadows organization. Dredge is excited to expand the continuum of services offered from The Meadows so that they can reach more people in need of the healing solutions offered from The Meadows Model. Dredge will continue to have an office on the Wickenburg campus and at the Phoenix business office. He and Walsh will work closely together during the transition period.
Walsh has long admired the reputation of excellence enjoyed by The Meadows and actively sought training at the workshops and events hosted by The Meadows in the Phoenix area. "I came to The Meadows because the reputation and work at The Meadows is world class and it is an honor to join this team of skilled practitioners," Walsh said.
The Meadows is an industry leader in treating trauma and addiction through its inpatient and workshop programs. To learn more about The Meadows' work with trauma and addiction contact an intake coordinator at (866) 856-1279 or visit www.themeadows.com.
For over 35 years, The Meadows has been a leading trauma and addiction treatment center. In that time, they have helped more than 20,000 patients in one of their three centers or in national workshops.The Meadows world-class team of Senior Fellows, Psychiatrists, Therapists and Counselors treat the symptoms of addiction and the underlying issues that cause lifelong patterns of self-destructive behavior.The Meadows is a Level 1 psychiatric hospital that is accredited by the Joint Commission.
The Meadows is pleased to sponsor a lecture by Dr. Peter Levine titled "In an Unspoken Voice: How the Body Releases Trauma and Restores Goodness," on March 30 from 9:30am to 4:00pm (Pacific Time) at the Westin San Francisco Airport.
With doctorates in both medical biophysics and psychology, Dr. Levine, a Senior Fellow at The Meadows, is the developer of Somatic Experiencing®, a naturalistic body-awareness approach to healing trauma. In his lecture, Dr. Levine will discuss that it is possible to live robustly with pleasure and creativity even when dealing with the most devastating experiences - and deceptively trivial ones.
Dr. Levine will address the nature of trauma, how it is a condition that can be healed from, as well as how the body is utilized to make that happen. During the lecture, Dr. Levine will describe how traumatic healing can be strengthened by learning to attend to the "unspoken voice of the body." The roots of addiction in unresolved trauma, insecure attachment and habitual childhood frustration will also be explored.
Friday, March 30 from 9:30am to 4:00pm (Pacific Time)
Westin San Francisco Airport
1 Old Bayshore Highway
Millbrae, California 94030
Registration available at http://www.regonline.com/builder/site/Default.aspx?EventID=1059970
The current news coverage regarding the alleged sexual abuse perpetrated by Sandusky can potentially be activating of old memories for many men and women. Most people react with disgust, rage, and shame due to their own abuse histories that involve being sexual violated. Some others may find themselves acting out or acting in without consciousness of the trigger for their behavior. Regardless of the outcome of the Sandusky case, there is help and more importantly hope for survivors of sexual abuse. It is imperative to process thoughts and emotions regarding the abuse. Vital is for the individual to recognize that they did nothing to cause the abuse. They are not to blame. An Insidious feature of sexual abuse is for the victim to internalize and carry the shame of the shamelessness of the perpetrator. Feelings of shame and guilt are pervasive. Feelings of anger and rage often are expressed directly and indirectly to others. A classic question most, if not all, survivors ask is "what did I do to cause this to happen?" Men, in particular, have a greater propensity to express their emotions with rage, covert / hidden depression, and if the perpetrator was male - homophobia. Hope for the survivor comes with processing the abuse and engaging trauma treatment modalities such as EMDR and Somatic Experiencing to gain some resolution of what happened to them. Surviving sexual abuse, particularly from childhood experience, allows the individual to establish sanity in their lives, intimacy with loved ones. It affords the individual the opportunity to embrace the joy that can be found in life. Message to the survivor: "you did nothing wrong", "you did nothing wrong". Stepping out and accessing help in the form of counseling, peer support, or inpatient treatment is the first step in the journey of healing. You are not alone. Secrecy binds the individual to the trauma. Secrecy allows the abuse to continue. We all have a legal, moral, and ethical obligation to ensure the safety of all children. Report, report, report.
Michael Cooter, MSSW, LCSW
Pain: Healing, Growth, and Awareness
Emotional pain often brings people into therapy and/or recovery. This may be the pain of depression, another relationship ending badly, or finally hitting rock bottom. Addiction, in a very real sense, is used to not feel pain. However, in the end, addiction creates more pain than it avoids. Entering therapy or recovery is often seen as a path towards no longer feeling this pain. However, true healing and recovery asks us to feel and accept our pain. It is through the experience of feeling our pain that we receive many of the gifts that support our healing and recovery.
Dave and his experience in healing and recovery is an example of how feeling pain is an important part of the healing journey. Dave sits in my office with tears sliding down his cheeks. We are exploring his childhood experiences and the reality of what growing up in his family was like. Through his quivering lips, he spits out "I've been working on this for so long. You start talking about my family and I'm back here in all this pain again. Why am I stuck?"
Feeling pain, especially pain connected to traumatic events from childhood, is often interpreted as "being stuck." After all, it is easy to believe that "if I was not stuck, I would not be feeling this pain." This is not the case! Pain is a normal and healthy human emotion. Pain is an emotion to be felt and understood. Pain is an emotion that helps to guide us in life. Pain is an emotion that has gifts to offer us: healing, growth, and awareness. Feeling pain does not mean we are stuck. Quite the contrary, it often means we are doing good healing work.
Dave originally came into my office struggling with addiction. He held tightly to his outward persona which he unconsciously used to hide his pain, shame, and core self from the rest of the world. On the surface, Dave's family of origin looked wonderful, nurturing, and loving. Dave believed that whatever struggles he had were surely about him and his own "defectiveness." He projected to the world the image of someone who had moved through life with seeming ease but about every 6 months or so, Dave would be overwhelmed by pain and spend hours crying to himself, unsure of where this pain was coming from. At the same time, his addiction was gaining momentum and the unmanageability of his life was becoming more apparent.
In therapy, we initially addressed Dave's addiction and helped him to create a support community. Then, we dug into Dave's history and the emotional pain that drives his addiction. Seeing his family and childhood experiences in the light of reality was not easy for Dave. Slowly, he started to see his parents as loving but wounded. He began to understand how their wounds impacted him and limited what they were able to offer to him. Dave started to see that he was not "defective" but wounded.
Dave initially dropped into his pain around his father. Over a number of tear-filled sessions, he explored, accepted, confronted, and started holding boundaries around his father's wounds. Dave had finally dropped into his pain and allowed it to guide him into his healing and growth related to his father. Issues related to his father still come up. At times, Dave feels accepting of his past and at others he feels anger. However, the awareness that Dave received by opening up to his pain and accepting the realty of his father set this process in motion and continues to solidify his recovery.
Dave still feels pain but it no longer seeps out every 6 months in overwhelming bursts. His pain, as opposed to signaling he is stuck, is a signal that he is healing. Dave's pain guided him to uncover and recognize the shame he had been carrying from his father. Feeling his pain and allowing it to guide him in his work has allowed Dave to be less reactive to his father as well as accept his father for who he truly is, a wounded man who loves Dave but is often unable or does not know how to show this. When pain comes up for Dave around his father, he is able to embrace whatever new understanding about his father and their relationship is being offered to him. He no longer stuffs his pain and acts out his addiction to avoid it; Dave now feels his pain, observes his reactions, and uses the tools he has learned in recovery to take care of himself.
Pia Mellody talks about the gifts we receive from all emotions, even the uncomfortable ones. Dave is experiencing and taking advantage of the gifts we receive from pain: healing, growth, and awareness. This process started for Dave when he started to FEEL his pain. Previously he had used his addiction to numb his pain, lived in a fantasy to pretend his pain did not exist, and stuffed his pain by putting on a "good face" to show the world. Now that he is in recovery, lives in reality, and allows himself to be known, he is healing, growing, and learning.
Pain guides us in our journey and helps us in our own self care. It gives us information about ourselves, our situation, and the people around us. Pain lets us know where our wounds are, when the wounds of others are being acted out on us, and helps us to slow down and truly understand the situation. When we stuff our pain or pretend it is not there, we unnecessarily handicap ourselves. Stuffing our pain is like walking around in a pitch black room with our arms at our sides. The chances of us walking face first into the wall greatly increase! With our arms out, we are better able to find the walls without hurting ourselves. Successfully finding the walls allows us to get an understanding of the room's dimensions or, in others words, the reality of the room. With our arms out, we can adjust to the situation. The same is true of our pain. As we feel our pain, we get an understanding of the reality of the situation and can adjust to it.
As we feel the wall, we stop walking to save our nose from a damaging encounter. Similarly, feeling our pain allows us to adjust our own interactions and self care. We may put up our boundaries. We may recognize the reality of another person and shift what we share and/or take in from them. We may leave the situation.
With our arms out, we naturally move more cautiously, keeping ourselves more balanced even though we haven't felt anything. As we open ourselves to pain, a similar experience happens. Even when we do not feel pain, we are more aware of how we take care of ourselves. Whether this is meditation, exercise, journaling, phone calls, meetings, therapy, or rigorous honesty, we keep our self care regiment in place more easily when we are open to feeling our pain. And when pain emerges to help us see more clearly ourselves or our situation, we can fall back on this self care regiment and add to it as necessary. There are many gifts we receive when we are willing to feel our pain.
As Dave sits in my office, feeling his pain, and wondering why he is stuck, I look at him with caring and love. With all the compassion I can offer I say, "You are not stuck. You are more open to your feelings, especially pain. And you are taking advantage of the healing, growth, and awareness that pain gives you. You have used all of this in exploring and learning about your relationship with your dad. But today we are exploring the more subtle wounds you have from your mother. You have opened yourself to this process before and you have developed tools to help you to do this type of work. I'll be here with you as your pain allows you to heal, grow, and understand your relationship with your mother. This pain is your guide - embrace it!"
Tim Stein is a Marriage and Family Therapist based in Santa Rosa, CA. His specialties include sex addiction and developmental trauma. Tim works with individuals, couples, families, and groups as well as providing presentations in the areas of sexual addiction, relationships, and developmental trauma.