By Thomas Best, MD, Director of The Meadows
The Meadows is offering a new program called the "Integrated Evaluation." This program combines our groundbreaking Survivors Week workshop with a state-of-the-art evaluative process.
In addition to attending the workshop, each client meets with a treatment team consisting of a psychiatrist, primary care physician, addiction medicine specialist, clinical psychologist, and nutritionist. The evaluation team works collaboratively to ensure that clients receive the most thorough, integrated, and comprehensive evaluation.
Offered at The Meadows for more than 20 years, the Survivors Week workshop examines the origins of adult dysfunctional behaviors by exploring early childhood issues; these can play important roles in various addictions, mood and anxiety disorders, painful relationships, and other emotional issues. In this revolutionary educational and experiential process, participants learn to identify and address family-of-origin issues that took place from birth to 17 years of age. The primary focus of the workshop is to learn to deal with the emotions that accompany any less-than-nurturing past event, and then to work on resolution of the consequential grief and anguish.
Each participant will meet with a member of our highly trained psychiatric staff who will provide a thorough psychiatric consultation. All of the psychiatrists at The Meadows are board-certified by The American Board of Psychiatry and Neurology, and all have received training in The Meadows' therapeutic model. They strive to view a person's mental health issues in a holistic context and consider all therapeutic options.
The in-depth medical evaluation includes a comprehensive history, physical examination, and thorough laboratory workup. A medical evaluation is extremely important when diagnosing and treating mental health concerns. Often there is a direct correlation between medical issues and psychiatric symptoms. When the underlying medical issue is diagnosed and treated appropriately, the troublesome psychiatric symptoms may remit without medication. A medical examination is also very important in the evaluation of alcoholism and drug addiction, as these disorders frequently lead to medical problems. Our board-certified primary care physician is also certified by the American Society of Addiction Medicine. Psychological testing is also valuable to the assessment process. The results are interpreted by The Meadows' Director of Psychology. Finally, a thorough nutritional evaluation addresses the nutritional needs of the client and any potential problems with food, such as an eating disorder.
At the conclusion of the week, the client meets with our professional staff to discuss the preliminary diagnostic findings and treatment options. A complete report is then sent to the client within two weeks.
For more information, please call 800-632-3697.
The Meadows Addiction Treatment Center is excited to announce its latest web project: DrugRehabFAQ.com.
The goal of the the new site is to clarify some of the basic questions relating to a patient's decision to enter a drug rehabilitation facility. In the future, the blog will also answer questions related to the experience itself, expectations and continuing care, which is a vital factor in long-term recovery success.
Some of those questions are:
How do I know if I need rehab?
How should I decide on a rehab facility?
Should my family be involved with my rehab treatment?
For the answers to these and other FAQs, visit DrugRehabFAQ.com.
Note: This article was originally published in the Summer 2004 edition of Cutting Edge, the online newsletter of The Meadows.
We Are All Neighbors
By Peter A. Levine, PhD.
What has happened to our world? Why this large-scale killing, maiming and torture as human populations increase in number and complexity - and as their access to Ethernet information grows each year, seemingly in inverse proportion to their compassion? Even when competing for their most basic resources - food and territory - animals typically do not kill members of their own species. Why do we?
While there are many theories of war, post-traumatic stress is one root cause not widely acknowledged, even though it is the single most important instigator of the perverse cruelty of modern warfare. Mankind's history of war, xenophobia and genocide has generated a legacy of trauma-induced dysfunction fundamentally no different from that experienced by individuals, except in its scale. There remains, however, an enormously important question: Can recovery from trauma be replicated on a larger, societal scale, with similar healing effects? At The Meadows, this has become our living promise.
Let us review what happens when a person is traumatized. First, his internal system remains aroused; he is always on edge, unable to relax or tune down. He is constantly aware of a pervading sense of danger, suspicious of everything and everyone. Not knowing why he feels threatened, this fear and reactivity escalate. This, in turn, amplifies the need to identify the source of the threat. Propelled by a tremendous terror and rage lurking just beneath the surface, he is unconsciously driven into re-enactments to help regulate the ongoing escalation of arousal.
Imagine now an entire population of people with a similar post-traumatic history. In fact, imagine two such populations located in the same geographical region, perhaps with different languages, religions and traditions. What will happen? Croatian civilians are sawed in half by Serbian soldiers. Atrocities are committed, in turn, by Croatian troops. Dozens of truces are called, and each time the result is the same: The urge to kill and destroy takes over, and insanity once again prevails. The Serbs and Croats have been repeating their violent patterns as virtual instant replays of World Wars I and II. Middle Eastern nations can readily trace their wars to Biblical times. Even when wars do not repeat with the kind of ferocity and brutality seen regularly around the globe, suffering in the form of societal dislocation, child abuse and other forms of hatred will. There is no avoiding the traumatic aftermath of war; it reaches into every segment of society.
Transforming Cultural Trauma
Trauma is an inherent part of the primitive biology that brought us here, biology which cannot be changed without completely redesigning us, down to our very cells. To release ourselves from reenacting our traumatic legacy, both individually and as a society, we must transform it. We can do so only by addressing the problem at its roots: in our physiology.
Several years ago, Dr. James Prescott, then at the National Institute of Mental Health, engaged in some important anthropological research on the effects of infant and child rearing practices on the prevalence (and absence) of violence in aboriginal societies. He found that the societies in which child rearing was characterized by close physical bonding and stimulation through rhythmical movement had low incidences of violence. Conversely, the societies with diminished or punitive physical contact with their children showed clear tendencies toward violence in the forms of war, rape and torture.
As we know from the studies of Dr. Prescott and others, the time around birth and infancy is a critical period. It is then that the infant associates the states of its parents with basic security and ability to regulate arousal. When parents are traumatized, they have difficulty imprinting their young with this sense of basic trust and resource. And without this sense of trust, children are more vulnerable to later trauma. One solution to breaking the cycle of cultural trauma is to involve infants and their mothers in an experience that generates trust and bonding before the child has completely assimilated the parents' anxious state.
In Scandinavia, I am involved in some exciting work inspired by my Norwegian colleagues. This project uses what we know about this critical period around infancy to allow not just one individual, but an entire group of people, to begin transforming the trauma of their past encounters. This method of bringing people together requires a room, a few simple musical instruments and some blankets strong enough to hold a baby's weight.
The process works as follows: A group of mothers and infants from opposing factions are brought together at a home or community center. The encounter begins with this heterogeneous group of mothers and infants taking turns teaching one another simple folk songs of their respective cultures. Holding their babies, the mothers dance while they sing the songs to their children. A facilitator uses simple instruments to enhance the rhythm in the songs. The movement, rhythm and use of voice in song strengthen the neurological patterns that produce peaceful alertness and receptivity. As a result, the stuckness and fixation produced by generations of strife begin to soften.
At first, the children are perplexed by the events, but they soon become interested and involved. They are enthusiastic about the rattles, drums and tambourines the facilitator passes to them. When not provided with rhythmic stimulation, children of this age do little more than try to fit such objects into their mouths. In this situation, however, the children join in generating the rhythm, with great delight, squealing and cooing.
Because these infants are not blank slates, but highly developed organisms even at birth, they send signals that activate their mothers' deepest senses of serenity, responsiveness and biological competence.
In this healthy exchange, the mothers and their young engage in an exchange of mutually gratifying physiological responses that, in turn, generate feelings of security and pleasure. It is here that the cycle of traumatic damage begins to unravel.
The transformation continues as the mothers place their babies on the floor and allow them to explore. Like luminous magnets, the babies gleefully move toward each other, overcoming barriers of shyness as the mothers quietly support their exploration from a circle around them. The joy and mutual connection generated by their small adventure is difficult to describe or imagine - it must be witnessed.
The group then continues, with smaller groups of a mother and infant from each culture working together. Two mothers swing their infants gently in a blanket. These babies aren't just happy; they are completely blissful. They generate a roomful of love so contagious that soon the mothers are smiling and bonding with members of a community they earlier feared and distrusted. The mothers leave with renewed hearts and spirits they are eager to share with others. The process is almost self-replicating.
Once a group of people has participated in the experience, the group can easily be trained to replicate it. The impact of this experience is so powerful that participants want to spread it throughout their communities, and many of them do so. The beauty of this approach to community healing lies in its simplicity and effectiveness. An outside facilitator begins the process by leading the first group.
The experience offers a gentle alternative to the destructive cycle of trauma, suffering and violence by allowing the biological imperative for natural bonding and love to assert itself. Resistance to stress and trauma, the development of basic trust, and the capacity for enduring personal and peaceful relationships are forged during a critical period of life.
Developing physiological and neurological patterns give us the instinct of the animal and the intelligence of the human being. Lacking either, we are doomed to act out our hostilities. With the two working together, we can advance on our evolutionary path, utilize all our human capacities and bring our children into a world that is safe.
Non-traumatized humans prefer to live in harmony. Yet traumatic residue creates beliefs that we are unable to surmount our hostility and that misunderstandings will always keep us apart. It is imperative that we make every effort to discover and teach treatment modalities like the Scandinavian model I described previously. We must be passionate in our search for effective avenues of resolution. Not just peace, but survival, depends on it.
Nature cannot be fooled. Evolution happens as a result of forces that threaten to destroy the species. Trauma is one such force.
Cutting Edge Editorial Board comments in response to this article:
The theory of childhood development and immaturity developed by Pia Mellody and its application to the patients at The Meadows is a most encouraging demonstration of how post-traumatic stress can be treated and individual destinies turned to the path of self-knowledge and relational peace. And while The Meadows applies its processes of analysis and recovery to individuals, at its center lies a template that we must apply on a broader societal scale.
Note: This article was originally published in the Spring 2007 edition of Cutting Edge, the online newsletter of The Meadows.
Understanding Sexual Recovery
By Maureen Canning, MA, LMFT
Sexuality is yoked with one's being - the body, mind and spirit. It is connected with one's identity, or essence. But as a culture, we have conditioned ourselves to experience and express our sexuality with a laser focus on physical gratification, the seeking of pleasure and release.
This is only a small part of what our sexual selves encompass. The totality of sexual expression is experienced through one's passion, creativity and life force energy. When we hear a moving piece of music; create art; connect with nature; lust after our favorite food, engrossed in its consumption; grow passionate about learning a new language or dance step, this is the expression of our sexuality.
This energy taps into the core of who we are. That's what makes sex addiction so powerful
and what sets it apart from other addictions. Our sexuality comes from the depths of our being, as does recovery. Examining and integrating healthy sexuality from this perspective becomes much more than just "mind-blowing sex." It becomes a spectrum of possibilities, a transformation of the whole self.
For several years, Anna has been working on her recovery from alcohol and sex addiction. Like most addicts, Anna had given up her most treasured hobby; it had been sidelined by the tumultuous life of her addiction. Anna had given up riding horses. Once an avid polo player, she had dropped out of the game and sold her animals. After several years of recovery, she was able to reconnect with her passion. Anna recently bought a new horse and is training several others. She rides almost every day.
"Maureen," Anna says in a somber tone, "I was riding my horse the other day, and I think I had a spiritual moment."
"What happened?" I ask.
"I had been rushing around yesterday morning, and, by the time I got to the stable, I was in a bad mood. When I got on my horse, she fought me, wouldn't do anything. She threw her head up and tried to buck me off. A friend watching me suggested that I stand up in the saddle and get myself centered, take a few breaths and feel her rhythm. I did what he suggested, let go of my stress and got in tune with her. When I sat down, she became calm. I rode in that ring and felt so connected to her. It was amazing."
What Anna is creating is connection, first with herself and then with life at large. She has come a long way in her recovery, and she is now reaping its rewards. Of course, it has taken time and a concentrated effort. For sex addicts, recovery can be a long and arduous but rewarding process.
Treatment planning for sexual addiction needs to realistically address the healing of one's personhood. In early treatment, the goals are focused and concrete: breaking through denial, surrendering to the addiction, acknowledging losses, making disclosures to loved ones, working the 12 Steps, getting a sponsor, going to meetings, etc. In this phase of treatment, the client is typically in crisis, emotionally overwhelmed, disoriented and experiencing withdrawal. Inpatient treatment is an intense process that can leave the client feeling inundated and emotionally fragile upon discharge. Patients often feel splintered, their ego state disoriented, their affect-management tenuous and their communication skills poor. The stress of re-entering life is, at best, a challenge and, more realistically, a trigger for relapse.
Extended-care treatment involves giving patients time to identify and integrate ego states, stabilize their emotions, grieve losses, begin trauma resolution, and implement treatment tools for relational development with self and others.
The profound shame that patients feel, and the slow but constant erosion of their personhoods, are the results of sexual addiction. The trauma and subsequent addiction result from a lifetime of ritualized behaviors and deeply embedded coping mechanisms. Patients run from their shame, using anger to act out and destroy any semblance of an authentic self. The recovery of the authentic self and the ability to live in one's truth must be extracted from the wreckage of the addiction.
About the Author
Maureen Canning, MA, LMFT, Clinical Director of Dakota and Clinical Consultant for Sexual Disorder Services at The Meadows, has extensive experience working with sexual disorders. She is a past board member of the Society for the Advancement of Sexual Health, as well as past president of the Arizona Council on Sexual Addiction.
Note: This article was originally published in the Summer 2004 edition of Cutting Edge, the online newsletter of The Meadows.
Denial is not a River in Egypt
By Robert Fulton, MA, LISAC, Administrator, The Meadows
One of the wittiest adages we hear in 12-Step recovery is “Denial is not a river in Egypt.” It is so witty, in fact, that many recovering people repeat it without asking themselves the absolutely important question, “If denial isn’t a river in Egypt, what is it?”
The answer seems too obvious for further inspection. Denial is about denying that I had a psychological problem. Most often, I denied that I was an alcoholic or an anorexic or that I was a sex addict. But now that I have admitted to myself and to another person that I am any one of those things, I am no longer in denial. I am back in control.
Sadly, intellectual admission often leaves the deeper denial in place – intact and poisonous. The alcoholic awakens every morning swearing not to have another drink and, by 5 p.m., heads to the bar. The anorexic, who has planned three healthy meals, looks at herself in the mirror, sees a fat woman, and decides not to eat. The sex addict at the SA 12-Step program shares the agony of his addiction and, after the meeting, hits on the attractive newcomer.
In recovery, behavior cannot be the driving force. Intellect and affect are the driving forces that determine my behavior. As an addict, I behaviorally shut off my affect and distort my intellect, so that I maintain the behavior that protects me from the awful confrontation with my childhood shame.
Denial of affect involves disassociating from those feelings that our primary caregivers taught us to regard as shameful. Our caregivers taught us to dishonor our feelings, because to honor them and to communicate was to be punished and to be shamed. We learned to separate self from the emotions generated by the truth of what we witnessed. In order to avoid the worth destroying poison of carried shame, we were forced to deny the feelings we had when we witnessed an emotional event in the family.
In order to medicate the pain of having abandoned our authentic self, we find ways to medicate the dissonance – we deny the truth of what we think; we submerge and camouflage the truth of what we feel. The self that emerges from the pain of denial becomes, in most adults, the only kind of “maturity” to which they have access.
We deny on an intellectual level, and we deny on an affective level. We deny intellectually by telling ourselves that two plus two is five. We were empowered to do that, or conditioned to do that, when we were growing up – and two plus two never added up to four in Mommy and Daddy’s household. Our father was a falling-down alcoholic. We said to Mommy, “Daddy’s drunk out on the lawn. He’s passed out. He looks like he’s dead. I’m scared.” And she said to us, “Don’t worry about it; he’s fine.”
The kid knows that the fear of his father’s drunken abandonment is real, but to have that truth, that reality, denied by his mother is to have his reality denied. The child then wonders what’s wrong with himself. Mind you, he doesn’t ask what’s wrong with his father or his mother. They are the ones acting shamefully, yet it is he who feels ashamed – he is carrying their shame. Because the kid’s real fear of the father’s death is being made illegitimate by the lies of the mother, the child himself is now experiencing a death of self – of his own emotional reality and his access to it. He is not allowed to feel the fear of losing his father.
This is the most damaging kind of shame-based denial, because it attacks the child’s very authenticity. He has learned that to have the terrifying emotions attendant upon Daddy’s drunkenness is not all right. Disassociation from self becomes habitual. Denial of self is honored in the dysfunctional family system.
When the child is older and he witnesses a shameful act, the kind of disassociation he experiences will be covered up with a more sophisticated form of social camouflage than when he was 5. For example, he may think that his father’s shameful drunkenness will disgrace the family in the eyes of the neighbors. The primary lie that Daddy is not drunk is justified by the need to remain socially acceptable. The young adult now needs a defense system that not only deflects his father’s shame, but protects his own social self as well. Such denial is often called loyalty and is praised as being politic. He is often told that his cover-up makes him a good citizen.
The child who has viewed his father’s shameful drunkenness may fear that his father will stop loving him should the father became aware that his son sees him as a failed father. In Michelangelo’s Sistine Chapel fresco The Drunkenness of Noah, Noah’s two sons come into the tent and see him drunk, and they experience intense shame. They identify with their father’s unexpressed shame at having abandoned his children and given up power in regard to his sons. The intended Biblical lesson is that to see someone in his nakedness is to obtain power over them. Rarely has the Bible been so psychologically deluded. It is not the children who have power over the parent; it is the shameless parent who holds power over the children through the mechanism of carried shame, setting off a career of adapted wounded-child codependence.
So denial, better than alcohol, is the best dysfunctional medication for shame. However, denial cannot salve one against that sense of hopelessness and despair that is engendered when one loses connection to self. It is then that we feel the need to buddy up to an addictive process that will give a false sense of power, that will eliminate the fear in a moment, that yields that one-up posturing of denial and grandiosity.
When dealing with these disconnects, one is driven back not only to the newborn-to-age 5 feelings of shame but to the adapted state of ages 5 to 17 as well. The early shame sets the stage for the acting out, through which each individual learns to dramatize brilliantly his dysfunctional avoidance of emotional truth. It is an artistic way of keeping from connecting to oneself and avoiding the agony of re-experiencing the death of our truth.
There is a Catch-22 in this artistic denial, no matter what relief it seems to give us. Even when we manage to get in touch with our honest feelings, if we do not have the tools to survive the encounter, we cycle right back into the wound of abandonment or of shame.
Feelings then seem to us a trigger to an unhealable vulnerability. They become something that we need to stay away from, which is why one of the first things a good clinician does (once a patient is reasonably stable) is to urge the patient to drop into his honest feelings, and to let him know that it is okay, that he is okay. He needs the security to feel that accessing his affect will not kill him.
This is actually what happens in the Survivors Workshop. People begin to express their affective authenticity, and they are not shamed – they are honored. And they begin to honor themselves. I often remember what I always said in group: that we have to learn to honor our feelings, which is to hold them – and ourselves – in high regard. Our feelings are our windows of insight into the depth of who we are. But all of that is for naught under the guise of affective denial when, in a defended posture, we compulsively seek to offset the initial wound of being defective, of being unworthy.
In reactivity to the carried shame of abusive childhoods, there are those who acquiesced and expressed their shame, pain, fear and anger in neurotic, seditious ways. Then there are those who rebelliously fought for some kind of voice, but who lacked the tools for connection. In either case, the trauma disconnects one from oneself.
The aim of treatment is to allow me to reconnect to me for the first time as the beneficent parent, the loving parent who needs to be nurtured for who and what I am. At the same time, I learn to present my authenticity and accept the vulnerability that my truth may meet within the world, even if the world shuns me. You may be sad, but you will have the joy and power and value of not disconnecting from the self. You do not rise above and go one-up; acceptance of one’s imperfect perfection is a soaring disengagement from that which is destructive.
People taking the first steps to deal with the trauma of carried shame will choose submission rather than surrender. This submission is often an intellectual admission that there is a problem. But unless the submission is also a surrender to the will, this apparent surrender of dignity will leave a bad taste; it will feel dissonant. It will be sensed as a false admission, one made to keep the depth of the real problem at a distance. The feeling of true surrender is internal peace. Only I will know. But I know I have surrendered when I feel that peace.
The concept of denial and surrender being in that same crucible is vitally important, because denial is a form of false security through control. If, by admitting we are addicted, we seek clarity for the sake of control, it is only to give ourselves the illusion of safety. We remain terrified of letting go of control, because if we let go of this charade, we are going to be left in the abysmal pit of carried shame. So our whole life has been to orchestrate this nonsense. We know it to be nonsense, but we don’t know anything other, so we medicate the nonsense.
In recovery, however, I am now invited to go to a place of powerlessness, and that is a miraculous paradox, because it is only there that I can be empowered. The first thing that has to happen is for you to acknowledge that change is impossible without help. When I surrender, I learn to trust another to give me that help, to help me get on the path to recovery. The recovering individual, once the path becomes a reality, takes the path and continues to go forward.
When somebody gets into recovery, and they begin to date again, it is like being back at 14 or 15, even though she is 40 or 50, because it is a whole new experience. There is the similar excitement and fear and passion – it is a whole new way of relating. It is not a state of authenticity and acceptance of self within memory. Because it is new, it is innocent. In recovery, we experience “innocence.”
And so the healthy lineage allows for the delight, the life, the joy, the possibility and the joy-pain – ever new, ever going forward. Healthy, functional shame, not the sickness of carried shame, is what fuels the joy and the richness, because it reminds me of my authentic self; it puts me back on the path, back on line. As you move in a new venture, it is all new and, therefore, a delight.
And you may find that you have overstepped and then feel ashamed of a behavior because it was all new, but it is now functional shame that allows you to become more intimate, to feel more deeply. I am imperfect, and I make mistakes. My mistakes may cause me pain, and they will. But they don’t make me bad. They only make me human. And that, I don’t have to deny.