Sanctuary for the Abused
Sunday, May 30, 2021
CHILDHOOD STRESS AND EMOTIONAL ABUSE ADD UP TO ILLNESS LATER IN LIFE
If you saw Laura walking down the New York City street where she lives today, you’d see a well-dressed 46-year-old woman with auburn hair and green eyes, who exudes a sense of ‘I matter here.’ She looks entirely in charge of her life, but behind Laura’s confident demeanour lies a history of trauma: a bipolar mother who vacillated between braiding her daughter’s hair and peppering her with insults, and a father who moved out-of-state with his wife-to-be when Laura was 15 years old.
She recalls a family trip to the Grand Canyon when she was 10. In a photo taken that day, Laura and her parents sit on a bench, sporting tourist whites. ‘Anyone looking at us would have assumed that we were a normal, loving family.’ But as they put on fake smiles for the camera, Laura’s mother suddenly pinched her daughter’s midriff and told her to stop ‘staring off into space’. A second pinch: ‘No wonder you’re turning into a butterball, you ate so much cheesecake last night you’re hanging over your shorts!’ If you look hard at Laura’s face in the photograph, you can see that she’s not squinting at the Arizona sun, but holding back tears.
After her father left the family, he sent cards and money, but called less and less. Meanwhile, her mother’s untreated bipolar disorder worsened. Sometimes, Laura says: ‘My mom would go on a vitriolic diatribe about my dad until spittle foamed on her chin. I’d stand there, trying not to hear her as she went on and on, my whole body shaking inside.’ Laura never invited friends over, for fear they’d find out her secret: her mom ‘wasn’t like other moms’.
Some 30 years later, Laura says: ‘In many ways, no matter where I go or what I do, I’m still in my mother’s house.’ Today, ‘If a car swerves into my lane, a grocery store clerk is rude, my husband and I argue, or my boss calls me in to talk over a problem, I feel something flip over inside. It’s like there’s a match standing inside too near a flame, and with the smallest breeze, it ignites.’
To see Laura, you’d never know that she is ‘always shaking a little, only invisibly, deep down in my cells’.
Her sense that something is wrong inside is mirrored by her physical health. During a routine exam, Laura’s doctor discovered that Laura was suffering from dilated cardiomyopathy and would require a cardioverter defibrillator to keep her heart pumping. The two-inch scar from her surgery only hints at the more severe scars she hides from her childhood.
For as long as John can remember, he says, his parents’ marriage was deeply troubled, as was his relationship with his father. ‘I consider myself to have been raised by my mom and her mom. I longed to feel a deeper connection with my dad, but it just wasn’t there. He couldn’t extend himself in that way.’ John’s poor relationship with his father was due, in large part, to his father’s reactivity and need for control. For instance, if John’s father said that the capital of New York was New York City, there was just no use telling him that it was Albany.
As John got older, it seemed wrong to him that his father ‘was constantly pointing out all the mistakes that my brother and I made, without acknowledging any of his own’. His father relentlessly criticised his mother, who was ‘kinder and more confident’. Aged 12, John began to interject himself into the fights between his parents. He remembers one Christmas Eve, when he found his father with his hands around his mother’s neck and had to separate them. ‘I was always trying to be the adult between them,’ John says.
John is now a boyish 40, with warm hazel eyes and a wide, affable grin. But beneath his easy, open demeanour, he struggles with an array of chronic illnesses. By the time he was 33, his blood pressure was shockingly high; he began to experience bouts of stabbing stomach pain and diarrhoea and often had blood in his stool; he struggled from headaches almost daily. By 34, he’d developed chronic fatigue, and was so wiped out that he sometimes struggled to make it through an entire workday.
John’s relationships, like his body, were never completely healthy. He ended a year‑long romance with a woman he deeply loved because he felt riddled with anxiety around her normal, ‘happy family’. He just didn’t know how to fit in. ‘She wanted to help,’ he says, ‘but instead of telling her how insecure I was around her, I told her I wasn’t in love with her.’ Bleeding from his inflamed intestines, exhausted by chronic fatigue, debilitated and distracted by pounding headaches, often struggling with work, and unable to feel comfortable in a relationship, John was stuck in a universe of pain and solitude, and he couldn’t get out.
Laura’s and John’s life stories illustrate the physical price we can pay, as adults, for trauma that took place 10, 20, even 30 years ago. New findings in neuroscience, psychology and immunology tell us that the adversity we face during childhood has farther-reaching consequences than we might ever have imagined. Today, in labs across the country, neuroscientists are peering into the once-inscrutable brain-body connection, and breaking down, on a biochemical level, exactly how the stress we experience during childhood and adolescence catches up with us when we are adults, altering our bodies, our cells, and even our DNA.
Emotional stress in adult life affects us on a physical level in quantifiable, life-altering ways. We all know that when we are stressed, chemicals and hormones can flush our body and increase levels of inflammation. That’s why stressful events in adult life are correlated with the likelihood of getting a cold or having a heart attack.
But when children or teens face adversity and especially unpredictable stressors, they are left with deeper, longer‑lasting scars. When the young brain is thrust into stressful situations over and over again without warning, and stress hormones are repeatedly ramped up, small chemical markers, known as methyl groups, adhere to specific genes that regulate the activity of stress‑hormone receptors in the brain. These epigenetic changes hamper the body’s ability to turn off the stress response. In ideal circumstances, a child learns to respond to stress, and recover from it, learning resilience. But kids who’ve faced chronic, unpredictable stress undergo biological changes that cause their inflammatory stress response to stay activated.
Joan Kaufman, director of the Child and Adolescent Research and Education (CARE) programme at the Yale School of Medicine, recently analysed DNA in the saliva of happy, healthy children, and of children who had been taken from abusive or neglectful parents. The children who’d experienced chronic childhood stress showed epigenetic changes in almost 3,000 sites on their DNA, and on all 23 chromosomes – altering how appropriately they would be able to respond to and rebound from future stressors.
'Kids who’ve had early adversity have a drip of fight-or-flight hormones turned on every day – it’s as if there is no off switch
Likewise, Seth Pollak, professor of psychology and director of the Child Emotion Research Laboratory at the University of Wisconsin at Madison, uncovered startling genetic changes in children with a history of adversity and trauma. Pollak identified damage to a gene responsible for calming the stress response. 'This particular gene wasn’t working properly; the kids’ bodies weren’t able to reign in their heightened stress response.,’
Imagine for a moment that your body receives its stress hormones and chemicals through an IV drip that’s turned on high when needed and, when the crisis passes, it’s switched off again. You might think of kids whose brains have undergone epigenetic changes because of early adversity as having an inflammation-promoting drip of fight-or-flight hormones turned on every day – it’s as if there is no off switch.
Experiencing stress in childhood changes your set point of wellbeing for decades to come. In people such as Laura and John, the endocrine and immune systems are churning out a damaging and inflammatory cocktail of stress neurochemicals in response to even small stressors – an unexpected bill, a disagreement with their spouse, a car that swerves in front of them on the highway, a creak on the staircase – for the rest of their lives. They might find themselves overreacting to, and less able to recover from, the inevitable stressors of life. They’re always responding. And all the while, they’re unwittingly marinating in inflammatory chemicals, which sets the stage for full-throttle disease down the road, in the form of autoimmune disease, heart disease, cancer, fibromyalgia, chronic fatigue, fibroid tumours, irritable bowel syndrome, ulcers, migraines and asthma.
Scientists first came to understand the relationship between early chronic stress and later adult disease through the work of a dedicated physician in San Diego and a determined epidemiologist from the Centers for Disease Control and Prevention (CDC) in Atlanta. Together, during the 1980s and ’90s – the years when Laura and John were growing up – these two researchers began a paradigm-shifting public-health investigation known as the Adverse Childhood Experiences (ACE) Study.
In 1985, Vincent J Felitti, chief of a revolutionary preventive care initiative at the Kaiser Permanente Medical Care programme in San Diego, noticed a startling pattern in adult patients at an obesity clinic. A significant number were, with the support of Felitti and his nurses, successfully losing hundreds of pounds a year, a remarkable feat, only to withdraw from the programme despite weight-loss success. Felitti, determined to get to the bottom of the attrition rate, conducted face-to-face interviews with 286 patients. It turned out there was a common denominator. Many confided that they had suffered some sort of trauma, often sexual abuse, in their childhoods. To these patients, eating was a solution, not a problem: it soothed the anxiety and depression they had harboured for decades; their weight served as a shield against undesired attention, and they didn’t want to let it go.
Felitti’s interviews gave him a new way of looking at human health and well-being that other physicians just weren’t seeing. He presented his findings at a national obesity conference, arguing that ‘our intractable public health problems’ had root causes hidden ‘by shame, by secrecy, and by social taboos against exploring certain areas of life experience’. Felitti’s peers were quick to blast him. One even stood up in the audience and accused Felitti of offering ‘excuses’ for patients’ ‘failed lives’. Felitti, however, remained unfazed; he felt sure that he had stumbled upon a piece of information that would hold enormous import for the field of medicine.
After a colleague who attended that same conference suggested that he design a study with thousands of patients who suffered from a wide variety of diseases, not just obesity, Felitti joined forces with Robert Anda, a medical epidemiologist at the CDC who had, at the time, been researching the relationship between coronary heart disease and depression. Felitti and Anda took advantage of Kaiser Permanente’s vast patient cohort to set up a national epidemiology laboratory. Of the 26,000 patients they invited to take part in their study, more than 17,000 agreed
Anda and Felitti surveyed these 17,000 individuals on about 10 types of adversity, or adverse childhood experiences (ACEs), probing into patients’ childhood and adolescent histories. Questions included: ‘Was a biological parent ever lost to you through divorce, abandonment or other reason?’; ‘Did a parent or other adult in the household often swear at you, insult you, put you down or humiliate you?’; and ‘Was a household member depressed or mentally ill?’ Other questions looked at types of family dysfunction that included growing up with a parent who was an alcoholic or addicted to other substances; being physically or emotionally neglected; being sexually or physically abused; witnessing domestic violence; having a family member who was sent to prison; feeling that there was no one to provide protection; and feeling that one’s family didn’t look out for each other. For each category to which a patient responded ‘yes’, one point would be added to her ACE score, so an ACE score of 2 would indicate that she had suffered two adverse childhood experiences.
To be clear, the patients Felitti and Anda surveyed were not troubled or disadvantaged; the average patient was 57, and three-quarters had attended college. These were ‘successful’ men and women, mostly white, middle-class, with stable jobs and health benefits. Felitti and Anda expected their number of ‘yes’ answers to be fairly low.
The correlation between having a difficult childhood and facing illness as an adult offered a whole new lens through which we could view human health and disease
When the results came in, Felitti and Anda were shocked: 64 per cent of participants answered ‘yes’ to having encountered at least one category of early adversity, and 87 per cent of those patients also had additional adverse childhood experiences; 40 per cent had suffered two or more ACEs; 12.5 per cent had an ACE score greater than or equal to 4.
Felitti and Anda wanted to find out whether there was a correlation between the number of adverse childhood experiences an individual had faced, and the number and severity of illnesses and disorders she developed as an adult. The correlation proved so powerful that Anda was not only ‘stunned’, but deeply moved.
‘I wept,’ he says. ‘I saw how much people had suffered, and I wept.’
Felitti, too, was deeply affected. ‘Our findings exceeded anything we had conceived. The correlation between having a difficult childhood and facing illness as an adult offered a whole new lens through which we could view human health and disease.’
Here, says Felitti, ‘was the missing piece as to what was causing so much of our unspoken suffering as human beings’.
The number of adverse childhood experiences a patient had suffered could by and large predict the amount of medical care she would require in adulthood: the higher the ACE score, the higher the number of doctor’s appointments she’d had in the past year, and the more unexplained physical symptoms she’d reported.
People with an ACE score of 4 were twice as likely to be diagnosed with cancer than people who hadn’t faced any form of childhood adversity. For each point an individual had, her chance of being hospitalised with an autoimmune disease in adulthood rose 20 per cent. Someone with an ACE score of 4 was 460 per cent more likely to face depression than someone with a score of 0.
An ACE score of 6 or higher shortened an individual’s lifespan by almost 20 years.
Researchers wondered if those who encountered childhood adversity were also more likely to smoke, drink and overeat as a sort of coping strategy, and while that was sometimes the case, unhealthy habits didn’t wholly account for the correlation Felitti and Anda saw between adverse childhood experiences and later illness. For instance, those with ACE scores greater than or equal to 7 who didn’t drink or smoke, weren’t overweight or diabetic, and didn’t have high cholesterol still had a 360 per cent higher risk of heart disease than those with ACE scores of 0.
‘Time,’ says Felitti, ‘does not heal all wounds. One does not “just get over” something – not even 50 years later.’ Instead, he says: ‘Time conceals. And human beings convert traumatic emotional experiences in childhood into organic disease later in life.’
Often, these illnesses can be chronic and lifelong. Autoimmune disease. Heart disease. Chronic bowel disorders. Migraines. Persistent depression. Even today, doctors puzzle over these very conditions: why are they so prevalent; why are some patients more prone to them than others; and why are they so difficult to treat?
The more research that’s done, the more granular details emerge about the profound link between adverse experiences and adult disease. Scientists at Duke University in North Carolina, the University of California, San Francisco, and Brown University in Rhode Island have shown that childhood adversity damages us on a cellular level in ways that prematurely age our cells and affect our longevity. Adults who faced early life stress show greater erosion in what are known as telomeres – protective caps that sit on the ends of DNA strands to keep the DNA healthy and intact. As telomeres erode, we’re more likely to develop disease, and we age faster; as our telomeres age and expire, our cells expire and so, eventually, do we.
Researchers have also seen a correlation between specific types of adverse childhood experiences and a range of diseases. For instance, children whose parents die, or who face emotional or physical abuse, or experience childhood neglect, or witness marital discord between their parents are more likely to develop cardiovascular disease, lung disease, diabetes, headaches, multiple sclerosis and lupus as adults. Facing difficult circumstances in childhood increases six-fold your chances of having myalgic encephalomyelitis (chronic fatigue immune dysfunction syndrome or CFIDS) as an adult. Kids who lose a parent have triple the risk of depression in their lifetimes. Children whose parents divorce are twice as likely to suffer a stroke later down the line.
Laura and John’s stories illustrate that the past can tick away inside us for decades like a silent time bomb, until it sets off a cellular message that lets us know the body does not forget its history.
Something that happened to you when you were five or 15 can land you in the hospital 30 years later
John’s ACE score would be a 3: a parent often put him down; he witnessed his mother being harmed; and, clearly, his father suffered from an undiagnosed behaviour health disorder, perhaps narcissism or depression, or both.
Laura had an ACE score of 4.
Laura and John are hardly alone. Two-thirds of American adults are carrying wounds from childhood quietly into adulthood, with little or no idea of the extent to which these wounds affect their daily health and wellbeing. Something that happened to you when you were five or 15 can land you in the hospital 30 years later, whether that something was headline news, or happened quietly, without anyone else knowing it, in the living room of your childhood home.
The adversity a child faces doesn’t have to be severe abuse in order to create deep biophysical changes that can lead to chronic health conditions in adulthood.
‘Our findings showed that the 10 different types of adversity we examined were almost equal in their damage,’ says Felitti. He and Anda found that no single ACE significantly trumped another. This was true even though some types, such as being sexually abused, are far worse in that society regards them as particularly shameful, and others, such as physical abuse, are more overt in their violence.
This makes sense if you think about how the stress response functions on an optimal level. You meet a bear in the woods, and your body floods with adrenaline and cortisol so that you can quickly decide whether to run in the opposite direction or stay and try to frighten the bear. After you deal with the crisis, you recover, your stress hormones abate, and you go home with a great story. For Laura and John, though, that feeling that the bear is still out there, somewhere, circling in the woods, stalking, and might strike again any day, anytime – that feeling never disappears.
There are a lot of bears out there. Chronic parental discord; enduring low-dose humiliation or blame and shame; chronic teasing; the quiet divorce between two secretly seething parents; a parent’s premature exit from a child’s life; the emotional scars of growing up with a hypercritical, unsteady, narcissistic, bipolar, alcoholic, addicted or depressed parent; physical or emotional abuse or neglect: these happen in all too many families. Although the details of individual adverse experiences differ from one home to another and from one neighbourhood to another, they are all precursors to the same organic chemical changes deep in the gray matter of the developing brain.
Every few decades, a groundbreaking psychosocial ‘theory of everything’ helps us to develop a new understanding of why we are the way we are – and how we got that way. In the early 20th century, the psychoanalyst Sigmund Freud transformed the landscape of psychology when he argued that the unconscious rules much of our waking life and dreams. Jungian theory taught, among other ideas, that we tend toward introversion or extroversion, which led the American educationalist Katharine Cook Briggs and her daughter Isabel Briggs Myers to develop a personality indicator. More recently, neuroscientists discovered that age ‘zero to three’ was a critical synaptic window for brain development, giving birth to Head Start and other preschool programmes. The correlation between childhood trauma, brain architecture and adult wellbeing is the newest, and perhaps our most important, psychobiological theory of everything.
Today’s research on adverse childhood experiences revolutionises how we see ourselves, our understanding of how we came to be the way we are, why we love the way we do, how we can better nurture our children, and how we can work to realise our potential.
To date, more than 1,500 studies founded on Felitti and Anda’s hallmark ACE research show that both physical and emotional suffering are rooted in the complex workings of the immune system, the body’s master operating control centre – and what happens to the brain during childhood sets the programming for how our immune systems will respond for the rest of our lives.
The unifying principle of this new theory of everything is this: your emotional biography becomes your physical biology, and together, they write much of the script for how you will live your life. Put another way: your early stories script your biology and your biology scripts the way your life will play out.
Unlike previous theories of everything, though, this one has been mind-bogglingly slow to change how we do medicine, according to Felitti. ‘Very few internists or medical schools are interested in embracing the added responsibility that this understanding imposes on them.’
With the ACE research now available, we might hope that physicians will begin to see patients as a holistic sum of their experiences and embrace the understanding that a stressor from long ago can be a health-risk time bomb that has exploded. Such a medical paradigm, which sees adverse childhood experiences as one of many key factors that can play a role in disease, could save many patients years in the healing process.
But seeing that connection takes a little time. It means asking patients to fill out the ACE questionnaire and delving into that patient’s history for insight into sources of both physical and emotional pain. As health-care budgets have become stretched, physicians spend less time interacting one-on-one with patients in their exam rooms; the average physician schedules patients back-to-back at 15-minute intervals.
Still, the cost of not intervening is far greater – not only in the loss of human health and wellbeing, but also in additional healthcare. According to the CDC, the total lifetime cost of child maltreatment in the US is $124 billion each year. The lifetime healthcare cost for each individual who experiences childhood maltreatment is estimated at $210,012 – comparable to other costly health conditions, such as having a stroke, which has a lifetime estimated cost of $159,846 per person, or type-2 diabetes, which is estimated to cost between $181,000 and $253,000.
Further hindering change is the fact that adult physical medicine and psychological medicine remain in separate silos. Utilising ACE research requires breaking down these long-standing divisions in healthcare between what is ‘physical’ and what is ‘mental’ or ‘emotional,’ and that’s hard to achieve. Physicians have been well-trained to deal only with what they can touch with their hands, see with their eyes, or view with microscopes or scans.
Just as physical wounds and bruises heal, just as we can regain our muscle tone, we can recover function in underconnected areas of the brain
However, now that we have scientific evidence that the brain is genetically modified by childhood experience, we can no longer draw that line in the sand. With hundreds of studies showing that childhood adversity hurts our mental and physical health, putting us at greater risk for learning disorders, cardiovascular disease, autoimmune disease, depression, obesity, suicide, substance abuse, failed relationships, violence, poor parenting and early death, we just can’t afford to make such distinctions.
Science tells us that biology does not have to be destiny. ACEs can last a lifetime, but they don’t have to. Just as physical wounds and bruises heal, just as we can regain our muscle tone, we can recover function in underconnected areas of the brain. If anything, that’s the most important take-away from ACE research: the brain and body are never static; they are always in the process of becoming and changing.
Even if we have been set on high-reactive mode for decades or a lifetime, we can still dial it down. We can respond to life’s inevitable stressors more appropriately and shift away from an overactive inflammatory response. We can become neurobiologically resilient. We can turn bad epigenetics into good epigenetics and rescue ourselves. We have the capacity, within ourselves, to create better health. We might call this brave undertaking ‘the neurobiology of awakening’.
Today, scientists recognise a range of promising approaches to help create new neurons (known as neurogenesis), make new synaptic connections between those neurons (known as synaptogenesis), promote new patterns of thoughts and reactions, bring underconnected areas of the brain back online – and reset our stress response so that we decrease the inflammation that makes us ill.
You can find ways to start right where you are, no matter how deep your scars or how long ago they occurred. Many mind-body therapies not only help you to calm your thoughts and increase your emotional and physical wellbeing, but research suggests that they have the potential to reverse, on a biological level, the harmful impact of childhood adversity.
Recent studies indicate that individuals who practice mindfulness meditation and mindfulness-based stress reduction (MBSR) show an increase in gray matter in parts of the brain associated with managing stress, and experience shifts in genes that regulate their stress response and their levels of inflammatory hormones. Other research suggests that a process known as neurofeedback can help to regrow connections in the brain that were lost to adverse childhood experiences.
Meditation, mindfulness, neurofeedback, cognitive therapy, EMDR (eye movement desensitisation and reprocessing) therapy: these promising new avenues to healing can be part of any patient’s recovery plan, if only healthcare practitioners would begin to treat the whole patient – past, present and future, without making distinctions between physical and mental health – and encourage patients to explore all the treatment options available to them. The more we learn about the toxic impact of early stress, the better equipped we are to counter its effects, and help to uncover new strategies and modalities to come back to who it is we really are, and who it was we might have been had we not encountered childhood adversity in the first place.
SOURCE
This is an adapted and reprinted extract from ‘Childhood Disrupted: How Your Biography Becomes Your Biology, and How You Can Heal’ (Atria), by Donna Jackson Nakazawa. Copyright © Donna Jackson Nakazawa, 2015.
Labels: abuse, ACONs, adrenal fatigue, adult children of narcissists, autoimmune, brain development, CFIDS, emotionally abusive mothers, fibromyalgia, illness, migraine, ptsd, toxic parents, trauma, unhealthy, woundedness
Monday, August 27, 2018
Sexual Anorexia
...and A Small Town Private Practice
The following is a conversation between Michael Zahab, a public relations manager at recovery facility, and the husband-wife team of Paul Hartman, M.S., Marriage & Family Therapist, and Ginnie Hartman, M.A., L.P.C. The Hartmans have worked together in private practice since 1991 at the Healing Center in Spring Lake, Michigan. Paul and Ginnie began their counseling careers in 1981 and 1985, respectively. They recently completed training with Patrick Carnes, Ph.D., for the treatment of sexual anorexia.
Michael Zahab (MZ): Please tell me about your professional background and your current practice.
Paul Hartman (PH): I'm a Marriage and Family Therapist in private practice, specializing in addiction issues. In many years of working with recovering alcoholics, I've tried to help those people who are physically dry move on to a higher level of recovery by dealing with family of origin issues as well as doing Twelve Step recovery work. Despite seeing much progress in my clients, I've continued to feel that something was missing in my work.
I've discovered in the last couple years that the issue I've seldom, if ever, addressed is sex addiction. So, after training with Pat Carnes, I began to do groups that specifically focused on this area. Most participants have been people who were already in recovery from another addiction-long-term recovery for some-but all were still having relationship problems and experiencing pain in their life. Once I began to address sex addition issues, once I made it the primary thrust of therapy, I began to see a tremendously positive response among some of my clients. I'm very excited about the outcomes I continue to see.
Ginnie Hartman (GH): My work for many years has focused primarily on individual families that have been affected by addiction. I have done a lot of group work on family of origin issues and have seen remarkable progress. After my training with Patrick Carnes, however, I began to look for and talk about sexual anorexia-and I have been amazed by the number of people-women, primarily-who struggle with this problem. I've long believed that when substance addiction is present in a relationship, sexual function is usually distorted. But I never understood the dynamics involved until I worked with Pat [Carnes]. I am so excited as I watch the participants in women's groups that have been together for quite a while bloom as they discover and explore their sexuality for the first time.
MZ: Do you believe that this is a new problem, or is it something that we've simply overlooked for many years?
PH: Awareness has been building for some years, beginning for us with the model Claudia Black developed in the early 1980's when she published, It Will Never Happen To Me. We've also had Pia Mellody's work to draw from. I was familiar with Pat Carnes' work through his books, but it wasn't until training with him that I set up groups explicitly focused on treating sex addiction.
This is an important point. Previously I put all my clients together in groups; I didn't differentiate. Generally, the clients in such groups became, after several months, became good friends. They felt safe enough with one another to disclose family secrets, but what they didn't do was talk about sexual issues. No matter how safe the environment, these issues never seemed to come out mixed groups.
My first (sex addiction) group was composed of men who had at least two of years of recovery and had done a lot of group work. When they came together in a sex addiction group, experiences came out that they had never before talked about. It's been the missing treatment piece for these men.
Frankly, I'm coming to believe more and more that the so-called primary addictions aren't truly primary addictions. I'm seeing more and more men for whom the primary addiction is sex addiction. The other addictions are secondary to sex addiction.
MZ: Spring Lake, Michigan, is not a large community. Has it been difficult to pull together enough people to conduct groups which address sex addiction?
P.H.: When I came back from the training, I wondered about this same question. As soon as word got out around the community that I was doing this, however, people were calling and asking to get in the group. Now I have two groups running concurrently, and could easily do one every night of the week if I had the time.
MZ: Ginny, what was your experience coming away from the training? Are you finding a similar situation among the women with whom you work?
GH: Although I've always treated some sexual dysfunction, I'm now just much more aware of the problem. After evaluating my clients more carefully, I realized that those who were in a relationship with an addict had invariably shut down sexually in some way and disowned their sexuality. Several women, when first approached about sexual anorexia, responded with such comments as, "I'm not sexual, and I could care less if I ever have sex again. I'm fine without it. I don't feel anything is missing." Other were being sexual with their partner, but only for their partner, not for themselves.
Each of these women had done family of origin work, a lot of recovery work, and were in a Twelve Step program. I had to really help them understand that they would not be fully recovered until they could embrace their sensual and sexual being. After announcing the group and suggesting Pat Carnes' book, Sexual Anorexia, I had a group of ten before I knew it. As word spread in the recovering community, I had another group of ten-and now I have people on a waiting list.
MZ: Do the women in group meet the criteria for sexual anorexia more than the criteria for any of the other sexual disorders?
GH: It seems so. The typical woman who has been in relationship with an addict has totally disowned her sexuality. She's decided she doesn't want or need sex any longer. This represents a shift to an extreme; these women have not had a lifetime of sexual anorexia. There are, of course, women who have been shut down sexually most of their lives, but that doesn't seem to be the norm among those I've seen.
MZ: Do the couples or individuals with whom you've worked have sexual or relationship issues, but no other apparent dysfunction?
PH: We occasionally see people like this, but, they're not our typical couple client. Generally speaking, our typical couple is in their late 30's or 40's and has been in Twelve Step recovery for six, seven, or eight years. The husband is an alcoholic with seven to eight years of sobriety and he's been active in A.A. During this time, his spouse has been working a good Alanon program.
When they come to us, we hear such stories as: "We're doing everything the program tells us to do. We're working the Steps; we've got a sponsor; we're not into our addiction, but our relationship is terrible and we're thinking of getting a divorce." After a deeper assessment of such couples, we quickly get into the issue of sexual satisfaction and dissatisfaction-and there it is.
MZ: Among the dysfunctional behaviors, are the Internet and pornography a factor? Tell me about this.
PH: I'd put this right on the top of the list. I continue to be amazed each week as people come in and disclosing the ways they use sexually explicit materials on the Internet for arousal and masturbation and how they go to chat rooms and how they then go out to meet people from the chat rooms. That's got to be one of the top issues we deal with in our marital therapy work. This is something that, two years ago, I never asked about. Now, I ask routinely.
GH: I can't tell you how many women who have come into therapy saying, "My marriage is falling to pieces, I don't know what's happened, my husband is up all night on the computer, on the Internet." They have no idea what's going on. As a therapist, you simply have to be aware of this problem.
MZ: How has the training affected your clinical approach and work?
GH: Understanding the anorexia cycle (preoccupation, distance strategies, sexual aversion, despair) has been so important for us and for our clients. It's so much easier to identify how sexual addiction has affected individuals and their intimate relationships. Previously, I recognized that some kind of cycle was in place, but I didn't have a term for it. The term "sexual anorexia" fit perfectly. Clients understand it, too. They know immediately what we're talking about. Consequently, it's much easier to then help clients see how that cycle had interrupted their own sexual maturity and growth. It's made all the difference.
PH: Our work in addictions has long had this basic premise: all current dysfunction is tied in to dysfunction in the family of origin-and that dysfunction often took the form of child abuse. One way people survive that kind of experience is to shut down emotionally. The focus of our work has been to help people access those repressed feelings and express them, and the result has been healing.
In contrast, whether it's Ginnie's sexual anorexia group or my sex addiction group, we focus explicitly on the sexual issues and the thoughts, feelings and behaviors that accompany them.
The other difference is that every week, the group is focused on something that is explicitly sexual. We really follow the outline we received at the training, starting with denial and going right through that outline, you have a subject and it just builds-it just provides the program.
We have a large population of clients who have been extensive family of origin work, so not all are starting from square one-but some are. Initially, I was concerned abut how I could take two divergent groups and treat them together. I decided to deal with child abuse early in the process. That piece of it was repetitious for some, but they didn't object. And those who hadn't dealt with these issues found it very revealing and helpful.
MZ: How did you implement what you learned in the training?
GH: I began evaluating my clients to discover those who had sexual disorder issues, and gave those who did some of the literature to read. I also checked with clients who had finished family of origin work and suggested they do some reading on the topic, too. Many more than I expected called back immediately asking to be in the group.
PH: It hasn't worked that well for me on the sex addiction side. I typically recommend Out Of The Shadows or Don't Call It Love. For a person who is in denial of their sex addiction, my experience is that those books don't do a lot to bring them out of denial. When reading about the behaviors that Patrick describes, many men focus on what they don't do.
One-on-one therapy, however, has help enormously. Through it, these men begin to understand that if they're spending an inordinate amount of time fantasizing about sex and/or objectifying women-regardless of what acting out behaviors they have-this alone is enough to make the diagnosis of sex addiction.
I also stress that such a diagnosis is important, not to put a label on them, but to help us know how to help. Some of these guys have been all over the mental health community looking for help, but haven't gotten it. They've been treated for anxiety disorders, depression, obsessive-compulsion disorder, you name it. Many of them have been on medications, especially the SRI's (seratonin reuptake inhibitors) with some improvement. But after all the treatment and all the Twelve Step experiences, they're still coming back saying, "Is that all there is?"
MZ: As a member of the group progresses, what indications or changes do you see?
PH: These male sex addicts have been carrying an enormous level of shame. I believe now that more shame is associated with sex addiction than any other dysfunction. Because of the shame, there's an extra need for secrecy. In treatment, we work to reduce their level of shame, and that alone has an enormous impact on their lines. As their shame decreases, their self-esteem increases. They start to believe, often for the first time in their lives, that they are valuable people. To me that's been the biggest change that I've seen emerge from this group. These men are beginning to really love themselves. They seem themselves as worthwhile, good men. It's so powerful.
GH: I think one of the changes I see is people rediscovering their passion for life. When you shut down any part of your being-particularly your sexuality-you just lose some of the passion and vitality for life. I see life back in their eyes, color in their face. I see a lot of physical changes in female clients. They move differently, they are able to wear feminine clothes again, and they report learning once again to enjoy touching and being touched.
PH: Ginny and I have seen similarities in progress and healing in both our male and female clients, but we have see one significant difference: the progress women make seems to be quite steady and straight ahead. The men in my group, however, initially made good progress breaking through denial. They could identify their dysfunctional sexual behaviors, and, I believe, genuinely wanted recovery. Yet week after week they came to group talking about slipping-going back to their dysfunctional sexual behaviors. I think what Patrick has learned about this in his research is that it's very typical in the first year recovery from sex addiction.
MZ: How is the support community where you practice?
PH: That was another concern I had. We have a very strong A.A. recovery community, but other Twelve Step programs are not widely available. There were no S.A. groups in our area, which meant clients had to drive 45 minutes to less than ideal groups. I'd advise therapists who try this approach to encourage your own clients to start a Twelve Step group-which is what we did. Attendance is typically twelve to sixteen people, and they've just recently expanded to an additional evening night. Both are well-established and well-attended. GH: All of the women I see are in Twelve Step groups, too. Two or three women have sought help for more family of origin issues. And when they finish this group (sexual anorexia) they too will probably go into one of our family of origin groups.
MZ: How critical is to have members of the family of origin geographically close with regard to progress with therapy and recovery?
GH: We have found, since we use experiential and psycho-drama techniques, that it isn't necessary for the family to be physically available.
PH: I agree. Today's treatment techniques enable people to heal whether or not they have direct access to family. A typical dysfunctional response is to cut off relationships-from parents, from siblings, from adult children. I think as long as those severed relationships continue, a certain amount of woundedness lives on inside the person. After they learn how to set boundaries, clients can go back and sustain family relationships-even with a member who has not been through recovery-most, but not all, of the time.
http://www.sexhelp.com/sa_small_town_practice.cfm
Labels: abnormal, abuse, denial, relationships, sexless, sexual anorexia, withholding, woundedness
Monday, February 26, 2018
Sticks & Stones Can Break My Bones...
by Mary Jo Fay, RN, MSN
We all remember that age-old adage "Sticks and stones can break my bones, but words can never hurt me." Well, I beg to disagree.
As a writer I know the power of words. At the same time, as a facilitator of two support groups and consultant to women (and a few men) who lived in households and relationships where words were used as weapons, let me tell you, those words have held on to many of these people like heat-seeking missiles -- only they're still seeking out their targets even after many, many years.
Try some of these on for size:
"I should have had that abortion instead of having you."In working with many of my clients, they all struggle with the same thing -- those powerful words that they have been psychologically "brainwashed" with have sent some of them on a self-limiting and/or self-destructive path. Even years after the person who originally uttered the emotionally abusive message is gone, the victim may still hear those exact words and phrases in their head, playing on as if the attacker is still in front of them, reciting the mantra every day.
"You are the worst mother on the face of the earth." (From a grandmother to her daughter, in front of her grandchild.)
"Why don't you quit being who you are and grow up?"
"With your grades you'll be lucky if the Army will take you."
"Why can't you be thin like your sister?"
"Why can't you ever do anything right?"
"You're not worth a plug nickel."
"You're the laziest child I've ever met."
Sticks and stones? Many feel that they would have rather been hit than attacked with the nebulous weaponry of brainwashing words. At least a broken arm or a black eye is evidence of wrong doing. But the destructive, stealth behavior of emotional brainwashing is so nebulous that it goes unnoticed until the damage is already done.
Want some specifics I see?
A 50 something-year-old woman who is terrified that her 91 year old mother thinks she's incapable of anything, and, as such -- has considered herself a failure all her life.
Two 50 something-year old twin men whose mother tells them she should have gone dancing instead the night she conceived them -- leaving them still afraid of her after all these years and blaming themselves for all their mother's problems.
A 30-something young gal -- Teri, whose sister Gail attacks her constantly and threatens that God will send her to hell because she is "unpure." (She doesn't worship the way Teri does.)
A 40 something gay guy named Jack, who feels that he'll never find love because for years his father told him God would punish Jack for being gay.
A 40 year old married woman who mourns the loss of never having a child after her first husband told her that "no one in their right mind would ever have a child with you," and he has since had a child with another woman. She, of course, is devastated.
Even teasing is powerful stuff. Saying things like, "Of course, I love you, honey. I don't care what anyone else says," has huge implications that everyone else thinks "honey" isn't up to her dear husband's standards.
Most of us can probably remember the childhood chant the fat kids often got -- "Fattie, fattie, two by four. Can't get through the kitchen door." How would you like to have been an overweight child and listened to that growing up? Words like those stick like glue to the very metal of our soul.
So what's my point? Be careful what you tell your children, your friends, and your family. Yes, even as grown ups we can still be affected by words -- especially if they have any resemblance to those we heard as kids.
Watch your teasing. Watch what you say when you punish your children for their mistakes. Watch your words as you compare your children's skills and weaknesses. "Why can't you be more like your brother? He really tries and you just pretend to work hard."
All are weapons that we may not even be aware of as incredibly destructive. Because if you believe the old adage -- "Sticks and stones -- you know the rest -- you may actually believe that what you say really can't hurt you.
But you'd be so terribly, terribly wrong.
Labels: depression, emotional abuse, failure, pathological, sticks and stones, unworthy, verbal abuse, words, woundedness
