“Trauma is to mental health as smoking is to cancer.”-Dr. Steven Sharfstein, Past President, American Psychiatric Association
Last week, I posted the first in a series of articles about children of alcoholics who remain trapped in an alcoholic lifestyle as adults. I examined the neurological underpinnings of a compulsive and “infinite loop” of ongoing and deeply painful involvements with partners and activities that reproduce the chaos of the addicted family of origin and endanger physical, psychological, and spiritual well-being. But while psychologists are increasingly interested in the neurology of compulsive behavior, we tend to believe that it stems from a variety of causes. Most of us look for “biopsychosocial” explanations for behavior, including the compulsion to repeat. When treating adult children who are recapitulating a painful past, one psychosocial angle we typically want to explore is the quality of parent-child relationships in a patient’s family of origin. The nature of parent-child interactions is important for several reasons. In this post, I will discuss how relationships with caregivers either perpetuate an adverse infinite loop, or inoculate a child against an alcoholic lifestyle by shaping self-esteem and expectations of others, and by affecting a child’s ability to regulate intense feelings and to process and heal from difficult events.
Nearly everyone understands that our earliest relationships affect us all our lives because they provide a model for us to follow as we engage with people outside the family. From the first moments of life, we form impressions of the world through interactions with our caregivers. Over time these impressions evolve and are stored in the mind as mental representations of the self and the other. Characteristic exchanges between self and others are also stored. When we internalize nurturing figures along with a representation of ourselves as loveable, it gives us a huge head start with respect to healthy adult adjustment. It stands us in particularly good stead as we strive to form healthy relationships with people outside our families. The support, encouragement and unconditional regard we receive from our parents forms the basis for good self-esteem and instills optimism about the world as a welcoming place. If our parents cherish and love us, we tend to feel that we should be, and are likely to be valued and loved by others. In addition, our positive mental representations of our parents can be recalled and recruited, when no one else is around, to establish a sense of calm and hopefulness when troubling events occur. The ability to self-soothe is a critical resource in life, and it is a source of protection against the abuse of substances and activities that we might otherwise turn to in order to numb emotional pain.
It is hard for parents who are preoccupied with alcohol and drugs, and stressful conflicts about alcohol and drugs, to be reliable sources of support and love for children. Children in addicted families are more likely to be abused, exploited and neglected. As a result, their mental representations of themselves and others, and their expectations about the type of treatment they can expect from others are pessimistic. Even if they can’t quite verbalize this, and don’t consciously think about it, they view others as untrustworthy and potentially dangerous. And they view themselves as unlovable and unworthy of respect. Children from addicted families are more likely to accept insensitive and abusive treatment from other life partners because this is what they feel they deserve, and because it seems “normal” to them—it fits with the information they’ve stored in their minds about how relationships are supposed to go. If they grew up feeling responsible for their parents’ pain, as so many children in addicted families do, they may also feel compelled to rescue and reform partners who are desperate and even abusive.
The absence of reliably loving and supportive caregivers fuels traumatic repetitions in other ways, too. Last week I talked about the high incidence of adverse childhood events (ACEs) in addicted families and the psychological harm that emanates from these events. The harm from such events is amplified for children who cannot discuss and process them with a trusted caregiver, and in addicted families both parents may be too overwhelmed by ongoing crises to provide this kind of help. Many children in addicted families are left alone with powerful feelings of fear, anger, confusion, as well as misplaced guilt and shame about having somehow caused the trouble between their parents. When these feelings can’t be expressed and assuaged, they become a crushing psychological burden and children try to protect themselves by repressing or dissociating from them. But banishing tormenting emotions to the unconscious doesn’t cause them to dissipate or disappear. It actually makes them stronger and more psychologically damaging. When psychic pain is split off from conscious life, it can’t be addressed and relieved by supportive adults who can help children to understand that they are not responsible for the family’s suffering. Deeply buried memories and feelings can’t even be alleviated by the passage of time and increased independence from a chaotic family of origin. Freud famously observed that in the unconscious there is no recognition of the passage of time. Repressed traumatic emotions and memories retain the status of current and prospective events. Tragedies that have already occurred and which the adult child has survived don’t seem like old news. Instead, they feel like catastrophes that are about to occur, at any time. Traumatized children who never have the opportunity and support they need to process terrifying events remain traumatized as adults. And, as they face the inevitable challenges and additional stressors associated with adult life, they can become overwhelmed by the burden of unprocessed, unresolved stress and trauma. For most, the dam eventually overflows and the trauma is released, but in disturbing ways. The release may come in the form of a disabling disorder of mood, a substance abuse problem, or damaging emotional and behavioral outbursts. It is also frequently released in the form of a re-enactment of hurtful past events with a partner whose unstable behaviors serve as reminders of these events and who is also driven to re-create a childhood nightmare.
Traumatic repetitions are a very complex phenomenon, and this article is certainly not a comprehensive explanation of why they occur. It does highlight, however, some of the ways in which the absence of reliably loving and supportive caregivers sets children on an unfortunate course toward an alcoholic lifestyle in adult life. Children who are neglected, abused and exploited grow up with skewed perceptions of themselves and a distorted sense of what constitutes a “normal” relationship, so they are prone to form unhealthy partnerships with others. They also grow up with an unmanageable burden of unprocessed traumatic memories that press for release and are easily triggered by disappointments and setbacks in adult life. Cumulative stress and psychic pain, along with a sad history of being harmed rather than helped by loved ones can easily lead adult children to turn to psychoactive substances and compulsive activity in order to find relief from suffering.
There are, fortunately, many things that adult children can do to avoid or escape the infinite loop–and many things parents in recovery can do to help minor children avoid an alcoholic lifestyle. I will talk about exit strategies in the next post in this series.
Read more about recovery for adult children of alcoholics in Dr. Wood’s book, Children of Alcoholism: The Struggle for Self and Intimacy in Adult Life