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life amounts to being trapped in inner turmoil, doubt, loss of meaning, isolation, unworthiness; feeling cold in our belly, devoid of hope; lacking faith in the possibility of liberation, missing succor; unable to endure external challenges or the inner chaos or emptiness; incapable of regulating our distressing mind conditions, finding our emotions unendurable; and most of all, desperate to soothe the pain all these states represent. Pain, then, is the central theme. No wonder people so often speak about the benign numbing effect of their addictions: only a person in pain craves anesthesia.
Addiction is a complex psychological, emotional, physiological, neurobiological, social, and spiritual process.
The issue is never the external target but one’s internal relationship to it. Are you craving and partaking of something that affords you temporary relief or pleasure, inviting or incurring negative consequences but not giving it up? Welcome to the meeting. Free coffee in the back.
Looking inward with compassion, most people will be able to locate themselves somewhere on the trauma/psychological-injury spectrum.
Except it’s not really love we get hooked on but our desperate attempts to cope with its lack, by any means necessary.
Psychiatrist Kay Redfield Jamison, one of today’s most eloquent authors on manic-depressive illness, also known as bipolar disorder, wrote the memoir Unquiet Mind. This book is essential reading for anyone wanting to appreciate the experience of an exquisite consciousness oscillating from episodes of hyper-elation to immobilizing despair.
This book is essential reading for anyone wanting to appreciate the experience of an exquisite consciousness oscillating from episodes of hyper-elation to immobilizing despair.
There are no measurable physical markers of mental illness other than the subjective (a person’s description of their own mood, say) and the behavioral (sleep patterns, appetite, etc.).
Other than modern culture’s typical, left-brain materialist bent, how did we arrive at this view of mental illness as an essentially biologically rooted phenomenon?
Diagnoses are abstractions, or summaries: sometimes helpful, always incomplete. They are professional shorthand for describing constellations of symptoms a person may report, or of other people’s observations of someone’s behavior patterns, thoughts, and emotions. For the individual in question, a diagnosis may seem to account for and validate a lifetime of experiences previously too diffuse or nebulous to put one’s finger on. That can be a first and positive step toward healing.
the world into which kids are being born these days might as well have been designed to promote disruptions of cognitive function and emotional self-regulation.
There are fifty or more neurotransmitters in the brain whose complex interactions we are only now beginning to explore, not to mention the almost infinite possibilities inherent in the lifelong intersection of experience with the biology of body and brain. Once again, the physiology of the brain is a manifestation and a product of life in motion and in context.
Is there any reason you might feel distressed? What’s been happening in your life? Is there anything hurting you we might want to change?”
Neurobiology is a continuum, as are “mental illness” and health. Emotional injury during development can have physiological consequences, even without abuse or neglect.
Sensitive people feel more, feel deeply, and are more easily overwhelmed by stress, not just subjectively but physiologically.
These are the children that Tom Boyce, a professor of pediatrics and psychiatry at the University of California, San Francisco, describes as orchids, “exquisitely sensitive to their environment, making them especially vulnerable under conditions of adversity but unusually vital, creative, and successful within supportive, nurturing environments.”15 The same “sensitivity” genes that in a stressed environment can help potentiate mental suffering may, under positive circumstances, help promote stronger mental resilience and therefore happiness.16 Sensitive people have the potential to be more
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Sensitive people have the potential to be more aware, insightful, inventive, artistic, and empathic, if their sensitivity is not crushed by maltreatment or disdain. The most sensitive of our kind have made some of the most lasting cultural contributions; many of these have also suffered the most intense pains during their lives. Sensitivity can be the quintessential combo package: gift and curse, all in one.
What is pushed down when a person is depressed is easily identified by its absence: emotion, the continual flow of feelings that remind us we’re alive.
Either way, repressing the rejected emotion is the surest way of escaping overwhelming levels of vulnerability, of avoiding a too-painful rift between oneself and the ambient world.
Thus the repression of emotion, while adaptive in one circumstance, can become a state of chronic disconnect, a withdrawal from life. It becomes programmed into the brain, embedded in the personality.
The mind is a meaning-making machine. It will generate stories that “make sense” of the emotions that, at a vulnerable time, it could not contain and perhaps still cannot.
Helen Knott depicts the same process with scorching eloquence: “Those brief
moments of the sharp blade dragging across skin provided me with a relief from the hate that I felt for myself. It was as if the moment the skin opened up, it became a vent that poured out all of my fucked-up whirling emotions … I didn’t want to die at that time—that’s not what cutting was about. I was doing it so I could put up with living.
It is our task, if healing is the goal, to make sense of them newly, now, with the benefit of adult discernment and compassion.
He had the addict’s lifelong discomfort with the self, the need to flee from his consciousness of himself: “sleepwalking with activity,” he called it.
Even the nomenclature should give us pause: the Greek origin of “schizophrenia” means “split mind.” The question follows naturally: Why would a mind need to split itself?
No fixed genetic destiny here, but a survival need composed of constitutional vulnerability and overwhelming life experience. One way for an organism to escape that agony, whatever its source, is to disconnect whenever the distressing emotions are triggered. In the face of trauma, splitting from the present is a form of instantaneous self-defense.9 From that perspective, it is a miraculous dynamic allowing vulnerable creatures to survive the unendurable.
“My feelings left my body. My spirit sat outside of me like an unacknowledged apparition. I didn’t know whose life I was living, whose body I inhabited. This wasn’t my story, my life, my reality … I was scared that if I tried to lean into my feelings, I would fall off the emotional edge and I didn’t know what I would do to myself.”10 What we call a disorder is revealed to be an ingenious means for an assaulted psyche to absent itself from agony.
Tuning out is dissociation’s less extreme cousin, part of the same family of escapist adaptations. It is invoked by the organism when the circumstances are stressful and there is no other recourse for relief, when one can neither change the situation nor escape it.
This adaptation then becomes wired into the brain, without the brain itself being the original source of the problem.
Caterina’s psychotic phase can be seen as a kind of inner haunting wherein all the intense emotions she’d had to stuff away as a child in order to carry out her “understandable” role came to take over her adult mind.
Rather, it arises as an adaptation to fit in with an environment where one perceives no welcome for being just who one is, with all one’s “imperfections.”
That message, “It’s not your fault,” conveys not just undaunted compassion, for which Damon’s character was starving inside, but wisdom, too. From behavioral problems to full-blown mental illness, it’s not anyone’s fault—nor, as we’ve seen, the fault of their brains or their genes. It is an expression of untended wounds, and it is meaningful.
It’s about our hurting world, manifesting the illusions and myths of a culture alienated from our essence. We turn to that bigger picture next.
We know that chronic stress, whatever its source, puts the nervous system on edge, distorts the hormonal apparatus, impairs immunity, promotes inflammation, and undermines physical and mental well-being.
What, in our society, are the most widespread emotional triggers for stress? My own observations of self and others have led me to endorse fully what a review of the stress literature concluded, namely that “psychological factors such as uncertainty, conflict, lack of control, and lack of information are considered the most stressful stimuli and strongly activate the HPA axis.”3 A society that breeds these conditions, as capitalism inevitably does, is a superpowered generator of stressors that tax human health.
Culture acts on our well-being via all manner of biopsychosocial pathways, including epigenetic causes; stress-induced inflammation; impairment of telomeres and premature aging; how and what we eat; toxins we ingest or inhale.
All stressors represent the absence or threatened loss of something an organism perceives as necessary for survival. An impending loss of food supply, for example, is a major stressor for any creature. So is, for our species, the absence or threatened loss of love, or work, or dignity, or self-esteem, or meaning.
“Though living in a nation that celebrates itself as the wealthiest in history, most Americans live on a high wire, with no safety net to brace a fall.”14 A better blueprint for allostatic overload could not be imagined.
A signature marker of stress is inflammation. I’ve encountered the links between the two in many of the patients under my care. Inflammation is implicated in an extensive range of pathologies, from autoimmune conditions to vascular disease of heart and brain, from cancer to depression.
A society that fails to value communality—our need to belong, to care for one another, and to feel caring energy flowing toward us—is a society facing away from the essence of what it means to be human.
What’s it like when each of the above needs is met? What happens in your mind and body when it’s lacking, denied, or withdrawn?
Just as I have named authenticity and attachment as two basic needs, so Bruce has identified people’s “vital need for social belonging with their equally vital needs for individual autonomy and achievement” and calls the marriage of the two psychosocial integration.3 A sane culture, Bruce and I agree, would have psychosocial integration as both an aim and a norm. Authenticity and attachment would cease to be in conflict: there would be no fundamental tension between belonging and being oneself.
Dislocation, in Bruce’s formulation, describes a loss of connection to self, to others, and to a sense of meaning and purpose—all of which appear on the roster of essential needs above. Lest the word “dislocation” conjure something hazy like “being lost,” he is quick with a graphic metaphor. “Think of a dislocated shoulder,” he said, “a shoulder disarticulated, out of joint. You didn’t cut off the arm, but it’s just hanging there and not working anymore. Useless. That’s how dislocated people experience themselves. It’s excruciatingly painful.”
Recall that the Scottish labor leader Jimmy Reid defined “alienation” as the estrangement of people from a society that bars them from shaping or determining their own destinies. The word has other meanings as well, including estrangement from our essence, from ourselves, and from others.
Like our other needs, meaning is an inherent expectation. Its denial has dire consequences. Far from a purely psychological need, our hormones and nervous systems clock its presence or absence.
When do you feel happier, more fulfilled, more viscerally at ease: when you extend yourself to help and connect
with others, or when you are focused on burnishing the importance of your little egoic self? We all know the answer, and yet somehow what we know doesn’t always carry the day.
Because we are biopsychosocial creatures, the rising loneliness epidemic in Western culture is much more than just a psychological phenomenon: it is a public health crisis.
And no wonder: even in parrots isolation impairs DNA repair by shortening chromosome-protecting telomeres.9 Social isolation inhibits the immune system, promotes inflammation, agitates the stress apparatus, and increases the risk of death from heart disease and strokes.
