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Treating the ‘Underneath Stuff’

Recently, after posting an article about the treatment of disordered eating behaviours, I received a comment from a fellow mental health practitioner. He suggested that rather than treat obsessive/ compulsive/ addictive behaviours, we should instead just acknowledge that some people are ‘wired problematically’. He suggested that to explore then emotional and psychological issues that manifest alongside and often underpin these behaviours, is ‘unnecessarily intrusive and painful’.
I totally disagree with him on this point and I wanted to share my response with you all! Read below!

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Though some people are potentially neurologically or genetically pre-dispositioned towards obsessive or compulsive behaviours, research has determined that those markers don’t necessarily condemn a person to becoming an addict/ display addictive tendencies. In fact, scientists suggest that it really is a combination of potential pre-disposition, COMBINED with environmental factors, that cause people to struggle with acting out.

This excerpt from the Universih of Utah Genetics Department summarises it quite nicely:
‘Scientists will never find just one single addiction gene. Like most other diseases, addiction vulnerability is a very complex trait. Many factors determine the likelihood that someone will become an addict, including both inherited and environmental factors.’ (https://learn.genetics.utah.edu/content/addiction/genes/)

For other people, there can be no history of addiction in the family and no possible ‘genetic markers’ indicating that they would suffer from obsessive or compulsive patterns themselves. Research in fact suggests that both trauma and poor attachment can be significant factors in the formation of these issues.

If you look at the 12 step model for addiction treatment (which is hugely successful across a multitude of compulsive behaviours from drug addiction to eating disorders, gambling and sex), the suggestion (which is not rooted in any scientific research, but merely on the experiences of addicts who managed to ‘recover’), the suggestion is that there is some sort of ‘malady’ that afflicts the addict, but that a weighty bag of shame, fear, resentment and other painful feelings are also at the root of wanting to act out. The program suggests that a person cannot heal the ‘pre-disposition’ (nor should even worry too much about the fact that they may have it), but that instead they should focus on healing the emotional and psychological narratives that cause them suffering, thus triggering them to want to use. Essentially: they will never heal the predisposition, but they can heal their internal experiences to the extent that they lose the compulsion to act out and can live abstinently.

Trauma expert and physician Gabor Mate, who’s one of the preeminent researchers and clinical practitioners in regards to compulsive/ addictive behaviours, suggests that environment effects brain chemistry and so though someone’s neurology may be altered in a way that implies a greater tendency towards addiction, it was in fact trauma, poor attachment or other environmental factors that bring about the behaviours.

This excerpt sums up his approach nicely:

‘Maté combines his clinical experiences with brain research claiming the source of addiction is in formative brain chemicals. For Maté, the first five years of life (and even the environment in the womb) dictate the likelihood of addiction. He then relates this theoretical point of view to studies connecting stress, abuse and lack of love and attachment to not only life problems (as they have been for some time) but to deficiencies in people's ability to process endorphins and dopamine -- the neurochemicals in our bodies that provide us with both pleasure and pain relief.’(Peel, 2011)

I myself (having worked with addicts and people suffering from eating disorders for ten years now), believe that trauma, fear and shame (and the avoidance/ numbing of these and other feelings), are what lie behind these behaviours. I do believe that there is often a predisposition (though not always, late on-set of these behaviours can occur, after significant trauma/ challenging life events, having never exhibited in any form previously), but that regardless, there are an onslaught of difficult emotions that accompany the desire to act out - and it’s essential these are addressed.

You described exploring the uncomfortable feelings that may arise when a person abstains from acting out on a compulsion as ‘needlessly invasive and painful.’ I disagree. I believe that though it may be painful, within a trusted therapeutic setting, it is not ‘invasive’ - in fact it is the only way to heal what are usually heavy burdens in a person’s life. The very fact that, as you named it: these feelings are ‘painful’; suggests wounding - wounding that deserves to be healed.

On treating and healing these wounds, the discomfort experienced when not ‘numbing’ with certain behaviours, is lessened. The person is then better able to resist the urge to numb or switch off and thus overcome a craving much easier.

If treating disordered eating and addictions consisted as solely labelling someone as ‘wired problematically’ and then letting them continue as they are - people would die.

There are no neurological or chemical ways to ‘re-wire’ people, so even if it was as simple as ‘problematic wiring’, that still leaves people suffering with no suggestions for how to treat them.
Neurology can be changed with psychological and emotional processing, that’s a proven fact (this article explains it well: http://healingtraumacenter.com/neuroplasticity-and-rewiring-the-brain/).
This suggests that seeking emotional/ psychological help, going to therapy etc, is the only current, viable option for addressing and treating the root of the behaviours I discussed in my article. Alongside behavioural change work (I use a lot of CBT and more recently have done some training in DBT), which helps to ‘train’ people to replace one behaviour with another healthier one, the emotional work is essential. All too often a patient simply CANNOT maintain behaviour change without also working on the narratives and emotions that arise when they make those initial changes. The pain and discomfort are just too pervasive.