One of the concerns of Medicine is the relief of suffering. The opiate crisis is evidence that we are not doing very well. That should not have come as a surprise. Let us consider the challenge that confronts us in its principal manifestations: The most severe suffering endured by man is surely that inflicted through torture. The essence of torture is the use of the body systems"--"mainly the pain system"--"against the self. Similarly, in psychological torture the mental faculties are redirected toward the progressive disintegration of the self.
Of course similar levels of pain, and similar fragmentation of the self, also occur without external provocation. The level of suffering is likely similar, but there is no external agency. We are coming to realize that those among us who suffer most severely and relentlessly, who suffer in the most diverse and varied ways, and who invariably fail to find recovery, are also victims of trauma. In particular, they are victims of early childhood neglect or abuse, collectively called 'maltreatment trauma.'
Inevitably, an environment conducive to maltreatment trauma is a risk for physical brain trauma as well. So the vulnerable infant and very young child are handicapped right from the start. Not only are they likely to suffer personally, but they may well inflict their dysfunction upon the outside world"--"on their employees, their spouses, and in particular upon their own vulnerable children"--"later in life.
This causal chain, rooted in early trauma, can account for much of the mental illness in our society, the bulk of criminality, the large majority of the medical costs of chronic disease, most of the cases of school failure, and the social costs of the many who are simply not able to navigate their world. It can account for much of the addiction problem that exists, a substantial fraction of extreme obesity, and the problems of early aging.
Chronic pain, extreme manifestations of PMS, an unusually thick medical file, and a raft of disparate complaints, combined with an arm's length of treatment failures that leave doctors baffled"--"all are virtually diagnostic of early developmental miscues kindled by maltreatment trauma.
There are also winners among the survivors of maltreatment. Many highly successful adults were forged in adverse childhood circumstances. But they have also been adversely shaped by them. A price has likely been paid in their emotional repertoire. An abiding need for self-protection may constrict their capacity for a loving, committed relationship. In the extreme, these are the sociopaths, calculating, manipulative, and cold-blooded. These are the true aliens in our society because one never sees them coming. They have good social cognition while lacking empathy. They victimize whomever they touch. They rule in the CEO suite and flog the rest of society to their singular and personal advantage.
Presently we are living in a society that favors the predator class"--"socially, financially, economically, and politically, while maneuvering in every way to shrink the safety net. Aid is dispensed on the basis of worthiness rather than need. And worthiness is judged on the ability to contribute labor. This does not compute. A German survey found some 10% of their population simply unable to manage in a modern society. And that's the state of affairs in a country with a robust and intact social welfare system.
Our own situation is likely worse, as is reflected in our declining life expectancy. The new unworthies are killing themselves in middle age. The young unworthies are routed into the criminal justice system. In consequence, the average foster child graduating out of foster care costs the State about $50,000 per year. (This was the finding some years ago in Utah.)
We need a solution to what we have identified as the root problem: early childhood trauma, which is now being propagated from generation to generation. The crisis in foster care is a tangible manifestation of the problem.
Wherein does a solution lie? In this inquiry, we are well advised to look to those who have recovered successfully. The problem of trauma is in fact ubiquitous; we have all been impacted to one degree or another. The good news is that most people are able to shed their traumas and move on. Most will have done so without recourse to the standard medical or psychotherapeutic remedies. Their path has been one of self-recovery. We refer to this as resilience.
Early childhood trauma undermines the capacity for self-recovery. We now know that that capacity can be restored, and conveying that message is the real purpose of this blog. Resilience is a natural competence of the nervous system. We develop it along with our other faculties unless that process is aborted or compromised. Even then, however, it can be restored. The key is to recognize that we are dealing with a kind of skill or competence, and that means conventional therapies can only play a marginal role.
A skill must be acquired; it cannot be conveyed either by means of medications of via psychotherapies. Recovery of the capacity of resilience can only occur via a process of self-recovery. It cannot be outsourced to any other entity. Medical remedies and psychotherapies can be supportive, but they cannot be the real story here. By now it is clear that these methods play at best a very peripheral role. This explains why opiates are destined to fail in their mission of bringing relief. On the other side, therapists tend to be the heroes in the staging of their own drama"--"quite irrespective of their actual clinical success. They sustain their self-respect on the basis of modest little triumphs that fail to resolve core dysfunctions.
The skill at issue is a brain skill, and the brain retains its skill-learning potential for as long as it is alive. To learn an ordinary skill, the brain must witness itself performing that skill. That turns out to be a general principle, one that also holds for the brain's key competence, which is to organize its own affairs. The vast majority of the brain's resources are consumed in the process of regulating its own activities, and that is in essence a problem of ongoing self-monitoring and self-correction.
We can augment that process by giving the brain additional information on how it is behaving from moment to moment. And that allows the brain to rescue itself out of the cul-de-sacs it has gotten into, and to restore proper functioning. The resulting recovery is broad-based and non-specific, touching on all realms of function that are under the management of the central nervous system. That means resilience can also be fully restored.
This process can happen in the course of hours, days, weeks, months, or years, depending on the severity of the brain insults at the outset. As this terrain has been explored over the past three decades, one thing has become very clear. It is impossible at this point to predict what a particular brain is capable of until it is given an opportunity to shore up and hone its skills. That holds true of conventional skills such as golf, and it is true here as well.
There is also a paradox: The methods reveal the most obvious improvements in the most severely impacted cases. One professional has a sign on the desk with the inscription that reads: "We produce miracles. If none occur, something has gone wrong." The miracle in this instance is the remarkable capacity of the brain for self-recovery, which we have collectively succeeded in unshackling. All we have to do is to provide the brain with a mirror to itself so that it can observe its own dance of self-regulation and thus boot-strap its way back to better function. Meanwhile, the brain retains the secrets to its varied competences. We have simply learned how to take advantage of them. The brain is in need of information rather than instruction.