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Comment by mindgam3 | Hacker News Reader

Yeah, this is pretty much the most matter-of-fact (and accurate) headline I've seen on hacker news all week.

What's funny (funny strange, not funny ha-ha) is that there even need to be headlines about this. In my mid twenties I struggled with some of the various addictions that were quite fashionable among the SV tech elite (work, Facebook, Burning Man, psychedelics, in that order). Thankfully I survived that period and was able to reflect on it, at which point a boatload of repressed childhood trauma began surfacing. After a number of years of working through that, the connection between trauma and addictive tendencies is so painfully obvious. Feeling bad + never learned healthy self-soothing rituals ==> take a hit of something to feel better ==> rinse and repeat.

I've known enough other people who struggled with similar issues to understand that my experience is hardly unique. I would go so far as to say that anyone who ever experienced addiction will understand at some intuitive level that their dysfunctional behaviors are connected to past trauma. The question is, why is mainstream psychiatry still so obsessed with "curing" addiction via chemical means, as opposed to through psychology/trauma recovery?

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> The question is, why is mainstream psychiatry still so obsessed with "curing" addiction via chemical means, as opposed to through psychology/trauma recovery?

I'm a psychiatrist, and at the risk of sounding defensive, I'm not sure where you are getting this from. I have never worked at any addiction program where psychological and behavioral interventions weren't the primary mode of treatment. There are medications that can help with diagnoses related to trauma or other contributors to addiction (PTSD, depression, etc), and a handful of medications that can address some limited facets of chemical addiction, but the bulk of treatment is non-pharamcologic.

The same is true when I got to national and international addiction conferences: medications are a side-dish, not the main course.

That is great, I don't exactly know where you are located. But as someone in California I can tell you that the amount of (at risk) kids that I've worked with throughout the years tells me over half of them were strung out on a solely medication based treatment. We were the first exposure to actual "therapy" that they've ever had, and it is by far the most effective thing many of them have ever been exposed to. Maybe it's a regional thing, probably a Californian thing.

I think you're conflating multiple factors here, mainly psychiatry and parenting. Child psychiatry is an extreme because the patient is most often not the one making decisions (which they're often not capable of anyway). Much of the time, the patient hasn't even really figured out what their "normal" is before their parents stick them with a professional.

Many parents, especially when looking at-risk demographics, look to psychiatry as an easy fix so that's what the doctors give them. The parents often can't afford to take time to drive their child to a psychiatrist twice a month let alone pay for the sessions. The end result is that psychiatry stuck in a terrible ethical spot, where their duty to treat not just symptoms but causes clashes with the realities where the parents are at the end of their rope. Are doctors stewards of health, responsible for the patient? Or are they professionals that have to meet their clients half way? I don't think there is an easy answer to that question.

Obviously there are many unethical and incompetent psychiatrists but my experience in California (as an adult) stands in stark contrast to all the horror stories I hear about child psychiatry from school administrators. As usual, there is a massive wealth gap and your mileage will vary.

A lot of the kids we've dealt with parents are typically incarcerated, dead, or no longer have custody of their children.

In our area sexual abuse is one of the main issues, usually these kids live with relatives(after the conviction) who are usually the most well off in the family. They still by in large get the short end of the stick even though the relatives/guardians try to work with psychiatrists, but we've heard how that goes. That's often how they end up with us, they (the relatives/guardians) bring their troubled kids to us for actual help, not just medication.

But hey I don't mind, we do better work (at least in our area), bring 'em all. Gets more kids off of substance abuse, gets them connected to people who care about them, and more times than not equips them to help their families and community by in large. And we don't even get paid (all voluntary), and that's how I prefer it.

Is your org more of a last resort for these guardians so they go to psychiatrists first or is it a discoverability problem in general?

Since you're all volunteering, I'm curious if the simple removal of the profit motive is enough to change the way all parties involved approach treatment or if its a matter of just having more time to devote per person (because the limit becomes your time and patience instead of their checkbook).

No, it's for any at risk kid, and many do come first. Most likely discovery since that would take a lot more energy and money.

Since there isn't really any motive to reach a solution, and no harm no foul if it doesn't work out. No one's going to really hold us to anything since it doesn't cost them anything more (sometimes less since we will pay for what they need when they are with us, none of that gets reimbursed).

The other thing is that the parents are often part of the problem.

I’ve seen a couple of “monster” children in my kids school who are highly disruptive and have some obvious issues that will be very difficult as they get older.

It’s pretty obvious why when you see the parents in action.

That's very common. Why would they act any differently, they've seen how their parents treat others, that's their model, even if it's a terrible one.

And interestingly enough, even those that despise their parents will still emulate their behavior, that's something I just don't get

The cynic in me is prone to blame it on the capitalistic nature of our modern society.

You've got to get your numbers up.

It takes way more time to properly deal with psychological issues through therapy than it does to just prescribe a pill. They've got their pill, feel slightly better, so now you get to put them in the "done" pile. So your hospital gets to say it treats 1000 patients per quarter instead of just 100, so they are more attractive to pharmaceutical companies which pay them oodles of money.

The less cynical way to look at it is that the health care system is overloaded and underfunded, they don't have enough resources to properly treat people so they "have" to take the quick and easy route.

Either way, it doesn't sound that great.

Of course this isn't analogous of the entire system, but I do see that a lot at least around here. But we never had very good hospitals or clinics for miles around. Just due to how much money is actually made, and how much they can spare.

Here we don't have too many options, which is why I think it goes to drugs so quickly. Though I personally believe that just about any issue I've seen can be fixed free from the use of drugs. Not a single one in the last few years have stayed on meds after working with us, and none of those have had any severe drawbacks (like suicide, self-harm, etc.) so that's a pretty decent track record. (in fact most are much better off after)

I have some personal experience with this in Mountain View CA. I was having trouble sleeping, to the point of losing the ability to think clearly. The physiatrist I saw only talked to me for about 5-10 min before getting me on some drugs (I've forgotten the names of). Now granted I needed sleep, and they did give me something for that, but at the same time they put me on antidepressants. It took almost a year to get off them. Each time I'd go in for an appointment it'd be a new person talking to me... it was useless, and frankly did a LOT more harm than good.

Something is seriously fucked up with some of these places.

With respect, most psychiatrists I know generally pay lip service to the idea of psychological counseling, but when the rubber meets the road end up relying on meds. I mean think about it. If you actually believed the root cause was psychological, you would become a clinical psychologist instead of going to med school just so you could have the title of Doctor and prescribe meds.

If you are one of the “other” kinds of psychiatrists, who deeply believe in psychological trauma recovery and are trying to fix the system from the inside, then I sincerely commend you for your work.

I probably know more psychiatrists than you do, so I'll offer a counterpoint: Outside of starting your own practice, nobody will pay psychiatrists to do talk therapy when they can pay somebody who didn't go to medical school to do it. For this reason, we end up doing mostly medication management, but at a good clinic this is as part of a team of social workers, psychologists, occupational therapists, etc.

Ironically, most US readers of HN will never have seen such a clinic, as the only places actually staffed this way are things like county mental health departments in states where they can get funded.

So, anyway, psychiatry training REQUIRES that each of us provide many hours of supervised psychotherapy. Some training programs are better than others, but we all graduate with a working knowledge of psychotherapy. Many of us have less opportunity to use it than we would like.

Which brings me to my final point: it's not either / or. That's a false dichotomy. It's about the right tool (or combination of tools) for the job. There are plenty of problems that there is no pill for, and a few problems that no amount of talking about it is going to fix. Horses for courses, and all that.

edit: I'm sorry to see you are getting downvoted. I think many people arrive at the same conclusion you have, based on their experiences. I can totally understand how you arrived at that opinion.

I don’t mind the downvotes. What concerns me more is the obvious logical circles you are spinning in order to make a weak argument in defense of psychiatry.

Your parent comment:

“I have never worked at any addiction program where psychological and behavioral interventions weren't the primary mode of treatment.“

Your latest comment: “Nobody will pay psychiatrists to do talk therapy... for this reason we end up doing mostly medication management...”

So let me get this straight. You are currently doing mostly meds, and you’re presumably working at “one of the good places” where psychological methods are the primary mode of treatment. So either you are completely okay with being relegated to a secondary role in treatment (unlikely, given how psychiatrists tend to dominate the conversation thanks to that Dr. title), or, more likely, you are not being sincere when you state your belief that psychological methods are primary. Which is exactly my point. Psychiatrists by their nature and training don’t believe non-pharma methods are the primary solution. Most really try to pretend that they care, but end up prescribing meds in the end. Which was my original point.

You've crossed into incivility in multiple places here. That's not ok on HN. Please review https://news.ycombinator.com/newsguidelines.html and refrain from posting like this, even when you feel strongly.

I've spent years working with past trauma and many hours in therapeutic circles with traumatized people, so I completely get where you're coming from and our views are probably sympatico. But there's a risk, when one's opinions come from the same intense experiences as one's feelings do, of not leaving enough space for other people. On HN, other people means other commenters, especially ones who are coming from an opposite position. Forum comments tell us very little about who we each are, and inevitably we sketch in the gaps from material of our own past experience. This leaves exchanges fraught with misunderstanding, especially when feelings are strong. We're all responsible for guarding against that.

dang, I appreciate your efforts to maintain civility and I sincerely apologize if my tone came across as disrespectful towards any member of the HN community. I also appreciate you mentioning your experience with past trauma.

Looking back on this comment, I agree that I could have worded this more respectfully. I will strive to do so better moving forward.

I would hope that HN is a space where you can call out illogical ideas, which is what I was trying to do. I reacted emotionally because I felt like I was being trolled, which is extremely common for anyone who exposes themselves by speaking about trauma. I can see now that the intent may not have been to troll me.

However, I do feel like I’m being singled out a bit unfairly here. Again, not excusing the tone of my own comment, but I’ve received a few replies that feel at least as aggressive as my own. There’s one in particular referring to the “stench” of my comment that felt a bit harsh. All I would ask is for the same standards of civility to be applied to all members.

If you see that comment and legitimately believe that mine was noticeably more over the line, please let me know.

"Patronizing stench" is not a fair phrase to direct at someone on HN, and I've replied to it. But there's still a difference, it seems to me. Your comments have been the ones sort of inducting this thread in a generally flamewarrish direction. That's understandable when strong views meet strong feelings meet strong experiences, and easy to fall into without fully realizing. This is provocative territory for a lot of us. But HN is lucky to have a user like phren0logy show up to offer his obviously relevant experience on the topic, and if other users respond by somehow questioning his choice of profession, that's a move that's unlikely to lead to better discussion.

The best ways I know of to avoid this are to stick to describing one's own experience and to look over one's comment several times for anything unduly personal. It can sneak in in a lot of ways.

I have friends who are in orthopedics, and they work with lots of physical therapists. They don't do the physical therapy themselves. Similarly, I'm the medical part of a team, and I'm cool with that. I do the parts that other people can't. It's a pretty standard arrangement and most psychiatrists who treat addiction work this way without much issue.

I think we understand those comparisons. The comparison that is missing, and where experience seems to be lacking with practitioners due to its how it has become structured, is doing therapies without harmful medications - that for many people have extremely negative side-effects, withdrawal symptoms - that some would argue cause more permanent problems/changes.

Would you also say that complex jobs require a whole toolbox, rather than just a hammer, wrench, or driver of some sort?

> going to med school just so you could have the title of Doctor and prescribe meds

Your comment really isn't with respect when you make this assumption about someone's profession based off no knowledge of that person's chosen career path.

I'm not sure what kind of a person knows many psychiatrists but doesn't understand that the boundary between psychiatry and psychology isn't some high garden wall whereby a psychologist tosses the ball over when they can't figure out the case.

Undoubtedly there are some psychiatrists who pursue the title for reasons other than the fact that psychiatrists have the vast majority of the power and funding in western medicine as compared to psychologists. Surely there are some who are genuinely motivated to solve the problem of human psychological suffering.

To those I have a serious question: why did you choose psychiatry over for example a PsyD degree? And: what are the key data points that make you believe that the pharma-centric approach is the one worth devoting your career to?

>why did you choose psychiatry over for example a PsyD degree? And: what are the key data points that make you believe that the pharma-centric approach is the one worth devoting your career to?

The patronizing stench of this comment aside, you’re attempting to wedge these two careers into the same hole when they are apples to oranges. At their foundation, the curriculums between the two are nowhere comparable.

My psychologist has been taught to conduct _psychotherapy_ at an expert level. My psychiatrist is trained to be a _medical doctor_ on all bases with additional expert knowledge in their sub field.

While you may have a certain disdain for the field of psychiatry, attempting to devalue the importance of the balance they maintain for a patient stems from ignorance of what they do.

> patronizing stench

That falls under what the site guidelines refer to as name-calling and ask you not to do.

https://news.ycombinator.com/newsguidelines.html

> I'm not sure where you are getting this from.

Not GP, but the prozac shrimp story probably didn't help the reputation of psychiatry in the United States at least. And to clarify: I do mean "reputation" - I don't know if it actually says anything about the state of medication - could very well be sanitation.

That is completely and utterly peripheral to if the medication works for humans. It is a sanitation and environmental issue period until someone can come up with an alternative that can be absorbed fully or pass into a degraded non-effective state which is a tall order given that even penicillin couldn't. That is also an issue for birth control medication but it is accepted as generally 'environmentally worth it' compared to the costs of increased r-strategy population growth.

Although there are certain parties interested in badmouthing psychiatry at every turn out of dogma and self interest - from the obvious of Scientology and their means of control to the fundamentalist and homophobe contingent angry over their role in destigmatization and having to look for new targets. They're pissed off that gay marriage is widely accepted - saying someone was for gay marriage in the 80's doesn't make them look wacko fringe like it did then but visionary from how utterly vindicated they were. They are angry that science "didn't stay in its lane". And psychiatry is science. Even in its bad old days of abuse of electroshock and lobotomies considered a valid treatment and despite qualitative aspects keeping it from hard equations and laws the fact that they let the evidence speak and draw the conclusions - 'no society is clearly wrong here - homosexuality is not a mental illness' is profoundly science in a 'and yet it moves' way.

So the next target for their otherphobic garbage of strawmen that I sadly am not making up is that psychiatrists and liberal parents want to reassign gender and provide hormone treatments and surgical treatments at will and everyone trans is a bathroom sexual predator.

Meanwhile back in the /bad old days/ of the past when gay-bashing was relatively accepted a trans Bond girl was treated as mere trivia with perhaps a few tasteless jokes that were still better than the horrific 80's AIDS 'jokes' instead of a 'franchise ruined forever' reaction.

This wasn't meant as snapping at you but at a clear frustrating trend that I have noticed.

Hm. According to her, Caroline Cossey (the Bond girl) was more or less hounded into giving up her modelling, TV and acting career due to the backlash. Not sure it's as simple as mere trivia.

https://www.mirror.co.uk/3am/celebrity-news/transgender-bond...

Huh I didn't know that - just that it wasn't of concern. I guess it might have been a case of tolerance bubble striking.

Just because you, and some people you know, have had addiction and trauma, does not mean there is a connection, and certainly that connection is not obvious.

I have relatives and friends with serious addiction problems who had no serious past trauma (of the kind described in this article)

Introduce me to any one of these people. I can almost guarantee that every single one has some form of developmental trauma. I’m willing to be proven wrong, but after seeing a dozen ish cases up close and personal, I’m currently batting 1000.

I would bet that the reason you are unaware of the past trauma is because the individuals have chosen not to disclose it to you, due to the stigma and shame associated with opening up. Also, in the most severe cases, the core wound is generally repressed until some shock to the system causes it to be more accessible.

I'm a former heroin addict. I don't have any physical trauma i'm aware of. I don't have anything in my past that I consider to be 'emotional trauma'. I had lots of friends that were also addicts (many of whom I remain friends with to this day), some of them had various forms of trauma, but many do not.

It is definitely the case that trauma can cause addiction. However, I think it's over-reaching to describe it as the sole cause, especially when it comes to physically addictive drugs like opioids. Sometimes addiction just is what it looks like it is - the brain's neural nets finding a trivial solution to their prime directive.

First, thank you for helping fix the addiction problem by reducing stigma through the act of writing about your experience. Not trying to sound patronizing here - that takes courage and I deeply respect it.

I don’t believe I ever claimed that trauma is the sole cause. As stated in an earlier comment thread, I believe based on experience that it is the primary cause especially of the most severe cases.

I do think you bring up a good point about some substances which are so physically addictive that it might entrap people who are less psychologically vulnerable than trauma survivors.

That said, if you don’t mind me pushing for a bit more clarity here - you must have known going in that heroin is an exceedingly bad idea due to its physical addictiveness. What was it that caused you to start taking it? I am genuinely curious, not here to judge you.

I might guess based on your comment that peer pressure may have been a factor, given many friends who were addicts. But if so, what was the root cause of the insecurity that caused you to be vulnerable to peer pressure in the first place?

(If it wasn’t peer pressure, whatever it was... basically I’m just trying to understand what was the root cause of you personally making the unhealthy decision to try heroin)

> That said, if you don’t mind me pushing for a bit more clarity here - you must have known going in that heroin is an exceedingly bad idea due to its physical addictiveness. What was it that caused you to start taking it? I am genuinely curious, not here to judge you.

I may be an odd case. I started reading about drugs on the internet, on Erowid, and various forums. I started experimenting, first with psychedelics and dissociatives, but then others things as well. Eventually I discovered opioids, and I just really really liked them. I sort of didn't believe the hype about their addiction potential, thought that I was strong enough not to have that happen to me.

I also have some social anxiety, and drugs generally helped me to socialize with other people. Both by reducing my anxiety in social situations chemically, and also by having something to talk to people about that we were both interested in (drugs).

> I might guess based on your comment that peer pressure may have been a factor, given many friends who were addicts. But if so, what was the root cause of the insecurity that caused you to be vulnerable to peer pressure in the first place?

I wouldn't say it was peer pressure that got me into these things. I sought them out, consciously. That being said, you are right to ask about the root of the vulnerability, but it wasn't so much vulnerability to peer pressure as it was difficulty socializing, probably caused by my generally introverted nature. If you want to try to connect that back to trauma, you could say that I had a difficult time in middle school socially, but I think that's a fairly common experience.

> (If it wasn’t peer pressure, whatever it was... basically I’m just trying to understand what was the root cause of you personally making the unhealthy decision to try heroin)

To summarize as best I can:

  - Genuine curiosity
  - Distrust in authority and their narratives about drugs
  - Social anxiety
  - Belief in my own invulnerability, common around that age (18-21 was the time in my life)
  - Really really liking the way opioids made me feel

Thank you for sharing this.

“If you want to try to connect that back to trauma,”

Guilty as charged :-)

you could say that I had a difficult time in middle school socially, but I think that's a fairly common experience”

Okay, great. This is a real thing that I can relate to. “Trauma” may sound like too big and scary of a word for something that we almost all experience to a certain degree in school. We could call it “bullying” or “social isolation due to kids being mean”, ultimately I’m referring to the same thing: some core experience of getting hurt which stuck with you for a while.

But, I would caution you not to downplay the impact of this on your development. Speaking from personal experience, downplaying the extent is very common for survivors of trauma/bullying/etc. There’s many different degrees of “difficult” time. Me, I got punched in the face in 5th grade for standing up (verbally) to the school bully. Later in high school I was socially shunned for being a small geeky kid in a big high school where I knew nobody.

That in itself wasn’t so bad, like garden variety schoolyard bullying. But for me, again only speaking personally here, the reason why I let myself get bullied at school was because I was being bullied at home. The home situation is what led to me not having the self confidence which attracted the bullies. Or rather, the occasional possibly ill advised self confidence, which is what led to me getting punched in the face.

Anyway, it sounds like you’re in a much better place now. So thanks for sharing your perspective.

Ya, I agree, it could, in a sense, be trauma. But I think my experience was not at all uncommon. I don't think I had it exceptionally bad, and given that, I find it hard to use as an explanatory variable. If almost everyone has a certain experience, but only a fraction of those people develop an addiction, what good is it at explaining the addiction?

I like Maté's theory but I think you may be getting at its weak spot here. He uses "trauma" and "addiction" in very general senses, so general that it begins to sound surprising if there's any person on Earth who's not both traumatized and addicted.

Yea I think some people can be quick to label discomfort as trauma nowadays. Like you said, if we’re going to expand usage of a term to include whole swaths of experience, the term itself becomes less meaningful.

This is probably super rambly. I chalk it up to new parent sleep dep and make no apologies for it.

What if trauma is simply a response to discomfort we don't learn to accept and grow through?

It stands to reason that if it's a common issue and situation, not learning from it could compound over time.

I consider this to be "trauma," though I take a more expansive and meaningful take on trauma, in that I consider, for example, the lack of initiating into capitalism and the overwhelming difficulty of living a life outside of a capitalist society to be traumatic because it can keep us from meeting our need for autonomy.

In that sense, I may be considering trauma to be a chronic denial of some need (needs being defined as the minimal set of things required to thrive). Without a clear awareness of needs, then, it becomes easy to deny trauma.

I also consider codependency (which has also been said to be too broad to be meaningful) to be a form of trauma, in that it's a chronic denial of the need for interdependency.

Personally, I think expanding a term to include everyone gives everyone an opportunity to more deeply self-examine and connect with others. I find it to be a way to bring more meaning in, not less. If you judge an expansive definition as meaningless, that doesn't actually make it true for others. It'll simply be true for whoever chooses to believe it. The issue, I think, is everyone really wants to hear very specific and targeted descriptions before accepting some diagnosis. I've seen it in friends suffering from depression, anxiety, and/or addiction: until they hear someone with a story really similar to theirs, they won't allow themselves to connect. I view this as one of the reasons black-and-white thinking is so difficult to heal through/from.

> I consider, for example, the lack of initiating into capitalism and the overwhelming difficulty of living a life outside of a capitalist society to be traumatic because it can keep us from meeting our need for autonomy.

What difficulty is that? Is something stopping you from living on public land in the wilderness?

> Personally, I think expanding a term to include everyone gives everyone an opportunity to more deeply self-examine and connect with others. I find it to be a way to bring more meaning in, not less. If you judge an expansive definition as meaningless, that doesn't actually make it true for others.

It's not that it's meaningless. It's that you can't use it to explain something. If everyone has experience X and 10% of people have outcome Y, then X cannot be used to explain Y.

I would like to see the results of a double blind test - if we look for trauma we can find it; or create it: https://en.m.wikipedia.org/wiki/False_memory_syndrome

From the article:

"in his 40s and 50s, he began to unravel the root cause – and that took him all the way back to Budapest, where he was born in January 1944. Two months later, [snip] “Right now,” the doctor replied, “all the Jewish babies are crying.” This is because, explains Maté, what happens to the parent happens to the child: the mothers were terrified, the babies were suffering,

Later, Maté’s mother, fearing for his survival, left him for a month in the care of a stranger. All this, he explains, gave him a lifelong sense of abandonment and loss which had an impact on his psychological health. [snip] To compensate for his buried trauma, he had buried himself in work and neglected his family."

I get that is a truth for him, but it sounds contrived as only a psychologist can do (without more context)

As stated in the Wikipedia link you provide, so-called “False Memory Syndrome” is fake news in the sense that it is not even recognized by any psychiatric manuals (not that the DSM is necessarily a reliable guide for actual illnesses given the things that make it in there these days).

To your point: yes, humans have the ability to make up stories about anything and do so frequently. Yes, there are bad or misguided psychologists out there who may manipulate some patients into saying something that isn’t true in order to, say, boost their career. Yes, there are bad psychiatrists and social workers who do the same thing.

On the other hand, child abuse is a real thing that due to the crushing societal stigma tends to be severely underreported. It’s like sexual harassment cases, except the risks are even higher, so most people just never talk about it. Some people go insane because they never even admit it to themselves and end up dying of addiction trying to fill an un-fillable hole.

Meanwhile, people talk about False Memory Syndrome like it is a problem of the same magnitude. It isn’t.

I certainly didn't wish to imply that abuse and trauma don't exist (don't we all have friends and family with horror stories?). And it seems obvious enough that trauma and abuse has hideous effects on people, including addiction.

I certainly can believe he was sad at 2 months old, for the reason given. I just find it unbelievable that that sadness became "buried trauma" that could be held in part responsible for neglecting his family later in life.

I originally said "if we look for trauma we can find it" which I wished to be the main point.

Dealing with trauma generally involves intensive therapy - maybe attention and help are the key - not finding "buried" trauma. E.g. the facility I am obliquely familiar with has a patient to staff ratio of 2:1, and is intensely into talking with patients.

Can you direct me to the facility you are familiar with?

Are you in New Zealand?

some form of developmental trauma

Depending on how you define that, doesn't nearly everyone have some form of developmental trauma? Is there really such a thing as a perfect childhood with no trauma whatsoever? Isn't going to puberty itself already enough of a traumatic experience for a lot of people out there?

I can guarantee that there are many people who have no past trauma who have addiction. I can't say exactly how common it is (it may be a minority for all I know), but I know for a fact that they are there.

I hypothesize that occasionally the trauma is being in the wrong social environment; being peer pressured in to something that digs in hooks.

I’m sure there are some of them out there. The world is a big place. My point is, the vast majority of serious cases can be traced to developmental trauma.

> the vast majority of serious cases can be traced to developmental trauma.

Citation needed.

Let me qualify that: every single case I have personally encountered, which is on the order of a dozen, can be traced to trauma. I’m making an educated guess about the wider prevalence. Getting societal scale data is practically impossible for many reasons including privacy. However, for those looking for some data points, I’m sure Gabor Mate’s book mentioned in the original article is full of examples. The most convincing academic references I am aware of at this time is are Dr. Bessel van der Kolk (“The Body Keeps the Score”, focused on PTSD) and Christine Courtois’s books including “Treatment of Complex Trauma“ and “Healing the Incest Wound”, both of which cite a large amount of research literature.

Lack of purpose itself can be a low-key trauma in itself. As infamously seen by the opiate epidemics. Their parents may not have been beating them but a sense of no future can still be damaging.

We're looking at emotional abuse, not physical abuse. Trauma isn't necessarily being beaten half to death by your parents, it's also having nurturing and support purposefully withdrawn, or being made wholly unavailable.

A kid can feel neglected and abandoned because they might have food and a roof over their head, but they're not getting nearly enough hugs and cuddles as they need. Or they grow older and they're not given any trust, the parents assume the worst intention the whole time and the kid becomes a scapegoat.

Or it's applied so inconsistently that you don't even know what's right and wrong, because you do one thing one day and it's praised and you do it the next day and you get your ass beaten for it.

It's not the sense of no future, it's the lack of nurture and care. And it festers because there's this whole belief that parents know best. The kid knows a damn lot too and needs to be heard.

I'm aware that emotional abuse can be quite damaging as well - despite how I may have phrased it poorly. I meant it more 'less than obvious' than emotional didn't matter.

Still that is interesting and I wonder if it maps well to the rates of depression with the rise of paranoid helicopter parenting or if that is a spurious correlation in itself. I have remarked that parents these days seem to consider it /ideal/ to be acting like they are antagonists of a YA Dystopian novel where they see devices sold boasting "Track your children secretively through technology" and think "That sounds like a good idea." instead of "That sounds incredibly messed up and would be considered satire a few decades ago." It might be more of a middle class issue - I'll admit to not having intimate details across the economic spectrum.

Dr. Gabor Maté touches on many of these issues surrounding addiction. There is a very insightful interview with him on Russell Brand’s podcast: https://www.russellbrand.com/podcast/053-dr-gabor-mate-damag...

What kind of trauma results in the sort of mild addictions a lot of us have (like netflix, internet addiction)

There's a distinction between addiction and habits and conditioning and, from my personal experience, you need to understand what is making you tick there.

There isn't a mapping of trauma to protection (which may lead to addiction). You do what you can to survive in one moment and, as you grow up, your methods of survival can become much more dangerous. And what you did to protect yourself as a kid won't serve you at all as an adult.

You might be addicted to Netflix because you were brought up in front of a TV. Is that trauma? That's between you and your therapist. You might be addicted to Netflix because it drowned out the sound of your dad yelling at your mum, and it gave you an escape. That's also between you and your therapist.

There's no prescription here, you have to explore how it all was for you and then you have to process it, how you protected yourself, and how you are now.

For example, an alcoholic might rely on booze because it numbs their emotions, and in their younger years they relied on suppressing their emotions in order to not be abused. Therefore to get emotional is overwhelming.

Or for me personally, I enjoy a drink or two because I have feelings I struggle with, that I wasn't allowed to feel, and I use the alcohol to maintain that. Before I could drink, I was withdrawn and I avoided people, after I could drink, I could go out and wear a mask. By drinking, I don't allow myself to feel what is really happening in me, to process it. A huge indicator of trauma.

I believe this is one of the few ways, if not the only way, to be compassionate with yourself and what you're going through and how you try to keep yourself together in it all.

I believe the technical term is “mild trauma.”

No, but seriously, like everything it’s a spectrum. On one end you could call it “somewhat lax parenting” like occasional neglect or emotional/verbal abuse when parents are stressed out. On the other end you have severe/chronic emotional abuse, sexual abuse, brainwashing, etc.

I would also caution against the term “mild addiction”. It’s either an addiction or it isn’t. I get what you’re trying to say though. Maybe “less harmful” or “less dangerous” would be more accurate at the risk of being less concise.

those are not mild addictions at all.

Avoidance is triggered when the mind is scared and it will grasp at anything external rather than go inside. Going inside will bring you to your self and this means ego death.

Try it. Next time you observe the mind when you reach for the phone. Wait just a tiny bit and observe the emotion just under the surface noise.

Trauma can be a rapid gateway to addiction, but it’s not required. The brain will seek to repeat anything that brings with it a happy shot of dopamine.

That’s pretty much what I think. Sometimes it’s overwhelming how much emphasis is placed on trauma and addiction. It seems some people would be quick to label seeking any behavior that feels good (sex, having drinks with friends and being silly, etc.) as addiction and therefore the user must be burdened by past trauma. I have no doubts that trauma and it’s connection to addiction is real, but the distinction between addiction and “normal use” is blurry and often a meandering line.

What starts as normal use may evolve into unhealthy use and spiral out of control. Or it might just stay normal forever. Like everything, there’s a range. Sometimes the trauma is self-inflicted, in form of isolating and loneliness - and a self-destructive circle inwards. I have personal experience with this.

Those don't rise to the level of addiction any more than people foisting their control anxiety on others is 'OCD'.

They're definitely addictions to some. Internet addiction is very real.

In which case, they aren't "the sort of mild addictions a lot of us have".

> The question is, why is mainstream psychiatry still so obsessed with "curing" addiction via chemical means, as opposed to through psychology/trauma recovery?

Substance misuse treatment, especially for opioids, _must_ include medically assissted treatment or it fails. The US has a bunch of opioid addiction treatment centres that don't offer any medical assisstance at all - purely psychogical - and all the evidence we have show that they don't work.

You're right that people need a holistic package of care, and that this often isn't provided in substance misuse treatment. But I don't know any treatment in the UK that is mostly medication.

Some addictions are more socially acceptable than others. On a continuum:

Least acceptable: Meth, heroin

Most acceptable: work (SV issue)

Middle: alcohol

You could add caffeine to the most acceptable list.

Middle: porn

Because it would mean facing their own issues and actually understanding psychology instead of thinking that there's such a thing as a chemical imbalance which can act as an original source that leads to disorders like OCD, bipolar, etc., rather than it operating in the inverse direction (past action leading to internal state). In other words, it's hard for those who maintain positions by claiming to know, to admit that they don't know.

Unfortunately I agree with you. Members of mainstream western society want to take a pill to solve all their problems. And there’s an entire Pharmalogical Industrial Complex supported by countless clinicians and academics, all of whom are highly incentivized to quash any attempts to approach the problem from the only angle that has a chance of working. And why would they? They’re all getting rich and tenured.

I have seen several psychiatrists, and all of them have prescribed therapy in addition to any medication. The medication is supposed to be a temporary aid while you get fixed, and generally it is the patients who only take the medication.

Right. That’s what everyone says, meds are temporary. In your case, were they temporary or are you still taking them?

I took them until I finally found and went to therapist that could help. That part was significantly more difficult, many people stumble there and stick to the medication for years.

Look at us getting downvoted :)

> chemical imbalance

No psychiatrist or psychologist still believes in the chemical imbalance model.

Aside from me having definite significant anecdotal evidence to the contrary, with all humility, do you have any resources that I can study to substantiate your reply so that I can confirm what makes you say this?

Pills are relatively cheap compared to psychologist time so are sometimes dispensed without therapy to cut costs (some state MedicAid programs were notorious for this - their clients were lower income thus uninformed and powerless).

>> never learned healthy self-soothing rituals. Can you talk more about the rituals you learned ?

In no particular order: breath meditation, bullet chess, exercise, sauna, Netflix, pizza, friendship, and deep house. Mostly bullet and deep house, if I’m being honest.

>mainstream psychiatry still so obsessed with "curing" addiction via chemical means, as opposed to through psychology/trauma recovery?

Because that method can't be scaled and monetized, so it can't pay for its own political representation.

Of course it can be scaled and monetized.

Psychologists are experts in branding and developing models which you can apply to your clients if you buy the workbooks and get the training and gain the accreditation.

Nonsense.

Workbooks aren't therapy, and therapy cannot be mass produced.

> Workbooks aren't therapy

You may want to look at the hundreds of computer based or book based CBT courses available for one example.