Why Punish Pain?
Drugs affect the brain by binding to receptors on nerve cells. Opiates work on our built-in receptors for endorphins—the body’s own, natural opiate-like substances that participate in many functions, including regulation of pain and mood. Similarly, tranquilizers of the benzodiazepine class, such as Valium, exert their effect at the brain’s natural benzodiazepine receptors. Other brain chemicals, including dopamine and serotonin, affect such diverse functions as mood, incentive- and reward-seeking behavior, and self-regulation. These, too, bind to specific, specialized receptors on neurons.
But the number of receptors and level of brain chemicals are not set at birth. Infant rats who get less grooming from their mothers end up with fewer natural “benzo” receptors in the part of the brain that controls anxiety. Brains of infant monkeys separated from their mothers for only a few days are measurably deficient in dopamine.
It is the same with human beings. Endorphins are released in the infant’s brain when there are warm, non-stressed, calm interactions with the parenting figures. Endorphins, in turn, promote the growth of receptors and nerve cells, and the discharge of other important brain chemicals. The fewer endorphin-enhancing experiences in infancy and early childhood, the greater the need for external sources. Hence, a greater vulnerability to addictions.
Chronicles of Pain
What sets skid row addicts apart is the extreme degree of stress they had to endure early in life. Almost all women now inhabiting “Canada’s addiction capital”—as the Downtown Eastside of Vancouver has been called—suffered sexual assaults in childhood, as did many of the males. Childhood memories of serial abandonment or severe physical and psychological abuse are common. My patients’ histories are chronicles of pain upon pain.
Carl, a 36-year-old Native man, was banished from one foster home after another, had dishwashing liquid poured down his throat for using foul language at age 5, and was tied to a chair in a dark room to control his hyperactivity. When angry at himself he gouges his foot with a knife as punishment.
But what of families where there was not abuse, but love; where parents did their best to provide their children with a secure, nurturing home? After all, addictions also arise in such families. The unseen factor here is the stress the parents themselves lived under, even if they did not recognize it. That stress could come from relationship problems or from outside circumstances such as economic pressure or political disruption.
The most frequent source of hidden stress is the parents’ own childhood histories that saddle them with emotional baggage they are not conscious of. What we are not aware of in ourselves, we pass on to our children. Stressed, anxious, or depressed parents have great difficulty initiating enough of those emotionally rewarding, endorphin-liberating interactions with their children. Later in life such children may experience a hit of heroin as the “warm, soft hug” my patient described: What they didn’t get enough of before, they can now give themselves through a needle.
The U.S.-based Adverse Childhood Experiences studies have demonstrated beyond doubt that childhood stresses, including factors such as abuse, addiction in the family, a rancorous divorce, and so on, provide the template for addictions later in life. It doesn’t follow, of course, that all addicts were abused or that all abused children become addicts, but the correlations are inescapable.
If we look closely, we’ll see that addictive patterns characterize the behaviors of many members of society, including high-functioning and respectable citizens. As a workaholic doctor, I’ve had my own non-substance addictions to feverish professional activity and also to shopping. In my case, I can trace that back to emotional losses I suffered as a Jewish infant in Nazi-occupied Hungary during the last years of World War II. My children, in turn, were subjected to the stresses of a family headed by a workaholic father who was physically present but emotionally absent.
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Feeling alone, the sense that there has never been anyone with whom to share their deepest emotions, is universal among drug addicts. That is what Anna had lamented on her wall. No matter how much love a parent has, the child does not experience being wanted unless he or she is made absolutely safe to express exactly how unhappy, or angry, or hate-filled he or she may at times feel. The sense of unconditional love, of being fully accepted even when most ornery, is what no addict ever experienced in childhood—not because the parents did not have it to give, but simply because they were too stressed, or overworked, or beset by their own demons, or simply did not know how to transmit it to the child.
Addicts rarely make the connection between troubled childhood experiences and self-harming habits. They blame themselves—and that is the greatest wound of all, being cut off from their natural self-compassion. “I was hit a lot,” 40-year-old Wayne told me, “but I asked for it. Then I made some stupid decisions.” And would he hit a child, no matter how much that child “asked for it,” or blame that child for “stupid decisions”? “I don’t want to talk about that crap,” said this tough man, who has worked on oil rigs and construction sites and served 15 years in jail for robbery. He looked away and wiped a tear from his eyes.
Gabor Maté adapted this article for Beyond Prisons, the Summer 2011 issue of YES! Magazine, from his book, In The Realm of Hungry Ghosts: Close Encounters With Addiction. Gabor is a Vancouver physician.
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