In his astonishing book, "Lost Connections: Uncovering the Real Causes of Depression, and the Unexpected Solutions", Johann Hari tears down the dodgy chemical imbalance hypothesis as the primary causation of high prevalence mental illness (i.e. depression and anxiety). In its place, he proposes nine common sense "causes", and seven ways for people to reconnect - both to the world and ourselves - as solutions to the rise of mental health issues. Hint: none of the solutions is pharmaceutical based. In the book, Hari makes compelling arguments for each cause of its solution, but probably the most emotional reaction he has to each of the nine causes is Cause Four: Disconnection from Childhood Trauma.
I'll give you a rough summary of this chapter (although I urge you to run and read the book). Hari meets with Dr Vincent Felitti, a doctor working in the American private hospital system, tasked with finding answers for why morbidly obese patients would still eat themselves into an early grave, even when conventional weight-loss programs appeared to briefly improving their health. So, Dr Felitti started to do something that was revolutionary in the health system at the time (and still might be in some places) - he asked questions about the history and function of the eating behaviour to his patients. What he found was nothing short of amazing... many of the patients had experienced extreme forms of childhood trauma, often physical and sexual abuse, and the eating behaviour leading to weight gain made them feel something akin to invisible or protected from re-experiencing similar abuses in adulthood. When they started to lose weight and become "healthier" using conventional weight-loss programs, they felt vulnerable and/or as Hari writes experienced "brutal depression, or panic, or rage." Logically, this makes no sense, but as I have seen time and again with trauma survivors, logic plays little role in their symptoms. What looks like chaos from the outside, and what traditional psychological approaches might call "dysfunctional", usually makes complete sense when you actually listen to the patient and seek to understand their subjective experience.
Dr Felitti later teamed with another scientist named Dr Robert Anda, and together they created a brief questionnaire, the "Adverse Childhood Experiences (ACE) Study", where
related to different traumatic childhood experiences are posed in a yes/no format. The questionnaire was later given to 17000 of the patients within the Kaiser-Permanente Health system in San Diego. The correlations from the results of these questionnaires were again astounding. For every category of traumatic experience you went through as a child, you were radically more likely to become depressed as an adult. For example, if you had six categories of traumatic events in your childhood, you were five times more likely to become depressed as an adult than someone who didn't have any adverse experiences. Surprisingly, the data showed that it was emotional abuse that was more highly correlated to depression than any other kind of of trauma (even more so than sexual abuse).
Hari goes on to argue that depression isn't necessarily an illness in and of itself, but it's a symptom of something deeper. I would argue that addiction is a similar beast, a symptom of deeper issues, rather than illness. And at this point, Hari goes into battle - with himself. You see, like a large percentage of people I've seen for therapy, Hari has his own history of trauma, and coming to terms with that fact is a very difficult part of the process for most people. The great American trauma therapist, Kathy Steele, calls this process, realisation - the ongoing action of being aware of reality as it is, accepting it, and then adapting to it effectively. And some clients show up for therapy in non-realisation, unable to grasp essential life experiences as factually belonging to their past. My experience of trauma survivors (particularly males) is that they might have some major non-realisations such as: "My childhood was fine!", "I had great parents", "I was naughty so they had to hit me!" or "The sexual abuse didn't affect me." And the reality is often that the more pervasive and entrenched the non-realisations, the more challenging the therapy is for the client. Mostly, clients have dissociated part of their experience that was overwhelming at the time of the event. And the integration of that experience, and the ramifications of the path from non-realisation to realisation can be painful.
My experience has taught me this: psychological trauma doesn't need to be extreme as childhood experience of violence to profoundly affect someone. Hari gives the example of a perfectly competent mother whose relentless negatively in childhood profoundly affected a friend of his in his adult life and relationships. This type of emotional abuse causes psychological distress to vulnerable children because we're neurobiologically hardwired to soak up messages from our caretakers and significant adults in our life. The adult causing the distress often doesn't mean to do this. They were doing the best they could in that moment with the tools they had at the time. This is never an exercise in blame because blame isn't a tool for healing. But non-realisations about these problems or explanations that don't include what happened to the person and how it actually affected the child it happened to are incomplete, because they are almost always a big part of the picture, and ultimately the solution.