Adam Blatner

The following are thoughts stimulated by reading a book by my friend Tian Dayton, who recently published The ACoA Trauma Syndrome: The impact of child pain on adult relationships, (2012, Deerfield Beach, FL: Health Communications Inc.).  The book notes that substance abuse affects not only the person involved, but often the family members, and offers ideas about how the family members may engage in a healing process later in their lives. Dr. Dayton has written several books about psychodrama and related topics, and has been a pioneer in the field of the treatment of substance abuse.

Several ideas occurred to me. First, people with significant psychiatric disorders—not only those who fulfill the diagnostic criteria, but also the several-times-greater number who qualify as “sub-clinical”—not fulfilling all of the required symptoms or signs, but those who partially fulfill all or fulfill only some—also, by their dysfunctional behavior, may well have disturbed and even traumatized family and friends. A corollary is that for everyone with a full diagnosis of not only substance abuse, but often many other psychiatric disorders, there are many more with a partial diagnosis. In addition to this disorder manifesting in various dysfunctions in the life of the “identified patient,” their behavior impacts others’ lives. No, more than “impacts”—these situations often result in traumas that can range from mild to severe and acute to chronic. As a result, the children and other relatives have scars and conflicts and secondary patterns that merit healing.

The second point is that for all the trouble made by recognized addictions, there is a good deal of trouble caused by other types of non-recognized “addictions,” entrenched patterns, destructive or excessive “habits”—imposing stress or trauma on children or other family members as well as for the identified “patient.” This applies also to the families of those with diagnosed or un-diagnosed major mental illnesses, paranoia, depression, schizophrenic tendencies, bipolar disorder (manic-depressive) tendencies; severe character disorders such as narcissism, histrionic personality, or obsessive-compulsive disorder; severe neuroses; and the many patterns exhibited by those with post-traumatic disorders—e.g., veterans, refugees, etc.

A third point is that I view degrees of stress-affliction-trauma as a continuum that involves a number of circumstances—age, degrees of resilience, frequency and intensity of the stressor, how much it’s compounded by other factors or other stressors, and so forth. And my point is that even if what was experienced by a child of someone with addiction or any of the other significant mental disorders might not qualify as a full “trauma,” it may have generated sufficient reaction patterns as to become a problem later in life. (In thinking about my own life, I question how much what I suffered would qualify as “trauma.” However, I don’t doubt that there were a number of events that were more than mere stress—I call these “afflictions.” And they made me a bit neurotic, and I’ve had to spend time working them out. Nor do I claim to be entirely free of all of these “afflictions,” though, to paraphrase Ram Das, they are “smaller.”) 

So, back to the consequences of various kinds of psychopathology on the family. Most people who were in such families—and that’s a goodly part of the population—have turned out okay, not themselves suffering from a fully diagnosed condition. But most of these folks, people who have coped, seem “normal” to their peers, earn a living, marry and have kids, etc.—most are scarred. They have more than a little residual wounding, and these wounds affect they feel about themselves and treat those close to them. They are good candidates for healing. They may or may not qualify as “disordered” according to the official diagnostic manual, but they suffer, and they make their family in turn suffer.

Interestingly, most of these folks have enough good ego strength to benefit from some reparative therapy. This therapeutic process may or may not be named as such. For some it happens in a personal development or growth workshop, a group experience structures so that adults can work through residual complexes, wrong understandings, and tendencies to act out in this way or that. Some are more grumpy, others are “too” nice, maybe even tending to be “doormats.” Some have carried on a few of the behaviors of their dysfunctional parents; others have over-done trying to be the opposite; and often there’s some mixture of these elements. Whatever, some re-thinking and re-processing is in order, some re-evaluation of their own behavioral repertoire and re-adjustment so that it’s more life-affirming for themselves and others.

It is in this sense that a goodly percentage of the population might benefit from “cleaning up unfinished business” in a personal-growth process. It’s not the same as saying that everyone’s “neurotic,” with the implication that long term, expensive, one-to-one therapy is indicated. But in another sense, well, everyone I’ve ever met has at least a few quirks and kinks that can be potentially upgraded to a looser, more flowing, positive adaptation. I’ve come to the opinion that this should be recognized as part of the work of mid-life and beyond. Many people have learned how to function and seem “normal,” and now it’s time to refine the skills so that one progresses from mere normality to what I call “flourishing.” Another way to say this is that personal development needs to be imagined as progressing beyond the medical model, but we can all benefit from weaving a kind of self-awareness and maturational process into our lives.

Another point I like about Dr. Dayton’s book—and some others that use psychodrama as one of the methods—, is that psychodrama is not a solo approach. It often works best when it is embedded in a program that also uses other methods and ideas. Some mix it with cognitive-behavior therapy; some mix psychodrama with elements of spirituality and other components in the “Therapeutic Spiral Method” of repairing personal emotional, sexual, or other types of trauma in people’s lives.

This fits my thinking that psychodrama should be recognized as an approach that needs to be integrated with other types of consciousness raising rather than as something apart. I liken it to surgery, which ideally must be used as an intervention that needs to be accompanied by all sorts of pre-care, post-care, and during-care: transfusions, antibiotic, nursing, physical rehabilitation, various medications before or after, education (including family members), and so forth. Some of these, if ignored, can undo the effectiveness of the whole enterprise, so they are not elective— they are really important. So, too, in psychotherapy, there are many components that include education, opportunities to practice new behaviors, catharsis, moving on to another deeper problem, and so forth. Psychodramatic methods can be helpful for some of these components, less so for others, and the point is that the focus needs to shift from what is the method to the coordination of various methods as befits the needs of a given client at a given point in the healing. Weeks earlier or later a different combination may be more appropriate.

This contrasts to the image of psychoanalysis, which goes on for months or years—seemingly the same process. In fact, even there the actual issues and procedures are rather different in the early, mid, and later phases of the process, and this difference is even greater for other approaches. Nor are they at all the same for all—each client merits an individuated approach.

We must not ignore the not-infrequent occurrence of an unexpected twist appearing, either because the client consciously or unconsciously withheld it during the initial evaluation, or it wasn’t appreciated as a factor, or something came up as the client began to change in therapy. These things then require an adjustment of the formulation if not the diagnosis itself. The point here is that the therapeutic process is dynamic and shifting rather than something that can be imagined as a x-diagnosis = y-treatment overly simplistic formula.

So, touching back to the book that started this discourse, Dr. Dayton’s discussion has elements that may be applied for the children of many kinds of neurotic and character-disordered parents—which may end up meaning most of us. This doesn’t imply that we all need “therapy” as it was imagined a generation ago; but it does imply that most people might well benefit from some personal re-evaluation and re-decision as a normal part of what mid-life was about. I see this as overlapping with a similar recognition that most folks might benefit from an opportunity to re-evaluate their spiritual or philosophical basic assumptions, again in the service of liberation.

What if “salvation” wasn’t a one-time event, but rather involved a thousand little peelings back of thin and not-so-thin layers of personal misunderstandings, defensiveness, old habitual reactions, blocked and absent awareness, and so forth, and that this occurred for most people over a period of thirty to forty years or forever, after the age of twenty-five? In summary, I would like to see a process of self-healing become a normative part of mid- and later life—just something else to do. It fits with the ideas of Erik H. Erikson who wrote about the last phase of life being one of finding integrity—and to me, integrity means integrating, tying together, the what has it all been about?!