You can’t force emotions; you really have to know what they are. For me, the important question is, what are the actual emotions underneath the action that are driving my behavior and where do those emotions come from? For me, it’s not a question of acting into the right emotion. It’s a question of understanding what are the source emotions from which we are acting. That is the really important question.

I completely appreciate the 12 steps, and I talk about them in my book where I have an appendix on them. I think where they fail or where they miss something is when they focus on action while tending not to look at the underlying emotions and the experiences that underlie those emotions. You can go to 12-step groups for a long time and never find out how traumatized you were. That’s where the missing piece is, and has been, for a long time.

The deep pain of childhood trauma can be the root cause of addiction.

The patients that I worked with—I’m talking about hardcore, street level drug users, people injecting cocaine and heroin and so on—not a single one of them ever came to me and said, “Doc, I was traumatized, and I’m using that as an excuse to do drugs.”

They didn’t know they were traumatized. No doctor had ever pointed it out to them. They thought they were just fuck-ups. They thought they were just bad people. They thought they were just addicts. They didn’t realize that they were using the addiction to soothe a deep pain that was rooted in trauma. In all cases of addiction that I have seen, there’s deep pain that comes out of trauma. The addiction is the person’s unconscious attempt to escape from the pain.

That’s not just my personal opinion. It’s also what large-scale studies show. In large population studies, you find that extreme trauma, whether in a population like the Native Indian population in your country or the Aboriginal population in Australia or the Native population in my country, with the loss of land, and the violence, and the forced abduction of their children, who were brought up for a hundred years in residential schools away from their families where they were sexually abused, generation after generation, there’s a huge statistical and causative link between that trauma and the addiction. That’s not a theory. It’s just reality.

Addiction is an unconscious attempt to escape from the pain of trauma.

And no it’s not only that. We also know that the brain itself; the human brain itself, is shaped by the environment. The brain is not purely genetically programmed. Brain development occurs in reaction to the environment. The necessary conditions for healthy brain development are healthy relationships with responsive parents. When the parenting environment becomes distorted or hostile and abusive, you’re actually distorting people’s brain development. This means they are going to be more likely to want to use substances to feel better in their brain in order to achieve a different state of the brain.

Whether we are talking about the emotional pain and the shame that’s at the heart of addiction or whether we are looking at the brain physiology of addiction, which is very much influenced by childhood experiences, we are looking at the impact of trauma.

To go back to the original quote about doctors, if we actually understood that all behaviors are, for the most part, coping mechanisms for emotions that we are not able to deal with, then the focus could shift not just to changing behaviors, but actually understanding the emotions that underlie them. That’s what I think is missing from medical practice. Whether it’s addictions or whatever it is, we are not seeing what’s driving it and what’s underneath it.

Brain development gets distorted in abusive and hostile environments.

Predisposition to Addiction

If a family knows that their child has a predisposition toward either addiction or depression, or both given the commonality of co-occurring disorders, what can they do to help ensure their child lives a healthy, happy and productive life?

Let’s say you don’t know anything about your child’s predispositions. What kind of childhood do you want to give your child? Don’t you want to give them a childhood in which they are loved, in which they are respected, regardless? You want to give them a childhood where they are accepted for who they are, where they are celebrated for who they are, where they can explore the world under guidance but with freedom, where they can be themselves and be happy being themselves. There is no difference in how you should want to parent one child as opposed to another child.

This is how we want to parent children, and it doesn’t matter what predispositions a child has, if they get these conditions of love and respect in their childhood, they’ll never be addicted, they’ll never get depressed and they’ll never be anxious—not in terms of the medical diagnosis of those conditions.

Love and respect in childhood helps to prevent addiction later in life.

Disease Prone Personalities

Explaining the disease-prone personality, you said, “No personality causes disease. So there’s no cancer personality. However, there are some common traits that, if they are present in exaggerated degrees, will make you more predisposed to the disease. They don’t cause it, but make you more likely to get it because they increase the amount of physiological stress you’ve got inside you…Stress is the thing that leads to disease or leads to conditions for it, but certain personalities are more prone to this stress.”

Such a concept is somewhat alien to mainstream medicine. Do you believe it can be proven? Is the idea of the disease-prone personality a philosophical supposition or a medical reality?

This is not really controversial at all because it’s a medical reality. It’s only controversial because most doctors don’t know about it. If you look at studies of patients with malignant melanomas, for example, there is no absolute cancer personality, and you explained this idea very well. But there is no one type of personality that means you are going to get this disease. That’s not going to happen. You can’t say that there’s a disease personality. But there are definitely disease prone personalities; certain personality traits that make a person much more likely to have a disease than people who don’t have that type of personality. There’s no question about that.

Personality traits like anger suppression make people more prone to disease.

It’s important to note that this tendency was discovered in relationship to malignant melanoma. People who developed malignant melanomas often tended to be people who didn’t express emotion in a healthy way and who suppressed or repressed their anger. Those are risk factors for illness. We know that. The repression of anger suppresses the immune system, as opposed to healthy expressions of anger. It’s not a question of philosophy.

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I was a physician for 33 years, and I didn’t begin with any of these assumptions. Nobody had told me about this. I just kept noticing, particularly when I worked in palliative care for seven years. We looked after terminally ill people, people who were dying of cancer, and I kept noticing and kept noticing and kept noticing that these people with auto-immune disease or with cancer typically had very tough childhoods where they survived by repressing their emotions, and that suppression of emotion was tied to their development of disease.

But I wasn’t the first one to notice this connection. It turns out that many doctors had remarked on this before. It had been noticed in ancient times; in Roman times. We are talking about doctors who go beyond just the body and are willing to look at the whole personality. They can’t help but notice that certain emotional patterns, certain personality traits make it more likely that you are going to get that disease.

Emotional isolation is a major risk factor in disease, addiction, illness and death.

It’s an observation, and whenever it’s been studied, it’s been shown to be the case. There have been many studies, and I outline many of those studies in my book, When the Body Says No, Exploring the Stress-Disease Connection. I am talking about clinical observations backed up by studies.