Breaking Trust:
Stress and Rupture
in Family Bonds
What you leave behind is not what is engraved on stone monuments
but what is woven into the lives of others.
—Pericles
Love and attachment are the primary forces that ensure life; without these powerful mind/body drives, none of us would be here. How we learn to love in our early relationships forms the template for how we love throughout our lives.
Much of our brain and neurological development takes place outside of the womb after birth and continues throughout childhood through the parent/child relationship. The endless tiny communications and collaborations between parent and child, each cuddle and coo, actually shapes our brains and our nervous systems. Children do not have the capacity to regulate their own emotions but depend on an “external regulator,” such as the parent, to woo them back to a sense of balance when they become distressed (Greenspan 2000). When a child becomes agitated, she has an inborn instinct to reach for her parent to lift her up and rock her back into a state of regulation, to soothe her stressed little nervous system, and help her to restore emotional balance.
“The child’s first relationship, the one with the mother or father, acts as a template, as it permanently molds the individual’s capacities to enter into all later emotional relationships,” says Alan Schore, assistant clinical professor in the Department of Psychiatry and Biobehavioral Sciences at the UCLA School of Medicine (Schore 1991). As the parent interacts with the child, the child learns the skills of relating and self-regulation.
According to Schore, when the portions of the brain responsible for attachment and emotional control are not sufficiently stimulated during infancy because the infant is neglected, these sections of the brain will not develop properly. This can result in a child who is impulsive, emotionally unattached, or possibly even violent. The sensitivity and responsiveness of a parent actually stimulates and shapes the nerve connections in key sections of the brain responsible for closeness, attachment, emotional regulation, and well-being.
How We Absorb and Develop
Skills of Self-Regulation
Discussions on parenting these days circulate less around what parents do to children and more around how parents are with them. The “space” between parent and child is what really counts. Sound emotional and psychological development are now understood to be related to the quality of the connectedness, attunement, and continuous interaction between the child and his or her primary caretakers. “Our nervous systems,” says scientist Daniel Stern, “are constructed to be captured by the nervous systems of others, so that we can experience others as if from within their skin” (Stern 2010). This is our biological basis for empathy and emotional connection. Nature designed us to have this emotional attunement so that we can fit into the clan effectively and efficiently picking up on signals from those around us, adjusting our behavior and adapting it accordingly.
A baby’s head is far too large to make it through a mother’s pelvis at birth; consequently, much of our brain growth (and hence brain/body neurological growth) takes place outside the womb throughout infancy and childhood. Children are born into this world only partially hardwired by nature for self-regulation; nurture does the rest. Through each tiny, soothing interaction with caregivers, children absorb the skills of self-regulation from their mothers and fathers and internalize them as their own. Children internalize and incorporate regular routines, a calm environment, and a soothing touch and voice, and all of these sense experiences sink into the child’s limbic system and their body clock. Through the acquisition of these actual experiences of self regulation, a child is able to learn to regulate their emotions and other basic functions such as mood, appetite, libido, sleep, motivation, and capacity for bonding. These skills of emotional/self-regulation are what allow us to move from extremes in thinking, feeling, and behavior toward balance in all of these areas. (Schore 1994).
Parents instinctively rock, coo, cuddle, and sing to their children to help them to feel safe and calm. When children are distressed, being held and reassured allows them to internalize the felt sense of tolerating or “living through” overwhelming emotions until calm is restored. Over time, children internalize the ability to “hold” their own, powerful emotions; in other words, they develop the skills of emotional regulation.
Nature Favors Connection Over Disconnection
Touch is the language of childhood. Parents and children who are held in a mutual embrace each experience that magic sensation of body chemicals that calm and nourish. Touching our children is like watering a plant; touch releases oxytocin—nature’s “brain fertilizer”—into their bloodstreams and, as a bonus, into the parent’s bloodstream as well. Touch also floods the child’s and the parent’s body with serotonin, the body’s natural antidepressant that soothes and regulates moods. “Hugs and kisses during these critical periods make . . . neurons grow and connect properly with other neurons,” writes Dr. Arthur Janov in his book The Biology of Love (2000). These hugs and kisses not only nourish the body of the child so that he or she can grow properly but they simultaneously nourish the parent’s body. Both are calmed and soothed. It is physically and emotionally heart smart, good for the body, the emotions, the soul, and the soul of the relationship. Nature rewards caring and close connection with body chemicals that make us feel good and punishes disconnection by flooding our bodies with uncomfortable stress hormones that make us feel bad, like cortisol. Alan Schore has demonstrated that cortisol, which floods the brain during intense crying and other stressful events, actually destroys nerve connections in critical portions of an infant’s developing brain (1991). Evolution ensures, through the chemicals of connection, that parents and children maintain sufficiently powerful and close bonds so that children will make it safely to adulthood. And it uses chemicals of disconnection to seal the bargain. Abandonment hurts.
Child researcher Megan Gunnar and her colleagues found that three-month-old infants who received consistent responsive care produced less cortisol than infants who had received less responsive care. When tested again at age two, children who were classified as insecurely attached continued to show elevated levels of cortisol, continued to fall into the less securely attached group, and appeared more fearful and inhibited than their more securely attached counterparts. Dr. Gunnar’s findings reveal that the level of stress experienced in infancy permanently shapes the stress responses in the brain, which then affect memory, attention, and emotion (Gunnar et al 1996; Gunnar 1998). Babies and toddlers may be better off with plenty of closeness and touching; like little puppies, they want to be on top of each other, and like all animals, they feel more secure and even learn valuable social skills through this interactive touching and play (Panksepp 2003).
Effects of Childhood Stress
Understanding the nature of these powerful attachment bonds helps us to wrap our minds around why the threat of rupture between parent and child, which is an ever-present concern of the CoA, causes such stress. Addicts abandon their children whether they love them or not; when they are in the throes of using, their substance comes first. Because parent/child bonds are survival bonds, threatening them through the trauma of neglect, mental illness, addiction, or divorce can cause us to experience that rupture as traumatic. Children want to stay close to their parents and may even join their parents in a compulsive habit (process addiction) such as overeating so they don’t feel on the “outside” of a behavior that disturbs, confuses, or abandons them.
Rejection can actually hurt physically. We use words like “broken heart” or “heartache” to describe the physical pain of rejection. “Social rejection activates the very zones of the brain that generate, among other things, the sting of physical pain . . . our brain’s pain centers may have taken on a hypersensitivity to social banishment because exclusion was a death sentence in human prehistory” (Eisenberger, Lieberman, and Williams 2003).
We are wired to want to imitate, model, and belong. When children of alcoholics/addicts fear abandonment by their primary caretakers, they can feel that their very lives are at stake.
Long-Term Effects of Toxic Stress During Childhood
The Adverse Childhood Experiences (ACE) study is one of the largest studies ever conducted on the relationship between maltreatment in childhood and long-term effects on health and well-being, and it tells us much about the CoA experience. The ACE study is a collaboration between the Centers for Disease Control Prevention and Kaiser Permanente, an integrated managed-care consortium based in San Diego, California. The ACE study found that the risk factors that constitute “toxic stress” and contribute to long-term physical, emotional, and psychological health were surprisingly common. The 2006 study, led by Robert F. Anda, MD, MS, and David W. Brown, DSc, MScPH, MSc, included more than 17,000 health maintenance organization (HMO) members who underwent a comprehensive physical examination that provided detailed information about their childhood experiences of abuse, neglect, and family dysfunction. This study quantifies the long-term effects of cumulative childhood toxic stress from growing up with addiction and/or other types of adverse experiences during childhood.
The researchers were not looking toward family addiction as a unique risk factor in their study design. Rather, parental addiction and the dysfunctional behaviors that clustered around it kept emerging through the collection of data as one of the statistically most significant causes of mental, emotional, and physical health problems in adulthood. People with high ACE scores who experienced the cumulative effect of growing up with a cluster of adverse childhood experience tended to be those who fell into the healthcare and penal systems in adulthood because their childhood stress was more than their brain/body could process. And the people who might have helped them to ameliorate their stress were often the ones causing it, or they were too overwhelmed with their own stress to be helpful to their children.
Why Childhood Stress Has a Long-Term Effect
Dr. Anda describes why ongoing, traumatic experiences such as growing up with addiction, abuse, or neglect in the home can have such tenacious effects. “For an epidemic of influenza, a hurricane, earthquake, or tornado, the worst is quickly over; treatment and recovery efforts can begin. In contrast, the chronic disaster that results from ACEs is insidious and constantly rolling out from generation to generation.” If the effects of toxic stress are not understood so that children can receive some sort of understanding and support from home, school, and community, these children simply “vanish from view . . . and randomly reappear—as if they are new entities—in all of your service systems later in childhood, adolescence, and adulthood as clients with behavioral, learning, social, criminal, and chronic health problems” (Anda, Felitti, et al. 2006).
ACEs Are Common
Contrary to the myth that adverse childhood experiences do not happen as frequently in middle- or upper-middle-class homes, toxic ACEs occur regularly and throughout all social classes and races. Dr. Anda feels that society “has bought into a set of misconceptions.” Some of those myths are that “(1) ACEs are rare, (2) that they happen somewhere else, (3) that they are perpetrated by monsters, (4) that some, or maybe most, children can escape unscathed, or if not, (5) that they can be rescued and healed by emergency response systems” (ibid).
In the ACE study, 94 percent of those studied had gone to college and lived in San Diego, a very nice and not inexpensive area to live in, and had access to excellent health care. But even in this population, adverse childhood experiences were common.
The ten Adverse Childhood Experiences studied were:
• Childhood abuse
• Emotional/physical/sexual abuse
• Emotional or physical neglect
• Growing up in a seriously dysfunctional household as
evidenced by witnessing:
—Domestic violence
—Alcohol or other substance abuse in the home
—Mentally ill or suicidal household members
—Parental marital discord (as evidenced by separation
or divorce)
—Having a household member imprisoned (ibid)
Adverse Childhood Experiences
Don’t Occur in Isolation
If a CoA grows up with addiction, that is probably not the only risk factor in the home. ACEs tend to cluster; once a home environment is disordered, the risk of witnessing or experiencing emotional, physical, or sexual abuse rises dramatically. Anda and his team learned that ACEs tend to occur several at a time. CoAs are statistically likely to also have several other co-occurring issues from the above list. For example, addiction is statistically likely to be accompanied by abuse, neglect, or emotional, physical, or sexual abuse.
High Cost of Ignoring Family Pain
In a recent edition of Addiction Report, researchers report that family members of alcohol and drug patients had higher average costs per member-month and average overall costs, including psychiatric and alcohol and drugs, AOD than control family members; they also had almost five times higher psychiatry/AOD costs and more than twice the ER cost. For both groups, more than 40 percent of total costs were attributable to in-patient stays” (Weisner, Parthasarathy, Moore, and Martens 2010).
According to Lewis D. Eigen of the National Association of for Children of Alcoholic (NACoA), “This means that a family of four would have $40,000 in excess medical costs from illnesses and emergency room visits. These do not include other social service costs, social welfare costs, law enforcement, education, and the like. Also, the costs are in constant dollars, so if there is typical inflation, the numbers would be larger. Historically, with medical inflation, we are looking at about $80,000 over a twenty-year span. Sis Wenger, NACoA’s CEO reflects that “We cannot afford to ignore the problems of CoAs, either financially or morally.”
Dealing with Toxic Stress
Dr. Anda refers to “dose and effect”; the more numerous the toxic stress clusters, the more serious and long term the effect and the higher the chance of getting involved in alcohol or drug use. There is also a higher risk for other issues, including having risky sexual behavior; STDs; contracting HIV from injected drug use; suffering from pulmonary disease; smoking-related lung disease; autoimmune disease; poor adolescent health; teen pregnancy; and mental health issues. There is also a higher risk of revictimization, instability of relationships, and poor performance in the workforce.
To deal with what constitutes a national health crisis, we need to reduce the toxic stress load on our developing children. It is very expensive to help people who fall into the healthcare system and the judicial system and improve their outlook once the effects of toxic stress have set in. Much simpler and less expensive is to change our parenting and educational practices and reduce the effects of toxic stress on the developing child. Rather than wait for diseases to develop and then address them one at a time in adulthood, Anda feels that we need to look at the child-rearing practices that create the kind of toxic stress that undermines long term health and resilience (Anda, Felleti, et al. 2006). The kind of toxic stress that pounds away at our autoimmune system in childhood and all too often results in fully developed disorders as adults.
No situation need be inherently traumatic. How we experience the circumstances of our lives determines whether or not we find them traumatizing. The presence of caring adults who help children decode the ever-unfolding situations of their worlds is a great protective buffer for the child. Without this reassuring presence, the child has no way of knowing whether or not to be scared, or how scared to be.