Based on thousands of hours of direct work with clients and my continuous commitment to ongoing training and learning, I’ve come to believe that there are four foundational causes behind most of our mental health issues and symptoms.
The two defining experiences in childhood
· Insecure attachment to a caregiver
· Being forced to sacrifice authenticity for acceptance
Two other defining issues in childhood and adulthood
· Failing to allow ourselves to feel what makes sense in the moment (and labeling emotions as positive and negative)
· Trauma, and most importantly, relational trauma
Of course, when these things go well, i.e., we have secure attachment or allow ourselves emotional authenticity, our mental health and sense of wellbeing tend to be much more healthy and adaptive.
Attachment in Childhood
It is well understood in psychology, and among developmental psychologists in particular, that the extent to which a child feels securely attached to a caregiver, usually, but not always, a parent, plays a foundational role in a host of factors that affect mental health for the remainder of a person’s life. A partial list of critical outcomes includes the ability to securely explore one’s world, a strong sense of independence, social competence, resilience and the capacity to regulate emotionally. Individuals with secure childhood attachment tend to function well across all domains of life and in future relationships. When attachment is insecure, we tend to experience substantial challenges across the same domains. Fortunately, it is possible to find some version of more secure attachment even later in life.
Authenticity vs. Acceptance
One of the greatest psychic battles of our lives, starting at birth, is the extent to which we feel compelled to sacrifice who we are in order to be accepted by the people on whom our survival depends. Some of us are fortunate enough to be mostly validated (behavior, ideas, personality) for who we naturally are, and the benefits of that are life-long. For those of us who are invalidated, or even punished, for who we are, we tend to struggle with worthiness, self-confidence and self-esteem well into adulthood. Regardless, we almost always sacrifice authenticity for acceptance if forced to choose. And children who do not surrender their authenticity also tend to pay a high price for not accommodating the wishes of key adults in their lives. As with attachment, fortunately, we can rediscover and honor our authentic selves at any point in life.
Feeling What Makes Sense in the Moment
Western societies, and American society in particular, tend to socialize us against feeling our emotions in an open, authentic way, and certainly socialize us against expressing emotion openly, particularly certain emotions in certain places. We are also taught that some emotions are good or positive and others are bad or negative. In my clinical experience, this combination is at the heart of much of the emotional distress and mental health symptoms we experience. You can see a more detailed explanation here, but the short version is that when we bury emotions, we bury them alive. They don’t go away, and when they resurface, they often come out very differently than they went in—dysregulation, rage, addiction, migraines, and over time, even illnesses such as autoimmune disorders and gastrointestinal disease. As for labeling emotions as positive or negative, we experience them differently just by labeling them. Unpleasant emotions, seen as “negative” tend to be more intense and last longer when we resist them. Similarly, we are biased toward honoring and welcoming emotions that feel good, that we label as “positive,” engendering a highly judgmental imbalance in our emotional experience. A good place to start for all of us is just to feel what makes sense in the moment. That alone, will address a lot of what ails us.
Trauma
The fourth foundational influence on our mental health and wellbeing is psychological trauma, and in particular, complex relational trauma.[1] While singular “Big T” traumatic events can certainly result in trauma symptoms, I have found that my clients who have experienced complex, relational trauma, particularly in childhood, have been emotionally and neurologically programmed by that trauma. Hyper-vigilance of the environment, particularly in the context of relationship, emotion dysregulation, anxiety, activated neurological states, and worthiness and shame issues, all tend to “follow” trauma histories.
Humans are wired for connection with others. However, if our neurological programming related to relationships is based on trauma, we get stuck between an evolutionary drive for connection on the one hand and fear of connection on the other hand. On the contrary, individuals who are not burdened with complex trauma histories are able to navigate life, including a wide variety of relationships, in much more adaptive, resilient ways and they tend to reregulate quickly when activated.
The very good news is that we have highly effective tools for treating and healing from trauma, even complex, relational trauma. Interestingly, that healing also tends to ameliorate what appear to be “free standing” symptoms such as anxiety, depression, addiction, OCD, etc., which are often just downstream products of trauma. Importantly, although treatment can not erase the fact that the trauma happened, in some cases, people can shift their relationship with trauma from post-traumatic stress to post traumatic growth or resilience.
So, much of the mental health challenges and symptoms I see in my practice are traceable to four things: insecure attachment in childhood, sacrificing authenticity for acceptance, suppressing emotion, and trauma. Of course, there are manifestations of mental illness that do not fit these etiologies (causes), but if my anecdotal experience is applicable beyond my own practice, then a whole lot of what ails us psychologically (and medically for that matter), could be addressed by focusing on a limited number of sources, both preventatively and with treatment after the fact.
[1] Some complex trauma is a product of severe abuse (sexual, physical, psychological) and therefore the symptoms of that abuse reflect deeper injury.