It is always a bit shocking to realize how many patients with addiction have been traumatized. I made my usual rounds this morning and there were several patients who had suffered severe trauma as kids and the trauma is now coming out as rage, anxiety, depression and addictive behaviors.
One of the things that a colleague of mine pointed out about individuals with addiction is that addicts are among the only people who can comfortably hold two conflicting ideas in their head at the same time without suffering dissonance. One of my patients this morning talked about his absolute certainty that he is an alcoholic and is unable to drink, and in the next sentence toyed with the idea that having a few shots of vodka at night was not really such a bad thing for him. Clearly, the logic is absent, but the absence of logic is not evident to the patient. This ability to say two contradictory things without a problem makes family members and therapists puzzled at best and feeling helpless at worst.
Trauma and addiction allows people to create a psychic architecture that requires a lot of walls, closets, compartments and closed doors. It is okay to keep one thought in the living room, another thought in the bedroom, memories in the locked closet, anorexia in the kitchen, bulimia in the bathroom, gambling in the basement, and none of the thoughts or compulsions talk to or see each other. It even puzzles the owner of the house as to where things are and how to communicate at the right time. Generally, the thoughts leading to the dysfunctional behavior are quite stealthy and generally speak without being asked.