They’re doing it for the attention.
It’s a refrain uttered everywhere, as people attempt to explain why troubled adults, adolescents, and children behave the way they do. Overused and indiscriminately applied, doing it for the attention has bothered me since I was a trainee in child psychology. Surely, humans do what they do for a wide range of reasons. And if someone is crying out for attention, don’t they deserve—need—us to notice? To attend?
Instead, seeking attention from others is all too often reviled. It’s dismissed as indulgent, considered a reward for undesirable behavior, a reinforcement of disavowed emotion. So, we stop being curious about others’ internal experiences — disconnecting from what they know, feel, need, want, fear — and, necessarily, we disconnect from our own. Rather than noticing, bringing attention to what’s happening inside no matter how confusing or intense or messy, we learn to turn our attention away. We numb, avoid, put aside. It feels safer to stop noticing. If we don’t give it attention, we can make it disappear or pretend it’s not real.
Not so in the process of EMDR therapy. There, the words, “Just notice,” are the foundational guideposts.
“Just notice,” we therapists say. “Let whatever happens, happen.” We may repeat this mantra countless times a day-- a reflex woven into procedural memory as we support clients dealing with trauma.
Just notice? The mother wonders, just notice what?, as she stands over the warming bed of her two-pound baby in the NICU. She tries desperately, silently, to notice what the nurse is showing her about her newborn baby’s skin tone. What if I never get it? she thinks. What if my ability to notice what’s important is broken?
“…and let whatever happens, happen,” we say, as the newly bereaved parent of a baby who died at birth looks at us with wide eyes.
“Let whatever happens, happen? I can’t just notice. I can’t trust my judgment. Just look at this baby, who my body failed, who I have failed…”
We say these words because we know that the key to healing begins with simply noticing. Pay attention. Be curious, see what happens next.
But it’s a catch-22. Trauma fractures our natural ability to notice. It disrupts our capacity to access that calm curiosity that allows us to stay connected to what’s happening inside. Bringing our attention to pain, even though it’s uncomfortable, seems to be essential to recovery. It’s as if we need people to be healed in order to access the healing.
Fortunately, as in all relational psychotherapy, EMDR therapists offer our attuned presence as scaffolding and support as people begin to turn their attention to their internal world. With EMDR therapy, we provide precisely the sort of nuanced appreciation for the ebb and flow of thought and feeling, somatic sensation, and memory that parents must bring to their babies and that, especially in the face of disruptions on the road to parenthood, can seem both frightening and out of reach.
It goes something like this:
As you bring your attention to yourself, just noticing, I will help you. I will notice with you. I will notice the subtle changes in your skin tone, as your cheeks redden and clear, as the tears rise and fall. I will note your breathing and breathe with you. I will not turn away from your fear or your pain or your anger. My nervous system will listen to the rhythms coming from yours. I will notice and then you can notice, too.
That subtle sensation, that flickering emotion, it all matters. “Notice that,” we say, inviting gentle curiosity, remaining just as engaged and attentive as when tears are flowing. “What are you noticing now?” we ask. So often, language is elusive but the emotion, the emergent shift, is palpable and so we lean in. “Just notice it,” we say, affirming that it exists even when it can’t yet be articulated. “That blossoming warmth? That stab in your chest? Just notice it. And when you do, when you let whatever happens happen, we will notice together. We will know its truth and meaning together.”
This is how we walk with our clients into the process of EMDR therapy where everything they notice, no matter how subtle, counts, not just the sobs or the searing flash of memory. It’s also how we accompany bereaved and traumatized parents into the new world born in the face of perinatal trauma. We notice the shrapnel causing pain and blocking healing. Just as important, we nourish and support the gradual creation of connective tissue that forms the foundation of a new sense of self: as a parent to this baby within the matrix of relationships, within this family.
All of it, every single nuance, counts.
“My baby only spent a few days in the NICU,” said one father to me in response to a call for interviewees for our book. “Are you sure you want our story?” “Our baby died,” whispered another. “Do you really want to interview us?”
It’s a common concern that parents express to therapists. Does it count? Does our experience really matter? Even if my baby is fine now, or if there are no marks on my body to prove that we’ve walked through the fire or no living baby to parent after all we endured? Do I have permission to notice what this means to me, how it actually feels? And if I do notice where it hurts, can I show you? Will you pay attention?
So we sit across from the families who land in our offices-- parents unmoored from what they used to know about themselves, about babies, pregnancies, and the way the world is supposed to work when you’ve followed all the rules, and we pay attention. We notice and most importantly, we trust what they notice. We show them with our engaged, calm presence, staying out of the way but staying.
If we’ve been fortunate to become a parent to a full-term, healthy baby, conceived, gestated, and born without incident, it can be challenging to learn to decipher these signs of dislocation and the consequences. When the road to parenthood has been pitted with earthquakes and storms, parents cannot trust in what once seemed natural and easy. Without that steady sense of “I can figure this out,” or “everything will be okay,” parents feel unmoored and may desperately turn to others to steady themselves.
They often turn to professionals, like us.
And yes, they are doing it for the attention.
And in fact, they benefit when we pay attention-- when we see them as they are, validate their experience of their journey, acknowledge their pain, and accompany them as nonjudgmental witnesses. Our attention is what helps them learn to notice both the obvious and the nuanced and let what happens happen. Our attention is what helps them regain feelings of confidence and competence. Gradually, they begin to believe in themselves as parents, including, “I can learn to read this baby’s cues,” or, “I can trust my sense that something is wrong (or right) with myself or my baby,” or, “My pain counts even though other parents are experiencing a grief and fear I can’t even fathom.” Or even, “I feel love and hope and joy even though strangers glance at my baby and turn away,” or, “I am a loving parent even though my baby died.”
Our attention validates these truths. Noticing them guides our clients to turn their own attention back to their lived experience in all its mess and meaning. Only then can they weave together the strands of their experience, appreciating them all as part of a larger whole.
Addiction is a dissociative response. Sounds like common sense, right? For many years we’ve operated in our practices fueled by this assumption. As individuals in personal recovery, the link between unhealed trauma/dissociation and addiction has been blatantly obvious. Even when we share our work with people on developing this new model of Addiction as Dissociation, we are met with a great deal of, “Well yeah, obviously.”
Yet the reality is that no contention in the literature has been directly made addressing this link… until now. The connection between unhealed trauma and addiction has been well asserted, with giants in the field like Gabor Mate, Bessel van der Kolk, and many others speaking to this link. What about dissociation? Dissociation comes from the Latin word meaning to sever. When an experience or a moment becomes too overwhelming for a person’s system to handle, we have a tendency to sever from that present moment, or from our core self. Dissociation is a very normal response of the brainstem that can activate when we are met with overwhelming distress. Dissociation can be adaptive (e.g., spiritual pursuits, proper use of guided imagery, daydreaming, the Netflix binge when you need to decompress) or maladaptive. When the manifestations of dissociation are maladaptive, they are likely to cause functional impairment. The various signs and symptoms of addictive responses can be examples of this phenomenon. Moreover, maladaptive manifestations of dissociation result when traumatic experiences or stressful events have not been processed and reconsolidated.
Both of us have been working very hard in 2019 to scour the literature and create a model that we are now calling Addiction as Dissociation. Regardless of your adopted stance on addiction (e.g., a disease, a response to trauma) or whether you even like the word (i.e., you may prefer behavioral compulsivity), this model will likely be relevant to your practice. We’ve prepared a table version of the model that you can examine in this blog. You are welcome to share it and we also value your comments on what resonates and what may still need refinement. Our scholarly paper that fully supports the contentions and flow of the model is currently under review and we will keep you posted about the more formal debut of this model to the world.
If there was a category in my high school yearbook for “Most Likely to Become a Junkie,” I would not have been a contender. Indeed, I was voted “Class Brain.” And none of my smarts could prevent me from developing an addiction problem on top of an already budding mental illness. I spent the Fall of 2000 in a state of suicidal use, not caring whether I’d ever wake up. Even as I tried to get sober and well shortly after turning 21, I didn’t think I’d make it past 24.
These period of days from July 4-July 8 are quite celebratory. Most everyone in the U.S. is in a festive place on July 4th, my belly button birthday is July 6th, and my sobriety anniversary is July 8th. This year I turn 40, a momentous occasion for me who once believed I couldn’t ever survive this long. And I celebrate 17 years of sobriety. At the start of these special days, my spirit was somewhat dampened when I saw a friend post a “joke” from a parody account set up to represent an Ohio municipality. The post apologized to members of the city for having a scaled-back fireworks display this year, due to the fact that they’ve spent so much money on Narcan. And they “thanked the junkies” for ruining everyone’s freedom celebration.
I have a very crude sense of humor and I am not a person who easily offends. And this “joke” infuriates me in a way I struggle to put into words. Whenever you talk shit about alcoholics or addicts due to your own ignorance, misinformation, resentments, or unhealed wounds, you are also talking shit about me and scores of people that I love. There are many others who would look at me and the life I’ve built today and say, “But Jamie, you’re different.”
I’m really not.
Yes, I am successful by every conventional American definition of the word.
That’s because recovery defines my lifestyle today.
And it began in a place where I was just as desperate as any other “junkie” who may need revived in the back of an ambulance.
People who meet me now or only knew a very public version of me as a child can have difficulty attuning to this reality. A few years ago after marriage equality became the law of the land, I attended my first same-sex wedding in my hometown. The ceremony was beautiful. I cried through most of it, not ever believing I would see this in my lifetime. And my illusions of liberal paradise were short-lived. I was seated randomly with one of the groom’s family members. He came around at the beginning of the reception and introduced me, “Dr. Jamie Marich,” to everyone at the table. He gushed about how accomplished I was, that I was an author, and everyone at the table seemed impressed.
Towards the end of the meal, the opiate crisis came up as a topic of conversation. One of the family members stated quite bluntly what a travesty it was that we wasted so much money on Narcan, especially for frequent fliers.
“They should just let the junkies die already.”
Of course this was not the first time I’d heard talk like this. A few years prior at an extended family event, I heard someone opining that the government should euthanize people who fail treatment after three tries. And yet this was at a gay wedding, where most in attendance seemed to be tolerant.
My stomach churned, unable to finish my meal, realizing just how much of a stigma problem we still have on our hands. I found myself in that familiar position of freeze, wanting to say so much, yet fearing danger if I did. I wanted to ask that guy, “What if it was your child in the back of that ambulance,” or challenge him with, “And what issue is happening in your life that you’re failing to address? I’m sure your stuff is causing harm to those you love, just maybe in a different way? Have you ever considered that scapegoating addicts may help you feel better about yourself and the role that people like you play in perpetuating a trauma epidemic that people take opiates for?”
At one point the mother of the person making the comment said to me, “I’m sorry if this is upsetting you, this isn’t the best dinner conversation.”
In fairness, the mother, a nurse, challenged her son and also seemed put off by his comments.
“What’s upsetting to me,” I finally managed through that pain of freeze, “Is that I am a person with 15 years in recovery. Alcohol and opiates. And I could very well have been one of the junkies you’re talking about.”
Everyone seemed embarrassed and tried shifting the conversation to congratulating me on my recovery and how “well I had done.”
I’m just glad I had the chance to start somewhere.
I never needed Narcan or professional assistance to come out of an overdose or withdrawal, but I was getting close to the point where I could have. And many people in my network of recovery today, including sponsees who are working to make a difference in the world, required professional assistance for their lives to be saved. Yes, some of them had to go through the system of care multiple times before they got it. And I’m so glad they did. Because many parts of the medical and care system (however flawed they may be) did not give up on them, they eventually learned not to give up on themselves. A person I interviewed for my dissertation research was pronounced dead on arrival twice during overdoses, and would go through twenty-six rounds of professional treatment. And she eventually got access to the proper trauma-focused treatment that she required, later going on to make a big difference in her community.
Every day I get to see what happens when we don’t give up on people. Many people who work for me or with me are in long-term recovery. As a professional serving people at all levels of recovery from addiction and mental illness, I am privileged to behold miracles and know that recovery is possible. I know that it can be frustrating—for as many recovery stories as I witness, I see just as many people struggling to get it. And I’ve known way too many people who have died far too young. If you are a first responder, work in the hospitals, or in criminal justice, seeing the consequences of addiction play out in full living color, I realize that you may be jaded. It’s not easy trying to deal with people who are in the grips of it. I invite any of you to come and hang out with people like me some time. See what happens farther down the road when people get well.
I also recognize that an addict or alcoholic may have caused great pain in your life and this can be a hardening experience. I am the first to admit the damage that we can cause in the lives of others around us, and I realize that no apology can ever begin to heal those wounds. For those of us who make it through, we do our best to make amends through changed behavior. And please realize that even those of us in recovery have been impacted by the consequences of others’ addictions. I’ve been married to two people in active addiction. The son of my recovery sponsor was killed by a drunk driver. And although there has been pain to wade through, we’ve both chosen to be part of the solution, which first and foremost means being present for people who need recovery.
There’s always a fear when we advocate for these compassionate approaches to recovery that such softness will only give people more excuses. So let me share the piece of direction that changed my life which, I believe, embraces the delicate balance between validating and challenging people. When Janet, my first recovery sponsor, heard the story of my life and the progression of my disease she said, “Jamie, after everything you’ve been through, it’s no wonder you became addicted. What are you going to do about it now?”
People only respond to challenge and direction when they have first been validated and humanized. It’s not the other way around. Shame fuels the progression of addiction, and the comments and jokes on social media—no matter how innocuous they seem to you—are part of the problem. Intoning the wisdom of Anais Nin, shame is the lie that someone told you about yourself. For most of us, that starts with unhealed trauma and escalates by contact with others who would have us believe the lie. We say in the treatment field that guilt is when you feel bad about the things that you do, and shame is when you believe that you are those bad things. Shame teaches that those messages of defectiveness define you.
I’m grateful that I hung around long enough to learn the difference. And I’m even more grateful that I met people along the way who helped me to uncover a deeper truth about who I really am. For as much professional therapy as I’ve received and as much time as I spend growing in my spiritual practice, I am further grateful that I can still acknowledge my vulnerability. I am only human. If I stop taking care of myself, the chance is very real that I could be in the back of an ambulance, even after seventeen years in recovery, for reasons connected to my addiction and mental health.
To the people that will inevitably need revived from an overdose somewhere in the world today, I send you my love, my empathy, and if you want them, my prayers.
We are not separate.
Institute for creative mindfulness
Our work and our mission is to redefine therapy and our conversations are about the art and practice of healing. Blog launched in May 2018 by Dr. Jamie Marich, affiliates, and friends.