I recently watched the excruciatingly real documentary Jacinta about three generations of women in Maine whose lives are torn apart by the relentless grip of opioid addiction. The film brilliantly takes the viewer inside the profound love of mothers and daughters that prevails over the ravages of abandonment and loss.
Soon after, I began watching the docudrama Dopesick that graphically reveals corporate greed beside the rampant destructive force of oxycontin on both individuals and communities. The two films merge at a tragic common point when we learn that in their early marketing efforts Purdue Pharma deliberately targeted the state of Maine because of high rates of jobs that cause physical injury and subsequent pain.
Both films sync well with my personal experience as a clinician in rural Western MA where I work with young children in families struggling with substance use disorders. Again and again, I see parents in recovery who have lost custody show herculean strength as they aim to follow every requirement of child protective services. But with the stress of separation from their young child, together with economic hardship, family conflict, and the added layer of social isolation brought on by the COVID pandemic, the force of addiction can prove too strong. They suffer a recurrence.
As a specialist in infant-parent mental health who knows too well what multiple disruptions in primary caregiving relationships can do to a young child’s development, I find this particular chapter of the story especially hard to watch. I see the joy and love when parent and child are together, followed by rapid escalation of “problem” behavior as a young child reacts in the only way they know how to this incomprehensible loss. I have written extensively about psychiatric medication used to treat behavior that represents a child’s effort at communication. But when a 2-year-old who has been separated from their mother for the third time in a year begins to bite and kick at daycare, a foster mother’s imploring request to increase their dose begins to make sense.
As I write this, I suddenly see a viciously circular problem arise. A pill to treat the complex problem of physical pain is one point of entry in the cycle. As Dopesick shows, medication in the form of methadone -with second generation drugs such as Subutex and Suboxone following soon after- has become a primary treatment for opioid abuse. The use of medication to treat problems of trauma and loss in young children completes the cycle.
That is not to say that all of these medications do not have a role to play. For opioid addiction, medication-assisted-treatment (MAT) saves many an individual not only from risk of lethal overdose and physical effects of withdrawal, but also the criminal behavior that may coincide with the desperation that accompanies these brutal physical symptoms. With the proper low dose of psychiatric medication, a young child’s behavior may become calm enough to allow them to stay in a foster home, avoiding the massive upheaval and disorganization that a new placement inevitably precipitates.
But when a pill is the primary treatment without attention to the full relational and social context of individual suffering, people remain stuck in patterns of disconnection and harm. We see a downward spiral of intergenerational trauma and loss tearing apart the fabric of our society. One can argue that this is true of both physical and emotional pain. As I wrote in The Silenced Child about pills as the primary treatment, “Because they can be so effective at eliminating distress in the short term, they are very appealing, almost irresistible, as a single solution in our fast-paced, quick-fix culture.”
I had the privilege to work as a clinician in an extraordinary program for families with young children struggling with substance abuse- FIRST Steps Together -in which relationships are the primary treatment. Peer Recovery Coaches- referred to in this program as Family Recovery Support Specialists- form the backbone, providing frontline support. They are embedded in a network of relationships among clinicians and supervisors. Together the staff hold families- including both mothers and fathers- as they navigate the bumpy road to recovery. Home visiting, individual psychotherapy, and parenting groups are all part of the network of support.
Shortly before the pandemic hit, The Pittsfield chapter of the state-wide Massachusetts program had embarked on a wonderful collaboration with Barrington Stage, a local theater company. The theater staff, members of FIRST Steps Together and I all shared in both silly games and deeply powerful and meaningful improvisation. To really help people suffering with both physical and emotional pain, a creative network of relationships and activities can help shift from despair to hope. For children such as my 2-year-old patient, immersion in healing relationships in the form of quality childcare, access to early childhood mental health services, home visiting, and a range of activities to support the caregiver-child relationship must occur together with medication for development to proceed in a healthy direction.
As co-author Ed Tronick and I describe in The Power of Discord, not a one-step or even two-step solution can bring healing from suffering. Addressing this issue of the “quick-fix” culture we write: “We need to let go of an expectation that the path to growth and healing will be smooth. Rather, the very rockiness, the unevenness of new roads we build going forward, leads us to a new view of ourselves and of the world. And not only psychotherapy, but more everyday activities such as joining a martial arts studio, walking in nature with a friend, cooking for others, or taking a photography class are all ways of healing the mind and body by opening ourselves up to a mess of possibilities for connection and belonging.”