1 Such disorientating states
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What happened when you lost weight?It looked like he had saved her life.Before long, she was back above 400 pounds.So Vincent asked her gently what had changed when she started to lose weight.It seemed mysterious to both of them.They talked for a long time.There was, she said eventually, one thing.She fled, and right away began to eat compulsively, and she couldn’t stop.This was when Vincent thought to ask a question he hadn’t asked his patients before.When did you start to put on weight?Susan thought about the question.She had started to put on weight when she was eleven years old, she said.Was there anything else that happened in your life when you were eleven?Vincent began to ask all his patients these three simple questions.How did you feel when you lost weight?When in your life did you start to put on weight?What else happened around that time?As he spoke to the 183 people on the program, he started to notice some patterns.Overweight is overlooked,6 and that’s the way I need to be.I was incredulous, he told me when I sat with him in San Diego.It seemed every other person I was asking was acknowledging such a history.People would know if this was true.Somebody would’ve told me.And even more, including most of the men, had had severely traumatic childhoods.Being very fat stops most men from looking at you that way.They needed someone to understand why they ate.After meeting a person who had been raped, he told me, I thought with a tremendously clear insight that sending this woman to see a dietitian to learn how to eat right would be grotesque.Far from teaching the obese people, he realized they were the people who could teach him what was really going on.Why do you think people get fat?The answers came in three different categories.To walk through those cell blocks with confidence, they explained, they needed to be the size of a refrigerator.And the third category was that it reduced people’s expectations of them.You apply for a job weighing four hundred pounds, people assume you’re stupid, lazy, Vincent said.When you look at a house burning down, the most obvious manifestation is the huge smoke billowing out, he told me.It would be easy, then, to think that the smoke is the problem, and if you deal with the smoke, you’ve solved it.Otherwise, house fires would be treated by bringing big fans to blow the smoke away.And that [would] make the house burn down faster.Obesity, he realized, isn’t the fire.One day, Vincent went to a medical conference dedicated to obesity to present his findings.They just assumed that they were making excuses.Vincent was horrified.But he knew he didn’t have hard scientific proof yet to rebut people like this.He wanted to gather proper scientific data.It’s a questionnaire.And then there’s a detailed medical questionnaire, to test for all sorts of things that could be going wrong with you, like obesity, or addiction.Are you suffering from depression?The people who filled in the form were somewhat wealthier and a little older than the general population, but otherwise fairly representative of the city’s population.It turned out that for every category of traumatic experience you went through as a kid, you were radically more likely to become depressed as an adult.If you had six categories of traumatic events in your childhood, you were five times9 more likely to become depressed as an adult than somebody who didn’t have any.If you had seven categories of traumatic event as a child, you were 3,100 percent10 more likely to attempt to commit suicide as an adult.They seemed to have found evidence that these traumas help cause these problems.The greater the trauma, the greater your risk of depression, anxiety, or suicide.In the same way, the more you were traumatized as a child, the more your risk of depression rises.Being treated cruelly by your parents was the biggest driver of depression, out of all these categories.People didn’t want to believe it.But we have barely begun, Vincent told me, to think through its implications.We have failed to see it as a symptom of something deeper that needs to be dealt with.There’s a house fire inside many of us,14 Vincent had come to believe, and we’ve been concentrating on the smoke.I think that’s a very important idea, Vincent told me.It takes away an experiential process and substitutes a mechanistic process. It turns your pain into a trick of the light that can be banished with drugs.But they don’t ultimately solve the problem, he says, any more than just getting the obese patients to stop eating solved their problems.Medications have a role, he told me.So he set up support groups where they could discuss the real reasons why they ate and talk about what they had been through.Once that was in place, far more people became able to keep going16 through the fasting program and stay at a safe weight.More than anyone else I spoke to about the hidden causes of depression, Vincent made me angry.After I met with him, I went to the beach17 in San Diego and raged against what he had said.I was looking hard for reasons to dismiss it.It seemed peculiar, and I didn’t really understand it.Then, as I discussed it with some people I trust, I began to understand.If you believe that your depression is due solely to a broken brain, you don’t have to think about your life, or about what anyone might have done to you.The belief that it all comes down to biology protects you, in a way, for a while.If you absorb this different story, though, you have to think about those things.I asked Vincent why he thinks traumatic childhoods so often produce depressed and anxious adults, and he said that he honestly doesn’t know.He’s a good scientist.He didn’t want to speculate.But I think I might know, although it goes beyond anything I can prove scientifically.When you are a child and you experience something really traumatic, you almost always think it is your fault.When I was young, my mother was ill a lot, and my father was mostly gone, usually in a different country.In the chaos of that, I experienced some extreme acts of violence from an adult in my life.For example, I was strangled with an electrical cord on one occasion.I know that if I saw an adult strangling a child with an electrical cord, it would not even occur to me to blame the child, and that if I heard somebody try to suggest such a thing, I would assume they were insane.I know rationally where the real betrayal lies in this situation.But still, I feel it.It’s there, and that feeling almost stopped me from saying this.Why do so many people who experience violence in childhood feel the same way?I have spent a lot of time thinking about this.When you’re a child, you have very little power to change your environment.You can’t move away, or force somebody to stop hurting you.So you have two choices.Or you can tell yourself it’s your fault.If it’s your fault, then there’s something you can do that might make it different.You aren’t a pinball being smacked around a pinball machine.You’re the person controlling the machine.You have your hands on the dangerous levers.In this way, just like obesity protected those women from the men they feared would rape them, blaming yourself for your childhood traumas protects you from seeing how vulnerable you were and are.You can become the powerful one.If it’s your fault, it’s under your control.But that comes at a cost.If you were responsible for being hurt, then at some level, you have to think you deserved it.A person who thinks they deserved to be injured as a child isn’t going to think they deserve much as an adult, either.This is no way to live.But it’s a misfiring of the thing that made it possible for you to survive at an earlier point in your life.You might have noticed that this cause of depression and anxiety is a little different from the ones I have discussed up to now, and it’s different from the ones I’m going to discuss next.I’ll come to biological factors soon.But childhood trauma belongs in a different category.It’s a psychological cause.By discussing it here, I’m hoping childhood trauma can indicate toward the many other psychological causes of depression that are too specific to be discussed in a big, broad way.The ways our psyches can be damaged are almost infinite.