Trauma and Addiction: The Science Behind 'A Star Is Born'

Never bring a psychologist to the movies. Why? Lame Freud jokes (“should’ve brought my mother”); they shout “trigger warning” before the hot dog and popcorn dance around before the main event; and, they case study every good character.

WARNING: Contains spoilers for “A Star Is Born.”

I just walked out of Bradley Cooper’s rock and roll Greek tragedy “A Star Is Born.” I went with another mommy friend, a former film student. As we were walking out, she said, “The movie was technically amazing, but even more so how it addresses mental health and suicide.” We talked about the way suicide has shown up in our lives and pondered on the factors that lead to death by suicide. My friend asked “can people get better?” Yes and no.

Jack was born to a 63-year-old father and 17-year-old mother (who died in childbirth). Though it isn’t stated in the dialogue, we can make the assumption from the beginning that Jack’s father was not a good guy, to say the least. His life began with an act of violence and an absent caregiver. Why does this matter? Jack’s brain was being shaped for addiction the moment he was born.

There are three types of stress: Tolerable, positive and toxic. Positive stress is when good things happen. Tolerable stress is more serious, but a loving caregiver acts as a buffer for the infant making stress tolerable. Toxic stress occurs when there is a stressor and no supportive caregiver around to buffer the infant’s repeated exposure to stress. This toxic stress impairs and disrupts brain development.

Our brains are not designed to handle the load of repeated toxic stress. When we experience tolerable or positive stress, our brain goes into production of stress hormones (adrenaline and cortisol) to prepare the body for the fight or flight response. Once the threat has passed, the brain gives the body the signal to stop production of the hormones. With toxic stress, our brain doesn’t shut off and finally impacts the development of brain circuits and other biological functions. Our brain always wants to be in a state of balance, so it makes adaptations and creates a system that adjusts to the high level of cortisol and makes it harder to shut down the stress response. This is known as allostasis load and it creates vulnerabilities over time.

So imagine baby Jackson, born as a result of (likely) sexual assault, no mother, an absent father, and the only reliable caregiver is a teenage boy. Baby Jackson cries, and no one is there to soothe. Baby Jackson’s brain tries to adapt to the constant toxic stress and creates a system that is sensitive to stress and anxiety.

Notice how Jackson exhibits all or nothing behavior? From his pursuit of Allie and subsequent jealousy, to hearing loss, to drinking; Jackson seems earnest but still manages to screw up. Why is that? Because his developed brain is sensitive to stress, Jackson began drinking at an early age to self-soothe. The brain then discovered that drinking increases dopamine and it’s pleasurable effects. And because we know the brain likes balance, it creates new circuitry that is sensitive to a reward and motivation system and weakens the ‘thinking’ part of the brain (executive functioning)… So, even though Jackson wants to change and knows the positive effect of it, his reward and motivation system is essentially overpowering his executive functioning. This is also why, even though he went through 12-step treatment, he still continued in addictive behavior. There is no step that acknowledges the biological and brain factors in addiction.

Jackson seems to have it all, but we look at the prevalence of addiction, depression, manic behaviors, suicide ideation, health problems and disrupted relationships, and wonder “WTF, Jack?”

Between 1995 and 1997, the single largest study was done on the impact of child abuse and neglect. The CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study found the higher the ACES “score,” the more likely an individual will experience depression, addiction, poverty, health-related quality of life, risk of perpetrating or being a victim of intimate partner violence, financial stress, multiple sexual partners (STIs), and more.

There are 10 adverse childhood experiences. Physical abuse, sexual abuse, emotional abuse, physical neglect, emotional neglect, a parent with a mental illness, an incarcerated relative, mother treated violently, a parent with substance abuse issue and divorced parents. An ACES score of over four is clinically significant. Jackson has an ACES score of 7.

So does early trauma mean you’re basically fucked? Not necessarily. Let’s look at Allie in contrast. Her father’s past alcohol problem is alluded to. There is no mother present, but let’s assume for the sake of example she experienced mental illness and divorced Allie’s father. Statistically, Allie likely experienced some form of sexual abuse before the age of 18. That would bring her ACES score to 4, which is clinically significant. So why is Allie relatively healthy compared to Jackson?

Allie has protective factors that balanced out the negative experiences, creating resilience. Resilience forms when our supports and protective factors outweigh negative experiences and allows us to “bounce back” from stress. Her protective factors include caregiver and child interactions that were positive and allowed her to learn skills such as emotional regulation, problem solving and self-soothing. As an adult, Allie is surrounded by people who support and encourage her while Jackson’s primary support is the codependent relationship with his brother.

What could have helped Jackson? Treatment that expanded past a 12-step program, education, eye movement desensitization and reprocessing (EMDR) therapy, a new social group, positive experiences that build resilience, and perhaps medication that addressed the maladaptive systems in his brain.

Did Jackson do any of that? No. Do we know for sure that any death by suicide could be prevented by any of that? No. Can we set ourselves and our loved ones up for success by having conversations about suicide and trauma? Yes.

For more information about the ACES study, go here.

For education and information on brain development, check out albertafamilywellness.org.