The triple threat model of human suffering

In Integral Master Therapist Blog, Integral Perspectives, Psychotherapy by Dr. Keith Witt


In the 57 years I’ve been studying psychology there have been three schools of thought about where psycho/emotional/social suffering comes from—nurture, trauma, and nature.

Nurture: Based on psychoanalytic theory, social psychology, and more modern attachment research, thousands of case studies, epidemiological data, and many longitudinal developmental studies support the idea that family, environmental, and cultural experiences strongly influence individual suffering.

  • The psychoanalytic model concludes that misattuned parents treating a child badly can create internalized conflicts which need healing insights and integration to resolve.
  • The attachment model developed by John Bowlby and Mary Ainsworth strongly suggests that parents who are not adequately present, congruent, or marked in their baby’s first year generate insecure attachment styles in some children that tend to persist into adulthood.
  • Social psychology, based on comparing different cultural experiences shows that cultural standards and taboos have major effects on human functioning. For example, if you received Dutch sex education you are significantly less likely to have distressed sexual relationships, STDs, abortions, and sexual conflicts with lovers and family members than if you received U.S. sex education. If you are black in the U.S, you are much more likely to be incarcerated, oppressed, and discriminated against than if you are black in Uganda. Being poor in Sweden is not as potentially castastrophic as being poor in the U.S. Social variables seem to affect each person’s levels of distress to some extent.
  • Epidemiological studies suggest that environmental toxins and socio-economic pressures can contribute to and amplify psycho/social suffering. For example, the U.S. diet is associated with chronic inflammatory disease, which affects anxiety and depression levels. Other examples are toxins like mercury and governmental/cultural disasters like wars and economic meltdowns (which can also be experienced as traumatic by many).

Trauma: Related to nurture, but more focused on stressful experiences is the trauma theory of human suffering. Based in learning theory and social psychology, adverse childhood events, traumatic events at any age, and/or toxic cultural elements determine adult suffering. The famous Adverse Childhood Events study demonstrates that the more of ten forms of abuse, neglect, or other painful disruptions like divorce or having a parent incarcerated, the more likely someone is to have most forms of psychological and emotional disorders (as well as many kinds of physical disorders).

Thousands of trauma studies have documented negative consequences from trauma for many (but not all, or even most) trauma survivors. Treatment studies from EMDR, somatic reexperiencing, neurofeedback, and dual focus therapies have demonstrated relief from symptoms for people identifying as having post traumatic conditioning from Big T or small t traumatic events.

Nature: Twin studies have yielding the amazing conclusion that personality traits are generally 40% to 60% heritable. This includes capacities for depression, anxiety, shyness, OCD, introversion, emotional reactivity, divorce, and other psychosocial problems.

Much more significantly, personality disorders—where people have major life-disrupting deficits in capacities like empathy, trust, proportionality, self-regulation, or self-awareness—have been shown to be 70% to 80% heritable, and that the other 20% or 30% cannot be reliably attributed to either family environment or life experiences. Current epidemiological data suggests that 15% to 19% of the general population can be diagnosed with a personality disorder, which is a pervasive and enduring characterological pattern of behavior that disrupts more than one important area of life. People with personality disorders generally experience their distress as a function of other peoples’ reactions to them rather than as a function of their personality deficits, and strongly resist suggestions to the contrary. This makes treatment of personality disorders different and usually more difficult than working with people who welcome feedback about their personal blindspots.


Which is right? Nurture deficits? Trauma? Genetic programming? Which explanation reflects the main source of psycho/emotional/social suffering? Even more importantly to therapists, coaches, teachers, and change workers of all kinds, what does this mean about helping people with distress?

Talk to aficionados of one approach or another, and they’ll usually have a conscious or unconscious bias for one or two explanations, and subtle resistance to the significance of one or two of the others.

The triple threat theory of human suffering—everybody gets to be right, but nobody is right all the time.

Integral theory says that everybody gets to be right, but nobody gets to be right all the time, and the data supports the idea that every individual is unique in how they are formed, and, more importantly, how they grow.

Nature, nurture, and trauma probably all affect each person’s palette of problems to some extent, with one being more prominent at any given moment, or for any given type of person with their unique life experiences.

How to help?

In my upcoming book, Trauma into Transcendence: Living a Happy Ending at the Beginning of Something Wonderful, I emphasize identifying and treating traumatic sensitization to enable people to develop more resilience. I’ve offered a four-stage model for addressing all three sources:

  1. Face the trauma.
  2. Grow your life story to include the trauma as a transformative event.
  3. Learn to choose healthier states of consciousness.
  4. Compassionately self-observe to know when something new or old needs to be addressed with stages 1 through 3.

The problem with writing a book that emphasizes trauma is that it tends to minimize nature and nurture as causes of suffering. When people are suffering from trauma learning, it’s generally best to begin with the trauma, and then proceed to other forms of work if the client doesn’t feel positively moving towards living a happy ending at the beginning of something wonderful. But there are inherent problems in diagnosing and treating people with different histories and personality structures.

Consider three women who endure the same horrible car wreck and are having panicky flashbacks to sounds, sights, and smells of the accident at the slightest trigger. One has paranoid personality disorder, one has no pre-wreck problems, and one had a preoccupied self-absorbed mother her first year of life, resulting in an angry resistant insecure attachment style. All have entered therapy to deal with their PTSD symptoms.

  • Paranoid person is suspicious of the therapist and resists any interventions like EMDR which involve surrendering to a therapist’s direction. She especially is offended when the therapist suggests that her chronic suspicion reflects a deficit in her ability to appropriately trust others.
  • Normal person eagerly tries first dual-focus treatment and then expanding her autobiographical narrative to experience the accident as a transformative ordeal in a heroic life journey. She leaves therapy relieved and feeling wiser and stronger as a result of her work.
  • Insecurely attached woman dramatically reduces her PTSD symptoms but is dissatisfied with her current relationship and complains to the therapist that she’s “Still not happy.”

All have gone to the same therapist who is using the same four stage model of treating trauma. Clearly paranoid person and insecurely attached person need more work to progress, but that work has less to do with trauma and more to do with self-awareness and correcting deficits in trust, intimacy, and self-identity. Like the trauma work, this involves facing the problems, growing their life stories, choosing healthier states, and developing compassionate self-awareness to navigate future distress, but that work requires the therapist to know the triple threat material and apply it practically. This is possible, but is often fiendishly difficult and potentially confusing depending on everything we’ve discussed so far.

Whatever the situation, I’ve found it incredibly useful to know the triple threat model, and I encourage you to consider using it to understand your and other’s pain.

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