Archive for April, 2009
Hearing Ourselves Talk
I think most who enter therapy do so with the illusion, at least initially, that a therapist can, or is supposed to, “fix” us. This is not the case, for the simple reason that nobody can fix anybody else. The value of therapy lies not in the advice of a wiser or more capable person but rather, in creating an environment where we learn to hear our own voice, and heed what it tells us. (And any therapist who purports anything else should be avoided like the plague, by the way.)It makes sense that we can only fix ourselves. Everything in our environment must pass through our senses and our intellectual and emotional filters to “get in.” The teachings and advice of others are only valuable (or destructive) to the extent that we allow them to be. The processing of thoughts, and the choice to see or do things differently rests on our shoulders alone. Barring invasive procedures, there is no other way it can be. All of our answers come from within. (On some level, we know this. We’ve all had the experience of feeling centered, connected to ourselves. Well, that’s our inner voice speaking: telling us we can trust ourselves to find our way, do the right thing, take care of ourselves.)
Sadly, this is not the case with children. Children are dependent on their caregivers to form ideas about the world, to learn what to let in and what not to, what constitutes self-care, self-love, truth, power, and the like. If a child’s innate ability to care for herself is threatening to her caregivers, that most valuable of human attributes, the “still, small voice,” gets disowned and repressed, for that is what the child must do to survive in such an environment. The child is in a bind in which she is forced to choose the caregiver’s needs or her own. Choosing self, in the child’s eyes, literally means death. (For more on this, read John Bradshaw’s books, Healing the Shame that Binds You and Homecoming.)
If a child learns to disregard her inner voice, she loses a critical aspect of her ability to care for herself. She struggles to trust herself because her internal guidance is off. And this is why, as adults trying to figure out why we feel so abnormal/depressed/addicted/rageful/disconnected/unlovable, it’s sooo important to listen to ourselves talk—and learn to really hear what we say. The process is not only healing, a way to purge the soul-poison, it also reconnects us to our disowned aspects and provides the answers we so desperately seek.
It’s also important to be heard. The way it seems to work is that we learn to hear ourselves best through the validation of others. By telling our stories in a supportive environment, we are validated, and thus learn to validate ourselves. This is Alice Miller’s idea of the “enlightened witness.” (And it may be unnecessary to add, but I will anyway, that we will never, ever get validation from the caregivers who deprived us of it as children. Looking there for it is a waste of time and energy, and keeps us entrenched in our pain rather than providing a way beyond it.)
Therapy is one way to be heard—in fact, most therapy models are based on “reparenting,” on being the sounding board the person lacked as a child—and probably the most expeditious (assuming you find a decent therapist), but it is not the only way. A supportive significant other is another avenue. So is any creative endeavor, such as writing or painting, that provides cathartic relief and gets the stuff out into the world where it can be examined and processed. The point is to get it out, get it out, get it out—but in a safe way, with safe people. And better by yourself or not at all than with someone you’re unsure about.
While going through this, there is another important aspect to remember: the gold is in the details. When talking about pain, it seems helpful to be as detailed as possible. Not my father was a sadistic bastard, but my father pulled down my pants and beat me in front of my best friend when I was six because I asked her over without getting permission first. I’m not sure why this is important, but I think that the more detailed the stories we tell, the more real our experience becomes, the more truth we uncover. And the more truth we uncover, the more healing can occur.
All of our answers lie within ourselves. They may be buried by pain, ignorance, shame, misunderstanding, and misinterpretation, but they are there. Our task is to trust that they are there and learn to listen to them. They are always right, and they will never let us down.
If Addiction Isn’t a Disease, Can You Drink Again?
Having had a spiritual awakening as the result of these Steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs. – 12th Step of Alcoholics Anonymous
Spiritual awakening. Psychic change. Moment of clarity. All the phrases that describe conditions for long-term sobriety refer to a transformation that “lifts the mental obsession.” Whether in a 12 Step program or otherwise, the psychic change seems a prerequisite for lasting sobriety. The logical question, then, would be this: if a genuine psychological transformation occurs, can a person drink again? Because such a profound change in outlook would surely result in a breaking of the addictive cycle.
The answer, I believe, is yes. How could it be otherwise if addiction isn’t a disease, but a habit, a coping mechanism, a choice? But because addiction is such a powerful and deeply ingrained habit, it is an extremely qualified yes. A person should be certain he is beyond the grip of his habit before he even considers drinking (substitute any ingestion method or behavior here) again. And to be certain, a person should subject himself to a thorough inventory before he makes any life-altering decisions.
Before deciding whether to drink again, a person should:
Deal with underlying issues (because addiction is a secondary problem).
Addiction is an attempt at self-care gone awry. A person uses drugs, alcohol, or other compulsive behavior to deal with underlying problems that cause overwhelming negative feelings like anxiety, stress, sadness, and anger. The underlying problems can go back a long ways, often to early childhood, and it can take many years and a lot of perseverance to really deal with them. This doesn’t necessarily mean fixing them or making them go away; acceptance is often the best you can do. But genuine acceptance is powerful, and usually enough to move on with one’s life.
I am not suggesting this is easy, or that everyone follows a similar path. But an earnest desire to deal with issues, however that looks to each individual, should be enough to get there eventually.
Have the feelings he’s been avoiding.
Feeling unpleasant feelings is not an easy process, either. If we learn at an early age to push down overwhelming emotions, un-learning that can involve an entire overhaul (a process difficult to pinpoint as every individual is unique). Help from supportive people is essential, and if we lacked supportive people in our childhood—often one of the underlying reasons for addiction—it can sometimes take awhile to figure out what supportive even means! So again, this can be a long, difficult process, and certainly not one to take lightly. But to avoid it is to leave a major part of the addictive cycle unaddressed, making another addictive cycle likely.
Develop more effective ways to deal with anxiety.
To overcome addiction, you must develop new methods of dealing with negative thoughts, negative feelings, and anxiety. This goes further than understanding underlying issues. This is about having tools to deal with these problems in the present, as they come up in everyday life. Part of this is dealing with the past so old triggers don’t have the power they once did. But it’s equally important to develop strategies for dealing with problems that used to make you drink. For example, you develop a support system of safe people so instead of drinking when you’re upset, you can call somebody to talk about your feelings. Or you create a plan to do anything else when the urge strikes: go to a movie, go for a walk, eat, treat yourself to something you wouldn’t normally buy or do.
The important thing is that the new ways of dealing with triggers are so thoroughly integrated into your life that they become second nature, in the same way the addiction once was.
Create a satisfying life.
Once an addict has dealt with underlying issues, come to terms with the unpleasant feelings he’s been trying to avoid, and developed new habits for dealing with anxiety, he’s on the road to creating a good life for himself. He begins to think in terms of moving forward, of what he wants: love from a supportive partner, a career, children, education; whatever makes him feel happy and complete.
Creating the life you want is the key to drinking again in moderation. When a person has more positives than negatives in his life and has addressed underlying issues, the pull of addiction loses its power. Priorities change. A person thinks through consequences before engaging in behavior that could put his good life at risk. The smarter choices become the easier choices. Drinking is something done in social situations or having a glass of wine with a meal, nothing more. As obvious as this sounds, the disease view of addiction so prevalent in our culture makes it difficult to see. But it’s true, and people all over the world have walked away from addictive behavior on their own, essentially because they’ve outgrown it and moved on to more productive things. You could call this attrition or simply growing up, but whatever name you give it, a shift in priorities and some sense of personal satisfaction was all it took for them to move beyond the addictive cycle.
Certainly this is easier for some than it is for others, but the point is that having something you want to keep is the best way to break the addictive cycle once and for all.
Finally, ask himself why he wants to drink again.
If a person has overcome an addiction and created a good life for himself, he should analyze very carefully any desire to drink again. The reasons should have nothing to do with quelling inner turmoil or avoiding feelings. And this is tricky, because all human beings have layers and layers of feelings, and those feelings never stop surfacing no matter how far along we are in our growth process. So it’s easy to delude ourselves into thinking we’re doing one thing when we’re really doing another. And it’s important to take all of this into consideration, and to get the counsel of someone you respect, before making the decision to drink again.
All that said, the biggest reason to drink again should be because you want to. I know that’s a heretical thing to say, but I truly believe addiction is a personal choice and that if a person chooses to use substances (or behaviors) responsibly, he can. The feeling of empowerment that comes from doing so, when you once viewed yourself as a helpless victim, can be tremendous. More importantly, that paradigm shift—from helpless victim to autonomous agent—carries over to other aspects of life, and serves well a person’s sense of responsibility, accomplishment, and determination. Somewhat ironically, responsible use of drugs and alcohol can be as empowering as abstinence once was.
Drinking again is not a decision to be taken lightly, and these are but a few of the things to consider when making that decision. This is not meant to be an exhaustive list, but rather, an outline of basic requirements. The important thing is that you’re honest with yourself about your intentions and act accordingly. Total abstinence is not a bad thing; it’s definitely the safest way to avoid complex decisions that could have devastating consequences if not well thought through. However, abstinence can be limiting, particularly if it means viewing ourselves as victims of a nonexistent disease and using scare tactics to keep ourselves from doing what we really want. Such a worldview keeps us unnecessarily tethered, and is never conducive to further growth.
Reading Material
Some of my recent posts have been pretty weighty, and it occurred to me that I should be footnoting them. So in lieu of a real post, which I probably won’t get to this week, here is a list of authors and books that have influenced my thinking. All of the addiction writers are, in my opinion, much too anti-12 Step, but I understand the reasoning behind their views.
This isn’t a substitute for good footnoting, but at least you’ll know where to go if you’re interested in the ideas.
Addiction
Thomas Szasz
Considered a heretic of the psychiatric world, his thinking is the clearest I’ve ever read on issues of personal freedom and personal responsibility. If you think the world of therapy is nonsensical and don’t understand why, you will find answers in any of Szasz’ numerous books.
• The Myth of Mental Illness
• Our Right to Drugs: The Case for a Free Market
• Pharmacracy: Medicine and Politics in America
• (and many more)
Jeffrey Schaler
A proponent of Szasz’ and an excellent writer.
• Addiction Is a Choice
Lance Dodes
A psychiatrist who has much experience in treating addiction
• The Heart of Addiction: A New Approach to Understanding and Managing Alcoholism and Other Addictive Behaviors
• See also my article about this book
Stanton Peele
The most well-known anti-disease addiction proponent out there. A bit of a grandstander, but some good information.
• Truth About Addiction and Recovery
• Also check out his website
Personal Development/Spirituality
Ken Wilber
Wilber’s book A Brief History of Everything was life-changing for me. His view of human development and spirituality is hands down the most comprehensive, rational, well-researched approach out there today. I could list other authors, but once you’ve read Wilber, everyone else seems incomplete; they have part of the picture, while Wilber sees the whole thing.
• A Brief History of Everything
• Integral Psychology: Consciousness, Spirit, Psychology, Therapy
• Integral Spirituality: A Startling New Role for Religion in the Modern and Postmodern World
• Also check out his website
Healing from Childhood Trauma
There are so many, but here are a few to get you started:
John Bradshaw
Alice Miller
Addiction and the Mental Illness Metaphor
I knew many 12 Steppers who said “the cure for my disease is meetings.” I never believed addiction was a literal disease, so I liked this back when I was a devoted 12 Stepper. It was a way of saying, or so I believed, that addiction was a mental illness: it made sense to me that meetings—talk therapy—could cure a mental illness, but I found it absurd to think they could cure a physical one. So, when people referred to their “disease” in meetings, I translated this in my head to mean “mental illness,” resolving my issue with the disease metaphor. I have since come to believe that the concept of addiction as a mental illness is as much a metaphor as that of addiction as a physical illness. And by virtue of the widespread misunderstanding about it, an even more dangerous one.
This is a difficult topic. I don’t know how well I can explain it, or convey its importance, without including a great deal of background material. I realize that calling mental illness a metaphor is to spit in the face of overwhelming popular opinion; I realize that a book length thesis is more suited to proving this point. Nevertheless, I am going to attempt at least an introduction to the idea. It ties into everything I write about and believe to be important in life: autonomy, personal growth, intellectual honesty. I think it’s really, really important. So here goes.
The confusion is mainly about the mind and the brain. Many people view these terms as interchangeable, or assume interchangeability because they haven’t given the topic much thought (and there’s no reason anyone would). But they are not interchangeable terms. They are, in fact, as different as hunger and…justice. Or sleep and philosophy. Or body and soul.
A brain is a prerequisite for a mind, much like a planet is a prerequisite for life. But just as not all planets foster life, not all creatures with brains also have a mind. In fact, although millions of different brains exist, Homo erectus is so far the only known creature with a mind; that is, with the capacity for abstract thought. In other words, tigers can’t think about math and dogs don’t worry about death. Only people.
The brain is a physical entity, objectively observable and researchable. Scientists have studied the brain enough to pinpoint physiological changes that happen in several different circumstances. For example, scientists know how a sleeping brain looks, how an agitated brain looks, how a dreaming brain looks. But no matter how far science advances in mapping brain chemistry, it will never be able to determine what a person is dreaming or agitated about. This is because the mind is an abstract concept, unobservable and unresearchable except by subjective description of its owner. In lieu of such a description, observers can only guess at what’s going on “inside a person’s head.”
That is the difference between mind and brain, and it is an unnavigable gulf. No amount of scientific research will ever allow people to read the thoughts of others, to know their hopes and dreams, to understand their emotions. For these are things that exist only in the subjective realm; they cannot be unearthed through the scientific method.
“Mental illness” is in most circles, lay and professional alike, taken to mean an actual illness, something treatable by medical means, with underlying physical causes even if they haven’t yet been determined. But a “mental,” that is, a mind, can no more get sick than an idea, an emotion, a society, or any other abstract conception. The mind exists only—please excuse the circularity—in our minds. If you agree that disease describes an organic dysfunction of some sort, then you must also agree that mental illness has to be a metaphorical term, because being a concept, the mind cannot deteriorate. (In cases where minds do seem to deteriorate, such as Alzheimer’s, it is actually the brain.)
There are two ways to go from here. One is to insist that mental illness has an organic source that we just haven’t discovered yet. Why, they have found evidence of genetic predispositions to addiction and that an addict’s brain looks different under the influence of drugs than a normal person’s brain, so it must be organic; ditto depression! These things may or may not be true. But they’re irrelevant. A genetic trail doesn’t make an addict. If it did, how could meetings and steps possibly “cure” addiction? Do they make the gene go away? Well, no, you say. You just learn to be really careful with your addictive tendencies, learn to focus on other priorities.
Or, put another way, you learn to practice personal discipline. You have, as any AAer can tell you, a psychic change.
This would not work for muscular dystrophy or Down’s Syndrome.
As for the brain differences in an addict (or depressed person): the brain also looks different between someone who loves the color blue and someone who doesn’t, between someone with a strong work ethic and someone with a not-so-strong one, between someone who loves dogs and someone who is afraid of dogs, etc. Brain changes are not synonymous with organic dysfunction. Brain changes indicate a release of different chemicals in different amounts, but are in no way indicative of disease in and of themselves. I would suspect that once a person has developed an addiction that his brain would look different than someone without the addiction. So what? The same could be said for someone who plays chess, someone who bakes, someone who rides motorcycles, ad infinitum.
Of course there is a physical component to the psychological. But when the issues are subjective ones—addiction, depression, anxiety, for example—brain chemistry means next to nothing. Researching it is, in essence, barking up the wrong tree. Science will never find a definitive cause of addiction because it exists only in the subjective realm. It can only be “treated” by the person himself, when he chooses to learn and practice different behavior.
The other way to go is to say that mental illnesses must be real illnesses because they cause so much suffering; who cares if they have an organic cause or not? Besides the organic cause thing, they fit every criteria for disease: pain, suffering, even deterioration of the mind and body…of course they’re real diseases!
No. And this may be the most problematic metaphor of the postmodern world.
Mental anguish is a terrible thing and yes, it causes much suffering, probably more than all physical illnesses combined. But lacking organic cause, “mental illness” is a metaphor. That is, rather than defining an actual ailment, it points to something else. And this confusion, this metaphor that everybody has forgotten is a metaphor, this insistence that mental anguish be treated as a literal disease, has caused at least as much suffering as the mental anguish itself. Because in the frantic race for organic causes, our complex, sensitive, multi-faceted, amazing humanity has been left in the dust. In the quest for scientific solutions, our interior world has come to be regarded as an unwanted stepchild, neglected, abandoned, even punished. We are trying, it seems, to eradicate our own subjectivity—something that cannot be done—and the evidence of this is everywhere. It is no coincidence that as our culture puts its faith in science to solve all its problems, it also embraces increasingly superficial values of beauty, truth, and goodness. Both are denials of the interior world that makes us who we are. But that is probably another essay.
What is the mental illness metaphor pointing to, then? To our interior, of course. But the interior, particularly its painful aspects, is complex and difficult to discuss. Its subjective nature and infinite layers of thought and emotion makes it unyielding to scientific testing and observation. Not wanting to admit defeat, science instead reduced the interior world to measurable physical phenomena. It’s not that this was wrong. It was just vastly, astronomically incomplete. And what they couldn’t study they ignored, or declared not to exist (the soul, for example).
And this is how the mental illness metaphor came to mean, to most people, a literal disease.
Seeing mental difficulties as a disease simplified things. The thought of taking medication for mental pain (another metaphor) is appealing, to say the least. But that simplification has only created more problems. Look at the widespread prescribing of antidepressants. Hundreds of millions of people take these drugs in desperate hope, or misplaced faith, that their problems will be solved (more evidence of interior denial, I believe; searching in exactly the wrong area for inner peace). Antidepressants do indeed change brain chemistry, but they are doomed to failure if that change is not accompanied by a willingness to address one’s emotional issues, which few do (thus the prescription in the first place). In short, people confuse mind and brain because they want to. Seeing them as the same means exoneration from the difficult work of addressing our pain: repressed beliefs and fears, anxiety, the comfort of false beliefs about oneself. Who wants to do this work? Practically no one, and when doctors tell us we don’t have to, we want to believe it.
The belief that mental illness is more than a metaphor has resulted in much confusion within AA. Saying you have a disease you have to go to meetings to cure, for example, confuses a critically important idea: helplessness and volition. There are many other examples. But the great thing about AA, and the reason it “works if you work it,” is that volition always prevails. Regardless of how AAers define their problem, AA is the one place where addicts can address their subjective issues (their emotional pain, their demons, their lack of self-discipline, their narcissism, etc.). That’s what makes it the most successful addiction program around. But think how much more effective addiction programs could be if those ideas were not confused, if people were clear on what they were addressing and why, and the exact roles of the mental, physical, social, and spiritual aspects of their problem. The illness metaphor stands in the way of this and until it gets resolved, addiction treatment is likely to remain significantly unchanged.
To mistake “mental illness” for anything other than a metaphor is a serious error in reasoning that does not serve addicts, their treatment, or mankind in general in any positive way. To fully understand addiction and help addicts, it is as important to deconstruct the mental illness metaphor as it is the physical disease metaphor. Lack of clarity on this point is a luxury the treatment industry cannot afford if it is to ever improve its abysmally low success rate.