Tuesday, November 11, 2014

The Human Face of Addiction

A lonely tree at the top of apartment rise building
Last week I had the opportunity to witness a panel discussion on the issue of addiction at St. Paul's Hospital. I was moderately interested in the topic of addiction, but went because it included heavyweights in the field, particularly Alfried Längle whom I had seen previously expound on logotherapy and whom I personally consider the "Dalai Lama of psychotherapy" as well as Gabor Maté who is a bestselling author and the equivalent of a medical superstar. Some of Maté's articles I had read online, and I had been impressed by its humanity as well as gutsiness. Finally, there was also Bruce Alexander whom I had not heard about but who proved also quite knowledgeable and who showed serious concern for the environment in both senses of the word, physical surrounding as well as nature.

And so the discussion commenced ten minutes later than planned in front of a filled auditorium with constant heavy rain outside. Längle opened up the panel by his definition of addiction, and I was already baffled. He started off showing us that addiction is indeed a very human activity. To be addicted means to be human, to have desires and to look for their fulfillment. Everyone is addicted to something to some extent. There is essentially nothing wrong with it except when it is done specifically to fill a certain void or used as an escape that eventually causes more harm than good. Immediately, we could feel the warmth and humanity of his view and his focus on existential matters.

Then Maté picked up where Längle had left off yet with a caveat. He mainly agreed with Längle's definition, and he pointed out that most of us are addicted to something or some kinds of repetitive and addictive behavior for different reasons, namely to get a sense of calm, relief, assurance or what-have-you. 

Yet the issue is whether we do it to escape alienation. In modern times we have more than ever cases of addiction, but historically there were phases where and when addiction was not a major issue or not much of a problem. It was Bruce Alexander who would elaborate more on this phenomenon and the external influences on addiction.

In the meantime, the main disagreement of Maté was that addiction was according to the actual meaning of the word, a type of slavery. People become enslaved to something and find it very hard to control. They become automatons, thoughtless machines that only exist to gratify those needs and pleasures. 

Maté read a quote from Victor Frankl's book, Längle's teacher and mentor on how there is the stimulus and a response and that the gap in-between is what is called free will, reason or an operating agent / ego. Although most of us most of the time do respond to situations via reflection, in the case of addicts that response is immediate (he snapped his fingers at this point) and does not include any type of will or decision on the part of the subject.

This observation was the main source of conflict or rather disagreement between Längle and Maté. Längle insisted that we still do have an albeit at times feeble voice of reason between the stimulus and response among addicts. The idea or goal of therapy would be to give empowerment and strength to that voice so that the afflicted addict can gradually break the habit and manage to break free from those shackles.

In fact, in most cases people do not become addicted right away, but it builds up perhaps with a drink or two leading to increased amounts over time. At all times, there is a decision, a voice saying yes (or no) to certain actions; rarely is there an automatic reaction from the onset. It is more a case of losing control than a complete loss of control.

There were some interesting observations about genetic as well as environmental factors that were brought up as well. Certainly some have genetic predispositions, but most of the addicts have had some kind of trauma in their past leading them towards addictive behaviors. In Längle's words this was trauma that has not been integrated creating the need for escape by various means. Maté pointed out that most of the addicts had experienced sexual abuse.

But one of the main conflicts of the night was whether addicts do have a still operating will or decision-making process. The danger or downside of such a view was according to Maté that people could accuse the addict of somehow or other being responsible for their addiction. 

That is when the white-haired Austrian Längle with the calm and soothing voice surprised me. Längle said if people were to construe his words in this manner, he would drop his perspective and theory altogether. To blame the addicts for their plight was definitely not his intended meaning; in fact, he meant the exact opposite. Here we see his humanitarian concern over simply being right and that he was even ready to sacrifice his own views for the benefit of others.

At that point, it seemed that the outspoken Maté had won the debate. But Längle would still not leave without a fight. Maté had challenged him to give a definition of free will. Längle gave the fact that despite constraints and strong forces from both within and without, there was a singular and personal voice regarding that situation. And yet, there were people who did not want to leave their addiction and that was fine. He had one particular patient who would see him on a regular basis saying that he did not want to drop his addiction.

Maté asked him why was that man going to see a psychotherapist in the first place. To that Längle responded that it was because that person enjoyed the human contact, the fact that he could reach out to another person, a human being who did not immediately judge or scold him for his actions.

Längle also said that if people followed their addictive behavior with mindfulness, then it was not as bad. For example, if a smoker enjoys their cigarettes, this is all right. It should not become a mere and thoughtless habit. People should be and become aware of their actions, and only if they sincerely and genuinely wish to quit their addiction, should they do so.

Then Maté argued what about people with obsessive-compulsive behavior. They would rather not choose to wash their hands a hundred times before leaving the building. Längle responded by saying that unhealthy habits would manifest themselves in different ways in different people. Since the person feels isolation and a certain perceived lack of power in situations, they would either seek an escape through addiction or their body would respond with different defense mechanisms to stressors, such as diseases like cancer or mental health issues like depression or at its worst even suicide.

In fact, the word dis-ease shows that the body and/or mind are not at ease, not balanced and that it is in many cases simply a natural response of the body. Such undigested traumas would also lead towards aggressive and dangerous behaviors both towards others as well as oneself. 

At one point, psychotherapist Längle was in fact counseling Maté, and it was then that Maté shifted his position and conceded that there was a miniscule moment or gap between the stimulus and the response. So Längle eventually won the debate and claimed that he did not know that Maté was an existentialist to which Maté shrugged and said "whatever that means."

Now I have left out an important voice here, the thoughts and ideas of Bruce Alexander. Although he was not as forceful in his opinions or in this discussion, he had indeed important and significant views on addiction and moreover our modern and alienated life-styles. 

At one point, Alexander said he was not going to blame all the pain and isolation on capitalism (to which Längle retorted why not, which drew an impromptu applause from the audience). Yet it is capitalism that often creates gaps between people and has more often than not harmful effects on social and personal relationships.

Nowhere is this more apparent than in the case of native people. Historically, they did not have problems or issues with addiction, but in modern times they have been feeling isolated from both their culture as well as the rest of society. Also turning people into money-making economic units causes conflicts in the fabric of relationships. As Maté claimed in places like Turkey, people did not merely go to stores to buy things and return home; instead they were often offered tea or coffee in the neighborhood stores.

In fact, neighborhood stores, which are a source of meeting and greeting people within the community have become more a thing of the past due to big impersonal superstores like Wal-Mart. We have lost touch with personalized service and instead are dealing with mass-produced commercial items for mass consumers like us. Maté also noted with regret that Fisher Price was selling car seats for one-year-olds that came integrated with an iPad holder. People are becoming and have become enslaved to technology at the expense of relationships with nature and with real people.

On the issue of nature, Bruce Alexander had more to say. We exploit nature, but it is us who have become impoverished as a result. We have lost touch with our core and principal values and live in a materialistic world filled with voids. We have become globalized and are dealing with significant amounts of anxiety and depression. All of this has not made our life more convenient or happy, but quite to the contrary. It comes as no surprise that substance abuse has increased in addition to health issues, both physical as well as mental.

Life is filled with pain, and we have to find our way through it without getting too bruised and damaged by it. This may sound rather pessimistic, but the hope is that we can manage to have healthier lives if we face ourselves and the issues that confront us head-on. Even when situations seem hopeless and there is no way out, there is a small ray of hope that can get us out of the prison we have essentially created (for) ourselves.

In some cases, psychotherapy can help us, but generally it is both about accepting oneself in one's precious and invaluable uniqueness and accepting and caring about others around us. Once we realize that it was merely our own faulty perception or illusion that we have a void within us and that in fact, we have and always had what we needed most at our own hands and disposal, then issues like addiction or diseases may become easier to control and deal with.

1 comment:

Vincent said...

Excellent review. I felt increasingly out of sympathy with Laengle, especially when he interrupted Alexander's exoneration of capitalism with the retort "Why not?" - which "which drew an impromptu applause from the audience"; hence the word "claptrap". Unthinking remark, unthinking applause for the person who uttered it. Who in that clapping throng was not in some way dependent on capitalism? Who knew a way to transcend it? Indeed it can be blamed, but only by those with a deeper understanding.

More generally, I criticize Laengle for pontificating on the topic of addiction. Being a psychotherapist doesn't make you an expert on social policy. Addiction is a societal problem and not just the business of the individual as he seems to imply. He should stick to his profession of serving the interests of those who pay him, but also remember that his responsibility to society remains as great as anyone else's.

Addiction—I'd agree with Mate's definition of "a type of slavery" has social implications. The Victorian temperance movement saw this clearly. They could not solve poverty but had success in getting people to "sign the pledge", for drink caused starvation and misery. Today it is more notorious for causing crime.

And when Laengle defended the man who kept going to the psychotherapist even though he had no intention to give up his addiction, his smug response reveals a vested interest. He cannot criticize someone who adds an extra addiction to the one he already has. Laengle is as dependent on his clients addicted to psychotherapy as a drug pusher is to hisclientèle.

I feel I have earned the right to criticize him after going some way towards training as a counsellor/psychotherapist myself.