- You bring your own Kleenex to the therapy session rather than use the ones the therapist put out.
- You feel guilty about Global Warming because once you discarded the whole pizza box rather than cut out and recycle the clean sections.
- You pretend the allergy pills worked so that your doctor won't be disappointed.
- When people ask, "How are you?," you tell them how your spouse is.
- Your kid gets a B and you conclude that you've failed as a parent.
- You stand on the subway so the seat can go to someone who needs it more -- and you're 78.
Maybe you have some more of these? Email them to me.
Not everyone would agree that these are all indications of codependency, and they certainly don’t cover the whole area – more the un-entitled variant. Codependency, of course, is not a scientific term, not in the diagnostic manual, so probably no two clinicians define it quite the same way.
I first came across the term as “co-alcoholic” around the late 1970’s. At that time, it referred to the alcoholic’s spouse, the Enabler, who played her/his own role in keeping the alcoholic behavior going. When rehabs expanded their horizons to other substances and adopted the term “Chemical Dependency”, the term “codependent” arose – in other words, it did not refer to the individual’s dependency, but rather on his/her collaboration with the behavior of the person who was chemically dependent – this often involved putting aside one’s own needs and taking on responsibilities that properly resided in the spouse’s hands. Codependent individuals had often grown up in alcoholic or otherwise dysfunctional families.
Over time, the term codependent came to apply more broadly to people who, regardless of whether they had an alcoholic/addict in the family, shared certain characteristics. In my book, the organizing belief is, “I am responsible for you, and not necessarily for me.”
Sunday, August 1, 2010
Codependent and More
You know you're codependent when:
Sunday, July 18, 2010
The Ebb of Personal Morality
This morning on a new PBS program that I commend to your attention, Need to Know, I listened to a reasoned discussion of the problem of what amounts to corruption in the alliance between pharmaceutical companies and physicians/scientists.
If you think about it, it is obvious that if my company (and I) will be more enriched by hiding scientific information indicating that our drugs may be unsafe or ineffective (or both), I may be more inclined to do so. (By the way, let’s say that we do 20 studies and our treatment shows up as significantly effective in only 1 of these – that will happen by chance. But if we report only on that one study, it will seem like something worth taking, and paying for.) Similarly, if I am a physician or scientist on the payroll of (or enjoying speaking fees from) a pharmaceutical company, saying nice things about their medications, and recommending them to others, will of course be in my financial interest.
What this morning’s interviewee (Jerome Kassirer, MD, former editor-in-chief of the New England Journal of Medicine) recommended was not increased government oversight, but rather holding individuals accountable for their unethical behavior. Without fear of consequences, and shielded from their consciences by being part of a large organization, people are likely to do what feels rewarding now, and blind themselves to the larger or longer-term effects.
One place we could look for evidence of that, I’m sure (but, by the way, not bothering to do a literature search for the purpose of this blog that 3 people read), is in social psychology. If everyone around me is doing something, and it is embraced (either overtly or with a wink) by the organization of which I am a part, it will be much easier for me to rationalize my behavior, even if in the back of my mind I know it’s not the right thing to do.
We have only to look at the ongoing, worldwide economic crisis, which some economist say threatens to hit again in a second wave, or to the latest devastating environmental crisis in the Gulf (amid the echoes of “Drill, Baby, Drill”), to find one example after another of human beings blinding themselves to the very serious eventual impact of their irresponsible behavior because of the intoxication of immediate gain (more money for me, more recognition, more power, more stuff, more euphoria).
As is my wont, I will now note the obvious parallels to addictive behavior. It is often said that, in addiction, the brain gets neurologically “hijacked.” People go to great lengths to protect a pattern of behavior and sensation, as if it were necessary to their survival. Their choices are ruled by immediate rewards (and fear of immediate unpleasantness); longer-term and more momentous consequences are rationalized away or simply ignored in the service of maintaining the addiction. Of course, in the long run, no one’s life is meaningfully enriched by intoxication, euphoria, escape, riches, fame, or power. But, for us humans, it appears that this is how the game is played.
Since the addict (like other human beings) tends not to be guided toward rational, “good” behavior by his or her own instincts, it is usually necessary for him or her to develop what I (and, I’m sure, others) call “healthy fear” in order to summon the initial motivation to take steps toward recovery. The activities often referred to as “enabling” are the behaviors of those surrounding alcoholics/addicts who cushion them from the negative consequences of their actions. When the alcoholic/addict finally gets to the point of having more fear of what will happen if s/he continues to drink (or drug or gamble, etc.) than the existing fear of what will happen if s/he does not – that is often the moment when the first efforts toward change are made. (Not much different for the sedentary overeater who suddenly goes to the nutritionist and the gym after having a heart attack.)
Once in recovery, addicts often eventually need to come to terms with things they did while actively addicted that were foolish, hurtful, unethical, etc. Their retroactive guilt and shame can sometimes trigger cravings to return to their substance for relief. Those who participate in 12-step groups get some help in addressing and resolving the guilt through some of the steps specifically focused on self-examination and reparation. (Others, of course, may go through a similar process in other ways, such as psychotherapy – I don’t think we have a pill for that yet.)
People behave best, it seems, when they are subject to a strong sense of personal responsibility for their choices. I am not suggesting that personal choice and free will are the only, or even primary, factors contributing to how people behave, but that a sense of personal accountability, closely connected with “healthy fear,” may be the only or best route toward doing what’s best for ourselves, our communities, our country and world. Researchers who fabricate or distort scientific findings, or hide contrary results, should be subject to losing their careers. Corporate workers (from the top executives who green-light projects or ignore unprofitable information to the front-line workers who run studies or sell mortgages or check the mechanical integrity of oil wells or Big Dig tunnels) will never change their behavior if only the corporate entity is sanctioned, while individuals continue to be rewarded. Promoting a sense of individual moral responsibility may be the big challenge of our time, if we are to avoid becoming the victims of our own largely primitive brains.
If you think about it, it is obvious that if my company (and I) will be more enriched by hiding scientific information indicating that our drugs may be unsafe or ineffective (or both), I may be more inclined to do so. (By the way, let’s say that we do 20 studies and our treatment shows up as significantly effective in only 1 of these – that will happen by chance. But if we report only on that one study, it will seem like something worth taking, and paying for.) Similarly, if I am a physician or scientist on the payroll of (or enjoying speaking fees from) a pharmaceutical company, saying nice things about their medications, and recommending them to others, will of course be in my financial interest.
What this morning’s interviewee (Jerome Kassirer, MD, former editor-in-chief of the New England Journal of Medicine) recommended was not increased government oversight, but rather holding individuals accountable for their unethical behavior. Without fear of consequences, and shielded from their consciences by being part of a large organization, people are likely to do what feels rewarding now, and blind themselves to the larger or longer-term effects.
One place we could look for evidence of that, I’m sure (but, by the way, not bothering to do a literature search for the purpose of this blog that 3 people read), is in social psychology. If everyone around me is doing something, and it is embraced (either overtly or with a wink) by the organization of which I am a part, it will be much easier for me to rationalize my behavior, even if in the back of my mind I know it’s not the right thing to do.
We have only to look at the ongoing, worldwide economic crisis, which some economist say threatens to hit again in a second wave, or to the latest devastating environmental crisis in the Gulf (amid the echoes of “Drill, Baby, Drill”), to find one example after another of human beings blinding themselves to the very serious eventual impact of their irresponsible behavior because of the intoxication of immediate gain (more money for me, more recognition, more power, more stuff, more euphoria).
As is my wont, I will now note the obvious parallels to addictive behavior. It is often said that, in addiction, the brain gets neurologically “hijacked.” People go to great lengths to protect a pattern of behavior and sensation, as if it were necessary to their survival. Their choices are ruled by immediate rewards (and fear of immediate unpleasantness); longer-term and more momentous consequences are rationalized away or simply ignored in the service of maintaining the addiction. Of course, in the long run, no one’s life is meaningfully enriched by intoxication, euphoria, escape, riches, fame, or power. But, for us humans, it appears that this is how the game is played.
Since the addict (like other human beings) tends not to be guided toward rational, “good” behavior by his or her own instincts, it is usually necessary for him or her to develop what I (and, I’m sure, others) call “healthy fear” in order to summon the initial motivation to take steps toward recovery. The activities often referred to as “enabling” are the behaviors of those surrounding alcoholics/addicts who cushion them from the negative consequences of their actions. When the alcoholic/addict finally gets to the point of having more fear of what will happen if s/he continues to drink (or drug or gamble, etc.) than the existing fear of what will happen if s/he does not – that is often the moment when the first efforts toward change are made. (Not much different for the sedentary overeater who suddenly goes to the nutritionist and the gym after having a heart attack.)
Once in recovery, addicts often eventually need to come to terms with things they did while actively addicted that were foolish, hurtful, unethical, etc. Their retroactive guilt and shame can sometimes trigger cravings to return to their substance for relief. Those who participate in 12-step groups get some help in addressing and resolving the guilt through some of the steps specifically focused on self-examination and reparation. (Others, of course, may go through a similar process in other ways, such as psychotherapy – I don’t think we have a pill for that yet.)
People behave best, it seems, when they are subject to a strong sense of personal responsibility for their choices. I am not suggesting that personal choice and free will are the only, or even primary, factors contributing to how people behave, but that a sense of personal accountability, closely connected with “healthy fear,” may be the only or best route toward doing what’s best for ourselves, our communities, our country and world. Researchers who fabricate or distort scientific findings, or hide contrary results, should be subject to losing their careers. Corporate workers (from the top executives who green-light projects or ignore unprofitable information to the front-line workers who run studies or sell mortgages or check the mechanical integrity of oil wells or Big Dig tunnels) will never change their behavior if only the corporate entity is sanctioned, while individuals continue to be rewarded. Promoting a sense of individual moral responsibility may be the big challenge of our time, if we are to avoid becoming the victims of our own largely primitive brains.
Monday, May 31, 2010
Avoidance as Addiction
I know, I know – they call everything an addiction these days. Sometimes it seems like a convenient excuse for people like Tiger Woods or that guy who married Sandra Bullock. But sometimes the question isn’t so much “Is this a true addiction?” as “Does it help to apply the addiction model to this problem?”
One case in point is avoidance of professional tasks – in my work at the Massachusetts lawyer assistance program, I’ve noticed that almost every lawyer (maybe every person) reports at least occasional episodes. In some cases, it fits under the oft-discussed category of procrastination, in the sense that we all often feel like doing something other than work. In other cases, it is more clearly associated with particular feelings and relationships. The feelings may include anger, regret, etc., but most often there is a high degree of anxiety or fear, which can be compounded, as time goes on, by shame.
Like the use of an addictive substance, avoidance behavior is instantly and powerfully reinforcing. Imagine a situation where you have to tell your friend Fred that you cannot actually loan him the money you had said you would. This will be a terribly awkward, uncomfortable, conversation. You anticipate his anger, disappointment, dismay, and yourself feeling like the cause of it (in an immediate sense, though of course you had nothing to do with the reasons he needed the loan). As you pick up the phone to call him, your pulse increases and you find yourself holding your breath. Imagine, now, that you reach his voice mail and hear “Because of a family member’s funeral in another state, I will be away until next Monday.” You now have a very good excuse for putting off this unpleasant chore. The relief! Your breathing and muscles relax, and a sense of wellbeing returns.
In avoidance, you get the same immediate benefit – the difference is that the excuse is not provided by Fred’s absence, but by internally generated rationalizations – “I’m too tired to do it tonight;” “This can always be done later;” “Maybe if I shelve it now, somehow the need to do it will go away;” “I’ve avoided things like this before, and nothing awful happened.” It’s not hard to see how rewarding avoidance can be – it can dramatically lower anxiety and other negative emotions.
As one who lingers over the newspaper a few minutes longer every morning than makes sense, momentarily pushing away the commute and the day’s tasks, I certainly understand the appeal of avoidance in general. In addition, particular types of work present their own seductive opportunities for delay, evasion, momentary escape. Cues for lawyers, for example, include the following:
• Having to tell a client something s/he won’t want to hear; e.g., your lawsuit no longer looks promising.
• Facing an unfamiliar task, e.g., I’ve never filed this kind of petition before.
• Dealing with ornery or otherwise unpleasant clients.
Of course, the particular situations that tend to elicit avoidant behavior will vary from individual to individual. Each alcohol or drug addict, similarly, will have his or her own set of “triggers” that elicit urges to engage in the addictive activity.
If the addiction model is at all useful to apply to avoidance, what measures would it suggest employing in order to “prevent relapse”? Here are some:
• Admit the problem. If history has shown that you have repeatedly avoided important duties in a way that is ultimately likely to lead to meaningful regrets, face the fact that there is a subset of your behavior that is not subject to your ability to think rationally.
• Don’t keep it to yourself; talk to someone else about it; make it real and accept that if you could fix it via internal dialog only you probably would already have done so.
• Identify the situations (external, emotional, etc.) that, for you in particular, are most likely to trigger counterproductive avoidance. This is done primarily by reviewing past examples.
• Though it’s just the sort of thing that we all tend to put out of our minds, practice thinking beyond the decision to avoid, and allow yourself to see the potential or likely consequences. For example, the client will be even angrier to find out about this at a later date, while if you get through the task now you will no longer have to dread it.
• If you are deceiving, hiding, or denying, recognize that these maneuvers perpetuate the avoidance and add to your burden.
With any addictive behavior (and I am only suggesting that avoidance can emulate an addiction*), few individuals will be motivated to take action until some kind of problem results from the behavior, but the hope is always that one need not “hit bottom” in an extreme (or career-heopardizing) way in order to accept reality and embrace healthy change. This is where a therapist may come in handy.
*It is worth noting, however, that there actually is a 12-step group called Procrastinators Anonymous: http://procrastinators-anonymous.org/.
One case in point is avoidance of professional tasks – in my work at the Massachusetts lawyer assistance program, I’ve noticed that almost every lawyer (maybe every person) reports at least occasional episodes. In some cases, it fits under the oft-discussed category of procrastination, in the sense that we all often feel like doing something other than work. In other cases, it is more clearly associated with particular feelings and relationships. The feelings may include anger, regret, etc., but most often there is a high degree of anxiety or fear, which can be compounded, as time goes on, by shame.
Like the use of an addictive substance, avoidance behavior is instantly and powerfully reinforcing. Imagine a situation where you have to tell your friend Fred that you cannot actually loan him the money you had said you would. This will be a terribly awkward, uncomfortable, conversation. You anticipate his anger, disappointment, dismay, and yourself feeling like the cause of it (in an immediate sense, though of course you had nothing to do with the reasons he needed the loan). As you pick up the phone to call him, your pulse increases and you find yourself holding your breath. Imagine, now, that you reach his voice mail and hear “Because of a family member’s funeral in another state, I will be away until next Monday.” You now have a very good excuse for putting off this unpleasant chore. The relief! Your breathing and muscles relax, and a sense of wellbeing returns.
In avoidance, you get the same immediate benefit – the difference is that the excuse is not provided by Fred’s absence, but by internally generated rationalizations – “I’m too tired to do it tonight;” “This can always be done later;” “Maybe if I shelve it now, somehow the need to do it will go away;” “I’ve avoided things like this before, and nothing awful happened.” It’s not hard to see how rewarding avoidance can be – it can dramatically lower anxiety and other negative emotions.
As one who lingers over the newspaper a few minutes longer every morning than makes sense, momentarily pushing away the commute and the day’s tasks, I certainly understand the appeal of avoidance in general. In addition, particular types of work present their own seductive opportunities for delay, evasion, momentary escape. Cues for lawyers, for example, include the following:
• Having to tell a client something s/he won’t want to hear; e.g., your lawsuit no longer looks promising.
• Facing an unfamiliar task, e.g., I’ve never filed this kind of petition before.
• Dealing with ornery or otherwise unpleasant clients.
Of course, the particular situations that tend to elicit avoidant behavior will vary from individual to individual. Each alcohol or drug addict, similarly, will have his or her own set of “triggers” that elicit urges to engage in the addictive activity.
If the addiction model is at all useful to apply to avoidance, what measures would it suggest employing in order to “prevent relapse”? Here are some:
• Admit the problem. If history has shown that you have repeatedly avoided important duties in a way that is ultimately likely to lead to meaningful regrets, face the fact that there is a subset of your behavior that is not subject to your ability to think rationally.
• Don’t keep it to yourself; talk to someone else about it; make it real and accept that if you could fix it via internal dialog only you probably would already have done so.
• Identify the situations (external, emotional, etc.) that, for you in particular, are most likely to trigger counterproductive avoidance. This is done primarily by reviewing past examples.
• Though it’s just the sort of thing that we all tend to put out of our minds, practice thinking beyond the decision to avoid, and allow yourself to see the potential or likely consequences. For example, the client will be even angrier to find out about this at a later date, while if you get through the task now you will no longer have to dread it.
• If you are deceiving, hiding, or denying, recognize that these maneuvers perpetuate the avoidance and add to your burden.
With any addictive behavior (and I am only suggesting that avoidance can emulate an addiction*), few individuals will be motivated to take action until some kind of problem results from the behavior, but the hope is always that one need not “hit bottom” in an extreme (or career-heopardizing) way in order to accept reality and embrace healthy change. This is where a therapist may come in handy.
*It is worth noting, however, that there actually is a 12-step group called Procrastinators Anonymous: http://procrastinators-anonymous.org/.
Sunday, February 7, 2010
The "Higher Power" Obstacle, part 2
As discussed in my last blog, deriving the benefits of 12-step programs (which, all other considerations aside, are by far the most available resource for those in recovery) involves finding some kind of comfort with the concept of a “higher power,” and this can be uncomfortable for those with a more secular orientation. The 12 steps might well be worded differently if the program had developed in recent years, but it dates to 1935, and to the experiences of founders Bill Wilson and Dr. Bob Smith, who drew their initial inspiration from a Christian movement, the Oxford Group. Just as countless people with no traditional religious belief nevertheless value the Golden Rule, it is possible to make constructive use of the 12 Steps as a psychological program without embracing theism.
Among the alternative “higher power” concepts that I have heard over the years from many of my patients in recovery is “G-O-D = Group of Drunks,” i.e., the sense that the accumulated wisdom of everyone in AA is likely to be greater than that of the individual. Indeed, as captured in the title of Kurtz’ history of AA, of crucial importance in recovery, from the AA perspective, is that the individual recognize that he or she is “Not God.” That is, it helps a lot to assume a posture of humility, recognizing that one’s own attempts to gain mastery over addiction have failed (usually case prior to coming to AA), and that grandiosity or over-confidence tends to be counter-productive.
Others may choose, in the role of higher power, a generalized notion of spirituality, which may include:
· Something akin to “The Force,” a connection with nature, or with the interconnectedness of all human beings;
· A transcendent state or awareness characterized by full and liberating acceptance of the universe as it is, and of having one’s own place in it (something related to what has in recent years been dubbed “mindfulness”);
· A commitment to compassion, and to other higher values that in many cases have slipped away over time, as the addiction has taken up more and more space in one’s mind. Author Karen Armstrong has discussed key, overarching humanitarian values that characterize virtually all religious philosophies but do not require a particular theistic belief.
· A psychological conception of the higher power as a part of the self, an internal representation. Many of us, even atheists, finds ourselves praying, or asking for help or guidance – without a belief in an external God, we must be communicating with a wiser or more intuitive part of ourselves. The part, for example, that awakens in the middle of the night with a new way to address a problem, or that sometimes seems to come up with answer we did not know we had. (When I was a songwriter, on occasion I had the sense that a song was writing itself “through” me. It flowed smoothly, and took shape as if the song already existed, and in fact I often thought I might have unconsciously ripped it off. Sometimes I had, but other times these became some of my better songs. A believer would be likely to attribute the process to God; an agnostic or atheist would have to view the experience as reflective of an internal connection to another part of onself.)
This is by no means an exhaustive list. Perhaps there are other concepts that have worked for you.
Among the alternative “higher power” concepts that I have heard over the years from many of my patients in recovery is “G-O-D = Group of Drunks,” i.e., the sense that the accumulated wisdom of everyone in AA is likely to be greater than that of the individual. Indeed, as captured in the title of Kurtz’ history of AA, of crucial importance in recovery, from the AA perspective, is that the individual recognize that he or she is “Not God.” That is, it helps a lot to assume a posture of humility, recognizing that one’s own attempts to gain mastery over addiction have failed (usually case prior to coming to AA), and that grandiosity or over-confidence tends to be counter-productive.
Others may choose, in the role of higher power, a generalized notion of spirituality, which may include:
· Something akin to “The Force,” a connection with nature, or with the interconnectedness of all human beings;
· A transcendent state or awareness characterized by full and liberating acceptance of the universe as it is, and of having one’s own place in it (something related to what has in recent years been dubbed “mindfulness”);
· A commitment to compassion, and to other higher values that in many cases have slipped away over time, as the addiction has taken up more and more space in one’s mind. Author Karen Armstrong has discussed key, overarching humanitarian values that characterize virtually all religious philosophies but do not require a particular theistic belief.
· A psychological conception of the higher power as a part of the self, an internal representation. Many of us, even atheists, finds ourselves praying, or asking for help or guidance – without a belief in an external God, we must be communicating with a wiser or more intuitive part of ourselves. The part, for example, that awakens in the middle of the night with a new way to address a problem, or that sometimes seems to come up with answer we did not know we had. (When I was a songwriter, on occasion I had the sense that a song was writing itself “through” me. It flowed smoothly, and took shape as if the song already existed, and in fact I often thought I might have unconsciously ripped it off. Sometimes I had, but other times these became some of my better songs. A believer would be likely to attribute the process to God; an agnostic or atheist would have to view the experience as reflective of an internal connection to another part of onself.)
This is by no means an exhaustive list. Perhaps there are other concepts that have worked for you.
Saturday, January 23, 2010
The "Higher Power" Obstacle
When embarking on a goal of abstinence from alcohol/drugs, which for many is the only realistic goal, self-help groups are certainly a key resource, whether or not the individual is involved in professional treatment. Self-help groups (which would more accurately be called mutual-help groups) offer a number of advantages – some level of relatively constant availability, a sense of comradeship with others in the same position, a venue for support, acceptance, congratulation, empowerment, etc., a wealth of practical advice – as much as needed, and at no cost (and no need for managed care authorization).
By far, the majority of self-help groups follow the Twelve Step model (mainly AA and NA). SMART Recovery also has a meaningful presence, at least in Massachusetts, but the sheer number of available meetings pales by comparison. (Comparing these two programs can wait for a later column.) In some states, other programs such as Women for Sobriety are also prevalent. Given the prominence of AA/NA, not to mention the impressive history of 12-step programs since their inception in 1935, it makes sense for most people in what is often called “early recovery” to at least sample AA meetings.
My experience, however, is that the majority of people, early in their exposure to AA, don’t like it. There are a range of reasons given, including a perception that “their problems are worse than mine” (and of course, an underlying preference to avoid getting involved with an organization that symbolizes loss of the beloved substance), but the obstacle about which I hear most frequently is “the God stuff.” There is, of course, no denying that AA itself began as an offshoot of the Oxford Group, a non-hierarchical Christian movement of the 1920s and 1930s which emphasized many of the themes still echoed in AA (but in the context of seeking to place oneself, nation, and world under God’s control). On the other hand, AA is explicitly not a religion, and invites multiple and individualized interpretations of “higher power;” in reality, there are many atheists and agnostics who make use of the AA program. But the wording of the 12 Steps can be a problem. The term “God” is used repeatedly, followed twice by the phrase, “as we understood Him” – making it sound as if the adherent must surrender to a God of the sort that could have a gender, and that in fact the gender is male.
A person of more secular, 21st Century sensibilities may well conclude, “This is not where I belong,” and walk away from a program that could, in fact, have much to offer him or her. In order to continue making use of AA, s/he must view terms like "God" and "Him" as metaphors for some alternative concept of a higher power. Some ideas on how that might be done coming soon.
© 2010 Jeffrey Fortgang
By far, the majority of self-help groups follow the Twelve Step model (mainly AA and NA). SMART Recovery also has a meaningful presence, at least in Massachusetts, but the sheer number of available meetings pales by comparison. (Comparing these two programs can wait for a later column.) In some states, other programs such as Women for Sobriety are also prevalent. Given the prominence of AA/NA, not to mention the impressive history of 12-step programs since their inception in 1935, it makes sense for most people in what is often called “early recovery” to at least sample AA meetings.
My experience, however, is that the majority of people, early in their exposure to AA, don’t like it. There are a range of reasons given, including a perception that “their problems are worse than mine” (and of course, an underlying preference to avoid getting involved with an organization that symbolizes loss of the beloved substance), but the obstacle about which I hear most frequently is “the God stuff.” There is, of course, no denying that AA itself began as an offshoot of the Oxford Group, a non-hierarchical Christian movement of the 1920s and 1930s which emphasized many of the themes still echoed in AA (but in the context of seeking to place oneself, nation, and world under God’s control). On the other hand, AA is explicitly not a religion, and invites multiple and individualized interpretations of “higher power;” in reality, there are many atheists and agnostics who make use of the AA program. But the wording of the 12 Steps can be a problem. The term “God” is used repeatedly, followed twice by the phrase, “as we understood Him” – making it sound as if the adherent must surrender to a God of the sort that could have a gender, and that in fact the gender is male.
A person of more secular, 21st Century sensibilities may well conclude, “This is not where I belong,” and walk away from a program that could, in fact, have much to offer him or her. In order to continue making use of AA, s/he must view terms like "God" and "Him" as metaphors for some alternative concept of a higher power. Some ideas on how that might be done coming soon.
© 2010 Jeffrey Fortgang
Sunday, January 10, 2010
Seeking The Answer
As I read a Boston Globe article the other day about the emergence of personal coaching as an alternative to psychotherapy (more oriented, they tell us, to goals/future/happiness than to addressing problems or illness), I picked up a glimmer of what must be a typical reader reaction: Now, finally, there's a new, better, right answer. Now I can access the people who really have the answer to happiness, rightness, etc. (Even though we learn that many coaches, though they have no widely supported standards or certification,are themselves mental health professionals, maybe that have just found a better path -- certainly one that allows them to charge more without having to deal with health insurance.)Within the established mental health field, of course, new/better/"the answer" therapy techniques never stop appearing. Each brings a series of books and traveling experts, and draws a slew of therapists who are, themselves, looking for an approach that will help them feel more effective and successful. Some of these techniques become passing fads, while others take root and hang around. Quite often, the new/better/special approaches eventually seem less different from what already existed, and blend in, to become partof the ongoing, fluid collection of perspectives on which the average therapist draws. The same thing happens with new medications – it is said, in jest but also accurate social perspective, that one should make sure to use new meds within the 1st 2 years, since after that their effects will become much less impressive.
In other fields, there is no scarcity or end to exciting new answers from the worlds of nutrition, exercise, and of course religious leaders (whose role in the last century has largely been transferred to mental health professionals).
Alas, it turns out to be a rare event when there is something genuinely new under the sun. And I’m not sure that anyone has The Answer. I recall, years ago, during the heyday of Stress Management, getting to know a professional who developed a nice sideline giving talks and workshops about stress. The techniques she had for making her audience aware of their stress level were eye-opening, and the relaxation techniques in which she guided them were, indeed, relaxing and provided a delightful break from the pressures of the day. So she was a local stress management guru, much like the long line of inspirational speakers on which we can overdose by watching PBS at fund-raising time. I got to know her, and liked her very much, but found her to be no less stressed than the rest of us and, in fact, to be juggling an untreated addiction. She was a very fine person and I’m sure she eventually addressed that issue – my only point is that we are all flawed, trying to get through, and not likely to be either finding or providing The Answer.
Yet we yearn to find a sage to follow and idealize, in our quest for a level of perfection and happiness which are not realistically attainable. We look at others, and they seem to be happier or more fulfilled or more successful, etc. Around 12-step circles, one sometimes hears the extremely useful guidance: “Don’t compare your inside to someone else’s outside.”
Of course, we should always be seeking more effective treatments and ways to alleviate suffering and advance wellbeing. But let’s abandon our fantasies of achieving flawlessness if we just find the right guru or hear the right infomercial.
As various forms of therapy/counseling/coaching/guidance come and go, and as those that seemed cutting-edge come to seem obsolete, what seems to be constant is that a crucial element in therapeutic outcomes is the quality of the relationship between patient/client and therapist – genuineness, acceptance of self and other, human connection, and appreciation of the moment – that’s probably as close to perfection as any of us can get, and maybe that’s enough.
In other fields, there is no scarcity or end to exciting new answers from the worlds of nutrition, exercise, and of course religious leaders (whose role in the last century has largely been transferred to mental health professionals).
Alas, it turns out to be a rare event when there is something genuinely new under the sun. And I’m not sure that anyone has The Answer. I recall, years ago, during the heyday of Stress Management, getting to know a professional who developed a nice sideline giving talks and workshops about stress. The techniques she had for making her audience aware of their stress level were eye-opening, and the relaxation techniques in which she guided them were, indeed, relaxing and provided a delightful break from the pressures of the day. So she was a local stress management guru, much like the long line of inspirational speakers on which we can overdose by watching PBS at fund-raising time. I got to know her, and liked her very much, but found her to be no less stressed than the rest of us and, in fact, to be juggling an untreated addiction. She was a very fine person and I’m sure she eventually addressed that issue – my only point is that we are all flawed, trying to get through, and not likely to be either finding or providing The Answer.
Yet we yearn to find a sage to follow and idealize, in our quest for a level of perfection and happiness which are not realistically attainable. We look at others, and they seem to be happier or more fulfilled or more successful, etc. Around 12-step circles, one sometimes hears the extremely useful guidance: “Don’t compare your inside to someone else’s outside.”
Of course, we should always be seeking more effective treatments and ways to alleviate suffering and advance wellbeing. But let’s abandon our fantasies of achieving flawlessness if we just find the right guru or hear the right infomercial.
As various forms of therapy/counseling/coaching/guidance come and go, and as those that seemed cutting-edge come to seem obsolete, what seems to be constant is that a crucial element in therapeutic outcomes is the quality of the relationship between patient/client and therapist – genuineness, acceptance of self and other, human connection, and appreciation of the moment – that’s probably as close to perfection as any of us can get, and maybe that’s enough.
Friday, January 1, 2010
Insane College Drinking
A recent episode of the wonderful NPR program, This American Life (which not only offers entertainingly quirky slices of life each week but can also be so much more informative than most of what we get from any media), trained its radio lens on the college drinking scene, and on the college deemed the nation's "#1 Party School." I recommend it to everyone. (http://www.thisamericanlife.org/Radio_Episode.aspx?sched=1330)
I have often noted that it is difficult to impossible to accurately diagnose Alcohol Dependence (colloquially, “alcoholism”) in college students – to identify those young men and women who will go on to function alcoholically long after college. Or, in other words, those who won’t radically curtail their drinking after moving on to the next chapter in their lives. Part of the problem is that, since so many college students so often choose to get very drunk -- because it has become normative! -- it is hard to know which individuals are losing control of their consumption, and which ones are choosing to drink like someone who has lost control.
The NPR program describes how one attempt after another to reduce college drinking through education, offering alcohol-free alternatives, etc. has failed to make a difference. What's so bad about binge drinking among the college crowd? The worst consequence is the recurrent deaths, through alcohol poisoning and dangerous (often unintentionally so) behaviors. And of course there is also collateral damage -- to property, people's jaws, private parts, or integrity, friendships, driving privileges, and, oh yeah, one's education.
I can't say I got the maximum benefit from my own college education. At that time, we were very distracted by the war in Vietnam and the many-faceted “Revolution” But I have to say I feel lucky that the drug of choice, at that time and place, was marijuana. It certainly presents multiple dangers of its own, and I'm not recommending it, but it does not approach alcohol in the potential havoc it wreaked on one's body, behavior, brain, legal status, family life, etc. Of course, most people engage in “normal” drinking in a way that produces little or no harm -- but it's hard to find anything like it at college, at a time of life when the brain is still developing. So, happy new year, and here's to those of us who somehow manage to survive our educations!
I have often noted that it is difficult to impossible to accurately diagnose Alcohol Dependence (colloquially, “alcoholism”) in college students – to identify those young men and women who will go on to function alcoholically long after college. Or, in other words, those who won’t radically curtail their drinking after moving on to the next chapter in their lives. Part of the problem is that, since so many college students so often choose to get very drunk -- because it has become normative! -- it is hard to know which individuals are losing control of their consumption, and which ones are choosing to drink like someone who has lost control.
The NPR program describes how one attempt after another to reduce college drinking through education, offering alcohol-free alternatives, etc. has failed to make a difference. What's so bad about binge drinking among the college crowd? The worst consequence is the recurrent deaths, through alcohol poisoning and dangerous (often unintentionally so) behaviors. And of course there is also collateral damage -- to property, people's jaws, private parts, or integrity, friendships, driving privileges, and, oh yeah, one's education.
I can't say I got the maximum benefit from my own college education. At that time, we were very distracted by the war in Vietnam and the many-faceted “Revolution” But I have to say I feel lucky that the drug of choice, at that time and place, was marijuana. It certainly presents multiple dangers of its own, and I'm not recommending it, but it does not approach alcohol in the potential havoc it wreaked on one's body, behavior, brain, legal status, family life, etc. Of course, most people engage in “normal” drinking in a way that produces little or no harm -- but it's hard to find anything like it at college, at a time of life when the brain is still developing. So, happy new year, and here's to those of us who somehow manage to survive our educations!
Subscribe to:
Posts (Atom)