A practical application of Existential Phenomenology to human cravings in developing a Contemplative Existential Therapy.
September 2023, by Jason Ross (MA Counselling Psychology, PhD student GCAS).
What if, what we are in the habit of calling “addiction” is not a break down in personal ethics, not so much an issue of being “out of control”, but a state of “denial”: a pushing away of that which we struggle to face. A phenomenological reading of Freud might conclude that this is the ego’s struggle: it does not want to be with things as they are; it is forever in waiting for a better time, a different place, an impossible destination – the false promise of complete fulfillment. The ego wants to be unmediated by the facticity’s of life. The perplexingly stubborn nature of this state of denial has us in the habit of thinking of it as some sort of illness or affliction. It is stubborn because it is denial in infinite regress: We are usually not only in denial of the actual addiction itself, proclaiming to ourself and others “it’s not that bad”, but in denial of how this compulsion serves to obscure something else, the “something” we don’t want to face. This something else is, more often than not, a source of pain. But, in a twist of terrible irony: in our ongoing attempts at escaping this pain, the compulsion becomes a pain in itself. Freud’s chief contribution may have been in recognising that there is always the return of the repressed through the “symptom”. Psychology is inclined to focus on treating these symptoms, but this is like the constant pruning of the branches of a tree. You can cut these branches back as much as you like but you are nowhere near the root. R.D. Laing proposed that every person was entitled to the benefit of their own symptoms, our symptoms tell us something about the things we are struggling with. Rather than something to be treated, symptoms are something we should be curious about, they tell us something about what it means to be human. Existentially speaking, we all share one fundamental, incurable, struggle – we all sit with a fundamental sense of lack or emptiness. Rather than something to be cured it is something to be endured. Addiction is the chief symptom of our fundamental sense of emptiness and the ego’s need to become something fixed and solid. According to Buddhism “The basic problem is not that we crave this or that thing, but that is seems to be our nature to crave.” (Loy, 2018, p.128)
Addiction is, therefore, the ego’s means of standing steadfast against the return of the thing we don’t want to face. This might be my own personal fears of not being good enough, of failure, of rejection or abandonment. All depending on my own personal history. But ultimately, existentially speaking, we all share an underlying fear that we do not even exist in the first place. This manifests in the ego’s need to make something solid of itself in the world. An existentialist perspective names this the “Oedipal Project” (rather than oedipal complex): To become the sustainer and creator of one’s own life, or as Nagarjuna (Buddhist philosopher) put it, to become “self-existing” (Loy, 2018). This is, however, an impossible project and such is the self-digging trench of “addiction”. In some ways addiction, especially in its extremer forms, is the eventual surrender to this fact: to give up on making something solid of myself and dive into my own emptiness through obliterating myself. Any process of recovery is, therefore, not a process of abstinence, per say, but a process of recovering a basic sense of self within a sea of potential emptiness, meaninglessness and insubstantiality.
Addiction could be reframed as a collection of potential compulsive behaviours in response to an underlying anxiety with regards to inherent feelings of “lack” to conscious experience. According to phenomenology, consciousness can only ever be consciousness of some “thing”, consciousness is not a “thing” in itself. This underlying sense that we have that there is something lacking to consciousness, as it is not a solid thing, leaves us with a feeling of emptiness, a question of “what if I am not real” or “what if this is all just a farce”. Buddhists call this “Dukkha” – perpetual unsatisfactoriness. When a person suffers severe enough trauma in their lives, rather than having a distorted view of reality, it is possible that a veil of illusion, a false sense of security in the world, is lifted. It is possible that trauma reveals existential truths about the world, truths we find too hard to face. What we call addiction becomes a flight from these felt realisations. Find a pub and you will find a war veteran drowning himself in the corner with the remains of his pension. It is because these habitual cravings are so difficult to resolve that we are attracted to conceiving of them as some fixed obstacle somewhere inside us – a condition of desire gone wrong in our heads. However, the answer may not lie in putting a lid on desire (abstinence) but rather in going into what it is that we truly desire and facing the things we are struggling to face. What we have come to call “recovery” is at risk of becoming a whole new process of denial through a constant stance of suspicion towards one’s own desires: a perpetual self-surveillance. Self- control alone is not recovery. To “recover” is to move from a “fleeing from” to a “going into” our true desires. It is to ask: What is the thing I am searching for at the bottom of a whiskey barrel? The aging veteran drowning himself in Guiness at the lonely end of a bar is, most likely, even if privately, asking himself some unbearable questions. What has this all been for? Recovery is the courage to sit with these questions, even if there are no clear answers.
What we have come to call “addiction” is, therefore, a state of denial of denial itself. Addictive behaviours serve to obscure us from the thing we are struggling to face, the existential questions we are asking ourselves: what are we all doing here and is it worth carrying on? Conventional recovery can surreptitiously serve as a form of further denial: by shutting the door on all and any longings – stopping at the doorway of our cravings and looking no further. What if a therapeutic endeavour was to fully enter into our own longing and discover what we find there; getting a sense of the thing we are most struggling to be, think or feel. For addiction to do its job, hide things from us, it must remain somewhat obscured from full view. In this way addiction is a form of alienation from our actual experience of things. Recovery can be an equal (even if opposite) form of alienation through renunciation of our longings. As Slavoj Zizek often warns, the renunciation of pleasure can easily turn into the pleasure of renunciation itself. Far too often, what we call “recovery” is simply a more risk averse form of denial: If addiction is a form of non-living through our own automated, compulsive and destructive behaviours, then recovery can be a state of non-living through putting all our longings on hold. An existential approach to “recovery” encourages us to embrace life in all its banality.
The human propensity for addiction is perhaps evidence of life’s absurdity. Addictive behaviours often fail all logic. From the supposed “outside” they may seem completely ridiculous. Often a person might ask “but, why are you doing this to yourself, it makes no sense.” In truth, so much of what we do makes no sense. However, ridicule is no cure. Far too often what is deemed “rehabilitation” takes on the form of the language of ridicule: pointing to the lack of logic in our behaviour. This seems to achieve very little other than yet another infinite regress: the ridiculousness of ridiculing the ridiculous. The objectifying practices of rehabilitation, through naming and shaming conditions, don’t seem to help much in facilitating agency and change in a person attempting to regain a sense of self-regulation. On the contrary, shame usually keeps us stuck.
My therapist once said to me “Stop doing the thing you have always done and do the thing you don’t know how to do”. This is, perhaps, the very definition of “recovery”. In fact, most of therapy is probably about breaking habitual ways of being in the world. But, how do we learn to do the things we don’t know how to do? The Russian psychologist, Vygotsky (2012), called this “the zone of proximal development”: the developmental leap that the child makes, often through his/her interaction with a caregiver, in learning to do something new, in becoming something she was not before. According to this perspective, development does not precede learning. We are not, therefore, predisposed to addiction but learn addictive ways of being with the world. Addiction is something that is learned through my encounter with the world. I can, therefore, learn a different way of being in the world. Learning to speak a language is perhaps the best example of this theory. The chid is exposed to something they do not know how to do, over and over, until one day they make a leap into something they did not know before. If I can learn addiction, I can surely learn alternative ways of being with my struggles? What I am, however, unlikely to “learn” is the absence of desire. To some extent, this is about learning a language about who and what we are. Is there a language for self-preservation that does not give in to the toxic positivity and self-policing perpetuated by the current self-help movement?
People in “recovery” are learning a new language: a new way of thinking and speaking about themselves. The significance of this reflective act, of consciousness, of languaging ourselves back to ourselves, is ignored in a purely scientific approach to human behaviour. There is a particular language of concern, typical of rehab-speak, that is inclined towards shaming: it proposes an “inside” and an “outside”; that there is a specific “addict” kind of person and a non-addict kind of person. People like us, addicts, supposedly have a certain developmental inclination that can’t be trusted. Giving compulsively into our own desires is supposedly inevitable. We might have let ourselves down enough times, tragically, to begin to feel we cannot trust ourselves, but should this distrust be treated as truth? Is this true only for the supposed addict? My argument here is that we are all inclined towards compulsive craving in as a means of dealing with our struggles. However, it is assumed that people on the “outside” of addiction can’t understand our struggles and that people on the “inside” require a different set of conditions, a different way of living, a particular kind of intervention into their compulsive cravings. I challenge this view: proposing that what we call addiction is an aspect of the human condition – the craving process is an integral part of the very fabric of our being. Compulsive cravings (for chocolate, sex, drugs, money and even exercise) are born out of an attempt to escape a particular kind of pain or struggle, to try and get ourselves out of the way, and are even part of an innate “spiritual longing” (to use a reluctant term):
There is a yearning that is as spiritual as it is sensual. Even when it degenerates into addiction, there is something salvageable from the original impulse that can only be described as sacred. Something in the person (dare we call it a soul?) wants to be free, and it seeks its freedom any way it can. … There is a drive for transcendence that is implicit in even the most sensual of desires.” – (Epstein, 2005, p. 8)
The Vedanta (the earliest account of consciousness) talks about “ahamkara” or “self-making”: As we encounter the world on a sensorial level, we experience perpetual cravings and aversions. It’s through these cravings and aversions that we establish a sense of self, “I am [this]”, “I am not [that]” (Thomson, 2015). A much scarier thought than all the shaming of rehab-talk is that this illusive self is the sum of my cravings. We are desire. As Samuel Beckett put it “You’re on earth. There’s no cure for that.” To live is to crave. The solution is not to avoid craving but to go into our own craving and understand it better. As Rumi says, “you must ask for what you really want”. Recovery from addiction is a coming to terms with our own craving. The craving for alcohol, drugs or sex is often a substitute for what we are truly craving – soothing. We want to go beyond our self. In the end, we crave the sensation of freedom itself. Freedom from what? According to existential Buddhist philosophy – we are all attempting to flee a gnawing underlying sense of lack or emptiness inherent to consciousness.
Perhaps even worse than the damnation of “My name is Jason and I am an addict” is “I am a recovering addict”: To be damned to a life of cravings but banished from acting on any of them. Not only does this pathologize a pre-given aspect of the human condition (our perpetual craving), but I have found that many people who considering themselves “recovered” are living at half-mast. It is as if they are holding their breath all the time in a state of distrust in whom they are. It is worth debating how much free will we have but therapy would be impossible if it couldn’t rescue some degree of agency. Personally, I dream of places where we can navigate between compulsive (and harmful) cravings and the freedom to express, to be, to indulge. What we call addiction is simply a flight from what we feel, who we are, and an aversion of the things we are finding hard to face. Compulsive craving offers us an escape route. As Albert Camus wrote “Man is the only creature who refuses to be what he is” (Camus, 1951, p. 11). To supposedly overcome “addiction” is to face being what we are but there is no real cure for what we are. The very word “recovery” implies the regaining of something. What is it that we are trying to salvage through recovery? What if the addiction itself is an attempt at salvaging something? The original feeling of unity with mother that we had as a child; an unmediated sense of the world before we had a sense of being an individual self; a getting beyond our existential dread (the confrontation with our own feeling of emptiness).
I am not proposing that we can’t get ourselves into deeply destructive patterns of compulsive craving. I am also not against the proposal that abstinence from a particular behaviour or substance might be the most caring thing we could do for ourselves. What I am proposing is that the notion that there is such a thing as an “addict” and that these people are the damned few, is a problematic and outdated remnant of a therapy system that was thought up by a stockbroker and a rectal surgeon in the 1930’s. (https://aahouston.org/about-aa/aas-beginnings/). Shame, confessionals, behavioural control and illness models are the remnants of a poor hybrid between religion and medicine. Care is the real solution. Care enough for yourself and care enough for those who are hurt by the outcome of the compulsions (no matter how sporadic). It is, however, critical that we tell the difference between “care” and “control”. Whether a parent, a practitioner, or a lover – far too often control disguises itself as care. If you want to know the difference, ask yourself if it feels like shame – then it is control. According to psychoanalyst Adam Phillips (2022), shame can be an attempt to recover our core morality. In other words, shame can be a (failed) attempt to remember the best version of ourselves. There is the illusion that when we feel shame, we will remember who we are meant to be. But this definition of who we are meant to be is a societal story – a function of social regulation. He sites homosexuality as an example of this – as something that people used to believe that they should feel ashamed about.
Coincidentally, homosexuality was once a feature of the Diagnostic and Statistical Manuel, a supposed disease of the mind that you could be diagnosed with. Diagnostic thinking, including the idea of addiction, is mixed up with the social construction of morality, of societal ideas of wrong-doing and right-doing. Psychotherapy is not a religious practice, it has no place reifying societal moral norms. Although “recovery”, of any kind, does seem to have to move through the feeling of shame, at least the feeling of exposing things that might have been hidden (even from yourself), shame itself is not the cure. We all tend to be able to reveal certain ideas about ourselves and hide other versions of ourselves. What we call addiction almost always involves some hiding. Recovery, therefore, should include some sort of exposure or revealing, but this should not be treated as a confessional (as psychotherapy is always at risk of immolating). Psychotherapy should move away from its risk of become a modern priesthood. Psychotherapy is better suited as an effort for discovering the truth of things, without judgement. As Michael Guy Thompson (1994) points out, Freud’s life endeavour was to uncover the truth. It is unfortunate that he attempted to do this in scientific terms, but psychotherapy, nevertheless is a relationship with the truth (of experience not of logic). The value of the average rehab model is that it is aimed at telling the truth; at a sense of community (or solidarity); it is concerned with belonging; it provides some structure and routine (or ritual), and it is a surrender to the fact that we do things we don’t quite understand. But most of all, “recovery” should be an attempt to salvage some sort of agency: the idea that there is something to be done beyond how we are determined by our own impulses, habits, and histories. The methodology for this, however, is problematic as it is founded typically on shame. There is no escaping shame. There is also no value in feeding it. Rather we should simply attend to its natural arising with equanimity. The treatment model being proposed here therefore begins with simply attending to who we are and how we are with equanimity.
According to Adam Phillips (2022), shame can expose how you have been subjected to the tyranny of your own internal ideals. Shame can also reveal to you what it is that you truly value. There is a beautiful line in Jeanette Winterson’s Written on the Body (2013, p. 56): “What you risk reveals what you value”. It’s a wonderful ethic and a good indicator that we are in trouble with addiction – we end up betraying our own intentions and risking the things that we most value. Any behavioural pattern can do this and so simply not drinking too much, for example, doesn’t solve the problem. We need to reflect on how we betray our own intentions (even if unconsciously so). What is this preferred self that we want to be? Can I make room for it? Am I holding on too tightly to it? Is alcohol an attempt to just let myself “be”? We seem to be forever at risk of holding on too tightly to ideas of who we are. Even though psychoanalysis is based on a rather deterministic model, it is equally, surely, founded on the intention to somehow intervene in our lives? What if we are all just looking for some relief from the ongoing struggle to exist? Human experience may come standard with degrees of shame, but that does not mean that we should settle for dwelling in that shame. Perhaps the best kind of “intervention”, therefore, is a “being with” or attending to (as Laing encouraged) rather than an acting upon (getting people to change).
I risk being accused of “promoting the occasional drink” to persons with identified problematic relationships with alcohol. This is not necessarily the case. The question for anyone who is in trouble with alcohol is: Can I drink safely or not? The answer to this question, I believe, lies in resolving the struggle they have been trying to resolve (or at least escape from) through alcohol. As Tom Waits put it: “I’d rather have a bottle in front of me than a frontal lobotomy”. We need to ask what is it that we are attempting to lobotomise. Why spend that kind of money on a psychiatrist when you can go to the pub, right? But, as far as an abstinence-as-cure-model goes, it is surely curious how complete abstinence is the proposed solution to alcoholism but not necessarily for sex addiction or obesity? For someone like myself, active in working with people’s struggles with addiction, this raises questions about some of our taken for granted ideas about what “addiction” actually is and what constitutes a “recovery”. My proposal is that what we term addiction refers to the relationship between a state of mind (linked to our struggles) and a compulsive behavioural pattern (that serves as a form of denial). This behavioural pattern does not necessarily have to involve substance use, but often does. For example: I am addicted to my own disappointment. I was about 10 years old when I first discovered my father in the act of attempting suicide. He survived (then) but it has taken my lifetime and his final self-ending (much later in my life) for me to come to understanding that my experience of that moment was one of “disappointment”. Disappointment now comes easy to me as a kind of state of mind. It’s a place I can habitually go to. Freud’s “repetition compulsion”, if you like. Alcohol doesn’t help with this but I don’t need alcohol to go there.
The word recovery does not only imply a return to health or cure, but the regaining of something lost or taken away. The question then lies in what has been lost and how can it be salvaged? Often it is our own integrity that we are attempting to retrieve, a particular sense of our self, a coming back from a state of alienation, a feeling of disconnection (even if from our own feeling states, good or bad). But “recovery” might be the wrong approach. In my case, the idea of recovery keeps me attached to my disappointment, my need for things to be different to what they are. I want to recover feelings of hope rather than the disenchantment my father left me feeling. However, it is more likely that the solution lies in going into my feelings of disappointment, to be with things as they are: acceptance rather than denial.
The particular concern I have with the notion of an “addict” is that these kinds of diagnostic statements become identity conclusions: this is what I am and therefore it describes what I am doing. This not only offers no insight into actual experience but also keeps us stuck: When it comes to the human experience, diagnostics are an aetiological cul-de-sac, preventing any further understanding of the phenomenology of things like addiction. Put simply, we end up concluding that I behave like an addict because I suffer from addiction. Let’s take a different example: a client says to me “I struggle to get out of bed in the morning”. I ask, “why do you think that is”. She replies, “I think it is because I am depressed”. There is no meaningful exchange in our conversation, so far. Not getting out of bed and depression are two ways of describing the same symptom. She is essentially describing herself as depressed because she is depressed. Depression is a word to describe a response (albeit lasting) to experience, not a fixed condition or self-description.
Addiction (much like depression) is therefore a word to describe our struggle with something. Even if it is through destructive cravings, or compulsive thoughts and behaviours, the struggle is real and we should be supported in this struggle, not shamed. Furthermore, to say I am behaving a certain way (addictively) because I am an addict is a tautology. The more a biomedical model takes precedence in attempting to explain the phenomenology of our struggles, the more experiences like addiction are compared to, for example, epilepsy or diabetes. But this kind of thinking was debunked some time ago already. Psychiatrist, Thomas Szasz (2011, p. 179) was one of the first to raise alarm bells in this regard:
“The claim that “mental illnesses are diagnosable disorders of the brain” is not based on scientific research; it is a lie, an error, or a naive revival of the somatic premise of the long-discredited humoral theory of disease. My claim that mental illnesses are fictitious illnesses is also not based on scientific research; it rests on the materialist-scientific definition of illness as a pathological alteration of cells, tissues, and organs. If we accept this scientific definition of disease, then it follows that mental illness is a metaphor, and that asserting that view is asserting an analytic truth, not subject to empirical falsification.”
Szasz asserted that the idea of “chemical imbalance” as the cause of our suffering was a falsification based on the outdated humoral theory of disease (the 19th century idea that the human body was made up of four humors or fluids: black bile (also known as melancholy), yellow or red bile, blood, and phlegm. Health was defined as the proper humoral balance.) Since Thomas Szasz there has, however, been considerable neuroscience with regards to addiction. For example, evidence of how differences in functioning of parts of the prefrontal cortex influence addiction. But, as far as science goes, it is also well established that a scientific approach alone is not helpful. There is an entire body of knowledge around this, known as phenomenology, that cautions reducing man to a natural object that can be studied like other natural objects – through measurement and by breaking the human as object down to its component parts. The reservation here is that a purely scientific approach to a person can never reveal the full richness of our lived experience. It is for this reason that I increasingly turn to philosophy rather than psychology: The field of psychology was arguably born out of philosophy, but it may have, in error, adopted a scientific approach and the fantasy of an objective external observer. This has placed limitations on its understanding of human consciousness and individual experience. The phenomenological argument is that we need to go directly into experience in order to understand it, there is no Archimedean point from which we can observe ourselves. Psychology, as it is predominantly practiced, has increasingly attempted to reduce us to a set of interesting facts.
Foucault, who was against both psychoanalysis and psychiatry (coincidentally a trained psychoanalyst) wrote extensively on how these “illness” concepts become forms of defining, classifying, controlling, and regulating people according to ideas of supposedly normal (and abnormal) behaviour. Even though I don’t refute the pain of “addiction” or that people feel helped by traditional treatment models, the tautology of I am (or was) doing this [insert addiction] because I have an “illness” is, ironically, part of the denial process. The illness model lacks accountability, and any “recovery” process begins with accountability in order to have the courage to face that which I am struggling to face. But the process should not be one of confession but care. Recovery takes care, accountability, responsibility, insight (into what am I have medicating) and courage to face the things that are hard to face. This does not exclude looking at biological predispositions and other causal factors but an existential analysis encourages a sitting together, therapist and client, in the “perpetual unsatisfactoriness of existence” and attempting to embrace what it means to be alive in this moment in time.
The bottom line is that the idea of addiction as an illness is not the only way of understanding and addressing these struggles. In the end, my father gassed himself in his own car. Perhaps it was his final attempt at liberation from his struggles, or a resignation to defeat from the ruins that alcohol had made of his life? These are not struggles to be taken lightly, they can literally be a matter of life and death. But all of us, everyday, in everything that we do, are in a struggle between life and death. “There is only one really serious philosophical problem,” Camus (1995) said, “and that is suicide. Deciding whether or not life is worth living is to answer the fundamental question in philosophy. All other questions follow from that”. In everything we do we choose to live or die.
I don’t call myself an “addiction therapist”, much like I wouldn’t call myself a “sex therapist”, because these experiences lie at the heart of what it means to be human. They are not specialised concerns. I sit, every day, with people who are perplexed by the hold that “addiction” has over them. I believe that it is from this perplexity that we are inclined to frame it as an “illness”. It is tempting because illness processes happen outside of our own volition. What a relief it is if my addiction is just something that I am attempting to survive, not something that I have done to myself. However, what if we are capable of having intentions even at a pre-reflective or unconscious level? It is easy to respond to the bewilderment of addiction by professing that the only explanation could be that this in fact a disease. For some people there is relief in having a diagnosis, it seemingly removes that shame. The problem is that the shame will come anyway. Illness models aim at “cure” and there is no curing for the human condition. The illness model, therefore, has me in a state of being constantly at odds with myself. If what we call addiction is an illness, what exactly is this an illness of? An illness of brain chemistry? An illness of reasoning? An illness of choice making? An illness of character? An illness of perception? The illness model does not fit into the realm of understanding our response to the experience of our very existence (which inevitably involves a trauma of some kind or other). It seems possible that the real concern should not be whether I am an addict or not but whether I am in a state of denial or not. Denial is something that we all suffer from to a greater or lesser degree, addict or non-addict. I believe that denial (partly through its estrangement from accountability) is always symptomatic of any so called “addiction”. However, there is no way of going through life successfully without some form of denial. Life would be too brutal otherwise.
The current trend is to separate behavioural addictions (like sex) from biological addictions (like substances). But, categorising sex addiction as purely behavioural and alcohol addiction as purely biological is a clinical misapprehension. One of the particular challenges with sex addiction is that the “drug” lies somewhat in your own biology and it is, therefore, much more complicated than avoiding booze and bottle stores. Furthermore, when it comes to substance addiction, it is not the substance you put into your body alone that is at play, but the interaction between those substances and your own neurochemistry that creates the powerful hook. Cocaine’s high, for example, is what it is because of its workings on a brain rich with dopamine receptors. But, this doesn’t even begin to incorporate what it does for you behaviourally as your “cocaine tongue” (as Guns&Roses put it) gets wagging. Furthermore, show me a substance addict where sex isn’t playing a role. I am yet to come across a single person suffering with substance addiction that does not share similar struggles with other kinds of addictions. To live is to crave.
My central point here is that addiction (of any kind, including and especially a substance addiction) are never entirely just behavioural or just biological, and abstinence does not equate to recovery from the overall phenomenology of addiction itself. Hence the psychoanalytic notion of “the return of the repressed”, or the “dry drunk”: those who are successfully sober but perpetually angry. To be conscious is to be in a state of craving. An illness model for “addiction” (and other human struggles that get listed in the Diagnostic and Statistical Manual) assumes it is an “epiphenomenon”: a secondary mental phenomenon that is caused by and accompanies a physical phenomenon but has no causal influence itself. This one-way causal link ignores the symphony of simultaneously existing phenomenon. It is like reducing the ineffable melody made by a string quartet to bows moving along strings. There is so much more than these purely material phenomenon that create the experience. As far as the neuroscience goes, we do know that addiction can involve deficits in inhibitory control, along with functional and structural changes in, for example, the dopamine circuits of the brain. These biological deficits are more likely a self-perpetuating consequence of ongoing addiction than the initial cause of the addiction itself. This doesn’t even begin to consider the results of trauma on addiction – on the brain and, more significantly, on our motivation to seek refuge in the false promise of soothing through whatever addiction (behavioural or otherwise) we might fall prey to.
So I ask, if addiction is an illness, then what is it an illness of? Biology, perception, attachment, relation, thought, feeling, or behaviour? My practice as a psychotherapist suggests, strongly, that it involves all of these everyday human phenomenon, and it is a mistake to reduce it to something strictly biological. Blind worship of physicalism, which the field of psychiatry has increasingly built an alter to, is frankly ignorant to the complexity of the phenomenon of addiction (or any other mental struggle). Some would suggest that medicine has come a long way since, for example, Foucault but, never mind Foucault, David Hume was writing extensively on the dangers of applying pure scientific reason to human phenomenon as far back as the 1700’s. Medicine’s gaze has only entrenched its physicalist position in a project of objectification that is even more concerning than arguably any other ethical concern that we might have at this stage in human history.
A common argument is that “normal” cravings and desires are very different from a clinical diagnosis of “addiction”. This seems to be a fallacy. No one starts off an addict. It is a development, usually in response to trauma. Imagine Bob: Bob the biker falls off his motorbike, he breaks his femur. It’s a painful event. They administer morphine for the first few days he is in ICU. Morphine is a highly addictive substance. Bob feels pain relief, maybe even momentary euphoria, but he is not so keen on the side effects. It mostly leaves him feeling pretty disorientated and nauseas. A week later he finds himself at home, still recovering, struggling somewhat. He goes through grueling rehab. He has pain, but he is still not so keen on morphine. However, Bob has a friend Bill. Bill is in a similar accident a few months later. A similar injury. By the time they get him to hospital, he welcomes the morphine. Bill also lost his son in a drowning 2 years ago. Suddenly, not only the pain in his leg but the unbearable pain of the immeasurable loss of his son momentarily dissipates. Month’s later, Bill can’t get enough of this morphine stuff, despite the side effects, despite losing his job. With increased use, maybe his anterior cingulate gyrus starts to atrophy – further reducing his ability for impulse control? Who knows, we didn’t get to measure regions of his brain before his son’s tragic death. We can only take guesses. Scientific ones, but they are still guesses. Bill just can’t get a grip of his life, he needs to abstain from morphine and similar drugs, but how? Being conscious is just too painful. Abstinence won’t solve his pain.
Given the increasing medicalisation of human struggles, it is not uncommon to compare addiction to, for example, epilepsy. But, even though it has been suggested that Freud’s hysteric patients were actually epileptic, I struggle with this increasing tendency to reduce experience to biology. Are we comparing “addiction” to epilepsy because they are both considered diagnosable? How do we account for the fact that homosexuality was once diagnosable? According to Szasz (1974) mental diagnosis are a matter of politics and economics, it is not medicine. Diagnosis is a culturally influenced phenomenon and the diagnostic criteria for a physical condition are entirely different to those of mental phenomenon. It’s a bit like looking for proof of love through an astronomy telescope. Freud did, reportedly, share the fantasy that we would eventually find proof of mental pathology in science, but we are not there yet, and I don’t think we ever will be – for reasons alluded to above. This is known as the “hard problem of consciousness”. As helpful as science is, there are aspects of human experience that remain ineffable. A good psychotherapy provides a means of dwelling within this ineffability. The biological basis of epilepsy can be detected through evidence such as scans or an irregular EEG. Even then, this process is not 100% scientific. We don’t always know the relationship between objective biological anomalies and experience, even when this comes to detectable biological phenomena. I injured myself pole dancing. Three different doctors gave me 3 different diagnoses. My scans indicate damage that was probably there all along and that does not necessarily coincide with my symptoms. Almost all treatment and diagnosis is a process of “try this and see if it works”. Medicine is all too often less scientific than we are comfortable to acknowledge. It’s a bit like an educated game of “bobbing for apples”, you just have to keep trying until you get your teeth sunk into something that makes sense. But, just because something makes sense doesn’t mean it is true.
Reducing addiction to a purely biological condition is part and parcel of the denial process, it’s how we turn our back on the perplexing ways in which we do things that make no sense in destruction of our own lives: Freud’s death drive. When people make a special place for “alcoholism” as opposed to “sex addiction”, this is part of the denial process. I once worked with Joe. A charismatic, successful, articulate man. He had been sober for 20 years. He was a poster boy for the AA, sponsored many people, knew the struggle, talked at conferences, seemed to know everything there was to know about addiction. His wife catches him sleeping with a friend and insists he come for therapy. Turns out, Joe has been secretly bedding anyone he can for the past 20 years. Although Joe’s life isn’t nearly as close to destruction as it was when he was looking for a solution to his anxiety at the bottom of a whisky bottle, there are aspects of his own life that he still hides from himself behind his sexual cravings, and he was still, secretly, potentially throwing it all away (through the risk of the things he hides from those he loves). It turns out that there are things Joe finds hard to face, a restlessness he cannot shake, a validation he seeks, a constant stimulation he craves, a high he can hardly resist, a sadness he fails to acknowledge, a false self he still portrays to the world, a fulfillment he still longs for. There seems to be better and worse ways for him to pursue his true desires, but there is no cure. There is also not much difference between his struggles and the struggles of any other client I work with. Such is the nature of the human condition – no satisfaction is permanent – just ask the Rolling Stones. It seems there are many supposed “addictions” that Joe could be said to be in denial of. He loves danger, for example. However, there is an addiction that I privately worry about: his obsession with the “steps” (AA), the meetings, his belief in a creator – something he soothes himself with over and over again. My conversations with him leave me with the unshakable sense that there is no such thing as “addiction”, only denial of the human condition, whether this be through religion, alcohol or opium. If there is something to “recover” it is the ability to embrace what we are. Maybe Joe should leave his wife and live out the sexual freedom he craves so privately? Maybe what we call “addiction” is simply the secret longing to discover the sensation of freedom, no matter how. For the existentialist there is no escaping, the only freedom to be found is to fully embrace the totality of our lived experienced. “For if there is a sin against life, it consists perhaps not so much in despairing of life as in hoping for another life and in eluding the implacable grandeur of this life.” (Camus, 1968, p. 91). For Camus, we defeat death, or the inherent emptiness in life, through living sensuously.
Reference:
Camus, A. (1951). The Rebel. An Essay on Man in Revolt. Vintage: New York.
Camus, A. (1995). The Myth of Sisyphus and Other Essays. Vintage: New York.
Camus, A. (1968). Lyrical and Critical Essays. Vintage: New York.
Epstein, M. (2005). Open to desire: Embracing a Lust for Life – Insights from Buddhism and Psychotherapy. Gotham Books: New York.
Loy, R. L. (2018). Lack and Transcendence: The Problem of Death and Life in Psychotherapy, Existentialism and Buddhism. Wisdom Publications: Summerville USA.
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Szasz, T. (1974). The Myth of Mental Illness. HarperCollins e-book.
Szasz, T. (2011). The myth of mental illness: 50 years later. The Psychiatrist , Volume 35 , Issue 5, pp. 179 – 182. DOI: https://doi.org/10.1192/pb.bp.110.031310
Thompson, E. (2015). Waking, Dreaming, Being: Self and Consciousness in Neuroscience, Meditation, and Philosophy . Columbia University Press. Kindle Edition.
Thompson, M.G. (1994). The Truth About Freud’s Technique: The Encounter With the Real (Psychoanalytic Crossroads, 5). NYU Press. Kindle Edition.
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Winterson, J. (2013). Written on the Body. Vintage Books: London.