Alcoholism, Psychology and “Cures”

Yesterday, I came across a statement that ran through my head like someone in a particularly ostentatious 70s track suit all day.

It was this: “There’s no cure for alcohol addiction”.

Umm… Yeah… Wait, maybe… No… Huh?

This statement seems innocuous enough. But it’s actually worth discussing in depth. In fact, I may put on my Wittgenstein hat for a second and say that maybe the statement says a lot more about how crappy our definition of “cure” is (and our idea of “health” is) than any actual information about alcohol addiction or dependency.

It’s true that there’s no magic pill that will make it so someone will never want a drink again. This isn’t Tintin. Alcohol addiction isn’t a bacterium: It can’t be killed.

There is treatment for alcohol withdrawal, of course. The treatments, near as I can tell, are not particularly great, and this research basically suggests that withdrawal symptoms only be treated when they emerge, not on any kind of preventative schedule. But that’s not what we’re talking about.

Yes, alcohol addiction can be a life battle. That’s also true for any other kind of substance abuse or dependency, depression, schizophrenia, PTSD, rape trauma, DID, bipolar disorder, borderline disorder, autism-spectrum disorders… Basically, anything that hits our neurochemistry is something we can grapple with forever.

But let’s be very careful here for a second.

A lot of people conclude from the fact that there’s always the risk of relapse with the vast majority of psychiatric conditions that there’s no real change to our personalities or who we are. We’re just destined to play out the same tragedies and comedies over and over again, like characters in a Greek play.

But developmentally, nothing could be further from the truth. People are always changing. They’re gaining new habits and losing old ones. Their values change, their political affiliations change, their interests change.

Recently, I’ve been finding that I’ve barely been playing any of the old AAA games that I’d sink hours into. I don’t do any online play-by-post roleplaying. And that’s not just because of professional obligations. I find that, even if I have some time, I may want to watch a show, do a roleplaying session in person, or even take a walk more.

That’s staggeringly common. I don’t know if I could be called a workaholic (though I have had many people express concern about how much I work and the standard I hold myself to). But I don’t spend as much time with leisure as I used to.

Now, why is that the case? Because I decided that I really should try to embody the values that I held dear for as long as anyone’s known me. I decided that there wasn’t going to be a magical time where I’d have my calling handed to me. I had to push it and step onto my own path.

So the same personality traits and values are there, but I’m expressing them differently and valuing them over competing values more highly. Is that “change” or not?

Let’s say I get strep throat once. I take the medication to treat it. It goes away entirely: Only trace amounts of the streptococcal infection remain. Then I get strep throat again. Was I “cured” the first time?

Okay. Let’s say I get strep throat once. I take the medication, but I skip some rounds. It lays dormant, then a new bacterial load hits me. Was I “cured”?

Let’s say that the strep throat cost me an organ system. The bacteria are dead but that body part will never come back. Was I “cured” by the medication?

The point is that the idea of a “cure” is actually sort of arbitrary. Even more importantly, we can get affected by the same disease several times and have each of those times be separate incidents.

So, now we can go back to alcoholism. Can it be cured?

The fact is, people can develop better habits to manage and cope with any kind of psychiatric problem. They can learn how to combine medication, support groups, healthy routines, the use of support networks, and sometimes the use of a professional or mentor (like an AA sponsor or a religious figure).

So is a mental illness more like an infection, in that we can get the same kind of illness multiple times from different proximate causes, or is it more like diabetes, in that it’s something that’s in the background and can flare up at any time?

The answer is actually sort of, “Both, sometimes more one than the other”. It’s also sort of, “Neither, because the ideas of ‘cures’, ‘treatment’, ‘management’ and so forth are all totally different when it comes to the mind”.

I say all this because people, when facing something like the soul-crushing fear and hurt from repeated sexual trauma or the agonizing intellectual despair of facing the fact that their steps away from depression may be temporary, begin to worry about each new day.

The wisdom of AA, that you take it a day at a time, is a good starting place. But it condemns the person with that kind of problem to a life where they are pulled by every ebb, flow, eddy and current of life. It makes their life reactive, not proactive.

Yes, someone with alcohol addiction problems may struggle for a very long time to find a set of new habits that will eliminate the temptation to turn back. Yes, many may always find that temptation to be there, not least because of the way that memory can tend to distort the bad and the good. Yes, events in our lives can sometimes permanently impact us and stick with us, haunting us.

But our losses, hardships and traumas don’t need to take something away. They can become assets and sources of strength. Our struggles with temptation can make us more compassionate and more aware of the value of life, and how rapidly we can see it slip away from us.

I firmly believe that most mental conditions can be conquered. I think we move from a stage where we battle every day, to a period where we are beginning to get good habits but there is a risk of relapse, to a stage where we have mastered the problem. The problem may come back, of course, but it could be in a new form. What drives a 20 year old in college into the bottle may not be the same as what drives a fifty-year old with a mortgage and a bridge club.

I have found that each of my crises in life, while related, have been distinct. I learned different lessons from each one. It’s too simplistic to point to one single problem that defines anyone. Just as a bacterium mutates and just as every organism is distinct, so too is “depression” or “alcoholism” an abstraction that we put onto a complicated phenomenon that is different each and every time.

When I work with people, I do often find myself having to warn them that what may seem like a temporary success is just a plateau, one they can slip off of. But if they keep doing the work, they are not likely to ever go back down to their original nadir. And even when they do, they will have the sangfroid to climb back up faster.

In any instance, combating and managing our bad habits, even when it may be a lifelong struggle, is a lifelong struggle worth doing. Every day, we will fight our weaknesses, our limitations, our hurts, and our ability to turn a blind eye to the others in our lives. We will fight to make sure that it is our love, hope and compassion that define us instead of anger and fear.

After all, why do people turn to drugs? There’s a lot of reasons, of course, and a lot of motivations, but it tends to boil down to, “I can’t handle something in my life without this drug”. Alcoholism is just a specific version of being unable to handle life, find joy and happiness or even some degree of entertainment to hold onto existence with, without some kind of external aid. People fill voids with all sorts of unhealthy habits: Biting their fingernails, abusing prescription medication, sex, even exercise. In fact, almost every victim of sexual trauma I’ve ever worked with literally finds themselves running for miles a day or exhausting themselves in the gym. It’s a combination of being able to run away from something, feel stronger and physically in control, feel free, and also get that endorphin high.

So when we “relapse”, what that often means is that life hit us in some new way we weren’t prepared for. It can’t be thought of as just the same problem in a new disguise: It’s actually a new problem, being dealt with in an old way. The problem isn’t just the addiction: That’s just a symptom. The problem is our inability to respond to the stress.

Life will always dish out a certain amount of suck, as I found myself saying yesterday. We will always face challenges and unpleasant situations. But they don’t have to control us or make us anything that we don’t want to be. We don’t have to resent those challenges or resent being alive through them. And we can learn how to face them without falling into destructive patterns.

Maybe thinking about it in terms of a “cure”, then, is just not helpful. Maybe we should think about it as a battle.

Can the battle against pain be won?



Truth, Christian Counseling, and Personal Commitment

It’s always surprising when and where you’ll find common ground.

One of my struggles, one that’s common amongst anyone who tries to help others in any capacity, is between my commitment to the truth and the need to protect others’ confidences. When you are told of a crime or an injustice, it is difficult to remain silent.

Christian counselors routinely emphasize the importance of truth in their work as well. While it often comes from a place of “God’s truth”, the main commitment to the idea of truth in word and deeds remains the same. As I read their analysis, I find it fascinating to see how they balance that commitment to truth with professional and personal obligations.

One thing I’ve repeatedly seen is that the only way through to recovery is truth. Acknowledging every ugly aspect of life is a vital step to be able to see the truly beautiful. Oftentimes, people who speak what they see as the truth are viewed as negative. But there’s nothing inherently pessimistic or cynical about honesty. In fact, it is fundamentally cynical to pretend that truth and honesty trade off. It says, “The world in matter of fact actually sucks, so the only way to be optimistic and positive is to lie”.

When we pretend that every claim is just as true as any other, we are denying the ability to face and identify injustice and to allow people to recover. The mind needs to be able to hold onto truths and to work against them. When a victim of a trauma or a person struggling with depression can think that it’s all “just a matter of perspective” that they’re hurting, it’s not just their own pain they are whisking away by rhetorical and philosophical magic, but everyone’s.

So, how can we stand up for truth while respecting the rights of others to choose to remain silent?

First of all, when someone tells me a secret, I will tell them if I am comfortable holding it. More importantly, I will tell them that I will never change my mind on my advice for them to say it. It’s their choice to be honest and truthful to their experience, but it’s my choice to advocate for it.

Second, I can stand up for the broader social issues that led to their pain. If I hear a victim tell me their suffering, I can stand up against rape. If I hear about depression, I can raise awareness.

Truth can be immensely positive. If we speak the beautiful truths, that can be a light that will lead someone forward.

I will undoubtedly repeatedly navigate this issue of confidences as I expand the circle of what I do. Being a secretkeeper is an important duty, and one I take seriously. But when it comes to me, my life, and my truth, I won’t compromise, and I believe that anyone who seeks to help others and be positive has to feel the same way.

feminism, psychology

Beauty, Inner Light, and What People Take for Granted

For those of you women who rightly or wrongly complain about men ogling, flirting aggressively, catcalling, or even fondling, allow me to share why those stories make me furious. (This is in no way intended to trump, only complement).

I’ve always believed, likely (as is so common in my life) due to the influence of superhero narratives, that when we have something special, it should be respected. Honed. Shared. Whether it’s because of our brain, our body, or something else, it should be acknowledged.

In my life, I have found that people have sometimes related to my positivity and optimism as a resource. They have taken advantage of it and have sometimes given very little in return.

This can make someone feel used, feel very much like a sucker. It can lead to resentment and serious hurt. It can make us feel, in Willy Loman’s immortal words, like a piece of fruit.

A beautiful woman who finds herself treated with a lack of respect is having something special, something valuable, be treated as something to be taken for granted.

When others have something special, it’s incumbent upon us to recognize that it is their choice to give it. We have to respect that they are like us, humans with feelings and needs. As Kant famously argued, we can’t ever treat another person merely as a means to an end. If we are going to do so, we have to respect their right to consent, and as a corollary their right to decline.

Any time we see someone treating someone else like an object or a tool and not as a person, it is our duty to stand up and say something. That’s including men with their friends, customers and bosses with workers, and any kind of people who are impinging on the generosity of others.