Addiction: Fun with Problems

In parts 1 and 2 of my addiction series I explored the broad concept of addiction and the early stage that I called simply, Stage Fun. Both posts included descriptions of the negative consequences of substance use and addiction.

Below, I discuss other kinds of problems and how they emerge as one progresses further along the addiction continuum.

What is Choice?

A common client refrain in the addiction field is that substance use is a choice. I agree. Yet there is more to the story than a rational yay or nay. Choice is in play during one’s early use, but over time dopamine plays a starring role in influencing choice. This is because of the jolt it delivers to the human brain as a result of substance use.

The brain of a substance user moving along the addiction continuum is like a child who after being spun through the air enthusiastically demands, “One more time!”  

We know that for some the choice to use becomes more automatic. For these individuals it is less than a fully formed rational decision. It begins to resemble something more akin to a knee-jerk reflex.

The choice to use might once have been the end result of mulling options to a straight-forward and innocuous question like, what shall we do this weekend? But over time your brain, being the genius that it is, notices patterns and seeks to simplify whatever process is in play.

The brain is an efficient system and loves shortcuts. It will eliminate conscious decision-making to save energy whenever possible. In time, the decision to use is almost instantaneous and addicts simply assume that a conscious choice was made.

Bad habits are hard to change

Margaret Wehrenberg refers to the brain’s ability to simplify complex operations as “chunking.” A chunk of information is basically a habit, “a complete and automatic set of actions that occur without conscious decision.”

Substance use evolves over time to become a habitual action for too many of us. Information is chunked together without our conscious awareness and we act accordingly. The addict eventually begins to rely on substance use to regulate an ever increasing assortment of life experiences: good, bad, or indifferent.

Most of us like to entertain the fiction that we are the captain of our own ship, that we are intentional and methodical at all times. But as one moves further along the addiction continuum choice is not as simple as saying I will or won’t do something. There are competing and unexamined forces at play.

What begins as fun morphs into an unconscious habitual solution to personal struggles. Given enough time this habit becomes an all-consuming need, a craving that dictates our choices and behaviors.

Phenomenon of craving

Dr. William D. Silkworth, who treated Bill Wilson, co-founder of Alcoholics Anonymous, at Charles B. Towns Hospital in New York City, wrote in “The Doctor’s Opinion,” in Alcoholics Anonymous, that all alcoholics “have one symptom in common: they cannot start drinking without developing the phenomenon of craving.”

Craving, in my opinion, is evidence of the inability to drink or drug safely. When activated, it subsumes all else. Craving is the internal driver that pushes alcoholics and addicts to consume. As the saying goes, “one is too many and a thousand is never enough.”

It can manifest silently or loudly, but one thing is certain, when craving enters the picture we have exited Stage Fun and entered Fun with Problems. We no longer want to enjoy our chosen substance, we need it.

Substance use is characterized by avoiding at all costs the experiences associated with not using. In other words, at a certain point in most addicts’ stories, use is no longer simply about getting loaded. Instead, the urge or craving to use is rooted in the avoidance of negative psychological and physiological consequences that emerge when one chooses not to use.

Our brain, once it grows accustomed to the rewards of using drugs and alcohol, learns that throwing a hissy fit (moodiness, impatience, anger, judgement, self-righteousness, etc.)  is a good way to get what it wants: an altered reality (and dopamine!).

Like everything else in addiction, craving is a double-edged sword. It propels one further into addictive processes and therefore is a negative force. Yet by encouraging use, craving protects the addict from experiencing the not so pretty consequences of withdrawal.

99 Problems

Addiction also unleashes real world negative consequences, things like: jail, injury, illness, death. These can happen early for some, but over time the process is fairly predictable. We begin to hurt loved ones, lose friends, suffer professional setbacks, face legal troubles, lose self-respect.

The further one travels into addiction the more one loses. As substances take priority, other things must fall by the wayside.

Some substances have the potential to speed up this process of loss, but the progression is the same despite the timeline. Yes, there is a qualitative difference between some classes of drugs, but just because it can take alcohol decades to destroy a life, does that make it less destructive?

Despite initial losses during Fun with Problems the benefits of use, for addicts, still outweigh the deficits and it’s “easy” to ignore such problems for many years. The brain tricks us into believing that despite the horror around us, substance-induced oblivion is the best option available to us. It provides an identifiably consistent answer to any question asked of it.

Individuals with so-called “high bottoms” are willing to address problems associated with the fun of substance abuse prior to losing as much as others who hit rock bottom. They don’t need to lose everything in order to change course. Thankfully, as addiction education has become more prevalent and substance use is less stigmatized there are more people who fit within this category. I wish the numbers were higher.

So, about that river in Egypt….

Because of the mind’s ability to wield powerful psychological tools like denial it’s easy for addicts to ignore the complex operations at play in their mind. This is especially true as long as substance use continues to provide relief.

We as a culture like to believe in our ability to look beyond appearances, but it’s too easy to assume that if someone looks good, they must feel good. One’s insides always match their outsides, right?  

The term “functional alcoholic” describes individuals who outwardly are meeting society’s markers of success. If major responsibilities are met the psychological or interpersonal consequences of addiction can easily be rationalized away as stress, poor nutrition, lack of exercise, insomnia, or some other real, but wholly inadequate explanation.

When living in the Fun with Problems stage this perception is one of the trickiest knots to undo, even for the addict herself. “I can’t have a problem. I’m still paying my bills. I’ve got friends. My family loves me.” All of these things might be true, but that doesn’t mean there isn’t a problem.

Unfortunately, many of us only become willing to admit to a substance abuse problem when Fun leaves the equation and we only are left with Problems. In my next installment, I’ll explore this final stage of addiction.

For now, here is one of the more devastating songs about addiction, Robbie Fulk’s “Barely Human” from his album Country Love Songs.

Addiction: Stage Fun!

Why do substances like drugs and alcohol work so well? Because as a broad class of consumables they have the ability to meet any need or desire. They are perfect in their chameleon-like ability to match, intensify, or alter one’s state of mind or being.

We can get mellow, relaxed, speedy, intense, spiritual (whatever that means!). We can hallucinate, laugh, lose touch with reality. We can (finally!) enjoy ourselves, let loose, and not worry: about responsibilities, relationships, jobs, money, family, fitting in, anything.

Whatever experience we seek to manufacture, however, there is a straightforward answer to the question of why substances are so effective. Neurologically, the rush of dopamine that accompanies substance use is a fuel that feeds the fire that can become addiction.

Positive Feedback for the Brain

Dopamine is a naturally occurring neurotransmitter that acts within the brain’s reward pathway. We cause its release with just about anything pleasurable: food, laughter, sex, you name it. Drugs and alcohol are uniquely effective because they create an intense spike of dopamine.

This dopamine jolt unfortunately is matched only by more of the same. Nothing else can duplicate the intensity of getting loaded. Nothing.

Even just the thought of getting high can lead to a dopamine spike. In studies of long-time heroin users, for example, it’s been found that dopamine levels actually are highest prior to use. That’s right, the brain’s reward system peaks before heroin even enters the body. Talk about a Pavlovian response!

Unfortunately, this response, compounded by increased tolerance, can contribute to overdoses as users ingest larger amounts of the substance to obtain the desired euphoric secondary effects. The brain may get its fix by simply anticipating a high, but addicts still need to experience a drug’s enveloping embrace to feel satisfied.

Tell Me More About the Fun

I laid out previously the identifiable progression of addiction. Part of that process, I noted, is the undeniable fact that early in one’s relationship with substances, use largely remains in the realm of fun.

For everyone who’s ever ingested drugs and alcohol the reasoning is straightforward, they are an effective means to reach an identifiable, if nebulous, end: happiness.  Thankfully, most people are lucky enough to remain in the fun stage without moving towards addiction.   

But again, drugs and alcohol are popular because they are so darn effective. We choose to use because it’s a blast.

Those of us who move towards harmful and then dependent use recognize early on that drugs and alcohol, in addition to their recreational facility, also are a highly effective coping strategy. They increase the intensity of pleasurable experiences, but over time they more importantly decrease the intensity of painful moments.

Focusing only on the negative aspects of substance use is a familiar “scared straight” strategy. Yet, it’s intellectually dishonest and just not that effective. For many adolescents, who developmentally are wired towards risk-taking and novelty, especially behavior that distinguishes them from their parents, this strategy actually can backfire.

Adults, when confronted only with the negative aspects of substance use reflexively will defend themselves against judgment. If you’re saying I’m wrong, and I don’t like being wrong, nobody likes being wrong!, then my best defensive option is to dig in and not let you win. In the old school, “I know better than you,” autocratic approach, the addict and the moralizer each hold one seemingly irreconcilable side of the ambiguous phenomenon of addiction.

What’s needed is for addicts to hold all parts of their substance use – the good, the bad, and the ugly – within themselves. Addicts need to work out for themselves every aspect of addiction and come to their own conclusions if they wish to change their behavior. (This is something that Motivational Interviewing does very well and one reason why I incorporate it into my practice.)

To only harp on the negative also is a subtle form of shaming that can contribute to an addict’s already refined ability to beat the crap out of her/himself. If someone yells at you, “Are you stupid? Don’t you realize this stuff will kill you?,” and you already are convinced that you’re stupid, well, this tactic merely serves as confirmation of one’s unconsciously ingrained and reality-defining concept of self: I’m a piece of shit.

Finger-wagging simply reinforces a desire to dig in and ups the ante for an addict to find some means of escape from feeling bad.

And there is no better escape than intoxication.

Substance use is a creative means to solving sometimes intractable, often debilitating, and always painful experiences. Substance use initially is not about relinquishing power. It is about feeling better. It is an immediate solution to real, albeit misunderstood, denied, or overwhelming problems.

At first, though, and about this we must be honest, it’s simply a hell of a good time!

Tending Towards Chaos

Unfortunately, drugs and alcohol too quickly can become the answer to almost any question asked of them, especially if asked at a very young age. Fun might be the original intent, but the ultimate impact can be quite the opposite.

Perhaps there is nothing inherently wrong with altering or enhancing one’s reality, but the impact of sustained substance use plays itself out on a longer time frame than just one evening. If given the time and space to unfold, addiction leads to chaos. The process is subtle, however, especially for the addict whose brain simply wants its reward and whose goal is just to feel better, even if only for a moment.

In my next post, I will delve further into addiction by exploring the stage of addiction I’m calling, Fun With Problems. For now, I’ll leave you with Black Flag’s sardonic commentary on the salvific qualities of alcohol, “Six Pack.” 

What is addiction?

Most of us know someone impacted by addiction. Most of us probably know an addict, whether we, or they, know it or not. But what does it mean to be addicted?

The reasons why people consume mind-altering substances vary: to relax, to have fun, to alter reality, to rebel, to escape, to ritualize important events. But substance use, in my understanding, can be boiled down to one simple idea: I want to change how I feel.

There is nothing inherently wrong with this desire, but herein lies the real danger of drugs and alcohol: they work! Substances are immediate and intense in their ability to alter one’s concept or experience of reality. They’re really good at what they do, perfect in fact.

To be addicted is not simply about (over)consumption of a substance though. Rather, it is a state of being in which one relinquishes power, choice, and control to a substance, or process, that once was beneficial and is no longer.

It is not useful or practical to continue repeating the same actions over and over again. Rightly named, this is compulsive behavior. Psychologically then, addiction can be understood as a compulsion to assuage the obsessive belief that how I feel is insufficient or wrong and should be changed.  

No, seriously, what is addiction?

From a clinical or process oriented perspective, addiction is a conceptual handle by which it is possible to take hold of, explore, and better understand a subtle, ambiguous process that includes both positive (yes, positive!) and negative consequences.

Segmented into stages, or perhaps a continuum, addiction looks something like this:

Experimental use > Social use > Regular use > Harmful use > Dependent use.

The original positive consequences that spurred use – fun! conviviality! connection! – bend towards the negative with increased use. But again, addiction is not merely about consumption. It is about the reasons for use, the patterns of use, the consequences of use, and the denial of the need for change or personal evolution beyond one’s relationship with drugs and alcohol.

Moving from early experimental and social use toward dependent use one’s life is reduced; that is, the components that contribute to a full life are gradually lost: family, friends, freedom, economic security, physical health, self-respect, meaning.

They are replaced over time by an increased reliance on substances to modulate one’s sense of “normal" or happiness. Graphically, this process might look something like this.*

At some point in this process, somewhere between regular use and harmful use, an invisible line is crossed landing one in addiction. It is possible, of course, to stop, examine this process, and implement change. However, the closer one moves to dependent use the harder it is to effect change.

As one’s freedoms are reduced one’s power, choice, and control are eroded and one’s life becomes narrower and narrower. This is characterized by the compulsion to repeat the same behavior over and over again and each time expecting different results. "This time, everything will work out!" And that, my friends, is insane!

To simplify this process even further, I borrow the model of addiction as conceptualized by a friend of mine in Alcoholics Anonymous:

Fun > Fun with problems > Problems.

Over the next few blog posts I will explore each of these stages in order to provide a means of understanding the confusing and all too often deadly path of addiction. For now, I’ll direct you to the song “Underneath the Bottle” from Lou Reed’s 1982 album, Blue Mask. A more perfect description of addiction would be hard to find.

*The continuum of addiction model was adapted from Atlanta therapist, Ralph Boynton, my former supervisor at Odyssey Family Counseling Center, and Annie Kelahan, my current supervisor at Therapy Works ATL.

After Orlando, Love is Not Enough

In the wake of the mass shooting in Orlando, a hate crime that targeted members of the LGBTQ community, a number of published responses have focused on love. People have waxed about the need to love furiously, to love deeply, to love radically, to love defiantly. I value these sentiments.

As a couples’ counselor, I regularly invoke the power of love to soothe a partner’s fear. I call forth love as the antidote to poisonous isolation and loneliness. I introduce love as the necessary balm to heal old, sometimes hidden wounds. Love comforts us and helps us create a secure base from which to act.

But is love the necessary ingredient for systemic change? Reflecting on tragedies brought forth by systemic injustice, systemic inequality, systemic oppression, systemic immorality, I am coming to believe that love is not enough.

Love is necessary, but love is not sufficient.

Love is relational. It is, at minimum, dyadic. It can extend beyond the I-Thou relationship, but it cannot exist without it. Without another, even a conceptual, imagined, dreamed of, or grieved for other, love is conceptual, an abstraction.

Love can inspire individuals to stay connected, to seek security, to seek justice, but as an abstraction, an aphorism, love provides no solace. Love is not what moves history. Love can soothe and hold us as we make or bring forth history, but it does not, in my understanding, change systems.

For individuals today experiencing the sting of loss, love is necessary for healing. But to effect change in our world, love is not enough.

Responding to Tragedy

I have tried to limit my consumption of news generated to exploit the tragedy in Orlando. Of the handful of media responses I have seen, the most powerful has been Samantha Bee’s monologue on Full Frontal. The crux of her speech is the insufficiency of the “standard operating procedure [that] love wins, love conquers hate.” Her position obviously aligns with my own.

I think what struck me the most was Samantha Bee's use of anger, her righteous indignation. In fact, after watching her monologue I decided to reread Malcolm X’s 1964 speech, “The Ballot or the Bullet.” 

Both highlight the systemic hypocrisy that undergirds so much of our nation’s history, then and now. There is a recognition that the deliberate speed of our democratic republic, while rational and perhaps even largely beneficial, also at times is a hindrance to necessary change.

Malcolm X pronounces at one point, “I'm not anti-Democrat, I'm not anti-Republican, I'm not anti-anything. I'm just questioning their sincerity, and some of the strategy that they've been using on our people by promising them promises that they don't intend to keep.”

The same, I think, could be said about politicians urging their constituents to pray or even to love in response to naked hatred such as took place in Orlando.

If change is what we want, we need more than love. It is time for action.

What Now?

We need, for example, to hamstring the power of groups such as the NRA, which successfully has stymied even the funding of national research on the societal impact of gun violence, an honest to goodness epidemiological area of inquiry if I’ve ever seen one.

We need to close loopholes that allow individuals to purchase weapons at gunshows without background checks. We need to reexamine the importance of high capacity magazines for civilian use. We need all gun owners to be licensed and registered. These are just the examples that come to mind at this moment in time.

Love may inspire action, but love is not the action necessary to engage in the arcana of updating and refining federal and state law to reflect current and shifting realities.

I recognize that this topic is not inherently therapeutic or healing. I recognize that I could lose clients over my belief that our country needs to amend its positions on firearm availability and safety. I also recognize that there are limitations to my field, and rightly so.

I help individuals heal. A part of healing is the resumption of living a full life. In my estimation, this includes being an informed and engaged citizen.

When our friends and family are being killed on a regular basis by individuals who have legal access to so-called “modern sporting rifles” inspired by military weaponry and which, by the way, also deliver hefty revenues to gun manufacturers, it is time to acknowledge love’s limitations.

Love can heal, but love cannot reanimate. At this moment in history, love simply is not enough.

What’s the Big Deal with Emotions?

Applaud them, deny them, love them, hate them, or ignore them: the fact is, we all have emotions and need them in order to live healthy, productive, satisfying lives. Why, you ask?

Let’s first start with when and how emotions got such a bum rap in the first place.

In the beginning, there was Descartes

In Western culture, the beginning of our dysfunctional relationship with emotions can be placed at the feet of the French philosopher René Descartes (1596-1650).

His famous dictum, cogito ergo sum (I think, therefore I am), assumes that consciousness (or mind, or soul) exists only within beings who can reason. Further, consciousness exists separately from the body. We exist because we can think. Reason is what separates and elevates humans.

In Descartes’ infamous vivisections – experiments on live animals – he rationalized that the animals’ howls and contortions were not an example of pain because animals cannot experience pain. Why? Because they lack the consciousness necessary to conceive of and therefore experience it.

For Descartes, self-evident pain was nothing more than reflex and not accurately reflective of a conscious experience. Animals exist instead through mere physiological instinct: an automatic and biological experience.

The charge: consciousness/reason exists separately from and in superiority to emotion/instinct. Emotion simply happens whereas reason is controllable.  

Dualism is a drag

In this worldview, reason is a disembodied logical force leading to increased understanding and control, a necessary ingredient for success in the world. Civilization rests upon reason and humanity is the pinnacle of this progressive forward-moving trend.

Emotion, on the other hand, is a primal, embodied, and biological force that moves us away from logic and mastery. It represents a dangerous and regressive force. Unchecked by reason, emotion will lead to impulsive decisions and uncontrollable consequences.

In Cartesian thought, emotion is a retrograde force that, in addition to being closer in proximity to non-human nature, also is believed to be more fully present in some humans, specifically women and non-Europeans.

Dualistic thought does not deny the existence of human emotion, but by defining it as a force at odds with reason it enables powerful humans to define what/who is and is not important. It undergirds the all too common practice of separating reality into good and bad regardless of the consequences.  

You’re so emotional!     

If this state of affairs remained purely theoretical we might have forgotten all about it and moved on with our lives. Unfortunately, the impacts of Cartesian dualism are far-reaching. Classifying reality into these camps has contributed to oppressive assumptions and identifications.

Our culture has mapped this either/or reflex onto a multitude of time worn dichotomies: men/women, whites/blacks, East/West, North/South, human/animal, urban/rural, science/art, technology/nature, wealth/poverty, etc. 

Dualism serves as a core foundation for the Western tendency to bifurcate and simplify reality into either/or categories. These categories end up excluding and oppressing, at worst, and denigrating, at best, entire groups of people, institutions, and ideas.

That’s right, the women are smarter….wait, what?

How many times have you heard someone say without irony that, “Women are more emotional than men.”? That “feminine energy” somehow puts women more in tune with their feelings.

The notion that women are more emotional – and men more rational – is not true. Men are emotional beings. Women are rational beings. To deny these realities is to damage all people. (See my blog post, “Men and Emotions” for a brief discussion on this topic.) The outcome of this falsehood is used to justify sexist practices in the workplace, at home, in politics, in religion, and virtually every space in our world.   

If viewed sympathetically, this worldview allows for complementarity. Men and women are better at different things! What I in my core essence as a man cannot do, you in your core essence as a woman can do. Or in the immortal words of Tom Cruise's, Jerry Maguire, “You complete me.”

These examples are useful as metaphors, but when reified as Truth they become suspiciously disempowering.

Viewed critically, dualistic thinking is a dangerous, oppressive force. All humans and animals experience emotion. There is no evidence, other than our insistence, that women are more emotional and men more rational. To deny men their emotional experience and women their rational experience stunts individual and cultural growth.

Why emotion-focused?

This oversimplification of a complex topic does not do it justice, but it opens the door to understanding why uncontrollable emotion is handled with kid gloves and discussed in whispered tones. It just happens and therefore is a chaotic force.

What if, however, emotions were viewed not as primal representatives of non-reason, but as physical data that allows us to live more fully authentic lives?

My client work significantly is emotion-focused and with couples I utilize an approach pioneered by Sue Johnson, Emotionally Focused Therapy for Couples. I believe that humans are social creatures and as such we utilize emotion to communicate with one another and with ourselves. We need others, specifically significant others, to be fully human.

(Note: when working with trauma and emotional dysregulation, I utilize some emotion-focused interventions, but I tailor and titrate my work with the understanding that emotion often is too painful for those experiencing traumatic stress. The goal might be embodied emotional fluency, but the road towards it I make as smooth as possible for those who require this approach.)

Descartes’ Error

Neurologist Antonio Damasio, in his book Descartes’ Error, examined the real world impact of emotionally stunted brains. To do so, he focused on historical and present day case studies of brain damaged individuals.  

The results of living without fully functioning emotional systems were not pretty. Emotionless living did not resemble a life of calm, reasoned simplicity, far from it. These individuals instead were not able to care for themselves. They demonstrated no ability to make “rational” choices. Indeed, many trauma survivors deaden their emotional experience in order to survive intolerable situations. This strategy, unfortunately, ends up hi-jacking some survivors who end up resembling zombies.

Damasio has developed what he calls “the somatic-marker hypothesis” to demonstrate the intricate, integrated, and interactive relationship between all parts of the human organism. Simply put: “somatic markers are a special instance of feelings generated from secondary emotions[i]. Those emotions and feelings have been connected, by learning, to predicted future outcomes of certain scenarios” (italics in original).

This means that we learn through an accretive process. We learn to live healthy, happy, stable lives by building upon past experience, and emotions are a primary means of accessing this knowledge. Emotions are data that we use to determine how best to live our lives.

Descartes’ error, according to Damasio, was to separate body and mind.

Working with emotion

Emotions are not forces that swoop down and take us over. They are the foundation of how we make healthy choices. Without the ability to understand and utilize somatic markers (i.e., emotions triggering us to respond appropriately) individuals are not able to use feeling/emotion to live rational lives.

I focus on emotion in my client work because emotions are vital to reasoned decision-making. They provide human beings with life-saving and underutilized information. They are a nonverbal means of making sense of our surroundings. They provide data that we might otherwise miss in our hyperfocus on logic and reason.

The emotion-focused approach takes into consideration one’s cognitive appraisals (thoughts and meaning) and action tendencies (behaviors). The goal often is not to change thoughts and behaviors, but to understand and accept the emotion driving them. Doing so allows us to identify our needs. Utilizing a holistic, organismic approach – taking into consideration all data at our disposal – makes true healing possible.  

Emotions are not more important than cognitions or behaviors. To prioritize emotion in the therapeutic process is an attempt to rebuild an atrophied human system. It is an attempt to use everything at our disposal to live full lives and, in some instances, to reconsolidate past traumas into stories of survival.

To focus on emotion is nothing less than claiming one’s full humanity, body and mind.

_______________________________________

[i] For those familiar with emotion-focused psychotherapy, Damasio’s use of the term “secondary emotions” differs from, say Leslie Greenberg’s. Damasio utilizes the term to designate emotion that is analyzed by the cortex and not simply experienced/processed by the body. 

You’re Not Alone: David Bowie and Secure Attachment

Growing up, I listened to David Bowie’s The Rise and Fall of Ziggy Stardust and the Spiders from Mars until the album cover fell apart in my hands. In my teenage wisdom, I duct-taped the cover back together. The masterpiece had to be protected at all costs. It still sits in my record collection in all its damaged glory.  

Ziggy was an album that demanded to be heard from beginning to end, from the apocalyptic opener, “Five Years,” to the final pleading lament of “Rock ‘N’ Roll Suicide.” This last song I remember listening to with a fractured ear. I identified both with the song’s suicidal protagonist and the song’s pleading narrator. I was always torn. I wanted succor and I wanted to be the hero providing it.  

I heard the song again this morning as I was eating breakfast. I was touched by its tenderness, yes, but also by the tension between its historically bound message and its timeless insistence. Bowie/Ziggy was exhorting a generation of children “to turn and face the strange,” as he’d charged his listeners in an earlier song. But he also was speaking to an innate human need for connection and love.

We need to know that we’re not alone. We need to know that we’re wonderful, no matter what.

Upon hearing “Rock ‘N’ Roll Suicide” this morning, I also was struck by the realization that too many of my clients exist without an experience of unconditional love and acceptance.

I feel sad even as I write this.

Who did you turn to for comfort?

This is a question I ask all of my clients during our initial sessions. I want to know who, as children, they turned to for support and solace. Some clients answer quickly, naming a parent or another family member. But too often, clients will simply answer, “no one.”

This is important information. It clues me into how this person has come to know the world and her place in it. It does not answer everything for me, of course; it merely offers a perspective on this person’s life. Early events do not absolutely determine who we become. We, after all, are an amalgam of experience, genetics, and individual resilience.

Lacking a foundational experience of security and safety within early relationships, however, can contribute to maladaptive core beliefs. These so-called working models cannot simply be swapped for healthy adaptive ones. We develop emotional schemes to make fast sense of the world. Once developed, these schemes are virtually intrinsic to who we are as individuals, second nature, if you will.

If these schemes emerge within a secure, stable environment we typically can rely on them to help us develop healthy intimate adult relationships. But if these schemes emerge within a chaotic, unstable, or neglectful environment there is the possibility that our working models of self and other will impede our ability to form satisfying and fulfilling adult relationships.

Cognitively, it is possible to work on verbalizing that we are OK and that the world is safe. But in order for real change to occur we need to experience in our bones some semblance of safety, security, and stability. This can only happen in relation with another. We cannot think our way into emotional stability; we must experience it with another, someone whom we can trust enough to be vulnerable.   

I can learn and practice self-soothing until the cows come home, but this cannot replace the human need for connection. We need others in order to be ourselves.

How this translates into lived reality will be different for everyone, but when we ask the question, “will you be there for me?” we need an affirmative answer in order to become our truest self.

We might not have models of healthy relationships

Existing or surviving in isolation – “I had no one to turn to” – even when all of our external needs are met, is not enough. (It’s sometimes not even enough for human survival, but that’s another story.) If as children we had no one to turn to, or if we experienced traumas that threatened our experience of safety, then how can we be expected to know how to be there for someone else?

Too many of us find ourselves living in isolation, whether we are in a relationship or not. Too many of us simply have no models for how to navigate healthy, loving adult relationships. We end up blaming ourselves. We end up blaming our partners. We end up seeking solace in strategies that might have helped us survive the worst of times, but that only serve to isolate us further from intimate human connection (e.g., substance use and other unhealthy behaviors).

Thankfully, psychotherapy is a restorative process. Recent research has demonstrated that neuroplasticity allows us to change not simply what we believe, but how we live our lives at the most fundamental level. For individuals, forming a safe, secure, and stable bond with a competent professional can aid in transforming our relationships with others. For couples, therapy can aid in creating a secure bond with our beloved.

You’re wonderful.   

When David Bowie died on January 10 this year, I cried. I felt a little bit lonelier than I had in the moment prior to hearing the news. He was an artist who had changed my life by reorienting me towards relation and away from isolation.

I also admit to some level of embarrassment: just another fan-boy mourning a celebrity. But so what? The guy changed my life. He provided solace. He provoked questions. He prompted me towards integrating the sacred and the profane.

Along with the exhortation in the final moments of “Rock ‘N’ Roll Suicide” that “you’re not alone” is the simple reminder, “you’re wonderful.” We cannot live in isolation and we cannot thrive without our partner’s unconditional positive regard. We need to know that our beloved will be there for us not only in spirit, but in body. We crave and need connection. We need to know that we matter to someone.

I can’t say it any better than Bowie/Ziggy already did so I’ll simply leave you with the final verses of “Rock ‘N’ Roll Suicide”:

Oh no love! you're not alone
You're watching yourself but you're too unfair
You got your head all tangled up but if I could only make you care

Oh no love! you're not alone
No matter what or who you've been
No matter when or where you've seen
All the knives seem to lacerate your brain
I've had my share so I'll help you with the pain
You're not alone just turn on with me
You're not alone let’s turn on and be
You’re not alone gimme your hands
You’re wonderful gimme your hands
You’re wonderful gimme your hands

Stress is a Good Thing!

Check out Kelly McGonigal’s ideas about stress. Her research has led to the paradoxical notion that stress is a positive force in our lives, provided we change our beliefs about it.

McGonigal began to rethink stress after reading the results of a study that tracked 30,000 U.S. adults over eight years. The study showed a 43% increased chance of dying for the participants who experienced high levels of stress, but this was only true for those who also believed stress to be harmful. The individuals who did not believe stress was harmful had the lowest risk of dying in the study. What gives?

The stress response primes the body for action and one of the ways it does this is through the release of oxytocin, a stress hormone sometimes referred to as the “cuddle hormone.” In addition to adrenaline and cortisol, oxytocin is released during stress as a physiological impetus to seek contact and support. As she notes in her TED Talk, “when oxytocin is released in the stress response, it is motivating you to seek support…. When life is difficult, your stress response wants you to be surrounded by people who care about you.”

Further studies have shown that when we believe stress to be a positive force in our lives, the negative impacts of stress are reduced; specifically, blood vessels do not constrict. Over time, this could reduce the risk of heart disease or a heart attack. In addition, oxytocin acts an anti-inflammatory and has properties that heal heart tissue damaged by stress.

McGonigal’s focus on secure attachment is important to me in my clinical work, as is her interest in creating meaning in our lives. In fact, she encourages us to “chase meaning.” Focusing on what matters most to us leads to opportunities to experience stress as a positive force. It also increases our chance to make contact with people who matter to us.  

McGonigal’s book, The Upside of Stress: Why Stress Is Good for You and How to Get Good at It, is on my list of must-reads for 2016!

Here is a link to her TED talk: https://www.ted.com/talks/kelly_mcgonigal_how_to_make_stress_your_friend?language=en.

A Reflection on Resilience: Wendell the 3-Legged Puppy

Today, my hero is a scrappy, 15 lb. puppy named Wendell Berry.

My wife and I foster dogs for Perfect Pets Rescue, a group that pulls dogs from Georgia shelters and transports them to the Northeast for adoption. Wendell Berry is about 4 months old and due to some kind of infection, had to have his left front leg amputated just below the shoulder. The probability of a happy ending for dogs like Wendell isn’t very good.

Wendell’s recuperating nicely after his surgery, but he remains terrified. He understandably is unsure who he can trust at this point in his young life. However, like all of the dogs we’ve had the opportunity to foster, he remains curious, tenacious, even forgiving. He’s one resilient little dude.

Wendell wakes up every morning looking and yearning for connection. He whines and howls for attention. He runs away with his tail between his legs when we give him the attention he deserves and desires, but he knows what he wants and he intuitively knows where to get it! He ventures further and further from his crate. He explores his new, albeit temporary home, and he rolls with the reality of missing one leg. In fact, he’s already taught himself how to use the food bin as a prop to get up on the “dog sofa”!

Oddly, Wendell leads me to reflect on my clients and all of us who struggle in this life. Despite the fact that suffering is unavoidable, it is possible to be hopeful, to be curious, to experience joy despite the inevitable pains of life. The scrawny, scrappy tripod dog curled up next to me does it multiple times each day. In his fear, he repeatedly forgets that we want to comfort and help him, but he always remembers that he yearns to be comforted. That wish gives him the courage to hop forward, over and over again. That wish drives his resilience.

Inside each of us there is an innate longing for connection. We yearn for secure attachment. We want to know that someone will be there for us, no matter what. I see all of this and more in this little lop-sided dog who is learning to navigate life on life’s terms. As Monty Python’s Black Knight says, “It’s just a flesh wound!”

Today, Wendell the foster dog is my inspiration.

Who is yours?  

Wendell Berry

Be Present, but Don’t Get Carried Away! What I Learned on Summer Vacation, Parts 4 and 5

Summer is over. 

Storm rolling into Bryce Canyon

School has started back, Labor Day has come and gone, the sun traces a lower path in the sky, and the autumnal equinox is upon us. The sweet smell of tea olive mixed with the evening light evokes a reverent nostalgia for something unnameable in my heart. It seems appropriate now to wrap up my blog series, What I Learned on Summer Vacation.

In my last post, I ruminated on the benefits of not taking action; that is, not always accepting the first offer or option. In this final post, I briefly turn my attention, first, to the importance of being present and second, to not letting one’s emotions get the better of you.

Every Day I Get in the Queue: Too Much, Magic Bus!

My mother, the organizer and grand poohbah of our family trips, loves guided tours. What you lose in flexibility and freedom, you gain in convenience: the very definition of modern life! You’re up at the crack of dawn every day, you experience breakfasts like you’ve never seen before, and over time you begin unconsciously to queue up for the bus with no prompting. Once aboard all you need do is be present for the ride, whether in body alone or both body and mind.

On board, you can expect some combination of silent meditation watching the world go by with increasingly intrusive and diminishingly interesting travel commentary from your guide. It’s just the nature of the beast. Being conscious of the absurdity of group travel somehow creates a deeper and more satisfying experience. In other words, it makes it a lot more fun.

Guided tours normally cater to an older, often retired demographic. This trip to see our National Parks in the western U.S. was no different. In the handful of tours I have been lucky enough to enjoy, my family often has both the youngest and the largest number of members on the tour. This in some ways hinders one of the implicit points of group travel – socializing with others like yourself – but it also means you are able to share the silliness of the experience with people who helped create your sense of humor and worldview.

Words of Wisdom

By the mid-point of this summer bus trip one female retiree, a former superintendent of a U.S. school district said my wife reminded her of her younger self. During one conversation about life and professional success as a woman this individual remarked that in all her years she never met a person who said, “I wish I’d worked more.” This simple message hit my wife and me like a ton of bricks. Were we falling into the trap of working too much?

Our American culture today too often embraces the supposedly beneficial notion of connectivity: always being available and always being on. The theoretical myth of this lifestyle is that it somehow, magically creates better work/life balance. But is this really what’s happening?

You can take a day off, get home early, or work from home, true, but connectivity’s price of admission is steep: you must be available at a moment’s notice for any and all “emergencies.” For all of our technological progress, Americans work just as much if not more than they ever have in the past. And if health and economic statistics are to be believed, it’s not helping us very much. When at work, work hard, yes, but don’t we also deserve to disengage from our professional lives?

When on Vacation, Be on Vacation

Bracketing the social considerations implicit in work it’s worth pondering the following question about our efficient, multitasking productivity: represented best by so-called smart phones that allow us to be both present and absent at the same time, a regular Schrodinger’s cat; is all of this efficiency and connectivity helping us to be more fully human?

Multitasking is a necessary and vital skill, but there is a fine line between multitasking and just being distracted. A cure for the ills of modern stress is to allow our bodies and brains the experience of less distraction and more presence. We can learn a lot from slowing down and simply doing one thing really well, even if that thing happens to be a member of a guided bus tour through national parks accompanied by retired strangers.

I think those of us who have the luxury of experiencing vacation can attest to the experience as being somehow qualitatively different than everyday life. For that reason alone it is worth experiencing the vacation state of being without the distraction of one’s “real life,” whether that’s work, school, or simply taking care of business.

Therefore, I submit that when on vacation, just be on vacation. Keep it simple sweetheart. Leave everything else behind and just be where you are.

The Importance of Milk Shakes

Entering Bryce Canyon towards the end of our trip we stopped for lunch along with every other tourist in the state of Utah. We patiently waited in line for about 30 minutes in hopes of consuming anything palatable and so I decided to reward myself with a milk shake.

My wife and I met in New York City when there was still a Howard Johnson’s in Times Square. Seriously, there was a Howard Johnson’s in Times Square! In the midst of all the energy created and consumed by New York, falling in love is an oasis in the sterile desert of hyper-reality that is contemporary Manhattan. And milk shakes can be helpful in fostering the falling.

On one of our first dates we shared a milk shake at the now defunct Times Square Howard Johnson’s. It was late, we were hungry, and we wanted something fast and easy. I still remember how my wife tilted her head just so as she bent to take a sip from her straw. I was smitten. As I said, milk shakes are very important!

Milk Shakes Worth Crying Over

Fast forward ten years or so to Bryce Canyon: my milk shake order had been forgotten by our waiter so I had to trek back to the counter to retrieve it. Excited, I returned to the table only to discover that the frozen concoction was too dense to consume. I nearly passed out trying to use my straw. Is there no justice in this world?!?!

I was cranky and pouty at this point in our trip and complained about the injustice of it all. I can nurse resentment with the best of them and I was headed down the highway to the danger zone of self-pity. Luckily, I was justly mocked by my wife and I snapped out of my first world self-pity in time to enjoy the wonders of the canyon. We even were able to watch as a storm rolled in and consumed the area. What a sight that was!

I was able to enjoy the awesome power of that experience by choosing to let go of my disappointment about the milk shake. To be fair, I wore my King Baby crown for longer than I’m proud of, but I was able to let go of my myopic tour-induced crankiness to be present for myself, my family, and my surroundings. Hallelujah!

Feelings Aren’t Facts

Emotion regulation is a paradox. On the one hand, it’s important to acknowledge or feel your feelings. At the same time, it’s just as important to keep in mind the transient nature of emotions. Feelings aren’t facts, true, but they sure pack a wallop.

There are strategies to aid one’s regulation of affect (e.g., identifying and naming the feeling, observing the situation from another perspective, getting help to co-regulate, distraction, etc.). However you choose to handle intense feelings, willingness might just be the first step. I must be willing to allow my emotions the opportunity to meander and change.

In the case of my Bryce Canyon milk shake, I eventually discovered that this milk shake was not worth crying over.

What I Learned This Summer

I hope that you have gained something from my vacation ruminations. As a reminder, here are the life lessons I took away from my summer vacation this year.

1. Have boundaries, but be flexible.
2. Seek out novel experiences.
3. Don’t always accept your first option.
4. Be on vacation when on vacation.
5. Don’t cry over bad milk shakes. 

Don’t Always Accept the First Option: What I Learned on Summer Vacation, Part 3

Monument Valley

Through a combination of sleepy early morning choices, airline inconsistencies, and long airport security lines we missed our flight. It was 6:30 in the morning, we were traveling in a group, and mistakes were made. When the calls and texts from the rest of the family started to arrive we realized that we – my nephew, my wife, and me – likely were missing our flight.

We were those people running through the airport with furrowed brows, wrangling out of control carry-ons, arriving just in time to see the jetway door closing on us. Naturally, we hoped against hope that the airline would reopen the door leading to a hilarious made-for-TV on-board reunion with our family. No such luck.  

Being mere yards away from your destination, blocked only by a heavily fortified door, it’s easy to forget administrative red tape and assume that you’ll attain your goal. In this case, the gate reps simply provided direction to the airline’s help desk.

Yay, vacation!

You Still Have Made a Choice

Upon arriving at the help desk we were told by a kind but pessimistic attendant that we probably wouldn’t meet up with our family until the next day. All of the direct flights were overbooked. The first and only option presented to us was a long, confusing, and exorbitantly priced new route.

We discussed the matter, searched online, even made some calls ourselves, but weren’t having any luck securing better options. We again spoke with the representative who remained doubtful about our chances. We were upset with ourselves, with the airline, with the universe, and we were hungry and tired. We were on the verge of accepting the first offer simply because it was there.

But rather than say yes, we made the best decision of the day so far: we decided not to decide. As any fan of the Canadian power trio, Rush, knows, “if you choose not to decide, you still have made a choice.” So, we chose to search for the nearest coffee shop.

We did not accept the first offer. Instead, we intentionally and consciously paused prior to taking the next step of our journey.

Don’t Just Do Something, Sit There!

Reflecting on this experience I’m reminded of a story I heard from an old Brooklyn roommate. She told me the story of a man who without fail, prior to leaving home, would always sit for at least one minute even if he was running behind schedule. The man’s theory: it was not healthy to start his day rushing mindlessly forward. More important than his schedule was his peace of mind.

It’s easy today to get caught in the belief that time is something either to be filled like a vessel or lost forever. Time, we believe, is something that can be known and understood, something that must be exploited, something that must be measured and monetized. As such, many people feel pressured to fill their lives with as much as can be crammed into every waking moment, an experience that contributes to an inability to tolerate boredom or nonactivity.

Addiction, for example, is an attempt to quiet the voices of one’s demons, fears, and worries. Substance use simultaneously anesthetizes and dampens while also creating meaning and consistency. Unplanned time is intolerable, but substances create the illusion of structure.

For addicts, then, one of the first lessons learned in recovery is the simple, but complex notion that recovery takes place one day at a time. If that’s too much time, recovery is an hour by hour, minute by minute, second by second process. Abstinence and ultimately recovery from addiction only requires that one not use right now, at this very moment.

Not using initially requires sitting with uncomfortable and painful feelings. Early in recovery it’s therefore vital to fill one’s time with activities until one learns to manage triggers: going to meetings, finding new hobbies, helping out friends, cleaning the house, anything so as not to use.

Ultimately, however, it becomes imperative for addicts to grapple with their own anxiety. It becomes necessary to sit there and not do anything. It becomes necessary to stop rushing headlong into the future (or the past, depending on your conception of the arrow of time!) and to slow down to assess one’s position in the world.

As an old AA friend used to say, don’t just do something, sit there.   

Which is what we did in the Atlanta airport at 7am; we sat.

Options

We found coffee, we complained, we did more research, we made phone calls, and we laughed. We all agreed it was fortuitous that no one else from our group was waylaid. The mixture of our personalities allowed for calmness, patience, and humor to color the proceedings.  

Feeling refreshed, we returned to the airline and decided to speak with another representative, whom I will call Sonja. Sonja was under the weather. Actually, she was sick as a dog, but she was a kind, helpful, and savvy advocate. She went to bat for us with her manager while suffering the effects of a nasty summer cold. Most importantly, she reassured us that while it might be a bit of a wait and a few dollars in fees, we would reconnect with our family later that day.

I have no idea what the crucial difference was between this attempt and our first, but it reminded me that the first opportunity, while logically more convenient and emotionally more calming, is not always the best option; it is usually a good idea to pause and reflect before taking a leap.

We reunited with our family later that day and even had time to enjoy a nap before dinner. And to this day, I’ve still never been charged those rebooking fees. Thank you, Sonja, wherever you are.

Stay tuned: I conclude my series, What I Learned on Summer Vacation, with a post on being present and letting go of negatives.