Friday, 23 January 2015

Working with Addiction Part Two

In working with addiction, if long term change is to be achieved, it is important to consider what encouraged the development of the addiction in the first place. A theory that many clients find helpful is the concept of the cycle of shame. The idea here is that the client may have had experiences which established a sense of deep inner shame, often in childhood. It is possible to create a distinction between guilt, a feeling resulting from the perpetuation of a regretted act, and shame, a conviction of being intrinsically bad at the core of your being. The second could be produced in childhood by physical, emotional or sexual abuse. The psychology of a child makes a young person inclined to attribute all that happens to his or her agency, and this is reinforced by parental and societal behaviour. If you do something disapproved of, you may have to sit on the naughty seat or be sent to bed without anything to eat; if you do something approved of, you may get praise or even a reward of some sort; this creates a Pavlonian response of linking what happens to you to your own behaviour. Of course, this is cemented in if the parent is abusive. Children who are abused are both enjoined to secrecy-a shame-inducing procedure-and also told that their own actions or manner is to blame for the abuse; for example, they can be accused of seductiveness, told that their own beauty is to blame, or be instructed that they show they enjoy the abuse. It is not impossible that abused children exhibit an autonomous response akin even to pleasure, for purely physiological reasons. All of these circumstances can lead to a child suffering a sense of being "dirty" - of shame. 

You can see that another factor here is that the abused child sometimes has a motive to avoid being angry with the abuser. It is often not safe to be angry with an abusive parent for fear of triggering more abuse or even worse; there can be, and not always without cause, a fear of being attacked, abandoned or even killed. If anger cannot find its natural target, it tends to be internalised and to boomerang, taking the shape of a profound sense of shame.

Nor are these the only circumstances which can be associated with shame. Being routinely disliked or bullied, being on the receiving end of name-calling, being emotionally deprived and unloved, can all produce a fundamental sense of unworthiness. 

Furthermore, shame, like measles, can be caught. A child who accompanies an alcoholic parent to a restaurant, for example, may feel deeply ashamed of the adult's behaviour, perhaps because he or she senses the disapproving attention which the parent's loud behaviour might be attracting. 

In the circumstance above, and in others, a keen awareness of humiliation may be present. Neurological research suggests that humiliation may be one of the most powerful and enduring sensations we can experience.

For many people, a negative body image may be a source of shame. Poor skin, being small, skinny or fat can produce feelings of inferiority, especially likely to be present if there is teasing or bullying. I have noticed that attractive people can be very liable to be bullied out of envy, the victims often accepting that they are unattractive, the exact opposite of the reality. People who are different, odd or eccentric, alongside people of exceptional intelligence and precocity, can also be shunned and excluded, losing in the process a feeling of belonging and acceptance. In England, finding yourself displaced socially or geographically can lead to being on the receiving end of snobbery or inverse snobbery. 

Those who have arrived from another country or find themselves socially isolated can suffer from the bigotry and prejudice of others. Racism, anti-Semitism and Islamaphobia can induce a sense of shame.

It is worth dwelling upon the difficulties faced by people who realise that their predominant sexuality is not heterosexual, especially if they encounter entrenched hostility to homosexuality in the family, school or religious group. Here they can be pressured to feel intrinsically wrong, even sinful.

For people, then, alcohol can be a refuge, a safe place, from which the ever-feared awareness can be banished. Perhaps, the prototype of a refuge is the womb, and the act of drinking, a profoundly oral act, can resemble the sucking on a breast which provides comfort and security after we have been thrust into the world. Within the cocoon of partial or near-complete loss of sensibility, other sensations can also be avoided. The most obvious of these are social awkwardness, shyness and insecurity.

With the first of these states, shame, it is usually much easier than the client might anticipate to dispel it. Very often, a discussion of the originating circumstances can enable the client to realise that there was no reason to feel shame at all, and, if there was anyone in the situation who might properly experience shame, it might be a parent, adult or group-anyone, in fact, except the client who has taken it on.

With anxiety of every kind, it is important to know that alcohol, like all other stimuli, is subject to the law of diminishing returns. A first drink may help, a second will help less and a third may be a hindrance. Here, the research evidence is quite conclusive; more than a small quantity of alcohol increases rather than reduces anxiety. This may be, as clients have suggested, because people feel ashamed of their reliance upon alcohol but also because anxiety is produced by the effort required of an intoxicated person to appear sober. The evidence suggests that drinking even a small amount of alcohol at night induces anxiety and enhanced tremelousness the following day. More to come.