Addiction Slides Short Version

The Historical and Spiritual Foundations of the Twelve Steps: Personal Significance

and a Pathway for Development

Jeffrey Rediger, MD, MDivMedical and Clinical Director

McLean Hospital SE and Community ProgramsHarvard Medical School

ConsultantGood Samaritan Medical Center

FounderCenter for Psychological and Spiritual Development

Presenter

Presentation Notes

Degrees from both med school and seminary; I love both science and spirituality. Their interaction is very fruitful. AA is a good example of how spiritual depth and modern evidence-based science can work hand in hand. Today’s conference is exactly about that. Religion and science have been at war for centuries; falsely polarized. For hundreds of years, people and scholars have been forced to take sides, at least in their professional lives, if not also in their personal lives. Oxygen and hydrogen -> water. My research. work in both psychiatric and medical settings/shouldn’t separate mind/body; started CPSD as a wellness approach; gift of western culture… Hegelian synthesis

SpiritualitySpirituality is the “eternal flame of life and love that burns in the heart;” the realization that there is something magnificent within us; an expansive “YES” to life and oneself and others

Religion is an effort to box that flame

Is about becoming human rather than “godly”

Transcendence comes through attaining the universally human

Whatever increases our capacity to know and experience love

“L i G d”

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Distinction between religion and spirituality. people can be religious but not spiritual, etc. Many of my friends are atheists…

SpiritualityOne’s “ultimate concern” (Paul Tillich)

Whatever it is that opens the heart and helps one feel more alive and connected

Whatever it is that is genuinely restorative of life and energy: nature, self-care, time with good friends, activities that promote self-knowledge, awaken hope and awareness of latent potentials within oneself and others

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With addiction, the addiction becomes the “ultimate concern.” In AA, the addict relates to God as he or she understands God to be. So AA exists in Missouri, India, Iraq, China, and South America.

Historical and Spiritual Foundations of the Twelve

Steps• Letter from Bill W. to Dr. Carl Jung on January 23, 1961

• Letter from Dr. Carl Jung to Bill W. on January 30, 1961

• Carl Jung

• Oxford Group

• William James

• Belief in the goodness and magnificence of the individual

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The one thing I want to talk about today: there is something magnificent and infinite within us – each one of us. When we taste that, the desire to take a drug or drink melts as a dim shadow. I believe that history is about the slow awakening over time to the magnificence within us. When religion gets it wrong – as it often does – science tries to get us back on course in its own way. When science misses something, then spirituality tries to get us back on track. Underlying AA is a deep belief in the underlying goodness and magnificent capacities of the individual – in the ability of people and families to help themselves and each other. They don’t need to be taught, controlled, or coerced. They – like we – need help awakening to our true nature. These influences all distinguished in their own way religion from spirituality and paved the way for a deeply positive faith in the capacities of the individual, and in people helping people.

“Hi, my name is Barry and I check my email two to three hundred times per day”

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Of course the question is the degree to which the “addiction” gets in the way of one’s ability to love and work.

Alcoholics Anonymous• Began in 1935 with a conversation between Bill W., a

stockbroker, and Dr. Bob, a physician who also suffered from alcoholism

• Today: AA is in over 200 countries, with 114,070 groups

• 2 million members in the United States alone

• NA numbers over 58,000 meetings in 131 countries

• Alcoholics Anonymous has sold over 30 million copies and has been translated into 67 languages

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The most successful mutual/self-help group in the world. The only requirement for membership is a desire to stop drinking. No dues or fees. It is not allied with any sect, denomination, political party, and does not endorse or oppose any causes. We are going to hear from other speakers later today about the scientific evidence that AA works, and is cost effective.

Carl Jung and the Twelve Steps

• Spiritus contra spiritum: Addiction is ultimately about a search for something higher

• One of the early forces distinguishing spirituality from religion

• Explored the deeper relationship of psychology and spirituality in the psyche

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We use the same word – Spirit – for both the highest aspects of life and for alcohol – spirits. The craving for alcohol is the equivalent, on a low level, of the spiritual thirst of our being for wholeness and union with what’s higher and infinite within us.

Individuation in Carl Jung• Individuation: the process by which the individual Self

develops out of an undifferentiated matrix such as the family or peer group, etc.

• For example, instead of not being genuinely happy until the loved one has stopped drinking, individuation suggests that each individual should develop his or her own capacities and follow his or her own highest aspirations. This is best for the person and also best for the addict.

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Jung believed that people and family members help each other most by getting a life and by following their own highest aspirations and wishes. We can’t change others, but we can change ourselves. Al-Anon, ACOA, etc. help family members move in this direction.

The Oxford Group• Founded in 1921 by Frank Buchman

• Not a religion or a denomination; was also one of the early efforts to distinguish religion from spirituality

• Represents a step away from organized religion and the belief that the individual must be taught, guided or controlled

• People helping people: one of the first successful examples of a mutual-help group

The Oxford Group

• “…one man talking to another or one woman discussing her problems with another woman was the order of the day”

• Good Housekeeping (1936): described the Group as having no membership, no dues, no paid leaders, no new theological creed, nor regular meetings. “A fellowship of people who desire to follow a way of life, a determination, not a denomination.”

Presenter

Presentation Notes

Universal rather than sectarian

The Oxford Group’s Four Spiritual Practices1. The sharing of errors and temptations with another

person

2. Surrender of one’s life - past, present and future - to God, as one understands God to be

3. Restitution to all whom one has wronged directly or indirectly

4. The use of an early morning “quiet time”, where the person reads spiritual literature and then with pen and paper seeks direction for the day ahead.

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As with AA, the goal is rebirth and self-responsibility for change.

Bill W. on the Oxford Group

• "The early AA got its ideas of self-examination, acknowledgment of character defects, restitution for harm done, and working with others straight from the Oxford Group…and from nowhere else.”

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We can easily see how this helps growth to occur, and can increase the work that is going on with a therapist.

Carl Jung on the Oxford Group

“…when a member of the Oxford Group comes to me in order to get treatment, I say, "You are in the Oxford Group; so long as you are there, you settle your affair with the Oxford Group. I can't do it better...."

Presenter

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Jung’s belief in the power of people helping people. This feeds the capacity of AA to be effective and cost-effective

Dr. Silkworth• Was Bill W.’s physician

• Advised Bill W. to change his approach and tell the alcoholics they suffered from a disease - that could kill them - and then apply the Oxford Practices

• Alcoholism as a disease and not a moral failing was different from the Oxford concept that drinking was a sin

• This is what Bill W. brought to Dr. Bob on their first meeting

• Dr. Bob was the first alcoholic Bill W. helped to sobriety.

Presenter

Presentation Notes

Disease concept moves addiction out of the camp of religion and into the camp of science, medicine and common rationality. A critical point.

Addiction as Moral Failing vs. Disease• Western Christianity evolved away from its original roots

when it adopted Roman legal concepts

• Sin became condemnation, rather than an error or “missing the mark”

• Law became more important than the person; no more did law exist only in order to nurture individual life and well-being

• Basic goodness was lost; guilt, shame and “not measuring up” permeated the western psyche (but not in Eastern Christianity)

• Disease concept: an effort to off-set condemnation of self and others, and to bring addiction into the fold of common rationality

Presenter

Presentation Notes

God became a Judge who is going to get you rather than the Physician who heals. Judgment and self judgment are two of the most difficult hurdles for the addict to overcome. Judgment and self-condemnation often drive and reinforce the addictive behavior.

“Our psychopharmacologist is a genius!” ‘

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Good that AA follows the disease model. However, this does not mean that it’s fundamentally about the medicine. The disease model is a scientific approach that is interested in what’s rational, provable and non-sectarian.

William James and the Twelve Steps

The Varieties of Religious Experience “…indicates a multitude of ways in which men have discovered God. We have no desire to convince anyone that there is only one way by which faith can be acquired….all of us, whatever our race, creed, or color are the children of a living Creator with whom we may form a relationship upon simple and understandable terms as soon as we are willing and honest enough to try. Those having religious affiliations will find here nothing disturbing to their beliefs or ceremonies…. “

The Big Book

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Was a Harvard psychologist; known as the father of pragmatism. Everyone who works with addiction should read this book. Would be titled “Varieties of Spiritual Experience” if it was written today. Deeply interested in what works and also in spiritual experience. Believed in the underlying health and goodness of the human being. Freud vs. James.

William James and the Twelve Steps

• “…the sway of alcohol over mankind is unquestionably due to its powers to stimulate the mystical faculties of human nature, usually crushed to the earth by the cold facts and dry criticisms of the sober hour. Sobriety diminishes, discriminates, and says no; drunkenness expands, unites, and says yes.””

• “The drunken consciousness is one bit of the mystic consciousness, and our total opinion of it must find its place in our opinion of that larger whole.”

Presenter

Presentation Notes

This expansion – the uniting and saying “yes” – this is what we all long for, at some level. I try to build a case later for how to experience that without a substance. James had a very positive vision of the human being. Addiction represents one of the highest aspects of the person gone awry, or misdirected. He wasn’t about “cutting out the bad part of a person”; he didn’t believe that the bad part exists. Fight or flight vs. parasympathetic.

The Mystic Consciousness of the Addict

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There’s little room in James’ thought for guilt, shame or self-condemnation in the addict. More about awakening.

Two World-views

Ancient Spiritualities

Person is perfect

Whole and complete; possesses all that is needed

Asleep

Treatment is to awaken

Disease Model

Person is flawed

Needs external knowledge or technology to be added

Deficit

Treatment is external: medicine, procedure, or external knowledge

Presenter

Presentation Notes

Rapprochement.

Two World-views


Divinity is within (both immanent and beyond)

Emphasis is on connection and wholeness

Illness begins in the Soul

Whole is greater than the sum of the parts

Western Thought

Divinity is external or non- existent

Emphasis is on individual expression

Illness begins in the Body

Emphasis is on the parts and the individual

Two World-views

Presenter

Presentation Notes

Gandhi; Dr.Santiago

Reflection: Two World-views


Person is perfect

Whole and complete; possesses all that is needed

Asleep

Treatment is to awaken

Disease Model

Person is flawed

Needs external knowledge or technology to be added

Deficit

Treatment is external: medicine, procedure, or external knowledge

Presenter

Presentation Notes

Reflection: as a clinician and as a person: take a moment to reflect on where you might stand, consciously and unconsciously, with these worldviews. Where you are with these has a large influence on how you view treatment and how you live your own life.

Thought Experiment

Given that spontaneous remissions may follow discernible principles, the place of consciousness in modern science and the better spiritual writings, what helps people heal? What most motivates people to help themselves and help each other?

It has taken hundreds of years to define the physical laws of the universe

Is it possible that there are laws or principles of the mind and heart that are more powerful than we realize?

Presenter

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I expect that we will reach a day when when the phrase, “It’s all in your head” will be regarded as the doorway of liberation rather than the thing no one wants to hear. But in the same way that the elucidation and elaboration of the physical laws took hundreds of years, so it will take time to elucidate the mental principles. Psychology as the flagship of health and healing.

Ambulances vs. Guideposts

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The metaphor of medicine as either a long line of ambulances at the bottom of the cliff vs. guideposts at the top. We’re here to talk about addictions that have already occurred today. However, this is still relevant because the principles or guideposts that prevent addictions also heal them. And, ultimately, we want to heal addictions, and help people enter recovery, rather than be left with coping strategies or maintenance plans.

Mask vs. the Person

Examples of masks: degrees, jobs, incomes, illnesses, age, appearances, roles we play

Masks are roles that we play: daughters, sons, lovers, spouses, employees, therapists, patients, clients, etc.

Masks are also illnesses and diagnoses: addictions, medical and psychological illnesses

Presenter

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We are all people first.

Parts vs. the Whole

In the West, we focus on parts to the exclusion of the whole:

a psychological problem is sent to the therapist

a medical problem is sent to the physician

a spiritual problem is sent to the priest, rabbi or minister

Presenter

Presentation Notes

The Docs at Good Samaritan often tell me that they treat the symptoms and I treat the underlying cause. The cause is often rooted in how the person feels, at a deep, even unconscious level, about themselves and the universe. Use the example of the person (with an addiction) who told me, (when I asked her, “what keeps you going...do you have any spiritual beliefs about the world?”) but had never told her other treaters, she said, that, “God lost me in the crowd when I was born.” Again, we need an underlying adequate ontology of the person - an intellectually satisfying and adequate model of Personhood. Medical problems are much more rooted in our minds and hearts than we easily see. Give an example or examples. E.g., the woman who had platelet crises every time her abusive mother called. Or htn, MI, etc.

New Model of the Person

So far:

The person is not his or her diagnosis or addiction

The person is more than the sum of biological, psychological and spiritual “parts”

It is a person who stands behind and orders all the “parts” and “masks” into a coherent whole

Presenter

Presentation Notes

But what does this mean? Can we go further?

PersonhoodOur concept of personhood is evolving over the centuries.

A new conception was the basis for the Declaration of Independence

Benjamin Franklin suggested the use of “self-evident” as a way to base the new political system on common rationality rather than sectarian religion

“We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain inalienable Rights, that among these are Life, Liberty and the pursuit of Happiness...”

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Story of Jefferson and Franklin regarding “self-evident.” Took time; slaves were considered only 3/5 of a person in regards to representation, etc. for a long time. History has been about the growing respect for normal people and their capacities for an internal world, for individual freedom and self-determination. Increasingly a more positive understanding of the person.

The Evolution of CultureReligion: People are fundamentally sinful, even evil creatures

Medicine: The disease model reifies disease

Psychology: Problems are reduced to deficits from childhood

Psychiatry: Problems are reduced to neuro-chemical defects

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However, we are still have a ways to go. Dominant negative paradigms still exist.

Deficit Models in ReligionReligion sometimes seeks to celebrate personhood in theory

But too often:

teaches a negative view of human life

restricts personhood to a select few

teaches the opposite in practice

seeks to control rather than liberate

Deficit Models in Psychology and Psychiatry

Reduce conflicts to deficits from childhood or neuro- chemical defects

Assume that the deficits and defects reflect something real about the person

This creates treatment resistance

“Before Prozac, she loathed company”

Presenter

Presentation Notes

There’s a place for these models; just aren’t the whole story. Lack a larger understanding of personhood.

The Evolution of Culture

A slow movement away from negative and deficit- based models towards a positive vision of the human experience

Democracy, human rights, increased emphasis on the self-evident dignity and inborn capacities and possibilities of all human beings

A flowering of the inner life and capacities for self- knowledge and self-determination

The Evolution of CultureThe theories of William James were a proto-type

Third-force psychology (Carl Rogers, Abraham Maslow) heralded a new direction

Alcoholics Anonymous, Meditation, Self-Help, Positive Psychology and Alternative Medicine represent a flowering

Flowering of consciousness and renaissance closely related to the meeting of East and West

Presenter

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These new approaches today represent a renaissance of the mind and heart, and a spreading awareness of the inner goodness and capacities of the individual.

Principles of Healing

We matter more than we have a clue about

We are more connected to others than we realize

We become what we focus on

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Presentation Notes

applies to many illnesses, and also to addictions. For the first: we matter more than we have a clue about. Perhaps this lowers the flight or fight response and allows the body to heal.

The Primacy and Dignity of Personhood

Each person brings something unrepeatable and magnificent into the world

We suffer to the exact degree that we fail to understand the dignity and magnificence of our individual life and being

At the bottom of much of illness and disease lies a longing to be seen, loved and valued unconditionally, as one asleep but with potential

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Many people agree with me in theory. It applies to everyone else except them. The point is that it does apply to each one of us.

The Primacy and Dignity of Personhood

Can be described in both “spiritual” and “non-spiritual” language

Is described in the best of spiritual writing: Imago Dei, the light within, divine spark, inner light, child of God, etc.

PII

Perfect, Immortal, Indestructible

From a higher perspective, the evidence of the five senses gives rise to an illusion: we are not our masks or who we appear to be

The perfection of imperfection: liberation comes from the growing experience that we are both perfect and imperfect human beings - “good enough”

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Tell the story of PII. This is what gives us the expansion, the “YES!” to ourselves and to the world that William James said the addict wants.

PIIbrings out the depth and genius of ourselves and each other

helps us be present to the possibilities and the beauty within our clients, and also within ourselves

revives hope and faith, which are vital forces for healing

emphasizes the unrepeatable, unique gift that each individual is; and that nothing can take this basic reality away

PIIIn spiritual language, the goal is to see the client, and ourselves, not with our physical eyes, but with the “eyes of the heart”

Seeing in this way liberates people and relationships for gratitude rather than fear

This offsets the human tendency to judge rather than seek to understand

The ubiquitous presence of judgment - of self and others - in human relationships is one of the main impediments to recovery for the addict

PII

“Here is my secret. It is very simple: It is only with the heart that one can see rightly; what is essential is invisible to the eye.”

“Well, I should tolerate the closeness of two or three caterpillars, if I want to get to know butterflies.”

-Antoine de Saint-Exupéry, The Little Prince

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The fox giving advice to the little boy, who has fallen in love with a rose... When we see with the eyes of the heart, we reflect love rather than fear, strength rather than weakness, acceptance rather than judgment, unity rather than separation.





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Now for the second principle: we are more connected to others than we realize.

Connection

One of the great sources of suffering and illness is the feeling or belief that one is alone

Healing often has to do with helping people feel less alone

This is one of the great strengths of AA

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When people feel seen, they feel less alone.





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Now let’s look at the third principle: we become what we focus on. This is a real problem for the disease model when taken alone.

The Focus

We become what we focus on: projection creates perception; and perception creates experience

Focus on the illness more illness

Focus on what’s right and healthy more of what’s right and healthy

We become what we cultivate and feed

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E.g., the person I treated who told me what she saw on the streets outside Boston Medical Center. This principle has implications for both addiction and the disease model. The addict is helped more by getting a meaningful and fulfilling life rather than on fighting the urge to use.

Spiritual Principles

Build on what is right and good within the person

Fill life with love and gratitude

Look for the positive roots of negative traits and re- orient the choices and behaviors into something positive

See the addiction as an opportunity to learn

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Focus on feeding the soul so that the urge of the addiction loses its strength. The focus is not the addiction, family system or problems of childhood.

Summary

Next steps in the evolution of human life and culture will involve:

Flowering of the inner life and its capacities

More positive view of human life and the capacity for self-determination

Elucidation of the higher, less material laws of human life and culture

This will transform our models of health and illness

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The larger issue: the helping professions must LEAD THE WAY in de-pathologizing mental illness. There is no way to do this except through growing into a model that views people and their inner capacities more positively and with less judgment. Our job is love the immortal soul and see what is trying to awaken. Moorjani is wonderful on this, p. 108. People are not non-compliant, “bad,” character disordered or ill in a way that genuinely defines them. There is nothing wrong with the person that cannot be fixed by what is right about them. They need our leadership in society regarding compassion and help awakening. A life of pain, confusion, and self-hatred is very difficult. Treating people with judgment only reinforces the condition.

In ConclusionAA represents an important step forward in regards to treatment models, brings together both spirituality and the disease model, and is a model of the future

People helping people: we can only give to the souls of another what we have given to our own souls

• “Your vision will become clear only when you can look into your own heart. Who looks outside, dreams; who looks inside, awakes.” Carl Jung

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“I believe that the greatest truths of the universe don’t lie outside us, in the study of the stars and the planets. They lie deep within us, in the magnificence of our heart, mind and soul. Until we understand what is within, we can’t understand what is without.” Anita Moorjani

The Magnificence Within You, by Akin Salawu

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Addiction Slides Short Version