An Existential-Phenomenological Perspective of Addiction, Recovery and Twelve-Step Programs
The following article is part of a series of articles where I explore the value of “philosophy as a way of life” for individuals in addiction recovery.
In this article, I briefly explore addiction, recovery, and the 12-Step program from an existential-phenomenological perspective and attempt to articulate the value this perspective can provide individuals in addiction recovery.
The Need for an Existential Foundation for Understanding Addiction
Most of the well-known models of addiction have as their foundation a natural scientific worldview and positivistic methodology, which are typically adequate for exploring phenomena that exist on a certain level of ontological complexity: primarily denoting the physical realm. However, such models are hopelessly inadequate in explaining complex phenomena such as addiction or any human behavior, which exist on higher levels of ontological complexity. For example, reward deficiency syndrome can only be understood as one of many possible physiological risks that interact with other aspects of being human, without having to reduce human behavior and motivation to neurotransmitter levels. Simply put, even though an addict may have altered neurotransmitter levels, concepts such as addiction are meaningless at the molecular realm of brain physiology. To talk at a molecular level about addiction is like saying that an amoeba, which only primarily exists in a primitive level of ontological complexity, has abandonment issues originating from poor object relations.
Existential psychiatrist Medard Boss (1983) pointed out that the natural scientific method has its limitations in explaining the human realm as it originated from and is only sovereign in the nonhuman realm (natural sciences). He is of the opinion that “they largely overlook how radically the nature of their object of study — human reality — differs from the make-up of every other realm known to us” (Boss, 1983, p. xxix). In our current context, one could say that Boss (1983) echoed the dangers of explaining higher-order complex phenomena, for example, any aspect of human being-in-the-world, by using methodology (i.e., empirical observation) and epistemology (i.e., positivistic) that are only relevant for lower orders of complexity. He believed that in Freud’s metapsychology and most other theories of human existence, there is inevitably an abstraction and tapering from our lived engagement in the world. In other words, human-being-in-the-world reduced to lower orders of ontic complexity.
Models based on a natural scientific approach, such as biologically oriented models, provide useful information about addiction, but they cannot adequately account for addiction because human beings are more than their physiology. In fact, the popular “brain disease” model of addiction, in light of the above, can only be described as absurd. Just because human behaviour has a physiological component, even as complex and influential as the neurophysiology at play with addiction, it is preposterous to describe any sophisticated human behavior, like addictive behaviour, that exists within interrelated intrapersonal, interpersonal and socio-cultural dimensions, as primarily a neurophysiologically-based “disease.” Boss (1983) suggested that we need an existential philosophical foundation to truly understand what it means to be human and what psychopathology is. An adequate understanding of addiction and recovery should be informed by an existential understanding of human nature (as well as a natural scientific perspective), otherwise, we remain prone to reducing our being-in-the-world to its constituent parts and consequently, may miss the big picture.
Existential Givens and Existential Anxiety
A central issue in addiction treatment and recovery is how an individual deals with the existential anxiety that arises when confronting ultimate concerns or existential givens. Moreover, addictive behavior can also be understood as a dysfunctional way of dealing with the anxiety induced by a confrontation of existential givens. It is imperative that an individual in recovery finds healthy ways to confront the givens of existence.
There are certain aspects of life that are within our capacity to control and manipulate, but there are also aspects that are given and cannot be avoided; we are “thrown” into these circumstances (Heidegger, 1927/1962). For Yalom (1980), the most significant givens of existence are the unavoidable freedom to choose the way we live our lives, the unavoidability of death, our social isolation, and the meaninglessness of life. For Yalom, the confrontation with these existential givens may evoke anxiety that we often try to circumvent or suppress. What distinguishes existential anxiety from neurotic anxiety, is that all people share the former, it is ontological in nature (Cooper, 2003). Temple and Gall (2016) made the distinction between the concepts of existential anxiety and fear. They point out that:
“Fear is a sensation the individual experiences resulting from an external object, that is, a definitive source. Anxiety, on the other hand, has no object, the threat of anxiety is nowhere” (Heidegger, 1962; Stolorow, 2007; Tillich, 2000; Weems, Costa, Dehon, & Berman, 2014; Yalom, 1980). For Heidegger (1962), the lack of objects in existential anxiety renders external factors meaningless and irrelevant. Existence itself becomes equal to nothingness because embedded in existence is the understanding of the certainty of death, that is, the end of existence. Everyday significance thus collapses and the individual is left with a feeling of strangeness and the sensation of “not-being-at-home” (p. 7)
With addiction, the existential anxiety generated with a confrontation with these four existential givens is even further magnified. For a person in active addiction, the threat of death is ever-present and many addicts have friends that have died as a result of addiction. Addiction isolates the individual in a pursuit that is ultimately meaningless where the capacity to choose is inhibited by the powerlessness over the substance and/or behavior. The experience of meaninglessness has been shown to develop into depression and substance abuse (Moore & Goldner-Vukov, 2009). In the next section, I will focus on one of these existential givens, freedom, and its relation to powerlessness.
Freedom (and Powerlessness)
The concepts of freedom and powerlessness are frequently used in addiction treatment and recovery groups. Freedom is mostly considered a positive state to strive for, and powerlessness is something to be avoided. Yet it is not that simple. Temple and Gall (2016) said that: “In the existential sense, freedom means to be distinct from external structures however, this leads to being engrossed by dread (Yalom, 1980) or angst (Langdridge, 2013). Human beings desire structure and experience a sense of being ungrounded when confronted with freedom.” (p. 9) May (1981) believed that freedom can enhance our lives or it can cause us to escape and regress from the “dread” or “angst” that it may bring forth. Existential thinkers stress the significance of freedom, personal responsibility, and freedom of choice. This perspective emphasizes the unique experiences and needs of each individual, and the responsibility each of us has for our choices and what we make of our lives. South African philosopher and statesman Jan Smuts’ theory of Holism — in its application to the human personality — is aligned with an existential view of freedom. The striving toward freedom is an essential and central component of Smuts’ view of human nature (Du Plessis & Weathers, 2015). Moreover, Smuts views the need for personal freedom as ontological, which I have previously referred to as the “will to freedom.” My personal perspective is that our existential need for personal freedom is one of our most fundamental human needs alongside the need for meaning and attachment. Hence, the collective pathology that arises when humans are forced into collectivist social structures where individual freedom is subservient to the collective. Smuts (1926) asserts that:
“To be a free personality represents the highest achievement of which any human being is capable. The Whole is free, and to realize wholeness or freedom (they are correlative expressions) in the smaller world of individual life represents not only the highest of which the individual is capable, but expresses also what is at once the deepest and highest in the universal movement of Holism.” (p. 321)
Addiction can be understood as a lifestyle that severely constricts freedom, whereas a recovery lifestyle allows for a fuller expression of freedom and wholeness in our being-in-the-world. A person has the free will to make choices that support either a recovery lifestyle or an addictive lifestyle. The choice and the responsibility are theirs alone. Even though a person might have a condition that limits their free will in relation to their addiction, known as powerlessness in recovery circles, it does not make them powerless over the choices they make, and they have to get the right support and to follow practices that will prevent them from regressing into this powerless condition.
While existential philosophy and psychology applaud the notion of freedom, it also acknowledges limitations of our freedom. The notion of existential limitations has significance in the context of addiction and recovery. From one perspective, addiction can be understood as an attempt to bypass certain of our inherent limitations. While in active addiction, an individual tries to control the uncontrollable, in an attempt to avoid and medicate natural human experiences of pain, disappointment, boredom, and so forth. Ironically, this attempt at control ends up with a person being more out of control, enslaved by the medium which they use to try and control what ultimately cannot be controlled. Flores (1997) pointed out that, “Powerlessness over alcohol and the acceptance of one’s limitation in relation to alcohol serves as a prototype for the alcoholic facing and accepting other limitations of the human condition” (p. 273). Ulman and Paul (2006), in their book The Self Psychology of Addiction and its Treatment: Narcissus in Wonderland, brilliantly explained how at the core of addiction dynamics, there is a narcissistic fantasy of having an unrealistic sense of control of oneself, others and things/events in the world:
“In the case of addiction, such a narcissistic fantasy centers on a narcissistic illusion of a megalomaniacal being that possesses magical control over psychoactive agents (things and activities). These latter entities allow for the artificial alteration of the subjective reality of one’s sense of one’s self and one’s personal world. Under the influence of these intoxicating fantasies, an addict imagines being like a sorcerer or wizard who controls a magic wand capable of manipulating the forces of nature — and particularly the forces of human nature. Eventually, a person becomes a captive of these addictive fantasies and then becomes an addict, lost in a wonderland.” (p. 6)
An Existential-phenomenological Perspective of 12 Step Programs
Carl Thune interpreted AA from a phenomenological perspective and believed one of the reasons AA is effective is because its members share their life histories in AA meetings. He expressed the view that in recounting their life stories, alcoholics are “taught how to interpret their past in a way that gives meaning to the past and hope for the future” (Flores, 1997, p. 281). Thune (1977) wrote about the importance of life histories:
“In a sense, then, one of the first lessons AA must teach new members is that their lives were incoherent and senseless as they knew them. Simultaneously, it must reveal the “correct” understanding and interpretation of the drinking alcoholic’s vision of the world before a new member can accept the full benefits of the program — a program which offers a different coherence and meaning to their active alcoholic lives. In other words, according to AA, not only do drinking alcoholics incorrectly perceive and understand the world, but they cannot even correctly perceive and understand their perceptions and understanding of it. Through therapy, they must learn new methods for evaluating them. More abstractly, it is not just a revised and now coherent vision of the world which AA offers, but one which has altered the relation between its components” (pp. 81–82).
AA states that the alcoholic suffers from a spiritually defective mode of being rather than a mere physical disability. For that reason, AA uses a more spiritually-oriented vocabulary “in the absence of a more accurate but inaccessible philosophical-ontological terminology” (Flores, 1997, p. 283). AA believes that alcoholism is only one, albeit the most important, manifestation of a defective lifestyle or mode of being. Stopping drinking, therefore, is the first, but only one aspect of recovery. The alcoholic needs a complete lifestyle change. From a phenomenological perspective, an alcoholic must give up their “self-perceived construction of his or her self that is associated with the alcoholic lifestyle” (Flores, 1997, p. 283). Thune (1977) concluded that “AA’s ‘treatment,’ then involves the systematic manipulation of symbolic elements within an individual’s life to provide a new vision of that life and of his world. This provides new coherence, meaning, and implications for behavior” (p. 88).
Another feature of AA that Thune (1977) felt is significant in its success is the constant introduction of oneself as an alcoholic. The self-proclamation of “I am an alcoholic” constantly reminds alcoholics that they are a drink away from their old lives. This is often a problematic issue for those whose interest in AA is superficial or purely academic. Unfortunately, they often fail to see the significance of this ritual. They tend to erroneously equate this statement with a form of self-debasement. What they fail to understand is that alcoholics practice this ritual proudly, and with every introduction, they are indirectly conveying an important message about and to themselves. Flores (1997) stated:
“The term “alcoholic” signifies everything (self-centered behavior, negative attitudes, corrupt values) that sober AA members must guard themselves from if they are to maintain a healthy sobriety. By constantly utilizing the self-definition of alcoholic, AA members automatically imply the opposite, which is everything a healthy, recovering, and sober member of AA must attain. AA members are thus reminded with each pronouncement of themselves as an alcoholic that they are just a drink away from losing what they have become, which is a person whose values, attitudes, and behavior is the direct opposite of an alcoholic. From this perspective, alcoholism is viewed as more than just excessive drinking. This is why AA believes that alcohol consumption cannot be curtailed without addressing and treating the rest of the alcoholic’s personality disturbances. Abstinence from alcohol is the first step required for breaking the alcoholic style of living” (p. 286).
Understanding addiction from this perspective validates the need for a new recovery lifestyle; without a shift in lifestyle and a new set of healthy practices, the addict will eventually gravitate towards his or her habitual mode of being-in-the-world. Kurtz (1982) is of the opinion that AA works because it shares and addresses many features found in existential philosophy. As mentioned previously, a prominent theme in existential philosophy is the realization that, as humans, we exist within limitations. By admitting their powerlessness over alcohol in Step One, they recognize and admit this fundamental limitation. Apart from the acceptance of this limitation, AA requires alcoholics to share this limitation with other alcoholics. “The invitation to make such a connection with others and the awareness of the necessity of doing so arise from the alcoholic’s very acceptance of limitation” (Kurtz, 1982, p. 53). Although AA suggests the acknowledgment of limitation, it does not abdicate the alcoholic of responsibility. Being confronted by our limitations “engenders the dread, fear, and trembling of Kierkegaard, the angst of Heidegger, the angoisse of Sartre, and the abyss of Burber” (Flores, 1997, p. 274).
Furthermore, a common theme in existential philosophy is the problem of suffering. AA recognizes suffering as an innate aspect of existence, with a potential positive influence on our lives. In the context of AA, suffering is given meaning because it creates impetus in the alcoholic to question his or her existence and to be open for change. Viktor Frankl (1953) believed that when we can place our suffering within some meaningful context, we are not defeated by it, but are helped to transcend it. Similarly, in AA members share “the kinship of suffering” and recovery depends on the mutual sharing of suffering. AA teaches the alcoholic that to be fully human is to need others, and provides alcoholics with a universally shared explanation for their suffering. From a Buddhist perspective, suffering or dukkha is caused by our unwillingness to accept the world as it is and our insistence on trying to make it fit our expected ideas or fantasies. Addiction is, in essence, a refusal to accept things as they are and an attempt to avoid the reality of necessary suffering. An important aspect of recovery is realizing the inevitability of suffering and learning how to cope with it in a healthy way. Happiness is earned only through hard work — not through instant gratification. Flores (1997) summed up this existential predicament of the alcoholic:
“Many existential writers believe that in such a confrontation between the realistic acceptance of the world as it is and the self-centered demands for unlimited gratification, reason would prevail and the individual would choose more realistically between the alternatives — continued unhappy struggles with old patterns of expectations or authentic existence with expanded freedom of choice and responsible expression of drives and wishes. With Socrates, we argue to ‘know thyself.’ In this fashion, AA members are taught to believe that the authentic existence advocated by the AA program holds the key to self-examination, self-knowledge, emancipation, cure, and eventual salvation. (p. 280)”
Without a phenomenological perspective of 12 Step programs, one can easily succumb to misguided critiques of the program, as many critics do. One must keep in mind that the Twelve Steps is an injunctive paradigm — a set of social practices. To truly understand the nature of Twelve Steps, one has to follow the three strands of valid knowledge accumulation: injunction, apprehension, and confirmation/refutation. This is where the problem originates with much of the critique of AA: To refute or validate the claims of AA, we have to follow the injunction first. It has to be experienced before one can confirm or refute the validity of the practice. Therefore, attempting to understand the Twelve Steps objectively, without a subjective perspective gained by following the injunctive practices, is misguided. Pragmatic philosopher John Dewey (1961) called this type of distal knowledge “spectator knowledge.” Dewey believed that authentic knowledge is only derived from one’s phenomenological experience of interaction in the world. Wilber (1995) echoed this:
“One of the great values of Thomas Kuhn’s work (and that of the pragmatist before him, and in particular Heidegger’s “analytic-pragmatic” side) was to draw attention to the importance of injunctions, or actual practices, in generating knowledge, and further, in generating the type of knowledge in a given world space.” (p. 282)
This may be phrased more simply as follows: “The first strand of knowledge is never simply Look; it is Do this, then look” (Wilber, 1995, p. 282). Therefore, if you want to claim any real understanding of the Twelve Steps, then “do” it — experience it — according to the suggestions. Without the “do,” all consequent interpretations (whether negative or positive) will necessarily be partial, and misguided.
In conclusion, in this article (part 2 of my “philosophy as a way of life for addiction recovery” series) I attempted to briefly articulate the value of an existential-phenomenological perspective holds for addiction recovery. In my next article, I will explore the perspective of addiction as understood of a misguided method of satisfying basic existential needs.
All references for this article can be found in my book An Integral Foundation for Addiction: Beyond the Biopsychosocial Model.