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Blog (by JH, no AI)

Thoughts on Psychotherapy

Blog | Dr. Jamey Hecht | Beverly Hills, CA
 
Posts in freedom
Addiction, or No?

A habit merits the term “addiction” when it costs you more than it’s worth; when you try to stop it, but find you can only put it “on pause” for a short while; and when you find your thinking (especially your judgment) is distorted by the high priority you place on repeating the habit. Another criterion is perhaps less important because it’s outside you, but it can be very important indeed: when multiple neutral or friendly people tell you they think you have a problem—especially if they haven’t spoken to each other about it beforehand. 

In an excellent book called In the Realm of Hungry Ghosts: Close Encounters with Addiction (2010), Gabor Mate argued that addictions have their roots in early trauma. He tells the story of the thousands of American soldiers who fought in the war in Vietnam, which at that time was part of the “golden triangle,” a geographical area that produced a large share of the world’s heroin supply. U.S. troops coped with horrific levels of combat trauma, including guilt/moral-injury; anxiety, uncertainty, and fear; bereavement and loss; the shock of seeing so much injury and death; and the various physical wounds, ruined health, lost limbs, and so on. Many became habitual heroin users. But when they came home, it turned out that for the most part, the soldiers who remained stuck in heroin addiction were those who had suffered childhood trauma, long before the war. The others were able to drop the habit, though heroin is perhaps the most addictive substance on Earth. 

Not every addict has a trauma background. But most do, and when you meet one who apparently does not, you can’t be certain they have (or have shared) a full knowledge of their own relevant personal history. While many different kinds of trauma can happen to a kid, the CDC lists a few of the big ones in its online material about Adverse Childhood Experiences (or “ACEs”):

Experiencing violence, abuse, or neglect.

Witnessing violence in the home or community.

Having a family member attempt or die by suicide.

Substance use problems.

Mental health problems.

Instability due to parental separation.

Instability due to household members being in jail or prison.

They add “not having enough food to eat, experiencing homelessness or unstable housing, or experiencing discrimination.”

This painful picture of deep human suffering should not be taken as a portrait of an “average addict,” since there’s no such entity. And what amounts to trauma is not actually the stuff that happens to somebody, but how it’s experienced. The mystery of resilience has to do with the kid’s temperament, circumstances, culture, and especially the interpersonal supports that did or did not keep the situation from being even worse. There are people who endured every ACE listed here, who have never been addicted to anything. And there are others who had only one or two of these to deal with, and in adolescence or adulthood became dependent on one or more substances or behavioral habits that cost them dearly. 

The difference is not a moral one, and there is no rational calculus about who had it worse, or who went on to put up the best fight against addiction or depression or anxiety. These pseudo-questions involve impossible apples-and-oranges comparisons and fictitious quantifications of how bad different childhoods were. The feelings are most important; the facts matter, too; but the measurements of them are largely illusory. The reality of trauma has to do with what happened inside the child: what the bad stuff meant to him or her. If parents are neglectful or abusive, a kid will infer that young person in the mirror is deeply flawed, and deserved the bad experiences. But if the same kid also has a benevolent art teacher, a well grounded mentor, a kind and wholesome uncle who is reliable and interested, sane and warm—the kid may be protected from drawing that toxic conclusion about the self, and grow up less susceptible to addiction, to cults, to swindles, to sadomasochistic attachments, and so on.

The trauma theory of addiction is the profound claim that we mammals, we primates, we human beings, have universal evolutionary needs for nurturance and protection, and when these go unmet, or are met with harm mixed in, addiction often results. The person seeks out whatever will soothe away the pain of neglect and/or abuse from long ago. Usually, it’s pain from very long ago: infancy is the first love relationship we ever have, the mother-baby dyad that sets the emotional foundation for the whole lifespan. Even if things don’t go relatively wrong until later in childhood, it’s the inner baby part-of-self within the older kid that’s most overwhelmed. Freud taught that each of us is all the ages he or she has ever been, so the baby who craves a substitute for the warm and milky breast is actually still active inside the active addict, running the show—which is why the addicted adult can be found making such poor decisions. A brilliant, short book by Abraham Twersky, Addictive Thinking (1997), spells out what that kind of cognitive distortion can sound, look, and feel like. 

But acute or chronic trauma need not be the only reason for addiction, and often there is a very useful significance to the person’s particular “drug of no choice,” as it’s sometimes called in twelve step culture. For example, with or without the expectable ACEs, people who have uncontrolled habits of excessive sexuality may be trying to prove to themselves that they are indeed attractive sexual beings, capable of evoking erotic participation from others. Boys who were repeatedly rejected by the girls they hoped to kiss—and that’s most boys, who mature more slowly than girls tend to do—can grow up with a lot to prove. Many spend their late teens, twenties, and even their thirties struggling to establish that they are not icky “involuntary celibates” who will never find a mate (even if the guy himself is now the only person who sees him that way). If they can do this without deception, and without heaps of gender-based resentment, and without excessive risks to physical and mental health, they may manage to accumulate enough sexual experience to falsify their own worry about it. They can be fortunate enough to realize one day that they have indeed established what they were so desperate to establish. Now they are free to let go of the pattern that looked like, or really was, “sex addiction.”

Shopping addiction can be like that, too. I’ve said “people with uncontrolled habits of excessive sexuality may be trying to prove to themselves that they are indeed attractive sexual beings.” Well, people with uncontrolled habits of excessive consumerism may be trying to prove to themselves that they are indeed successful participants in the world of consumption, including the spells cast by advertising. Ads comprise a powerful technology of conscious and unconscious persuasion that links people’s self-esteem to their capacity to get hold of whatever product or service is being defined as beautiful, validating, and necessary. If I succumb to this, my identity will be bound up with my ownership of the bag, the boots, the car, the designer version of whatever I’ve been convinced I need.

Insofar as this is true of somebody in particular, that person’s sobriety will have a lot to do with identity: achieve an internal locus of value, and you can also build up an internal locus of control that defeats the addiction. When a person suddenly comes into a sum of money, a lot can be learned by watching how they spend it: the speed of the spending, but more importantly, the buying choices they make. If you are making large purchases of “designer stuff,” you might be an erudite connoisseur of fine handbags and their nuanced history since the year 1588. But it’s more likely you are buying an Hermes bag for $9,850 because that is what the surrounding culture told you was important, valuable, and above all, validating for the identity of the buyer. It is, ultimately… a bag.

A designer purse like that “says” plenty, but just what it says depends on the wisdom of the beholder. The message can range from “look, I am successful, you would be fortunate to share sex, love, friendship, or business with me” to “look, I cannot think for myself, and remain profoundly naive about the available better uses to which money can be put.” Those uses include appropriately limited altruism, where you get good feelings by helping others who need help; buying experiences (especially travel, but also course-taking, conference-going, skill-building, etc.) rather than things; connecting to the past and to the globe by acquiring works of art that speak to you; funding ambitious projects that you find fascinating and beneficial to the communities of which you count yourself a part; and so on.

I know brilliant, beautiful, accomplished people who collect high-end designer handbags. I see it as an expression of their aesthetic enjoyment of these exquisite objects. I also see it as a mechanism of compensation for early experiences of having to do without the goods that other kids had. If your peers in elementary school and middle school and high school all wore flashy stuff and drove expensive bikes, while you wore hand-me-downs and walked to school without wheels, you might well benefit from disproving the worry that they are blessed and deserving while you are deprived and unworthy. And the collectors I’m thinking of are at least as psychologically sophisticated as I am; they know all about their own formerly unconscious motivations for spending “real money” on glam and bling. But they do it anyway, and apparently it serves them well. Rather than judging anybody for buying or selling luxury goods, I am commenting on some of the common underlying dynamics that contribute to habitual choices which can come to feel quite unfree.

And that’s the issue with therapy for troublesome habits: is the habit a free and informed choice? Is it an addiction, or would we get better results framing it as a mere habit that needs tending? The more it costs you—in money, time, opportunity, relationships, access, etc.—to continue with the habit, the easier it is to decide that you must stop. The less it costs you, the more reluctant you or I will be to use the term “addiction,” or recommend 12-step programs, or insist that only abstinence will constitute recovery. Mild addictions to substances or behaviors can be addressed with a commitment to “harm reduction.” Someone who drinks a few times a week but does not lie about it, nor have blackouts, nor have a Jekyll-and-Hyde personality change when they’re intoxicated, is probably a person who can reduce drinking by, say, 65% without too much struggle. But if it turns out to be a big struggle, then the language of addiction might be very useful for getting hold of the habit and changing it.

If you’re dealing with repeated behaviors that you suspect are costing you too much in money, time, peace of mind, or otherwise, consider booking a session with me. We can join forces to help you figure out your relationship to the habit in question, and find the best ways to change for the better—guided by your values and goals.

Email me through the contact form on this website, or call 917-873-0292.

Work, Overwork, and the Need to Belong

People have an evolved need to be part of something – to belong to a family that belongs to a tribe. Anyone who doesn’t have that can become susceptible to whatever offers itself as a substitute, even if the eventual price of belonging is unclear at the outset, and turns out to be too high. We are a profoundly social species, and the more isolated somebody is, the greater their risk for getting absorbed into a company that has cult-like features—especially if these only become obvious after some time has passed, and ties have been formed.  

In Bowling Alone: The Collapse and Revival of American Community, Robert Putnam showed that people in the USA used to be connected to large numbers of neighbors and peers, by all sorts of clubs and civic groups and religious institutions that were larger than the household, but smaller than the state—the Elks Club, the Knights of Columbus, Boy Scouts, B'nai B’rith, and so on—and that since the 1970’s, most of these have shrunk or even vanished. For my MFT internship (2012-2016), I trained in Gestalt therapy at a Los Angeles nonprofit called The Relational Center whose motto was and is: Isolation hurts. We help. See also Johann Hari’s excellent book on this issue, Lost Connections: Uncovering the Real Causes of Depression – and the Unexpected Solutions.  

Our drive to be part of something larger than ourselves is a core need that’s sometimes fulfilled in wholesome ways, even today. If we’re fortunate, it can arise where we earn our daily bread. Teamwork on the job, if it goes well, feels good and works effectively. It’s not necessary to spoil it with cynicism by deciding that it’s all a swindle, just because management planned it for the purpose of maximizing the owners’ profits and the shareholders’ return on their investment. Yes, management did set up a personnel structure, with its cooperative and competitive dynamics; and yes, they did so mainly with those financial motives. But it’s a wasteful mistake to use this fact to empty-out the value of a collaborative experience. Enjoying your job doesn’t make you the dupe of exploiters—unless your employer happens to be exploitative. So it’s pretty important to have some criteria for that category.  

If the company’s internal communications are laced with the rhetoric of family life, does it feel icky and bogus?  

Prioritize your physical and mental health, and take a close look at the effects of your current employment on those two factors.

Is it a permissive environment, where bad interpersonal behavior has no consequences? Or an over-policed one, where H.R. feels overzealous and unpredictable?  

Do rewards for extra hard (or extra good) work go to everybody, not just the suits in the suites?  

Are you stuck in your current role, or can the leadership be convinced that they could make better use of you in another one where you feel you’d add more value? If you contribute advice for improving processes, products, or practices, does that get rewarded or punished?  

Do you feel misled about important aspects of your role, or are they frank with you where it counts?  

Bonuses and raises are not the only genuine sort of rewards—there’s paid time off, broader choice of tasks and teammates, more control over your schedule and remote work, and so on. Be wary if you put in a heroic chunk of overwork, and they either ignore it, or pay you in symbolism, praise, and thanks, but nothing more.

Consider that the ideal job, the real peach on a high branch, gives you three things:

·      enough meaning

·      enough money

·      adequate work-life balance  (WLB) 

Awful jobs are missing all three, and are way too close to what sociologists have called “social death,” in which one’s humanity is under dire assault by some combination of abuse and neglect. The late Barbara Ehrenreich wrote a poignant bestseller called Nickel and Dimed: On (Not) Getting By in America, about such jobs, and the vexing struggle for upward mobility. More recently, in Democracy Awakening, professor Heather Cox Richardson has taken account of the way access to opportunity waxes and wanes cyclically through the history of the United States.  

A good job can provide you with any two of these, but not all three—and if the one you need most is the one that’s missing, the job’s not so good. Sociologist David Graeber made a splash with his Jeremiad on corporate culture, Bullshit Jobs, which he defined thus: “…a form of paid employment that is so completely pointless, unnecessary, or pernicious that even the employee cannot justify its existence even though, as part of the conditions of employment, the employee feels obliged to pretend that this is not the case.” Bullshit jobs pay plenty, and they don’t take over your whole week—but their lack of meaning takes on a creeping toxicity the longer you work there, because the company culture requires you to fake it. Even if the work is (relatively speaking) socially and environmentally harmless, you still come to feel you are selling your integrity because you have to bullshit other people, and yourself, that the work is not, in fact, the bullshit it really is. This is sometimes called “golden handcuffs.” 

If there’s work-life balance and meaning, but not much money, it may be possible to add a lucrative side-hustle without becoming exhausted. If there’s good money and real meaning, but you’re frazzled and sleepless, that strategy’s not available; you may need to negotiate more time away, or build an exit ramp.  

Aristotle wrote a book of ethics for his son, where he states: Happiness is not amusement, it is good activity. Ideally, work is a form of serious play that gives us a role in the community and compensation for our labor in that role. On your way to a vocation that really suits you, remember that the gatekeepers will be behind you one day; that the stepping-stones are temporary phases of your life with something to teach you, however unpleasant; and that you must steer your life in the direction where you want it to go.

If this post resonates with you, consider booking an appointment with me at 917-873-0292, or email Jamey@drjameyhecht.com. Sessions available in-office in Park Slope, Brooklyn, and remotely in NY, NJ, TX, and CA.

If You Could've Done Better, You Would Have

We often want to help people with their regrets, by telling them: “If you could have done any better, you would have. The reason you didn’t, is that you were constrained by your trauma background, your history.”

They reply that this is a slippery slope; that if they allow themselves the solace of explaining their bad choices by invoking their past history, they might recklessly let themselves off the hook for all kinds of error—laziness, impulsivity, greed—in the present and the future.

But it is not a slippery slope, so long as we locate the determinism in the past, where it belongs, and the freedom in the present, where we need it. Both the past and the present are constrained by the effects of the remote past I call my childhood. But the past of my young adulthood is already fixed, whereas the present is still relatively fluid, with room for choice and decision.

What is the precise extent of today’s freedom? How far can I hope to excel my previous performances? How free am I this morning, to do better than before? The only way to find out is to do the best I can now do, and learn about the flaws in today’s efforts only in hindsight, later on. Only tomorrow’s perspective will reveal the hidden limits of today’s freedom. I can best reach those limits—I can make optimal use of today’s undefined opportunities—by living as if I were entirely free of the constraints my origins impose on me. I am now 55. For my twenties, therefore, this process is now complete, so I’m now free to conclude that at 25 I indeed did the very best I could do—even though some of my choices that year were relatively disastrous. Had I been more free, I would have done better.

This is not a moral framework; the goal is to understand, not to excuse. Understanding will give me the breathing room to choose how to handle the moral dimension of my past conduct, prioritizing compassion over punishment, wisdom over bitterness, edification over regret.

Every child experiences some particular mixture of three things: getting the good stuff (love), not getting the good stuff (neglect), and getting the bad stuff (misuse, or worse: abuse). The particular mixture supplied by a particular childhood has consequences—exerts constraints on our freedom of thought and action—for the whole lifetime. But those constraints can loosen and fade with experience, especially with enough good experience. At no point am I ever in a position to assess exactly how much my early years are still shaping my current actions and perceptions right now.

So: today, I will do the best I can, as if I were no longer limited by the consequences of my origins. Tomorrow will show me why I got as far today as I did, achieving no more and no less than my level of maturation could permit. The psychotherapy that helps me understand the tragedies of my young adulthood also equips me to improve my future, not only because it helps me learn from experience, but because it explains why I suffered from the particular ignorance that I did.

Today’s ignorance will be tomorrow’s knowledge. As I contemplate the ways I fell short in the past, the more compassion I can muster for my youthful self, the less regret I must endure today. From present contemplation of my past mistakes, I must learn both prudence in dealing with the outside world, and mercy in dealing with myself.

Of course my history limits my choices. But exactly how much? I don’t know, and that’s a good thing. Our ignorance of the precise nature and extent of our constraints is part of our freedom. And just as a temperate optimism can enhance my odds of success in the world outside, my inner life will likely go better if I let myself assume I have achieved more growth and healing than I can readily prove. “With every mistake,” wrote the Beatles, “we must surely be learning.” In the absence of an impossible certainty, we are better off trusting in the human spirit’s innate powers of development.

One way to have that experience, to grasp for that faith, is to “see” your elderly future self kindly smiling down on you from the future. You might as well… look.

If this post resonates with you, consider booking an appointment with me at 917-873-0292, or email Jamey@drjameyhecht.com. Sessions are available in-office in Park Slope, Brooklyn, and remotely in NY, NJ, TX, and CA.

Chasing Status to Avoid Love

In F. Scott Fitzgerald’s great American novel The Great Gatsby, a self-made millionaire aspires to win the heart of a woman he once loved. Daisy is married and unavailable, but Gatsby has idealized her for years. He knows that she appreciates the outward signs of wealth, fame, and power—things that confer status—so he reinvents himself as a wealthy tycoon, hoping this will impress her enough to make her value him. He benefits from this quest because it focuses his energies, motivates him, and brings him the clothes and cars and cash that sometimes make life fun and exciting. Gatsby makes his money by bootlegging liquor during Prohibition, when it was illegal and therefore risky and lucrative. Alcohol has destroyed myriad lives, but in moderation it has been part of the good life in many cultures for millennia; one could argue that Gatsby’s path to success was not so antisocial as to be self-discrediting—he is no Al Capone, and no Macbeth. But such success itself poses a problem: if it all works out, and Daisy is won over by glitz and bling, how will he know she really loves him? Gatsby is a man, not a Rolls Royce or a bank account.

The book ends in tragedy, when Gatsby is killed by another character. But had he lived, one possible outcome would’ve been a temporary affair between him and Daisy, followed by some kind of disillusion. Either she would reject him and stay with her boorish husband (Tom), or Gatsby would tire of her upon realizing that she loves his status, his money, his power, more than she is capable of loving him. Such disillusion would be agonizing, but it would do him a world of good. Disillusion is the way out of illusion, and some illusions can be extremely hard to escape because their logic has a seamless continuity that conceals the exits. Of course I want to live in a giant mansion; of course more money is always better, ad infinitum; of course a higher status will enhance my success at anything I could possibly undertake in life, including finding a mate. It is because these assumptions seem so obvious that their fundamental error is so hard to detect.

Freud taught that the purpose of psychoanalysis (it applies to mental health treatment in general) was to help people to love and to work. The idea that more-is-always-better has serious drawbacks on both sides. In work, it threatens what we call “work/life balance” and risks work addiction, in pursuit of ever-more earnings, far beyond our ability to enjoy them. In love, more-is-better can mean either of two troublesome things. It can mean I am stuck in a compulsive accumulation of temporary partners, building my “body count” without checking its effect on my wellbeing. Or it can mean I am doing what Gatsby did, pursuing just one partner, but using means that are accumulation-based: if I have more status than these competitors, then I’ll win the competition for her. What gets neglected here is the way my toys and my success can upstage the merely human, unique individual I actually am. I also may fail to notice how much my attention is diverted from my “Daisy” onto the men with whom I’m busy competing, jockeying for position, comparing the size of our houses (paging Dr. Freud), etc.

If such a disillusioned Gatsby can survive the disillusioning experience, he may win the real prize, one more valuable than the solid gold toilet, or the victory over his male rivals, or even Daisy herself. The real prize is a mature freedom: freedom from the endless compulsion to accumulate ever more status and wealth, and with it, freedom from the need to woo the kind of person who remains focused on that kind of stuff. Whoever escapes from the prison-house of status-seeking gets to love and be loved by people who are also free of it.

There are plenty of good reasons for a couple to want lots of money, or for a single person to want wealth in an eventual marriage. Raising kids, running a small business, keeping a theater afloat, endowing a community’s nonprofit, all these require plenty of cash and become impossible if there isn’t enough, and the list goes on and on. What’s not so good, is chasing wealth as a substitute for self-love, and hoping that the display of this wealth will attract somebody else who has the same confusion between wealth and love.

People who are unconsciously afraid of love might not be able to tolerate getting the love they really need, but do not want. So they collude with similar people to form relatively loveless couples, held together not by deep affection, acceptance, and desire, but by the glue of status, purchasing power, and the conspicuous display of resources. Real love is associated with eventual death, because if I fall in love with one unique, mortal, individual person, I will one day lose them and it will matter to me. If I marry someone I really love who really loves me, I move forward on what Kierkegaard called “the stages on life’s way,” and this means leaving youth behind and getting closer to the end. Focusing on status and trophies can instead create the illusion that I am outside of the arc of the life cycle, that my world is one of endless youthful playdates and context-free experience, often of a dissociative, thrill-seeking kind. Diverse pleasures have their place, and there’s nothing inherently bad about thrills. But it’s worth checking: am I doing this as a defense against something else? Might I be partying quite this much because I am avoiding something?

If this post resonates with you, consider booking an appointment with me at 917-873-0292, or email Jamey@drjameyhecht.com. Sessions are available in-office in Park Slope, Brooklyn, and remotely in NY, NJ, TX, and CA.