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Blog (by JH, no AI)

Thoughts on Psychotherapy

Blog | Dr. Jamey Hecht | Beverly Hills, CA
 
Posts tagged sex
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.