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Heal

In “The End of Trauma: How the New Science of Resilience is Changing How We Think About PTSD” (2022), author and doctor George Bonanno highlights an inborn and often untapped resilience people can cultivate after exposure to traumatic events. A combination of being optimistic about the future, having confidence in the ability to cope, and a willingness to see trauma-inducing threats as a challenge; together can enable a flexible thriving in circumstances when one’s natural resilient abilities might otherwise be doubted. Moreover, Bonanno suggests that such skills may be honed and become easier to muster over time, perhaps even becoming partly automated with age (2022, p. 58, 123, 211).

Besides polishing skills at building resilience to address traumatic stress, author Haider Warraich in his book “The Song of Our Scars” (2022) states that to deal with various forms of pain and suffering more generally, several non-pharmaceutical approaches can be of value. For instance, exercise is a “potent stimulant of the body’s innate painkillers” (p. 232), while hypnosis, the original method of pioneering scientists including Sigmund Freud, today “offers tantalizing hints about an unexplored dimension within us all whose potential remains entirely untapped” (p. 237). Warraich similarly considers the potential of placebo medications to activate our own healing systems, even when administered with the awareness of the subject patient (p. 243). Many people also find benefit with yoga, meditation and, more recently, psychedelic therapy.

Despite the potential promise held by holistic mind-body approaches, are they not still reductionist in the sense of failing to account for the patient’s personal or social contexts? In the forward to Norman Cousins’ book titled, “The Healing Heart: Antidotes to Pain and Helplessness” (1983), Professor of Cardiology at the Harvard School of Public Health, Bernard Lown, observes that contemporary medicine has focused too sharply on the disembodied disease, rather than on the patient themselves: “This conventional biomedical model, through giving lip service to the patient as object of care, largely ignores the subjective dimension” (p. 11). Lown goes further by offering that an over-reliance on science and technology sidesteps the important aspect of human touch and connection in treating patients:

“It is far easier to learn how to interpret scientific data than to acquire the art of obtaining a sound history or performing an adequate physical examination. A skewed cybernetic ensues, wherein inadequacy of bedside skills increases resort to technical solutions” (1983, p. 21).

Warraich adds a contemporary perspective to this view in stating that

“an increasing loneliness and corresponding spiritual void set the stage for modern stressors as being borne increasingly by the individual rather than shared by the community, and rising anxiety wrought by a world that is increasingly digitally connected but interpersonally fractured” (2022, p. 177).

Addiction psychiatrist Anna Lembke, referenced in Beth Macy’s exploration of the opioid epidemic in her book Raising Lazarus (2022), expresses concern that some pharmacological approaches, including those used to wean people off opioids, can only ever be bandage solutions, as what is truly needed is

“a wholesale reinvestment in communities, starting with universal health care. If doctors keep simply medicating people who are anxious and depressed… society will be robbed of the energy that incites the political will to create change… we are broadly using these drugs to fix what are essentially social problems” (2022 , p. 216).

Even more broadly, Norman Cousins declares that ultimately “Holism means healing – not just of bodies but of relationships” (1979, p. 123).

Bonnano, G. A. (2021) The End of Trauma: How the New Science of Resilience is Changing How We Think About PTSD. New York, United States: Basic Books / the Hachette Book Group

Cousins, N. (1979) Anatomy of an Illness as Perceived by the Patient: Reflections on Healing and Regeneration. New York, United States: W. W. Norton & Company

Cousins, N. (1983) The Healing Heart: Antidotes to Pain and Helplessness. New York, United States: W. W. Norton & Company

Macy, B. (2022) Raising Lazarus: Hope, Justice and the Future of America’s Overdose Epidemic. New York, United States: Little, Brown and Company

Warraich, H. (2022) The Song of Our Scars: The Untold Story of Pain. New York, United States: Basic Books / the Hachette Book Group

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Suffer

In his book, “The Song of Our Scars: The Untold Story of Pain” (2022), author Haider Warraich states that since the dawn of the Industrial Age, when human bodies were viewed as machines, our pain alarm beeped if the gears started to grind, and morphine then “became the lubricating grease that you could pour over the cogs to get the body rolling again” (p. 143).

Besides physical maladies, the modern era appears to have also birthed a deepening spiritual disease, perhaps beginning in the Atomic Age when humanity realized not only its “creative powers hold the potential for self-destruction” but that its industries have “disturbed the ecological balance and… contaminated (our) own milieu”, according to theologian Henri Nouwen. In “The Wounded Healer: Ministry in Contemporary Society” (1972), he references psycho-historian Robert Jay Lifton’s claim that nuclear man is “characterized by; 1) a historical dislocation, 2) a fragmented ideology, and 3) a search for immortality” (p. 6, 7). Do these characteristics not still carry resonance today?

With the Information Age came the rampant advertising of the pharmaceutical industry, and the marketing of medicine directly to doctors. This approach paralleled corresponding advances in medical science that “deem(ed) suffering unacceptable” (2022, p. 147). People in pain sought refuge in doctors’ offices, at pharmacists’ counters, and even on the street, with the drugs of choice being a host of anxiety and pain-easing narcotics, stronger morphine derivatives, followed by even stronger compounds including fentanyl. Warraich states that strong chronic pain prescriptions were a poor choice from the outset, as “they are simply too blunt and too powerful, rocking the delicate balance of the body’s natural pain-regulation systems” (2022, p. 177).

Journalist Beth Macy describes the larger context of the opioid crisis in her book “Raising Lazarus: Hope, Justice, and the Future of America’s Overdose Crisis” (2022), where “rampant OxyContin prescribing, set against a backdrop of economic devastation, had been the taproot of the epidemic” (p. 240). The scale of the overall resulting devastation was only faintly mirrored in the pharma industry’s payouts for its hand in the crisis (p. 283).

How does suffering on this scale reconcile with our supposedly compassionate human nature? Does numbing some forms of pain inadvertently create others?

Buddhist doctrine states more generally that suffering, or Duhkha, including many modern ills, finds its root in “our fundamental misunderstanding of the true nature of ourselves and reality”, in which we are seen as separate, individual entities. “Good or bad for me” then scales up to “good or bad for us” to include groups and societies where “greed, aggression, and indifference don’t just poison our lives, they poison society” (September 2022, p. 44). Probing deeper, can human suffering grow from what are initially personal, painful, physical sensations, all the way to conflict and war that can form a sort of collective trauma? Or, do things (also) grow the other way; from collective trauma all the way down to personal suffering?

Beyond the Industrial Age, the Atomic Age, and the Information Age, are we on the cusp of evolving into a new age of humanity, and if so, what might it look like? Will it be artificial, or real, or both? Can technology and spirituality play a role in uniting us on some level? Or, does the poisonous nature of our greed, aggression, and indifference foreclose such opportunity?

Macy, B. (2022) Raising Lazarus: Hope, Justice and the Future of America’s Overdose Epidemic. New York, United States: Little, Brown and Company

McLeod, M. (July 2022, print: September 2022), No Self, No Suffering, in Lion’s Roar: Buddhism, Meditation, Life, Halifax, Canada: Ben Moore

Nouwen, H. (1972) The Wounded Healer: Ministry in Contemporary Society. Garden City, United States: Doubleday & Company Inc.

Warraich, H. (2022) The Song of Our Scars: The Untold Story of Pain. New York, United States: Basic Books / the Hachette Book Group

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Addiction

In his revealing book “The Urge: Our History of Addiction”, author and doctor Carl Erik Fisher states addiction is not a purely medical or scientific issue, but rather a culturally contingent function of unprocessed pain, “a brain disease, a spiritual malady, the romantic mark of artistic sensibility, a badge of revolution against a sick society, and all of these things at once” (2022, p. xiv).

Fisher traces addiction’s early roots with alcohol and drugs such as morphine through and including the nineteenth-century Temperance movement, twentieth-century Prohibition, Alcoholics Anonymous, and the War on Drugs, up to the current Opioid epidemic. The social stigma attached to addiction continues to be the biggest hurdle to a compassionate response in its treatment, where sufferers are seen as morally corrupt people often with a genetic predisposition to the addictive effects of various substances (2022, p. 124).

The early twentieth-century Harrison Act in the United States led to hard enforcement through regulation and a corresponding increased use of harder drugs, which themselves fell both into categories of “narcotics” associated with minorities and the poor, and into regulated “medicines” which often included prescribed versions of the same substances for consumption by the rest of society. The pejorative moniker “junkie” ascribed to destitute urban addicts who scoured junkyards for scrap metal in order to purchase street drugs, worked both on this literal level, and as a reference to how “respectable” society viewed them as human trash (2022, p. 145).

The pharmacologizing of psychiatry, which appeared to have “cracked the biological code of mental illness” with a growing panoply of medications, changed its scientific model from electrical neurotransmission, to efforts at altering chemical neurotransmission with pills that could ostensibly provide the solution to a wide range of mental health issues (2022, p. 234). In terms of drug tolerance, can the numbing effect of medicines quell physical and mental pain over the longer term, and how does this relate to addiction?

Only recently has the study of addiction been willing to consider whether behavioural adaptations, including to power, sex, eating, exercise, gambling, and the internet in general, qualify as falling within its sphere. Critics of this broad-brush view claim that over-pathologizing behavioural addictions can wind up adversely classifying them as mental disorders “merely because we like doing them a lot and miss them a lot when we stop” (2022, p. 117).

Certain approaches of addiction treatment favour abstinence, while newer research suggests “too rigid a focus on abstinence can cause an ‘abstinence violation effect’ wherein resuming substance use after a period of self-imposed abstinence, those who experience guilt, shame, and hopelessness are more likely to return to harmful use” (2022, p. 249).

In a report titled “A Hole In The Head: Can a Brain Implant Treat Drug Addiction?” (September 2022), author Zachary Siegel examines the implications of a surgical technique originally developed to treat chronic pain known as Deep Brain Stimulation (DBS) in addiction treatment. He observes that 6-inch long ‘metal chopsticks’ inserted through a nickel-sized skull hole and into a patient’s nucleus accumbens can deliver continuous electrical impulses which in theory give people with addictions more control over their impulses. After reporting on this research, Siegel concludes it is not a panacea, and that “Addiction might be more a symptom than a disease, a powerful compulsion generated by a matrix of pain and conflict within us” (September 2022, p. 32). Carl Erik Fisher echoes this sentiment in the closing words of his book:

“Addiction is profoundly ordinary: a way of being with the pleasures and pains of life, and just one manifestation of the central human task of working with suffering. If addiction is part of humanity, then, it is not a problem to solve. We will not end addiction, but we must find ways of working with it: ways that are sometimes gentle, and sometimes vigorous, but never warlike, because it is futile to wage a war on our own nature” (2022, p. 300).

Fisher, C. E. (2022) “The Urge, Our History of Addiction”. Canada: Allen Lane – Penguin Random House Canada

Siegel, Z. (September 2022), “A Hole In The Head: Can A Brain Implant Treat Addiction?” in Harper’s Magazine, Volume 345, Number 2068 (pp. 25 – 32). New York, United States: John R. MacArthur / Harpers.org

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Alienation

According to Carl Erik Fisher in his book “The Urge: Our History of Addiction” (2022), despite evidence that North American Native populations used drugs and alcohol prior to European contact, they did not experience any apparent addictive harms until after they had suffered the schismogenetic effects of war, disease, poverty, and forced relocation. The European colonists and traders “swapped whiskey for crushing debt and mortgages on Native land” in efforts to pacify and tie Natives to the new economy (p. 34).

Psychologist Bruce K. Alexander’s “Dislocation Theory of Addiction” (December 2010) states that the fundamental cause of addiction is not the biological effects of a broad swath of substances and destructive behaviours themselves, nor an inherent vulnerability in particular individuals, but rather, in Fisher’s paraphrasing, “society’s wounds” (2022, p. 37). Dislocation can refer to the effects of being torn from culture and society, the loss of freedom and sustaining connections between individuals and their families, or the loss of opportunity for self-determination and expression, and wherein addiction is defined as a means of adapting to the increasingly onerous and dominant nature of modern life. Social fragmentation results from these adaptations as having become excessive in many individuals. Not surprisingly, the compulsive drug use observed and reported in research on animals, including Alexander et. al’s “Rat Park”, was itself demonstrated to be an artifact of “the radically isolated conditions of the standard experimental situation” (July 2014).

The so-called Official View of Addiction drawing from nineteenth-century moral and medical perspectives sees it as a genetically-predisposed incurable disease of “deviant individuals within otherwise well-functioning societies” (2014). The problem with this view, according to Alexander, apart from stigmatizing addiction, is its apparent unassailability due to the force of rhetorical presentations and their corresponding shaping of popular opinion, notably in the late twentieth-century War on Drugs, as well as scientific community entrenchment including the widespread identification with hi-tech neuroscience, all of which continue to largely undergird addiction criminalization, policy, and treatment.

In an essay titled “Man neither Free nor Responsible” (1958), philosopher John Hospers uses examples of criminal activity and the legal notion of a guilty mind to state that maladaptive behaviour more generally can have deeper roots in trauma, as it is often “brought about by unconscious conflicts developed in infancy” of which the individual had no control or perhaps even knowledge (1958, p. 292).

Eminent sociologist Émile Durkheim refers to alienation as “anomie”; “the social breakdown of norms and values resulting in an existential lack of connection to meaning and purpose. Both this sense of dislocation and the actions of addiction supply industries, some scholars argue, are the core drivers of today’s opioid epidemic” (2022, p. 38).

Alexander, B. K. (December 2010), “Dislocation Theory of Addiction”, Simon Fraser University, Canada, [HTML document] retrieved from https://www.brucekalexander.com/articles-speeches/dislocation-theory-addiction/250-change-of-venue-3

Alexander, B. K. (July 2014), “The Rise and Fall of the Official View of Addiction”, Simon Fraser University, Canada, [HTML document] retrieved from https://www.brucekalexander.com/articles-speeches/277-rise-and-fall-of-the-official-view-of-addiction-6

Fisher, C. E. (2022) “The Urge: Our History of Addiction“. Canada: Allen Lane – Penguin Random House Canada

Hospers, J. (1958) “Man Neither Free Nor Responsible” in Hook, S. (Ed.), Determinism and Freedom in the Age of Modern Science (1958), reprinted in Minton, A. J. & Shipka, T. A. (Eds.), Philosophy: Paradox and Discovery Third Edition (1990), (pp. 292 – 299). New York, United States: McGraw-Hill.