The Wound and its Healing
This page is part of the addiction series, which provides recovery resources for specific addictions (hallucinogens, opioids, stimulants, alcohol, and cannabis) as well as material on trauma, personal healing, and the journey of recovery. View all of the pages by clicking on the Addictions link in the Categories menu or by scrolling to the bottom of this page.
Each page in this series is structured as a series of stories derived from my professional work. That’s what addiction is, ultimately: a complex, layered, interwoven story of human frailty and resilience.
Near the war memorial with its grassy sward – where Joseph once lived, and pursued his hallucinogenic and shamanic dreams – a clutch of the city’s oldest structures are slowly crumbling toward the sea. The redbrick building where I began my career as a counselor is there, an edifice that was a shoe factory when my grandmother came to this city more than a hundred years ago. The steam-powered clock lies across the street, belching discordantly every quarter hour. Tourists gather around its colossal brass works to hear the rumbling tones. The road ends just beyond the clock, at the waterfront. Farther up the hill, back toward the war memorial and the college, the green summit of the old newspaper building – from which Houdini suspended himself, long ago – stands like the faded prow of a submarine, its round windows mimicking portholes. Old hotels and industrial buildings and mansions are the concentrated relics of this neighborhood, built for the citizens of a city that no longer exists in this place. Many structures have been renovated – or gentrified, in the contemporary vernacular – and display sandblasted glass in place of the old, mottled diamond panes. Until a few years ago, this tumbledown stretch of streets was on its way to being derelict. Substance users and runaway kids and the huddled homeless gathered in the porticoes of heritage buildings. The hub of industry had rolled westward, into newer parts of the city, its modern architectures unimpeded by quaint and archaic forms. But the city is situated on a narrow peninsula, densely populated, and the scarcity of land has motivated developers to reexamine these old streets with their narrow alleys. The stone facades have been cleaned up, the cedar beams sanded and textured in postmodern style, the damp basements closed off. And the substance users, the homeless, the kids trying to escape terror and horror – they’ve been pushed out, edged a few blocks down. Each year they are pushed farther east, so that the city may continue its reinvigoration without heed to its underlying distress.
My grandmother spoke of a time when this was not a city but an outpost facing the sea and ringed by endless emerald forests. She came here as a child, raised her family here, grew old in the home of her youth, and is now buried near land once owned by Rudyard Kipling. When he visited in 1889, Kipling was captivated with the landscape, and later he purchased a property “of some four hundred well-developed pines, a few thousand tons of granite scattered in blocks at the roots of the pines, and a sprinkling of earth.” That property, long since developed into residential homes, is perhaps a hundred yards from the clinic where several of my students work. The main hall of the clinic is constructed in the style of the Haida people, who inhabited this land for thousands of years before the arrival of European settlers. The stories of the Haida, in which the trickster is most prominent, lie on the land as a deep stratum upon which layers of other tales have been built: of the Spanish, sailing past the river delta, hundreds of years ago; of English settlers who built the city’s stone structures; of Asian immigrants sailing across the wide sea; of my ancestors coming here before and after the Great War. Countless stories are wrapped up in this city, protected by the slow accretions of history. And they are all one story.
My sense of belonging and of place is wound tight by the grid of these streets. And I am saddened, now that the city is a metropolis, to be part of an urban culture intent on the exclusion of its most vulnerable. The first clinic in which I worked – the old shoe factory – became gentrified many years ago, and is now far too expensive to house a rehabilitation clinic. We were edged eastward along with all the others. My friend Aaron still works in that clinic, now located at the rear of a building above a car park with the highest rate of auto crime in the country. Aaron returned to the parking lot after work one afternoon to find a used heroin rig in his car.
The momentum of gentrification may be described by an imaginary line running parallel to the streets named for railway magnates and city founders from the nineteenth century. West of the line lies industry, development, modernity; east of the line is poverty, destitution, addiction. The line is not a fixed border but rather a boundary of loose tendrils and eddies. The zone of its influence is perhaps twelve blocks wide, six on either side. At any given moment this zone is dominated by construction and renovation projects that crunch eastward a little more each year.
Fifteen years ago, the line ran down the center of the street that borders the college on its west side. The line has moved four blocks since, and now hovers near the old department store where as a child I shopped with my mother. The store used to make its own peanut butter, in a tiny belfry-shaped structure atop the building. The belfry, in turn, supported the logo of the store, built upon a metal scaffolding that resembled a miniature Eiffel Tower. The logo, a giant red W, rotated above the city. When I was a boy, that W was perhaps the city’s most distinctive architectural feature.
Within two or three years the line will have moved east again. It seems to be accelerating, somehow. Soon it will intersect with the old Kipling property. This acceleration is a recent development, and I am not sure what to make of it. Years ago, when my counseling office lay precisely on the line, the line itself seemed stationary. From the window of my office I would look west, across the street and into the gentrified zone. An upscale restaurant occupied one corner of the intersection. Waiters in white aprons hovered above patio tables. The clean cobbled street wended toward downtown, was fronted by a series of gift shops that catered to tourists from the cruise ship facility nearby. The scene was a gestalt of urban revival. But if I walked out of my office, down to the corner, and turned east instead of west, it was as though I entered another neighborhood entirely. Wandering groups of the homeless and the mentally ill, substance users selling and buying, panhandlers mumbling with their eyes cast down toward the littered street. And the smell of rancid piss in doorways, which is the surest sign of a location east of the meridian.
The line remained fixed during the three years I worked in that office. A temporary equilibrium prevailed between the pressures of advancement and retreat. Then suddenly the interface gave way, began sliding east, and it has continued to gather momentum in recent years. At the moment, the eastern edge of the line’s zone of influence is the lane where I encountered the minotaurs. On the far side of that lane the homes are unfettered, the boulevards safe and clean, the residents yet untroubled by the landslide of addiction and crime and poverty that soon will sweep across them. When it does, the residents might blame the city planners, the police, the school system. Perhaps they will fall prey to racist tropes, to their fear of teens, to their judgments about the traumatized and the impoverished. Or perhaps the neighborhood will discover itself to be a community of inclusion. Then the line will move again, to forge a new turbulent edge, and the city will weave its unfinished and ramshackle tale.
The line cannot be dissolved or extinguished. It is a manifest function of human nature and is matched by the line drawn upon the inner life of those struggling with addiction. On one side of the inner line is a legacy of wounds and neglect and a conviction of one’s own fundamental inadequacy. On the other side lies renewal, and clarity, and the transformation of those twisted wounds into wisdom. Among substance users, the location of this inner line is defined by a specific moment: the day on which the decision is made to stop using. The line might move, of course, staggering back and forth in a series of relapses; or it might spread all the way across the inner landscape, remaking the ground in a new image of creation. However it travels and is encountered, this line is the longitude of addiction.
In the first years of my practice, the urban line bisected a small diner situated at the oblique intersection between a lane festooned with overhanging power lines and a street known mostly for its consignment stores. The straightest route from the clinic to the diner was through the lane. But it was necessary to be cautious in choosing this route; various local residents lived in the lane, behind the Dumpsters, and sometimes there were incidents between them, or involving passersby. It was prudent, while skirting the Dumpsters, not to be distracted by blood stains on the pavement. But in those days I did not worry about walks through alleys. The residents tended to recognize me, I was young enough to be convinced of my invulnerability, I was confident in the simple power of goodwill. And indeed, nothing happened to me in that alley.
Aaron and I visited the diner almost daily. We sat at a table near the window, with a view of the street. (There was a patio, too, but if the wind blew from the east, and through the alley, the wafting smells tended to discourage appetite.) Often, when we were uncertain about how to proceed with a particular client, or how to resolve a conflict between a client and ourselves, we would retire to the diner to discuss the matter over coffee. One of those discussions, involving outcomes and aggregate statistics, established the mood and trajectory of my career.
We had a list: all the clients from the previous two years. Aaron suggested we review this list to establish how well we were doing. How many clients were improving, recovering, healing? In what ways were we helping, and how might we expand the reach of our assistance? Our clients were a diverse group with a range of ailments: alcoholism, depression, anxiety, anger, addiction to opioids and prescription medication, physical challenges of various kinds, cognitive impairment, hostility, suspicion, cynicism, suicidal ideation, insomnia, despair. They were, on the whole, a group of people fundamentally lost, scrabbling and flailing, sometimes giving themselves over, finally, to the wish for death. Often, rage was their distinctive feature: a roiling, trenchant fury, a heat that emanated from their pores and their eyes. It was, for some of them, as though they were molten inside, and blackened by burning, and striking out in search of cool water they could not find. Years, decades they had been searching and burning, the pain of it spreading into their joints and nerves, the natural entropy of the heat denied by constant stoking. Such clients were like the coal boilers of steam trains: scalding metal, blue and mottled with the heat, a furnace within, with a small door that opened into the fire.
Aaron and I reviewed the list, name by name. Some of our clients had vanished, or died. Some had walked out, or had been difficult enough that we had negotiated their withdrawal. We did not like to expel anyone from the program; we preferred instead to refer them to another facility, or to find them individual care, or to discover alternative ways of making things work. It seemed unfair to admit people, subject them to a lengthy assessment process, allow them to complete a portion of the program, then summarily eject them. If we had let them in, it was then our responsibility to facilitate their completion. And most did complete the program. But occasionally a rotation would begin with twelve clients, be reduced to ten by illness or legal issues, and be further compromised by internal conflicts or interpersonal corrosion. In residential rehabilitation, peers exert as much influence as staff. Perhaps more. Such a cohort might finish with four or five clients, barely hanging on, proud to have made it through but bewildered and disoriented.
The complexities of the program were amplified by a developmental tendency: among the addicted, psychological growth is impaired during the entire period of use, from the outset of the habit until its discontinuation. Most substance users become addicted in early adolescence, somewhere between ages nine and fifteen. This span is intended to be one of psychological integration, of piecing together diverse aspects of the self to construct a unified identity. The mercurial nature of adolescents is a function of those aspects playing off one another in rapid sequence. Addiction introduces a caesura into the natural rhythm of development. Consequently, addicted adults are frozen at the emotional age at which they began using. This is also true of many survivors of childhood trauma. They become stuck, their inner life frozen at a certain age, the momentum of their development halted by the inertia of the wound. For the addicted, the stalling of their development is jump-started by rehabilitation.
In residential treatment programs, this dynamic has the peculiar effect of creating the precise emotional environment of early high school. Cliques, competition, posturing, insecurity, romantic triangles, overwhelm, dramatics of every conceivable incarnation. Clients sneaking into each other’s rooms, whispering in the washrooms, dividing themselves between winners and losers. Plotting to become favorites of the staff, or skulking away from chores, or bullying. Men tend toward caricatures of machismo, as is common among fourteen-year-old boys. Women vary in their archetypes, though some become cheerleaders, or mean girls, or princesses. Others are simply trying to find their way.
For healthy adolescents, the full blush of adulthood typically arrives somewhere between the ages of twenty-eight and thirty-two. Adult users in recovery from addiction complete their delayed adolescent development in roughly three to five years. The first year is the hardest, requiring the most care and sensitivity. The temperament of the user in early recovery is fragile, and flurried, and mutinous. In our program, Aaron and I rarely worked with clients who were beyond the first year. Some were not beyond the first minute, and arrived drunk or high or stoned. Many were still using. In addition to these challenges, the vast majority were also survivors of various forms of childhood trauma as well as adult injury or illness. And almost all possessed a fundamental suspicion of programs like ours, of people like us. Our program was, all in all, typical of the social services and addictions milieu.
In such an environment, measures of success are a matter of personal philosophy. In the diner, going over the list, Aaron and I wondered what we were searching for: examples of transformation, or clients who had crossed their own inner line and remade themselves, or profound and ongoing change? Or perhaps something more modest: an inkling, a nudge, a tiny increment? The alchemy of transmutation is often what the addicted seek and what their families expect: a revolution in character and behavior, a charming and spiffy new self, shiny enough to banish the old shadows. And indeed we found two such examples on our list. One per year. People who seemed on the threshold when they came in, already undergoing a sea change, their old habits rolling under. Those two clients – a mother in her forties, committed to a better life for herself and her family; and an older man, a logger who had lived alone in the bush for many years – changed in profound and pleasing ways. Softer, more open, and recognizing in themselves their capacity for self-direction. They claimed that inner line and moved it, forcefully. They shaped it into a circle of inclusion and safety. It became a ribbon of turned and seeded ground.
I asked Aaron if he thought that two successes in two years was enough. It seemed an awfully small number. And I, who was starting out in those days, trying to make a difference, trying to establish what making a difference meant – I wanted a tangible sense of progress, of efficacy. I wanted to feel that I could enter the life of another person and be an instrument of change.
Aaron did not answer. Instead, he asked another question: is one success enough? What about the client who spoke, finally, of his experiences in Vietnam? What of the woman who decided, after decades of denial, to face the fact of her husband’s violence? What of the dozens of clients, broken and discouraged, who found companions in the program and discovered the shreds of their dignity? And what of those who drifted through, resistant and unavailable, and who seemed to learn nothing from us? Did we not sometimes see them, years later, and did they not remember some small and simple kindness – a bit of friendly humor, an acknowledgment, a reminder of how it feels when someone looks at you with regard rather than rancor? Isn’t it true, suggested Aaron, that these small transformations constitute the essence of healing?
So when she asks me, in that familiar way – hushed, conspiratorial, a sliver of shame buried in the hopefulness of her manner – what she can do about her son, I think back to that day in the diner. It’s where I go in my mind every time I hear the many permutations of that question. She is not asking about small changes, increments of growth. Her boy is nineteen and hopped up on crystal meth, and she is terrified that he will swerve her car into the oncoming lane. Or that he will run up a debt, the gang will come for him, and he will be found lying dead on the boulevard by a man walking his dog early on a Sunday morning. Or that he will simply forget everything and everyone, will become a ghost, and will disappear. She has heard these stories and the many others that twist within her. And she is terrified. But she knows that most people will blame her for what has happened – her parenting must be at fault, they will say – so she downplays, even to herself, the seriousness of her son’s predicament. She tells me about her family coming here from abroad, when her son was seven, and his subsequent struggles at school. She wonders if this might have played a role in what has happened. Possibly it has. Not only the exodus itself, which must have been terrifying for them all, but what came before and after: the tension and suspicion and hiding, then a long and uncertain journey, then a new culture, clashing values, poverty. Yet if they had not come, if they had not fled on motorcycles at night across the mountains, into a safer country and then across the sea, that boy would now be dead, or in prison with the rest of the family, or an expert, by now, in the firing of rocket-propelled grenades.
She describes the ways in which tension between her son and his father pushed the boy toward defiant and reckless peers, how his academic struggles led to problems with discipline and attendance. How he discovered, in the park behind the school, alcohol and cannabis and finally, to complete the trajectory of his disintegration, crystal meth. Down to the smallest detail – an altercation between the boy and his mother at the mall, about the purchasing of shoes – her story is exactly like countless others. She has come here, to this community forum on addictions, to get some firm guidance about how to proceed. She needs to know how to save her son from death.
And because her story is like all the others, I experience my own familiars: anxiety, uncertainty, trepidation. The answer she craves is not one that I can give. I do not have a panacea for her. No amount of reassurance from me will mollify the truth of her situation. It is a hard truth, which cannot be softened by affirmations or false promises. And it is this: she must wait, and offer what support she can, and keep strong her tether to him by whatever means she is able. Cutting him from the life of the family, which is what her husband has proposed, may simplify the entanglements and prevent her son from pawning family heirlooms; but such strategies provoke emotional turmoil and typically lead to more using. More crime, too – because if the family heirlooms are no longer available, other means must be found to secure the supply of substance. Dealing, robbery, prostitution, violence.
As she leans closer, as people circulate around and inspect the various tables with their brochures for treatment programs, I hear the deep cracking of her voice that she is trying to conceal. She does not want to break down here, become a curiosity, a madwoman. Despite the avalanche of tension within her, she cleaves to her dignity, her clarity, her purpose. She has come here to ask one simple question: what can she do?
I think of the slow climb of those on the paths of healing, the untangling and resolution of old wounds, the switchbacks and setbacks and fragile confidence that seems at first to be absent, then glimmering, then strong and persistent. I remember that old conversation with Aaron, and the profound transformations that rarely come, and the ease with which the raw statistics can be made corrosive and debilitating. So few seem to make it all the way home.
And yet, this is how I answer her: many, many people come through. But they cannot be forced out of the labyrinth of their addiction. They must instead be called, by something inside their own inner life. And it is impossible to predict what that call might be, when it might come, how it might deliver its clarity and compassion.
This mother, who has herself come through turmoil and pain, who has traveled across the world to raise her family in safety and peace, reminds me of the goddess of compassion who inhabits almost all spiritual traditions. For Chinese Buddhists she is Kuan Yin; in Christianity she is Mother Mary. The Tibetans call her Tara. As far back as the skein of spirituality runs – to the Egyptians, for whom she was Isis, and to others, long before history and writing – the goddess of compassion has extended her welcoming touch to the lost. And her reflection, in this mother searching for a wandering child, comes here today to ask what the goddess within her already knows: hold fast, wait, invite, don’t give up.
She is already doing all that she can do: seeking resources and assistance, finding the path so that her son, when he straggles in from his own wilderness, will have signposts to follow. Places for support groups, and treatment, and counseling. And later, programs for school, and vocational planning, and the piecing together of a recovered life. And she knows that such resources cannot be made conditional – she cannot force him into treatment, for example, by threatening to kick him out of the house – but neither would it be wise for her simply to accept his behavior as inevitable. Stay in it, I tell her: assert what you need, what you will and will not accept from him. Remind him that even though you cannot negotiate his movement away from addiction, you are still involved in countless details of parenting. Addiction does not remove him from the spheres of daily life and love.
I suggest that it might be a good idea to continue talking to her son about his using, and that she remember to frame such discussions in the context of care and not of judgment. Probably it’s also a good idea to share with him what she discovers in her addictions research: programs, facilities, tendencies. What she learned here, at this forum, and at other places she has been. She cannot walk her son’s path, or coax him this way or that; but she can illuminate his way somewhat, as the goddess moon shines upon the spinning earth.
She stands here, uncertain and frightened, keeping an eye on the milling crowd, her courage muted but clear. No doubt she would be willing to do much more than come here – walk through fire, wrestle a dragon, descend into the molten earth – to save her son. She possesses strength sufficient to such tasks. If only she could lend that strength to him, for a single moment of decisiveness. It might be enough to carry him through. And she wants to lend it, indeed to offer it without reserve or condition. She would give all that she has for him, and then give more, and be lost to herself so that he might be redeemed. I sense the way in which she extends herself toward him, beseeches him, begs him. Yet he turns from her, and follows his own trammeled track.
She cannot give him what he needs: to find his own way.
I hope that he does. And I am grateful, on his behalf, that his mother has chosen to approach her son’s addiction – which is a dilemma shared by the whole family – with thoughtfulness and receptivity. She has not imagined herself an expert, an arbiter, a judge. She is trying to learn, she remains open, she refrains from blaming the boy or his peers or his school or society. Despite my initial trepidation, I find it refreshing to speak with her. Many parents are bitter, and blaming, and so sure of their own questionable strategies – surprise interventions, forced treatment, tough love – that they succeed only in making the plight of their child immeasurably more fraught. The parents of those struggling with addiction tend to fall into two distinct camps: disappointed, distancing, dismissive on the one hand; supportive, empathic, solution-oriented on the other. Addictions counselors speak frequently with the former group: parents who mask their anxiety with cynicism, whose strategies with their kids are defenses against their own vulnerability. The latter group are fewer in number. I do not often see them in the clinics, but sometimes they show up at events like these. Occasionally they enroll in counseling classes, where I am privileged to work with them. Such parents – aware of the psychological and emotional aspects of addiction, open to their own growth and learning, willing to face whatever the situation demands – are a great, unacknowledged blessing in the life of an addicted person. Sometimes the parents are buffeted by their distress for many years, holding open the gate, calling into the wind in search of that lost child. There is no guarantee for those parents, no sure return on their sacrifice. Yet they persist, and endure, and sometimes the child returns.
Often, indeed, the child returns, responding to the call that is beyond easy explanations: psychological, spiritual, medical. The call speaks from a place beyond such definitions. It is a force, and a great mystery. We live inside its glow and flicker – may it last as long as the earth keeps rolling.
The list began with two, and in the intervening years it has grown immeasurably. Or perhaps it began with the number zero, with my childhood failure to draw my mother away from her alcoholism. And maybe it was incremented, finally, to the number one after my own adolescent reckonings with both alcohol and cannabis. Zero, one, then two: then from there upward, with slow and steady rhythm, staking out all the territory along an infinite trajectory of growth. I have long since lost count. Thousands and thousands who have come through, who have vanished and returned, whom I have met going and coming on this strange road of shadows. Their number exceeds, by far, the count of those traveling elsewhere, inward, onward, backward, sideways, downward.
This is not what the statistics claim, what the newspapers say, what the cultures of addictions recovery assert. Within those interlocking circles one hears frequently of the grimness and the danger. Bleak numbers, cautionary tales, failures. Yet that map is not my landscape. On the ground, along these crumbling streets, I encounter success every day: people who have brought themselves back, have emerged from those tunnels and labyrinths, have found and followed a flicker of illumination in the dark.
In the public mind, with its diet of new studies and media reports and anecdotes heard on the street, the world of addictions has come to be perceived as a disconsolate world of disintegration and death. But typically, addictions counselors do not share the public perception. They are familiar with that particular dialect of persuasion and have not found it to be consistent with their experience. Theirs is a different kind of calculus, one that I have come to see as being of the number line, and of the prime numbers that lie along it.
The number line is infinite. Zero, one, and two stake their place on a track that climbs ever upward, toward numbers that we will never see and never know. This line of numbers is equivalent to the infinite varieties of human experience. Along the number line lie all the possible numbers: even, odd, fractional, irrational. Each category is defined by the characteristics of its members. One particular category, that of prime numbers, is uniquely interesting: the primes do not repeat with regularity, and their values cannot be easily predicted or derived. They are found in unexpected places on the number line, they appear and disappear – and yet they are the foundation of all the other numbers (every natural number is a product of prime numbers). The prime numbers embody the greatest unsolved mysteries of mathematics. And, as the mathematician Euclid proved over two thousand years ago, the number of primes is also infinite.
In my own work upon the number line of addictions, I have come to perceive those who find their way home as the prime numbers. The success of such people – in responding to the call, in facing their own shadow – cannot be predicted or derived from simple steps or formulations. No single path exists upon which they are found, no pattern of searching will find them. Yet their success is not random (nor is the appearance of primes upon the number line). Successfully recovered addicts demonstrate tendencies – openness, adaptability, clarity, personal warmth – that distinguish them to the practiced eye. This is true of prime numbers also, which arrange themselves upon known mathematical trajectories.
Upon an infinite line of potential suffering there reside an infinite number of places for healing. It is this boundlessness that I see in my travels, both in the city and outside of it. The individual primes grow upon that number line, they increase without end, and they cannot be reduced nor divided. They go on forever, and will always do so. This is a fundamental theorem in the mathematics of addiction.
The word prime has many meanings, but my favorites are those that relate the word to the origins of things, to the dawn, to the first and essential features of the world. Prime refers to youth, to hope, to the essential and the indivisible. Prime numbers fit perfectly into themselves and into no other quantity. Prime can also be used as a verb, meaning to make ready, or to freshen, or to prepare a tool for use. These meanings remind me of the two features that those in recovery from addictions seem to share: a feeling of being renewed, of being made whole and indivisible; and an awareness of an inner core, a unique and sustaining center that carries them forward.
Prime can also refer to a distinguishing mark. And typically, the mark of addictions is clear and unequivocal – not to the public, perhaps, but to those who share in the cultures of addiction. Sometimes the mark is perceived by the recovering user as a stain, or a badge, or a soft place of ramshackle wisdom. It remains, this calligraphy of scars, rendering the burned lines into relief. These lines travel across soft and fragile skin, tracing the paths of distress, linking the ridges and hollows of hard-won knowing. This scarification, which marks the sacred and the priestly in so many cultures, is the stigmata of recovering addicts also. Few would wish away these primal scars.
I park my car in front of the clinic. The road crews are gone now. I hear the rumbling of city trucks echoing back to me from a few blocks down, and I turn to see the snake of slowed traffic climbing the hill. At my feet, a wide strip of fresh pavement contrasts with the faded gray of the old road. I follow this strip with my eye, tracing its path westward toward the machinery and dust. I wonder how far they will go, replacing these sewer lines, how many miles of new tunnels will traverse the streets. And I wonder if people will go down into these enlarged sewer tunnels, as they have in other cities: the hiding and the desperate, the mentally ill, the kids bored and restless and looking for a thrill. I think of the Moscow underground, of the enclaves hiding there, and of the wide tunnel I recently entered in a city to the south: warm, protected from the rain and other intrusions, smelling of too many things.
I’m glad that I will not be required to walk in the lane today. I have managed to find a parking spot almost at the front door, from where I can see Laura and Elias in the back. Olivier will be there too, probably, making strong coffee in the tiny kitchen. I knock on the glass door. Elias looks up, then comes to let me in. We walk to the meeting room, settle ourselves, and wait for the others. Elias mentions that he is a little tired, that perhaps he needs a break after a long season of difficult work: clients in court, or in the hospital, or dead. Too many deaths recently, he tells me. Last week the fiancé of a client hanged himself. They had been fighting, she left in anger – and returned ten minutes later to find him dead on the rope. Hoping he might still be alive, she had heaved against his weight, tried to free him, lifted the corpse with her frail weight. Yet he stayed, and swayed, and would not permit her this last kindness. When the ambulance came the paramedics cut him down. She has told Elias that it’s all her fault – if only she had not left; if only they had been able, together, to get off heroin; if only the long and twisted thread of her life had not grown into this tangled and strangling knot.
Laura and Olivier come into the room. As usual, Laura looks rested and calm. She is an unusual character for this environment. Most of us are eccentrics, in one way or another, misfits. We do not dress well, our cars are old, we are interested in unusual things. We do not, except in our own milieu, fit in well. But Laura is not like this: her manner is elegant, and poised, and untroubled. Among her clients she is perceived as an archetype of kindness. She must be in her fifties, though she looks much younger, and each year the glow of her illumination deepens. She would make an excellent emissary of the culture of addictions counselors. Elias and Olivier and I are probably too strange, and odd, for such a role. Laura would make us look normal, almost.
She has been on holiday, to a cove along the coast where she and her husband go every year. She shows us photos of the beach, and of the sun setting in brilliant hues. As we admire the third picture – a panorama looking west, in the direction of the seaside town where I spent summers as a child – she asks if we have heard about the suicide at the cove. Olivier nods, and asks her if she means the man in the car. Yes, she says, the man who drove purposefully into the sea, backward down the boat ramp, with the car windows open and the water rushing in. He changed his mind, apparently, and began screaming for help. Or perhaps he was not calling for aid, but instead was arguing with the forces that had placed him there. He did not get out of the car. The old man on the beach could not swim and could not help. The car sank. Laura came to the cove the next day, heard the story, turned the details over in her mind. She wondered if alcohol was involved, or perhaps cocaine. She imagined a long and hidden history of trauma and pain, a tale now buried in the silt of the man’s desperation. We talk about our familiarity with deaths in cars, with similar suicides, with people who change their minds and occasionally survive.
The conversation meanders toward other, similar tales of surrender and death. And then it moves, and is balanced by, news from Olivier: the animal killer is doing better, has harmed neither himself nor any smaller, more vulnerable creatures, is in touch with law enforcement. He has been seeing Olivier weekly and is planning to move, next week, out of the treatment center. He and another client have rented a small apartment. They will try to continue the routines, the structure, the positive environment of the treatment center. Olivier is hopeful about the man’s future. Elias remarks on a strange tendency among those who are most damaged: sometimes they make the most remarkable improvements. And yet, despite the truthfulness of this comment, despite its hopeful and positive tone, I cannot muster any goodwill or respect for the man who has killed animals. The nature – the anti-nature – of his crimes provokes too much within me: anger, revulsion, horror. I would make a poor counselor to him, and I’m glad that Olivier speaks well of the man’s progress. Olivier has seen enough violence in his own life that he can look upon this man and his deeds without flinching. His empathy toward such clients derives from his own courage.
Elias follows with a vignette that has amused him. He has been asked, by a physician, to work with one of the physician’s patients. Typical stuff: addictions, family issues, intermittent depression. But the physician has requested that Elias use a specific psychological model, one of the newfangled models that arrive every year or two with academic credentials stamped upon them. The fresh approach, the transformative strategy, the one hidden trick that all the others have missed. Since I began in this business, new models have followed a predictable trajectory. First there is a revelatory enthusiasm fueled by fantastic anecdotes of client transformation. The new model will, it is claimed, fundamentally change the field. Then these assertions are bolstered by research results showing impressive numbers. Then come practitioner training, professional development credits, presentations at conferences. Books follow, as do media reports. By then, the limited usefulness of the model – it works only with certain clients, and in specific situations, and is sometimes unaccountably unsuccessful – is buried by the momentum of marketing and of hype. Eventually, after three or four years, the limitations become more widely known and the model takes its place behind another new and emerging model, which will, once again, transform everyone.
No end of models have we in addictions work, and infinite rivalries between them. Yet not much progress from those models, not much at all in helping those who are most troubled, wounded, vulnerable. Elias’s rueful tone is well-earned, is bolstered by what is perhaps the most consistent finding in the helping professions: models don’t matter much. The clients who do well in counseling speak not of models but of people: empathic, caring, compassionate. The counselors who demonstrate such qualities tend to have clients who report progress. This, says Elias, is known as the model of humanity. He does not care for the artificial complexity of the new and fancy models, which try to establish a scientific determinism ill-suited to human nature – which is not a mechanism and does not lend itself to complete explanations involving chemistry, genetics, and cellular biology. Human nature and personal character are not derived from these only. They are forged, foundationally so, by something not captured by a neurological charge.
Elias is correct. His approach is humane and effective. And yet, people like him are becoming less common in this work. Within the last generation, psychology and counseling have been subject to the physics envy that infects all the social sciences. Our founding traditions and philosophies – holistic, integrative, at ease with creativity, culture, and spirituality – have been cast aside in exchange for research funding focused mostly on brain mechanisms. As a result, many counselors and psychologists are much less imaginative and much more reductionist than they once were. Fewer practitioners take a holistic and integrative approach. At professional conferences I hear much about neurological studies, brain imaging, genetics, and the illusion that technology will solve pressing human problems. Some of these approaches may eventually help people with addictions in a variety of ways. But addiction is among the most complex of all human behaviors: almost always it arises in response to underlying duress – a mental illness, typically – which itself is often a response to a triggering trauma or a lifetime of traumatic stress. Addiction is much more than simple chemical dependency or genetic predisposition. All the features of human vulnerability and resilience are wrapped up within addiction, all the layers and intricacies of human nature. Our histories and our hopes, our suffering and our pain, our frailty and our defiance: all there, in addiction, fused and conjoined within us, playing out in infinite trajectories.
It is not surprising that approaches focused on brain structure, neurology, genetics, and biochemistry have failed to slow the rising rates of mental illness, addiction, and trauma. To believe that such approaches can, on their own, vanquish these varieties of suffering – their breadth, depth, and turbulent wake across all human societies – is to believe that an oar can tame the sea.
People heal from addictions in a variety of surprising and encouraging ways (connection with communities and cultural traditions; physical activity and immersion in nature; music, craft, and art, among many others). If done properly, these practices nudge, by incremental degrees, the body and the mind toward health. They are complex and multi-faceted behaviors – just like addiction. They work because one kind of complexity slowly replaces another. There is no shortcut to this path. Healing is always a hard-won and human journey. Why would we want it to be different?
Here we are: Elias’s empathy, Olivier’s rapport with a frightening and violent man, Laura’s kindness. No models, no mechanisms, no talk of brain structures and genetic imprinting. Nothing but honest and authentic human relationships.
In a lighthearted tone, Elias describes how he plans to adapt the language of his case notes to satisfy the referring physician. Words such as exploration, insight, empathy, emotion, vulnerability – simple words, true to the spirit of Elias’s approach – will instead be translated into strategies, behaviors, models, goals, outcomes. The physician, who seems truly enamored of the new and spiffy model of counseling, will understand from Elias’s notes that something is happening, the client is moving forward. But the physician’s understanding of that progress, and its cause, will not be the same as Elias’s. They will be communicating across a gulf of pedantry.
We discuss the possibility of developing our own new and fancy model. Laura will be our spokesperson, the presenter to media outlets. Olivier and Elias will write the book. This imaginal project occupies us for a few minutes. It’s a diversion toward levity rather than cynicism. We know that soon we will be telling stories about pain and death. We know that addiction is a companion to human nature. It cannot be tamed or vanquished or banished from the human landscape. In our city, as in most places, the raw numbers of addicted people will continue to rise. Social, economic, and cultural factors have created a surging momentum that will run forward until the forces that sustain it are addressed: poverty, paucity of education, fragmentation of emotional development, absence of mentoring and leadership. For our part, Elias, Laura, Olivier, and I must always seek illumination to counter the heaviness carried by our clients.
We look for the redemptive moment, the spark, the dawn. We need to be tender-hearted in this business. Otherwise we are of no use.