I’m only a medical graduate but I have lived experience and I really feel the addiction recovery to have been the actual special thing about my journey back from DID. To me addiction is the opposite of contentment. I suppose that makes it discontentment! Substance use, self harm, we should come up with a name for being out of control of your body while still being conscious (trance/dissociation?), these are the individual behavioral symptoms. I’m reading Trances People Live and Dr Stephen Wolinsky calls them deep trance phenomena. He also makes it sound like he refers to them as the parts of a IFS/DID system, and in so far as I can tell, he calls them individual consciousness but essentially focuses of autohypnosis. I often feel like I’m intruding on an academic paper with illiterate comments when I reply here but I’ll say sorry and take the chance! Just wondering what you guys think about that.
Hi glad to hear from you! I think "discontented" is a good description of the addiction process; I identify with it, at least. If one is contented, one is generally not reaching for the "more more more" of addiction.
The idea of internal conflict from different "consciousnesses" makes some sense. Bill Miller (of Motivational Interviewing fame) is a big proponent of conceptualizing addictive struggles as ambivalence.
Yes! The endless hole to desperately fill with more whatever. It didn’t matter to me what the thing I was addicted to was. Buying things, smoking, drinking, everything to me was the cure to an endless hole that failed me but became a habit. Dr Wolinsky (and I think I’m in agreement) says that the addiction is an attempt to replicate the deep trance state of choice, becoming a consciousness of its own. I understand that to mean a dissociative process of sufficient complexity where you’re acting against your nature or as though on another nature. I’m sorry if I sound too excited by something simple or otherwise obvious but I have a stake in the matter for my own health! Do you conceptualize from your experience with IFS that this would be ambivalence between “parts”? Every time I’ve smoked a cigarette when I’m putting it out I have the thought that this one is the last one and I have an ego dystonic feeling the next time I light one but the voice in my head is just like “it’s okay this one more time. Quit next time”. Thank you for responding! I’ve also downloaded Motivational Interviewing 😅.
I think that's a very common experience of real-time conflict, but I hesitate to say every single experience of addiction falls under that description. In the end there are many different experiences of addiction and people use the word differently. Skog (an older epidemiologist) has a nice breakdown of different phenomenologies of addiction, consider eg the "resigned addict" who recognizes a problem but feels helpless to change.
I hear you with the feeling of intruding on an academic paper....."monocausotaxophilia"???? I love this Substack but it can pack a punch. A suggestion....for the ones who feel like imposters, please have a reference somewhere in the post for any mentioned acronyms.
As a non-specialist in addiction medicine--my specialty is mood disorders--I very much appreciate Dr. Fisher's (and Dr. Aftab's) pluralistic perspective on addictive disorders; e.g., as Dr. Fisher puts it, seeing addiction as "... a complex, multifaceted human experience that touches all of us in different ways. "
And while it's true that the term "biopsychosocial" can veer into vague eclecticism, I do think a bio-psycho-social-spiritual perspective is useful for understanding not only addictive disorders, but also most serious psychiatric conditions in general.1
In this regard, I strongly recommend the recently released book by my colleague, Dr. Cynthia M.A. Geppert, titled "Addiction and the Captive Will: A Colloquy between Neuroscience and Augustine of Hippo." Dr. Geppert shows how Augustine's doctrine of the "captive will" provides a spiritual parallel to current models of addiction involving choice, learning, and abnormal brain function. I think Dr. Fisher and readers of Psychiatry at the Margins will find this scholarly but accessible book very enlightening--and may I add, this recommendation is completely unsolicited!
C.A. Soper has a radical new theory of mental illness, including substance use disorders. He believes that mental illness evolved to keep us from killing ourselves. He thinks the traits of mental illness, like numbing, listlessness, delusion, work to make us incapable of decisive action and rational planning when we're in extreme psychic pain so that it becomes harder for us to commit suicide. Substance use is one of these adaptations: it's hard to kill yourself when you're falling down drunk or passed out. https://open.substack.com/pub/eclecticinquiries/p/what-if-mental-illnesses-arent-illnesses?r=4952v2&utm_campaign=post&utm_medium=web
Thanks for sharing this. There's a long history of scholars in addiction science using an adaptive framework. The most notable might be Bruce Alexander, who started writing about this at least as far back as the early '80s. I interviewed him recently and in fact the title of my substack "Rat Park" is pointing to and honoring his work. https://open.substack.com/pub/carlerikfisher/p/why-we-cant-therapize-our-way-out
Also of interest to this topic are Khantzian, William Miller, Jim Orford, and many more!
I am skeptical of sweeping and simple explanations of mental suffering, but I do think in the general discourse and certainly in psychiatry we underestimate and overly discount the function of addictive behaviors.
I’m only a medical graduate but I have lived experience and I really feel the addiction recovery to have been the actual special thing about my journey back from DID. To me addiction is the opposite of contentment. I suppose that makes it discontentment! Substance use, self harm, we should come up with a name for being out of control of your body while still being conscious (trance/dissociation?), these are the individual behavioral symptoms. I’m reading Trances People Live and Dr Stephen Wolinsky calls them deep trance phenomena. He also makes it sound like he refers to them as the parts of a IFS/DID system, and in so far as I can tell, he calls them individual consciousness but essentially focuses of autohypnosis. I often feel like I’m intruding on an academic paper with illiterate comments when I reply here but I’ll say sorry and take the chance! Just wondering what you guys think about that.
Hi glad to hear from you! I think "discontented" is a good description of the addiction process; I identify with it, at least. If one is contented, one is generally not reaching for the "more more more" of addiction.
The idea of internal conflict from different "consciousnesses" makes some sense. Bill Miller (of Motivational Interviewing fame) is a big proponent of conceptualizing addictive struggles as ambivalence.
Yes! The endless hole to desperately fill with more whatever. It didn’t matter to me what the thing I was addicted to was. Buying things, smoking, drinking, everything to me was the cure to an endless hole that failed me but became a habit. Dr Wolinsky (and I think I’m in agreement) says that the addiction is an attempt to replicate the deep trance state of choice, becoming a consciousness of its own. I understand that to mean a dissociative process of sufficient complexity where you’re acting against your nature or as though on another nature. I’m sorry if I sound too excited by something simple or otherwise obvious but I have a stake in the matter for my own health! Do you conceptualize from your experience with IFS that this would be ambivalence between “parts”? Every time I’ve smoked a cigarette when I’m putting it out I have the thought that this one is the last one and I have an ego dystonic feeling the next time I light one but the voice in my head is just like “it’s okay this one more time. Quit next time”. Thank you for responding! I’ve also downloaded Motivational Interviewing 😅.
I think that's a very common experience of real-time conflict, but I hesitate to say every single experience of addiction falls under that description. In the end there are many different experiences of addiction and people use the word differently. Skog (an older epidemiologist) has a nice breakdown of different phenomenologies of addiction, consider eg the "resigned addict" who recognizes a problem but feels helpless to change.
Thank you for responding! You’ve given me lots of new resources to study. I’ll hopefully bother you again on your newsletter!
I hear you with the feeling of intruding on an academic paper....."monocausotaxophilia"???? I love this Substack but it can pack a punch. A suggestion....for the ones who feel like imposters, please have a reference somewhere in the post for any mentioned acronyms.
Good suggestion 👍 thank you
PS bought your book!
As a non-specialist in addiction medicine--my specialty is mood disorders--I very much appreciate Dr. Fisher's (and Dr. Aftab's) pluralistic perspective on addictive disorders; e.g., as Dr. Fisher puts it, seeing addiction as "... a complex, multifaceted human experience that touches all of us in different ways. "
And while it's true that the term "biopsychosocial" can veer into vague eclecticism, I do think a bio-psycho-social-spiritual perspective is useful for understanding not only addictive disorders, but also most serious psychiatric conditions in general.1
In this regard, I strongly recommend the recently released book by my colleague, Dr. Cynthia M.A. Geppert, titled "Addiction and the Captive Will: A Colloquy between Neuroscience and Augustine of Hippo." Dr. Geppert shows how Augustine's doctrine of the "captive will" provides a spiritual parallel to current models of addiction involving choice, learning, and abnormal brain function. I think Dr. Fisher and readers of Psychiatry at the Margins will find this scholarly but accessible book very enlightening--and may I add, this recommendation is completely unsolicited!
Best regards,
Ron
Ronald W. Pies, MD
Professor Emeritus of Psychiatry
Lecturer on Bioethics & Humanities
SUNY Upstate Medical University
1. https://www.psychiatrictimes.com/view/can-we-salvage-biopsychosocial-model
P.S. Dr. Fisher's book, The Urge, is cited very favorably in Dr. Geppert's book.
RP
C.A. Soper has a radical new theory of mental illness, including substance use disorders. He believes that mental illness evolved to keep us from killing ourselves. He thinks the traits of mental illness, like numbing, listlessness, delusion, work to make us incapable of decisive action and rational planning when we're in extreme psychic pain so that it becomes harder for us to commit suicide. Substance use is one of these adaptations: it's hard to kill yourself when you're falling down drunk or passed out. https://open.substack.com/pub/eclecticinquiries/p/what-if-mental-illnesses-arent-illnesses?r=4952v2&utm_campaign=post&utm_medium=web
Thanks for sharing this. There's a long history of scholars in addiction science using an adaptive framework. The most notable might be Bruce Alexander, who started writing about this at least as far back as the early '80s. I interviewed him recently and in fact the title of my substack "Rat Park" is pointing to and honoring his work. https://open.substack.com/pub/carlerikfisher/p/why-we-cant-therapize-our-way-out
Also of interest to this topic are Khantzian, William Miller, Jim Orford, and many more!
I am skeptical of sweeping and simple explanations of mental suffering, but I do think in the general discourse and certainly in psychiatry we underestimate and overly discount the function of addictive behaviors.