Can the works of existential philosophers like Jean-Paul Sartre be useful to psychotherapists working with addiction?

With addiction recovery rates estimated at somewhere between eight and twelve per cent, it is clear that a change in treatment approach is needed (American Addiction Centers, 2019). Freud believed that mental health issues could be understood by exploring someone’s past. Sartre and other existentialists think that it is easier to understand human behaviour when we look to their future. The question should be, what motivates a person to act out their addiction? While the focus on future motivations is vital, it is not possible to ignore how commonly trauma is linked to addiction. We will also see how addiction is not just the problem of the individual but also how society contributes to it. We will look at how the common existential themes of isolation, meaninglessness, responsibility and freedom can be understood in the context of addiction treatment. This essay is written for an integrative institution; we will also see whether new and alternative treatments need to be considered for the benefit of the client.

What is addiction

Addiction can take many forms, but this essay will discuss physiological addictions to substances such as illegal drugs and sugar rather than addictive behaviours. Alcohol or its chemical name ethyl alcohol is a psychoactive drug so will be referred to as a drug. Although it is a controversial subject, refined cane sugar will also be referred to as an addictive substance. As DiNicolantonio et al. (2018) concluded in the British Journal of Sports Medicine: “sugar has been found to produce more symptoms than is required to be considered an addictive substance”.

Personal Biases

My experiences with addiction must be acknowledged. I consider myself an addict in recovery from sugar addiction and Binge Eating Disorder (BED). It serves me to provide evidence that sugar addiction is as dangerous as other addictions as this allows me to feel like I am not merely a person of weak will. Similarly, if I can demonstrate that traumas cause addiction, then it absolves me of responsibility, and I am free to blame external factors rather than seeing addiction as a flaw in my character. I will monitor these motivations.

Does trauma cause addiction?

Dr Gabor Maté, one of the world’s leading experts on addiction states that “all addictions—whether to drugs or non-drug behaviours—share the same brain circuits and brain chemicals” (2008, p129). The intention of the heroin addict is the same as the compulsive shopper: to change the physiological state of their brain. Maté (2008, p36) says that “a hurt is at the centre of all addictive behaviours.” The size of the hurt may differ, but it is still there. This focus on the intention correlates with how Sartre saw man as “the being who hurls himself toward a future and who is conscious of imagining himself as being in the future” (1996, p259). The addict is hurling himself towards a future when he does not feel pain. Similarly, Heidegger (2001) believes that we pull ourselves from ahead with our motives, rather than being pushed from behind by past events. The existentialists, like Maté, understand behaviour through motives, not causes (Cooper, 2003).

If freedom from pain is the motivation for addictive behaviours, then it is necessary to understand what causes the pain.  Maté’s (2008, pXI) question is never “why the addiction” it is always, “why the pain? There are plenty of experts who believe that trauma causes addiction. To Shanta (2003), the research is clear - addiction is not something that the weak-willed do for pleasure; most hard-core substance addicts grew up in abusive homes.  Maté (2008) goes a step further and shares that in his twelve years of working on the Downtown East-side of Vancouver, every one of his hundreds of patients had suffered trauma. These traumas came from emotional, physical or sexual abuse.

Numbing the symptoms

Maté (2008, p33) believes that “addicts are self-medicating conditions like depression, anxiety, post-traumatic stress or even ADHD.” Our Western model of medicine rarely treats the cause of the problem but instead attempts to numb the symptoms. A U.K. based survey found that eighty per cent of doctors admitted to over-prescribing antidepressants (The Pharmaceutical Journal, 2004). The addict follows the same pathway when they use their addiction to numb their pain.

The pain is the message

Johan Hari (2018), urges us to see emotional pain as a messenger. The pain is there for a reason. The pain tells us that we need to change something in our lives. When a hand is placed on a hot stove, the pain forces the person to move the hand away. The emotional pain is trying to provoke the same reaction. It wants the person to move away from the cause of the pain.

A significant challenge to working with addiction is that the messages that the body is trying to communicate become so difficult to hear after trauma. Trying to work out the source of psychological pain is much harder than with a burning hand on a stove. Dr Bessel Van der Kolk (2014, p53), an expert in trauma recovery, states that “after trauma, the world is experienced with a different nervous system. The survivor’s energy now becomes focused on suppressing inner chaos.” Much like Nietzsche, who stated that “there is more wisdom in the body than in your deepest philosophy” (1883, p48), Van der Kolk urges therapists to work with the entire organism and not solely with the mind. For the addict, the messages from the body become even harder to hear as they numb their inner chaos with their substances.

Is talking about trauma even helpful?

There are a growing number of therapists who question the efficacy of ‘the talking cure’ for dealing with trauma. Stanislav Grof (2018), the founder of Transpersonal Psychotherapy has said, that after years of psychoanalysis, clients can “give you lectures on their problems, only the problems do not change.”  Van Der Kolk does not trust Freud’s (Breuer & Freud, 1893) statement that trauma “immediately and permanently disappeared when we had succeeded in bringing clarity to light the memory of the event by which it was provoked.” He has found that “traumatic events are almost impossible to put into words” (2014, p231).  He uses T. E. Lawrence’s (1935, p27) description of fighting in the war to demonstrate this:

‘We learned that there were pangs too sharp, griefs too deep, ecstasies too high for our finite selves to register. When emotion reached this pitch, the mind choked; and memory went white till the circumstances were humdrum once more.’

Similarly, when the United Nations sent in Western Counsellors to help the victims of the Rwandan Genocide, the ‘talking-cure’ was not welcomed. The Rwandans felt that the aid workers were intrusive and re-traumatising victims by forcing them to relive their stories. One Rwandan (paraphrased by Leech, 2015) described how “they would take people one at a time into these dingy little rooms and have them sit around for an hour or so and talk about bad things that had happened to them. We had to ask them to leave.” The Rwandans could not understand how talking to a stranger about highly sensitive material could be helpful and could suggest that the ‘talking-cure’ is merely ineffective. An alternative explanation is that this is a Western solution useful for solving Western problems and does not translate into other cultures.

Van der Kolk’s (2014) most treatment-resistant patients benefited from new techniques like neuro-feedback and EMDR and Dr Maté is an advocate of psychedelic-assisted psychotherapies like ayahuasca. These treatments are currently receiving a great deal of press and research. Of particular interest to the therapist may be psilocybin mushrooms which have just been categorised as a ‘breakthrough therapy’ for treating depression, and MDMA, which is now prescribed for the treatment of PTSD in the USA.  Garcia-Romeu et al. (2019) have recently concluded a study that saw a significant reduction in alcohol misuse disorder following LCD use. With more and more research being conducted in this area and cities like Denver and Oakland in the U.S. decriminalising psilocybin, the existential therapist may soon have another legal and effective tool to help them in their practice.

My recovery from addiction only began once I was introduced to modalities that involved the body as well as the mind. I had several years of traditional ‘talk-therapy’ that did not enable me to stop the addiction. It was only with the addition of Transformational Breathwork and Body Mapping that I saw progress.  My frustrations with the limitations of talk-therapy should be highlighted here. I remain aware of a desire to promote the use of alternative therapies in addition to ‘talk-therapy’ because it is my opinion that alternative methods of recovery are under-utilised.

What Van der Kolk and Grof do believe to be effective in ‘talk-therapy’ is the creation of the therapeutic relationship. Van Der Kolk (2014, p58) states that “trauma almost invariably involves not being seen, not being mirrored and not being taken into account.” Instead of trying to create theories and label the client’s past issues, the existential therapist can work on mirroring the client and being fully present for them. Yalom (2001, 08:56:30- 08:56:40) agrees that “overwhelming, research evidence shows that good outcomes depend on the intensity, the warmth, the genuineness [and] the empathy of the therapeutic relationship.”

Existentialism is too morbid for an addict.

Cooper (2003, p37) states that one of the most significant criticisms “of existential philosophy is that it is overly morbid: that it tends to focus on such experiences as despair, anxiety, and mortality to the neglect of more positive and pleasurable experiences.” As shown earlier, addicts have suffered a great deal. It may merely compound their misery to tell them that they are simply a ‘being towards death’ as Heidegger (1962) does. If even a great existentialist like Kierkegaard “withdraws from the dizziness of freedom” (Kierkegaard, 1941) then perhaps these ideas need to be softened for the addict. Gabriel Marcel’s (1949) work, with its focus on joy and hope, may be easier to hear for a client who has lost this perspective.

However, the argument for a focus on the starker areas of life is that it will enable the client to live a more complete and intense life (Cooper, 2003). The existential therapist can work on treating the causes of the addict’s pain rather than merely numbing the symptoms further as Gabor Mate encourages.  It is not possible to selectively numb emotions, when a person numbs anxiety, loneliness and fear of death they also numb joy, love and happiness (Brown, 2010).

Is taking responsibility helpful?

Similarly, a confrontation with one’s freedom and responsibility could overwhelm a struggling addict.  Sartre (1989, p34) thinks that “being is terrifying... characterised by its absolute mystery and impenetrability” and that you have “to take responsibility for things you have not initiated or wanted.” How does one inform a victim of child abuse that they must take responsibility for this? This suggestion could easily cause a rupture between the therapist and the client... or much worse. Sartre (1943a) and Heidegger (1962) would see it differently. They would emphasise that by denying the addict’s freedom and responsibility to choose their past, they also deny the freedom to choose a future of recovery (Cooper, 2003).

An understanding of Heidegger’s (1962) concept of ‘leaping-in’ and ‘leaping-ahead’ would be useful to the therapist. By ‘leaping-in’ and informing the client of their responsibility, Van Deurzen (2009, p69-70) would say that you are “robbing them of themselves and their openness to the world.” The intention should be to find a “way of giving the other his care back in an authentic manner”. Van Deurzen goes so far as to say that learning to ‘leap-ahead’ of the client and giving them “a sense of the overall perspective of their lives and of reality is exactly where existential psychotherapy is at.”

Is addiction a disease?

Addiction and many other mental health problems are labelled as a disease or illness by medical practitioners (Bierer, 2017). Szazs (2008, 38:10 - 38:28) says that mental illness is not “a disease with origins to be excavated but a behaviour with meanings to be decoded.” Laing shares Szasz’s views and argues that society holds on to a medical model of mental health because if its causes can be attributed to biology or genetics, then society does not have to examine how it contributes to the problem (Spinelli, 1989).

Van Deurzen (2012, p30) believes that actually, the psychologically distressed individual has just turned away from facing the typical struggles of life. They are not diseased; they have just become “clumsy at living.” Van Deurzen sees the role of the therapist as simply someone to help the client to face up to their situation and wake up from self-deception (Cooper, 2003).

Twelve Step Recovery Programs start by having the addict admit that they are powerless over their addiction. At first, this sounds like a very anti-Sartrean idea. However, the meaning is not that the addict is not responsible, but that they become powerless when substances are in their body (Immersion Recovery, 2018). Alcohol is an example of a drug that alters consciousness. If a mind is altered, then is the addict still free to choose their actions? Does Sartre’s (1943a) demands for responsibility and conscious awareness at all times apply when a substance has taken control of their consciousness? It could be argued that the person was conscious when they took the drug. However, if the person is an addict, then once the drug’s effects have worn off, the withdrawal symptoms would still be affecting the addict’s mind and body. Where this cycle starts or ends is not clear, but with alcohol addiction recovery rates being so low within the medical system and Twelve Step Programs it seems clear that labelling the problem as a disease has not helped (American Addiction Centres, 2019).

The opposite of addiction is connection

Johan Hari suggests that “the opposite of addiction isn’t sobriety. It is connection” (2015, p293). Sartre’s (1943b) famous quote that “hell is other people” demonstrates that social connections are difficult, not just for addicts.

Connecting is difficult, but the damage done by loneliness is even more severe.  This is supported by Eisenberger’s (2003) research that shows that the regions of the brain that light up in response to physical pain react in the same way in response to social ostracism. If this is true, then the existential therapist can help the addict by improving their social skills. This can be done in a manner favoured by Laing and existential-humanistic therapists like Yalom who says he tries to inquire about the client-therapist relationship  “at each session even if it has been productive.” Yalom (2001, p72) suggests questions like “How are you and I doing today?’ or ‘How are you experiencing the space between us today?’” Practising safe social interactions within the therapeutic frame could support the addict in connecting with people in the real world (Spinelli, 1989).

Sartre’s statement that one must “begin by isolating man on the instantaneous island of his present” (Sartre, 1943a, p109) is not supported by the U.K. Drug Policy Commission. In 2012 the Commission stated that “drug problems need to be seen and addressed within their wider social and economic context; entrenched drug problems appear to be significantly linked to inequality and social exclusion” (cited in Maté, 2008 XIX). Unsurprisingly the area of the U.K. with the highest addiction rates correlates with some of the highest unemployment rates. A prime example of this is in Hull, where the decline in the fishing industry has seen the simultaneous rise in both unemployment and addiction (Maté, 2008).

There is a famous study known as ‘Rat Park’ conducted by Alexander et al. (1981) that demonstrates the impact the environment has on addiction. In this study, there were two sets of rats, either housed in cages or an idyllic rat environment that enabled social interactions, flowing water and free space. Alexander shared how “nothing that we tried instilled a strong appetite for morphine or produced anything that looked like an addiction” in the rats kept in the idyllic environment. Whereas the caged rats consumed twenty times more morphine than those in Rat Park.

Does the addict need to find meaning?

Van Deurzen (2009, p89) interprets that in Sartre’s later work, freedom and action are “not seen as something that depends on the will and the isolated individual, but rather on the communal interest.” This echoes step twelve of Alcoholics Anonymous (Wilson, 1952) which requires a commitment from the member to move from self-serving motives to the serving of others by helping other alcoholics into recovery. A quote attributed to Nietzsche but used by Frankl (1967, p116) states that “he who has a ‘why’ to live for can bear almost any ‘how’”. By providing someone with meaning and purpose outside of themselves, they may find the motivation to recover.

Hari (2018) demonstrates how other cultures deal with the problem of meaninglessness and depression. He shares a story about a Cambodian rice farmer whose leg was blown off by a landmine, had a new limb fitted but did not recover. He became depressed, anxious and filled with despair. So, the local neighbours and doctor got together listened to his issues and decided to buy him a cow. They realised that he was anxious because he was in physical pain and unable to farm the land. However, they realised he could easily be a dairy farmer. The cow was the antidepressant and an analgesic. To them, Hari (p159) says “an antidepressant was not about changing your brain chemistry...it was about community, together, empowering the depressed person to change his life”. The difference was made because the man’s social situation was changed, he was able to find meaning in his work, and it was all enabled by the care of the community.

While finding meaning seems like a useful tool for recovery, a younger Sartre (1943a) might consider this an example of ‘bad faith’. It is merely a way of avoiding the confrontation with the meaninglessness and absurdity of being human (Cooper, 2003). Here we find an example one of Cooper’s (2003, p39) main criticisms of Sartre and all of existential philosophy; that it is “a vast and sprawling edifice, replete with debates, contradictions and half-completed arguments.”

Sartre’s philosophy seems to have changed in order to keep up with the changing political environment in Europe. Van Deurzen shows how Sartre made the point that the therapists “rather than seeking to change the individual by altering the self and its objectives, this has to be done in relation to the political, cultural and social world in which we exist.” (p100, 2009). Sartre’s earlier writing was set in a Europe that had just been confronted by the possibility of destruction by nuclear war. He was also writing in a France that had just come out of Nazi occupation. He was a man writing about freedom in a country that had just lost its freedom. As socialist sentiments grew in Europe, Sartre’s views on individuals and connection seem to have changed to keep up (Bakewell, 2016).

Cannon (1991) believes that a Sartrean existential therapist should help a client to create a life that balances their individual freedom with a worthwhile life project that encompasses the historical, social and political factors of the present time. This project needs to ensure that the ‘practico-inert’ features of the generation do not limit the progress into the future. It may be possible to take Kierkegaard’s (1884, p188) notion that “whoever has learned to be anxious in the right way has learned the ultimate.” If there is a ‘right way to be anxious’, Sartre would have that anxiety channelled into a project that finds this balance that Cannon (1991) describes.

Conclusion

For the existential psychotherapist, the goal of their work requires a great deal of balance. A balance between gaining an understanding of how past traumas affect motivations. They need a life project that balances individual freedom with community and meaning. Further work needs to be done to understand why psychedelic-psychotherapy has such beneficial effects in the trials and how to use this tool safely. Exploration of cultures that utilise more of the community’s ability to heal could help Western methods expand their range of strategies for healing. An integrated approach that embraces new tools like neuro-feedback and psychedelic-psychotherapy with proven existential techniques like phenomenology is going to be critical to the future of addiction recovery.

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