'Alcohol, drugs and suffering' - The Dulwich Centre

by Terry Callahan

This paper was first published in the Dulwich Centre Journal 2001 Nos 3&4.

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Introduction

As a counselor new to the field of alcohol and other drugs, I have been struck by the appearance of pain and suffering in the stories of almost all those who consult me. Often the appearance of pain and suffering coincided with that of alcohol and/or other drugs in the life of the person. In fact, in many instances the person’s story of their relationship with alcohol/drugs is almost inextricable from their story of pain and suffering. This paper is a brief report on a project in which I attempted to witness to the stories of suffering and alcohol use by Mary (not her real name), who has been in conversation with me for nearly eight months.

I found myself constantly running into brick walls as I tried to think my way through this work. I am now familiar with at least one of those brick walls, and it is what I call the Theory Wall. I quickly discovered that Alcohol and Other Drugs counseling is a minefield of competing theories (surprise surprise!!), especially when it comes to the relationship between drug use and pain. I started hearing phrases like ‘self-medication’ in reference to persons who used drugs to manage a psychiatric condition. I also started to notice in newspaper stories and other articles, constant references to drug ‘addicts’ or ‘alcoholics’ who abused these substances to ‘avoid pain’, and that this pain was often tied to early experiences of abuse and so on. The implication seemed to be that getting in touch with this pain and experiencing it fully or cathartically would be healing and help overcome the person’s need for alcohol/drugs. In other words, the addict/alcoholic was really ‘running away’ from things. It seems this is a mortal sin in our culture that prizes ‘facing up’ and ‘working through’ as a privileged, and now naturalised, metaphor of healing.

It is unremarkable that these theories should have influenced me as I tried to listen to various stories. These theories or accepted wisdoms act like a force-field so that questions and assumptions I make as a counselor all line up in a particular pattern. Eventually you hear what you expect to hear. This leads to the death of surprise or curiosity in a conversation. The temptation of Theory for me is also tied up with wanting to have control of a conversation, wanting to know in advance where the conversation is likely to go.

I did not want to stay stuck in front of or behind the Theory Wall. But the temptation is strong because it is theoretical and ‘scientific’ discourse that is most legitimated and legitimating in our culture. That was the problem. At first I felt that if I wanted this paper to offer anything to others, it would have to arrive at, or support, a theory of the relationship between alcohol/drugs and pain/suffering. And this would clearly be a cause-effect relationship. I found myself madly going through recorded conversations looking for common factors and trends. But doing this is to engage in the widely supported practice of abstraction … literally, ‘a tract that is away from’. This is to produce a discourse that is thin, generalised, statistical and, in the end, that really applies to ‘no-one in particular’. (But this is in no way to negate the usefulness in some contexts of statistical information and trends.)

I had not realised how deeply ingrained this scientific attitude is in me. But coming to name it and tell something of the story of it frees me to properly situate this work as fitting within a different framework of understanding – a narrative approach. As such, I knowingly value and privilege the specific, concrete and personal details of these conversations, the idiosyncrasies of language and meaning employed by persons, the local, the hitherto invisible. That is, the very things that are residual to a so-called objective view. The strategy is one of thickening, elaboration, teasing-out, respectful deconstruction of the well-worn or taken-for-granted. It is a move into complexity, while resisting the temptation to simplify. Story or narrative holds complexity, celebrates it, nurtures it in strange twists and turns, metaphors and images, that radiate in every possible direction. Story is a strong/fragile ever-changing plotting of abundant life. Indeed, narrative is constitutive of identity and action. The stories we make up make us up. We make up our minds and our actions in and through and with stories. I have also tried to listen for those traces, those small broken threads that might be woven into significant alternative stories. Importantly, this is a written re-telling of these conversations with Mary and others. The course of these conversations was not the same conceptually or chronologically as this report. The conversations were more a woven cloth, at times bewildering in its colours and patterns, from which I have pulled some threads. I do not want to give the false impression of order, neatness or ‘perfection’ where in fact it never existed and cannot exist. The following are thus reflections on these conversations relying on narrative ideas and practices.

The interplay of suffering/pain and alcohol/drugs: Drinking in liminal space

I was faced with an initial dilemma in these conversations. Should we externalise Pain or Alcohol? In the end, we externalised both, foregrounded one and then the other.

I understand externalising from a number of different viewpoints:

It locates the problem outside the person. It does this in an intentional response to dominant discourses that insist on locating the problem within the person, or identifying the problem with the person. It gets around various ‘pathologising discourses’ of the dominant culture.
Externalising is also the idea and practice that is congruent with a social-constructionist view of the world. That is, the person and her beliefs, values, commitments and so on, do not somehow just arise from within the individual, ‘from the depths’, as it were. All aspects of the person are situated historically, politically, socially and culturally. These are realities bigger than and constitutive of the person.
Externalising opens the space for the person to rethink their relationship to the problem and its supporting ideas and practices. This is space for the exercise of intelligence and responsibility that is otherwise closed off or unavailable when the problem is collapsed onto or into the person. To externalise is then to ‘render visible’ what has hithterto been invisible, so the person can be invited to think about their position vis-a-vis the problem/alternative story.
Externalising also situates the Problem in such a way that others or even whole communities or families can reflect on their respective relationships to the problem, rather than the person-as-the-problem.

As Mary and I entered into these conversations, it soon became clear that Mary held complex and often very nuanced positions with respect to the effects of alcohol or suffering in her life. That suffering took various forms: Depression, Grief, Always Pleasing Others to name a few. These have all been externalised at times over the last five months. If I had to conceptualise what has happened over these conversations, I would say that as Mary separated from Alcohol, she has met Suffering/Pain/Hurt in a new way.

Drinking to death: Alcohol and loss

Mary’s only son, David was killed in a car accident in his early twenties. Mary unhesitatingly pinpointed this moment as the start of a problematic relationship with Alcohol in her life. She was able to identify a single moment, one day after her son’s death, when one of her friends handed her a glass of wine and said ‘Here. Try this. It will calm you down.’ That was that. Over a period of ten years, Alcohol slowly gained the upper hand in Mary’s life, to the point where she was hospitalised. It was in the hospital that I first met Mary and we started our conversations. Mary identified many different effects of Alcohol in her life. These ranged from:

Damage to her health and well-being.
Increasing isolation from friends and family.
A deep sense of shame and embarrassment.
Increased worry and anxiety from her father and daughter and son-in-law about Alcohol in her life.
The way Alcohol used up her money.
It did in fact ‘calm her down’ at certain times and helped her to mellow out.
It had ‘sneaked up’ on her and ‘overtaken’ her before she knew what was happening.

Mary was very clear about where she stood with respect to Alcohol and its effects in her life. She wanted complete separation from Alcohol and wanted to regain her life. She said that the reason why she wanted to separate from Alcohol and its effects were:

Alcohol works closely with Secrecy and Sneakiness. These things were not okay with Mary, who said ‘I am an honest person’. In particular, Sneakiness had created ‘distance’ between herself and her dad, and she prized her relationship with her dad very highly indeed. This was further complicated by her father’s Muslim values around Alcohol.
She did not want to put her daughter through the trauma of her death if she stayed dedicated to Alcohol.
She valued her health and well-being ahead of Alcohol.
She wanted her life, and not premature death, which Alcohol was leading her toward.
She no longer wanted ‘life down the black hole’ but preferred life closer to the light of day.
Alcohol was associated with the Bad Mary, and she wanted a closer relationship with the Good Mary.
She wanted a closer relationship with her granddaugher, Sophie, and Alcohol was getting in the way of this, by eroding the trust between Mary and her daughter.

But it was also clear that Mary’s relationship with Alcohol was not just all negative. When Alcohol made its first serious appearance, it did help ‘calm her down’ as she had got to the point after David’s death where ‘she was really wound up’ and ‘could not stop’. Alcohol fulfilled a function at this point in time.

In another conversation, Mary talked about some of the ‘turning places’ in her life, one of which was Geelong. She said that in this place, she became extremely isolated and never had people around to her house. When she described her relationship to Alcohol at this time and place, she mentioned that she would sit at home drinking and, while drinking, ‘I would talk to myself’. When she elaborated on this, she was ‘giving herself a good talking to’ and ‘talking reason to myself’. She said she only ever did this when she was drinking and with the intention of ‘getting her life together’. She described this as ‘like going mad’, but a madness that kept her somehow sane or connected with her purposes and hopes for her life in her now shattered world.

Mary was faced with some big questions: what is to be done in the face of Death? Or more precisely, what did Death do to the face of Mary’s world and its meanings? And where and how did Alcohol insinuate itself in this shocking intrusion of Death? If we think of Victor Turner’s schema of separation-liminality-reincorporation as one possible map of grief (Turner, 1986), then for Mary, Alcohol accompanied her in all these phases, although reincorporation has seen a complete ending of her relationship with Alcohol. Part of the liminal experience for Mary turns around the way Death got its ruthless fingers into almost all of Mary’s hopes and beliefs. Death had:

Taken her son David from her permanently.
Destroyed Mary’s long-cherished hope for a daughter-in-law and grandchildren through her son.
Completely undermined her belief as a mother that ‘I could protect my child from all harm’. She was ‘not there’ when the accident happened.
Overturned her understanding that ‘If I was good, I would be rewarded’.
Convinced her that she had lied to her son David about the nature of life and the future.
Led her into a cynical attitude to life and a ‘loss of naivete and innocence’.
It was also the accidental nature of David’s death that had shattered Mary’s understanding of the world. This death was much harder than her mother’s death, as she had been a ‘ripe old age’, whereas David was just at the start of adulthood.
Death talked her into blaming herself for David’s accident, instead of the truck driver who ran into him.

I mention all of these aspects of this conversation with Mary, as it is an unpacking of Death and its effects and the pain and loss associated with it. Where did Mary stand with respect to Death and with respect to her departed son David? It was as if Alcohol in tandem with Pleasing Others and Depression had conspired to ‘keep Death and its effects on hold’. Nonetheless, Mary held an alternative story about her relationship with Death. She had in fact summoned the courage to speak at her son’s funeral and comfort his grieving friends and remain available to them over the months following the funeral. Mary understood this as standing up to Death. David was now on the ‘other side of the door’ and ‘I will see him again’ and knowing this made her unafraid of Death, as it will mean reunification with her dead son David. For Mary, it is clear that ‘Love is stronger than Death’, both the love she bears for David and for her remaining child and grandchild.

Mary also talked about how Death, and its major effect, Loss, had slowly ‘shrunk’ over the years so as not to occupy all her waking time and thoughts. Mary had recently decided to keep only some of David’s things in a small box, ‘into which I can look when I want to’. This was, she said, her way of managing some of the effects of David’s death on her.

What was the relationship between Alcohol and Grief and the ‘Bipolar Depression’ the psychiatrist had named as her condition? What I do know is that, as Alcohol receded, Grief and Depression and Always Pleasing Others came into sharp focus and were more available to be unpacked and reconstructed or deconstructed. Mary also put great store in our conversations as these were ‘just for her’ and were thus undermining Always Pleasing Others. The very act of our conversations and Mary’s commitment to them was itself a big part of an alternative story of Kindness and Caring Toward Myself. This Kindness and Caring Toward Myself is indeed a new thing in Mary’s life, a strange territory in which she is still orienting herself.

The most recent conversations have focused on Always Pleasing Others as opposed to Caring and Kindness Toward Myself. As the tide of Alcohol receded, these other concerns have become more visible. How did Alcohol come between her and her grief, her and her dead son, her and her depression, her and Caring for Myself? How did Alcohol influence her relationship with all these aspects or realities of her life? And if Alcohol did interpose, was that ok or not ok? And why? Mary said that ‘Alcohol allowed me to just “sit on the fence” and “not move one way or the other”’ with respect to many major concerns in her life, from Grief to Depression.

Reauthoring: Talking to myself, from isolation to connection, a reworked meaning of life

To reauthor is to take up of those thin traces, those sparkling moments, that do not fit the dominant problem story and to spin them into a more complete and useful alternative story and preferred identity. It means identifying points in the landscape of action and linking them back and forth with the landscape of identity, which takes in intention, values, beliefs, hopes and so on. Reauthoring can then take the person into the preferred and hoped-for future and out of the problematic future predicted by the dominant story of the person’s life. For Mary, reauthoring involved the filling in of several alternative stories almost simultaneously. This was a matter of necessity dictated by the tangled nature of many of our conversations. Mary named these alternative stories as Just Doing (as opposed to Thinking Too Much), Caring and Kindness Toward Myself (as opposed to Always Pleasing Others), Finding The Middle Ground (as opposed to High or Low), and Giving Up Playing God. I would like to elaborate on just one of these alternative stories, Caring and Kindness toward Myself. Perhaps in some ways it includes the subplots of Just Doing, and Finding Middle Ground.

Mary had at several different times in our conversations identified Always Pleasing Others as a concern. She said Always Pleasing Others was underpinned by various beliefs instilled in childhood by her mother and her schooling, beliefs about unselfishness and ‘doing good to others’. Thinking of yourself had been construed as ‘selfish’. Mary identified the fact that Always Pleasing Others had at times so dominated her life that she had forgotten about Grief and herself. She also said that certain ideas of Motherhood were closely tied up with Always Pleasing Others, especially one’s children. She said that Always Pleasing Others talked her into ‘forgetting myself as a person almost totally’.

Mary, however, was also able to retrieve from the past some moments of Caring and Kindness To Myself. In particular, she recalled her love of high-jumping as a child and teenager . She said ‘I felt good about myself’ when jumping and that she was in touch with ‘joy’ and that she ‘had her whole heart in it’ when jumping and that it was a natural high for her. She said that both her father and her coach would have recognised her pleasure and her skill at high-jumping, although later on Competition intervened and lessened her enjoyment.

Mary also identified other moments in the landscape of action. She has recently taken up swimming with her daughter and granddaughter, and she identified this a significant victory over Thinking Too Much, which normally results in Mary making excuses against doing anything for herself. She said ‘I just said, “Yes”. I just did it’. She also told the story of buying some bath mats, not because she needed them, but because she wanted them and they were beautiful and gave her pleasure. All of these were moments in a reauthoring of Mary’s story of Caring and Kindness for Myself. Importantly, Mary identified her commitment to our conversations as a further event in the story of Caring for Myself, as it was ‘something I have never done before’ and it achieved something that various drugs and psychiatrists had overlooked. In all of this, Mary was fulfilling a desire and a hope expressed early in our conversations about ‘taking responsibility for becoming a person of value’, and of honouring her own worth. Other values and intentions she mentioned with respect to this new story were around fun, joy, optimism, loyalty to self, and courage to venture into new territory.

Therapeutic letters

I have written Mary a number of letters over the course of our conversations. She expressed some enthusiasm about these letters, and said that the letters ‘make it more real somehow’ and that a letter is like a ‘medication’. In all, I have sent her six letters, approximately one a fortnight. As David Epston and Michael White and others have said, therapeutic letters add another dimension and richness to conversations. These letters both ‘capture’ the substance and tone of a particular conversation and extend it through further reflective questions and speculations that were not to hand in the thick of the actual conversation. They allow the person and the therapist pause to ruminate on what has been said or unsaid and to formulate questions or comments that had not occurred to them at the time.

I have found also that letters allow me to maintain a much more personal connection with the person, as I am all the time addressing them as ‘you’ or using their name. I mean this in comparison to the normal ‘case notes’ that talk in the third person in a quite detached and matter of fact style. And case notes are of course destined for the file rather than the person. They are for the institution and its goals and purposes, and exist within an ‘instituitional discourse’ that more or less erases the particularities, the ‘grain’ of a person’s life, the things that make them unique, in the interest of classification and treatment and control of one kind or another.

For me, therapeutic letters have been a good antidote to ‘case notes’, as they are transparent, personal and extending of the person’s stories about herself and her life. They can allow space for more of the multiple meanings and possibilities to emerge. They can allow the person and the therapist to tune in to as yet unheard or suspected resonances, the ‘surplus of meaning’, in what has been said or unsaid. These letters are personal also in that they use as much as possible the person’s own language and idiom. They are not translations into expert or professional therapeutic discourse. Rather, they are a re-presentation and thus an acknowldgement of the person’s unique language and style and history. They remain experience-near while pushing into unchartered territory, or unworded or unthought landscapes of action and identity. They are also much more tentative and hesitant in tone and intent, compared to the certainties and taken-for-granted notions that might underpin case notes of different kinds.

Mary had some interesting comments about the first letter I sent her, comments that I included in the second letter:

Mary, you said that reading the first letter was like ‘reading about someone else’ and that it was ‘like a page out of a novel’. And that you ‘felt quite detached from it’. Who is this ‘someone else’ you are reading about? Is this ‘someone else’ the new person you are becoming? The word novel I think means ‘new’…so is this a page out of the new story of your life?

You said also the letter ‘made it all real somehow’ and that the letter is like ‘a medication’.

These letters picked up various aspects of our conversations and sought to extend them and conserve them:

Fun, you said, has not been around very much of recent years and you seemed very pleased at its reappearance. I was wondering where else Fun has been in your life? Is having Fun important to you? Why? Who would have witnessed you having Fun in the past? What would they have seen you saying or doing that showed that Fun was around?

And at another turning point:

You said that you were ‘heading up hill slowly’ and no longer just downhill. You are going ‘one step at a time’ and ‘not skipping any steps’. You said that this was ‘new knowledge’, as before you would want to get everything done in one hit. (Have I got this right, like cleaning the house one room at a time rather than the whole house at once?).

And when I asked Mary how she was getting to the Middle Ground she so desired:

You said that not drinking (which you have been very successful at) has helped you to regain a clarity of thinking. You said you love not feeling dependent on drink. You said you felt really good about this. You recognised that you were not getting anything out of Alcohol and that it was a journey of no return. You said that not drinking is helping you to get to the middle ground of life.

With respect to the most momentous event in Mary’s life, the death of her son David in a car accident:

You talked about ‘not being able to control what happened’. Alcohol, you said, ‘takes away the thinking process’ and ‘numbs you’. Nothing you could do could make it better, there was no solution and you felt ‘overwhelmed’ by this event. You described yourself at this stage as being ‘like the Battery Bunny’, as you could not stop or sleep. You said that before David’s death you were ‘innocent, optimistic and naïve’ and that ‘I had lost my innocence’ as a result of his death. You described this innocence and optimism thus: ‘If I am honest and caring and good, then my life well be good and I will be rewarded’. You said that now you are ‘cynical and fatalistic’. Again, I have lots of questions about this: what is your relationship to the ‘innocent, naïve Mary’ now, and what is your relationship to cynicism and fatalism? Where do you stand with respect to these two stances toward life? Do either of them suit you at this time? Why or why not? Are there other stances toward your life that you have thought about or experimented with? What are they?

Mary also talked of Alcohol in her life and this featured in some of the letters thus:

You recalled someone at some stage saying ‘You need a drink to calm you down’ and ‘You’ll feel better’. Mary, when you say that Alcohol was numbing, what was that experience like, physically and mentally? Did being numb enable you to do certain things, or not do? What was it like when the numbing wore off? … You said that after a while the drinking became ‘robotic’ and that Alcohol was ‘insidious and sneaky’. What do you mean by robotic? Automatic? Was this something you noticed at the time or is it in retrospect? Was it useful to you that it did become ‘robotic’? Can you tell me a story about Insidious and Sneaky Alcohol at this time? … You said that Alcohol at this time was ‘a bit of a comfort’ and a ‘little bit numbing’ and like a ‘security blanket’. Mary, you also said that Alcohol at the time put you in a ‘mellow state of mind’ at times, and at other times led you to ‘hysterical laughter’. It somehow enabled you to ‘get through the impossible’.

With respect to some other realisations about her life:

You said that for a long time ‘I was trying to play God with my life’. But also that, while at Geelong, while you were isolated and Alcohol had a grip, you used to have ‘conversations with myself’ and ‘talk with my self’. You said that you used yourself as a sounding board and listened to your own voice. Mary, you were laughing when you said this! But more seriously, was talking to yourself a way of staying connected with your self in your isolation? While you point to the influences of Alcohol in all of this, what were you saying to yourself at the time? Did it make a difference? Did talking to yourself lead to feel more or less of a person? Mary, toward the end of this conversation, you said that you had to face the ‘loss of control’ in the face of ‘trying to control everything in my life’. You said you have developed some ideas about Destiny in your life and Acceptance. You said that at times you have ‘stopped fighting it all’ and ‘stopped playing God’ and ‘stopped hating myself’, even though you said you have not stepped entirely out of the ‘feeling of being nobody’. You said that now you ‘feel more mellow’. That is, mellow without Alcohol. What is the difference? And do you prefer these new ideas of Destiny and Acceptance to your earlier ones of Control and Self-Hatred? Lastly, how is Acceptance at work in your life now? What difference does it make to your life and your relationship to your self?

Conclusion

I have brought to the foreground of this paper some of the problems and preferred ways of life that were externalised in Mary’s conversations with me over a period of six months. I have described some reauthoring conversations. The continuous use of therapeutic letters throughout has also been elaborated.

Themes of suffering, death and alcohol use have been explored through these conversations. Suffering and death are of course experiences that can take a person to the edge of all that is familiar. My conversations with Mary have me reflecting a great deal on some ideas dear to narrative approaches to therapy. One such idea is that of ‘agency’. What happens to a person’s agency in the midst of profound suffering and anguish? How is this suffering to be honoured in conversation without further damage to the person? What is this suffering testimony to in the life of a person? Rather than understanding recourse to drugs or alcohol in the face of suffering as evidence of a personal problem or pathology, what are the other possible meanings in such recourse? At one level, drugs and alcohol are a response to suffering and pain. In what ways might this response be unpacked and storied so that skills and knowledges and beliefs about self hidden within it are not totally obscured by a dominant understanding of drug/alcohol use as a sign of weakness or individual pathology? Mary’s generous and enlightening conversations with me have helped me understand the many nuances and possibilities in such a response. Further conversations with her into the future will explore other hopes and dreams for her life apart from Alcohol. I look forward to this.

Reference

Turner, V. (1986). Dewey, Dilthey, and Drama: An essay in the anthropology of experience. In V. Turner & E. Bruner (Eds.),The anthropology of experience (pp. 33-44). Chicago: University of Illinois Press.