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[From Sagetimes.com: In-Depth Exploration]
Dr. Patrick Carnes
3/27/2001 2:28:00 PM
The following is an excerpt from a televised program hosted by world renown therapist and best selling author Dr. Patrick Carnes of the Meadows. To purchase this or any of Dr. Carnes other tapes or books, please visit the SageTimes bookstore.
We live in a very addictive prone culture. The thing about sex addiction is sex addiction has something to offend everyone. The total figure for addicts and people who are involved in addiction in our culture is 131 million people. We have 28 million adult children of alcoholics; our families are living in a very disruptive world. This is a group of people who literally cannot stop being sexual. It's not a matter of morals, not a matter of character or family or upbringing or self-control. They can see that disaster is going to happen, this is going to cost them their family; this is going to cost them their job. This may even cost them their lives, as we shall see in the series, but they can't stop.
So, we're talking about when a system becomes dysfunctional. Now there are many systems that are involved in the ecology around addiction and we will review those various systems. As we look at those systems, however, my job or mission, is not necessarily to make you comfortable. What I'm going to try to do tonight is to raise questions about how you live your life, to get you to reflect on things that maybe you could do differently.
The first system I'd like to talk about is the biological system. Taking care of our bodies becomes one of the most important things that can happen for all of us and especially for people who are in recovery. If we haven't got our bodies, we haven't got anything. So, attending to our bodies becomes a very important way of thinking about ourselves.
It was in the middle thirties when Hans Selye introduced into our culture the word "stress". It's interesting how that word came to be in his mind. He started by looking at the immunological system of the body and what he realized is that as human beings, as organisms we have only evolved so far. That, in fact, if we take a look at how people react organically in terms of stress or having anxiety or rather experience a stressful thing, our bodies are prepared to do one of two things -- either to fight or to flee.
From the beginning of humankind's history our bodies were geared to do those things. So, when we experience something anxiety producing, our body experiences a preparation -- it gets ready and once that body is mobilized if all we do with it is have another cigarette or a cup of coffee it's not going to help us. What we need to do is discharge that energy and so, one of the things that we need to take a look at is how do we exercise our bodies?
What I'd like to invite you to do tonight is think of yourselves as a consumer of health information and think of when you were in high school or college and you participated maybe in some athletics. What happened then is you were literally in training. Now, what in training means is that when you're in training you know that there is going to be a stressful event - a tournament, a game, some kind of a match. And so, you prepare for that and here's how you prepare.
You develop skills, you develop stamina, you practice every day, you build the endurance of your muscles. You work on plans like, "How am I going to strategize about dealing with this?" So, you get ready for that anxiety and how you're going to deal with that stressful event.
The origins of the phrase "in training" actually have very, very ancient roots. In fact, the Greek word for virtue "virtu" means the pursuit of excellence, whether it be athletic excellence, emotional excellence, spiritual excellence. In other words, virtue encompassed many different ways that a human being can pursue excellence. Unfortunately, what we do in our culture is when we pursue athletic excellence, that's it. The other thing is that when people leave high school or college they don't think of themselves as being in training any longer.
The good news is that now we are having the time where people who are in their forties, fifties, and sixties are seeing themselves as lifelong athletes. We're starting to see people try to improve themselves personally and spiritually as part of that process. We call that holistic medicine -- taking a look at the whole person. So, things are changing dramatically but many people still have that image.
For people who are in recovery, it's a very important concept, because recovery is like being in training. We've learned about people who leave treatment centers, that 27% of them fail in being able to maintain their sobriety. It's not because of the quality of treatment that they received, not because of the talent of the therapist or the kind of effort that the person has put into their therapy. Literally 27% of them fail because of acts of God.
In other words, what happened in the first three months after treatment is they ran into something that no one planned for. Death of a parent, death of a pet, car accident -- something happened which literally was too much for them.
You know, there is an old saying that has been around for some time, that God will not send you more than you can handle. Well, the truth is, treatment centers are filled with people who God sent more than they could handle. We know that we're going to find times in our life, which are going to be stressful, anxiety producing events and so, we need to prepare for them. The way you do that is you build up endurance, you develop a plan, you work on your skills, and what have you, that's called being in training. A recovery program is literally being in training, a daily thing that you do and, one of the keys to that is taking care of your body.
Now, in the field that I know best, which is sex addiction, we find, for example, taking care of your body has many, many different kinds of forms. A common problem for almost two-thirds of sex addicts is insomnia. In other words, they use sex as a way to get to sleep or a way to survive the night. We have to end up doing a lot of teaching about how to cope with insomnia, that it is the sleep disorder that they're confronting, that they need to find other ways that are not destructive to themselves.
There is a lot that we can learn about sleep; there are, in fact, many different kinds of things that effect people in their sleeping. For example, there are people who can't go to sleep, there are people who can't stay asleep, and there are people who wake up too early. There are a lot of reasons that that happens.
One is that it can be related to your eating. I don't know if you've ever noticed, but the best nap of the year is on Thanksgiving. People eat Thanksgiving and literally they gorge themselves on the turkey and then they sort of spread throughout the house, crash, take a nap -- right? They die and then they wake up, have a turkey sandwich, and crash again. Now, why does that happen? Well, turkey is filled with L-tryptophan, which is a natural sleep-inducing agent and so is milk, which is why milk is a good thing to drink before you go to bed. So, sometimes it has something to do with what you do in terms of eating and drinking.
For some of us, it has to do with body rhythms. The circadian rhythms, and I'm sure you've all heard of people who are night people and people who are morning people. If a morning person meets a night person, it's a problem because they are their very best at the opposite times of the day. Now, changing those circadian rhythms is very, very challenging.
One of the things that corporations have found, for example, is that they go to what they call flexi-time -- where people come in and work at the best time of day for them. The reason is that you get the best out of people when they're working at their optimum time.
The next system that needs to be attended to is the psychobiological. The psychobiological system is an interface system. What I mean by that is it's a blend of two systems and it's how they impact one another. So, for example, how you take care of your emotional well-being is going to effect your physical well-being. How you take care of yourself physically, is going to affect yourself emotionally.
In health maintenance organizations and insurance companies they know that people who use health services, roughly 80% of those services are used by 20% of the people. The other remarkable part about that is that of those 20%, 80% of those people really aren't sick, what they have is an emotional problem that's coming out physically. A good example is in the case of alcoholism.
In alcoholism we've learned that for somebody to go through treatment, the family members go to visits to physicians for things like influenza, strep throat, accidents, all of those kinds of things are reduced 60% in the first six months after the alcoholic has gone to treatment. What that means is the stress of living with an active alcoholic takes a tremendous toll on the family members and it comes out physically. So, people have what we call psychogenic or psychosomatic illnesses.
The flip side is also true. That how people take care of themselves physically is going to manifest itself emotionally. John Grist at the University of Wisconsin took people who were coming to the mental health unit who were talking about problems with anxiety and, he put them into two groups. He put one set into intensive group psychotherapy and the other set he put into intensive jogging groups and he measured after 10 weeks. What did he find? The joggers got better.
Now, as a person who works with groups for a living, I need to take a look at that. We need to understand that people really need to take care of themselves physically in order to affect their emotional well-being and, it's not just in terms of exercise. I mean exercise is logical. People understand that because when you exercise, like when I do my morning run, it releases a natural tranquilizer in your body called norepinephrine. You feel better. I notice that when I don't run and I don't do that regular exercise, I don't feel as peaceful. And it isn't just the physical stuff; it's also things that you put in your body.
Recovering people absolutely need to take a look at what they do with their food. We are referred adolescents who are described as incorrigible and behavior problems. You know, when they get into treatment, yes they have problems and we deal with the problems, but one of the things I notice is when they get in a structured environment and eat regular meals, suddenly they start to become balanced. And when you ask the kid what they had for breakfast when they go to school in the morning -- cherry Coke -- and then we wonder why they have such a turbulent experience. So, in other words, the point I'm making is that how we take care of our body is more than just taking care of the body, we're also taking care of our emotional well-being when we take care of our body.
In addition to the psychobiological, there is also the personal system, the personality. There are lots that recovering people need to attend to here in terms of how to take care of themselves. One of the things that I would underline tonight is what I call thinking about details. Part of the path back to recidivism, where a person would relapse and have a slip, starts with what we call lifestyle imbalance. In other words, they will get over-extended, things will be out of control, and they will be doing things that will be crazy.
What happens is if you think of your lifestyle as a scale and when somebody gets their lifestyle out of balance, that is the time that they are most vulnerable to addiction. The stages of relapse start with that imbalance, euphoric recall and wouldn't it be nice. They feel entitled because they feel so overextended. What they need to do is to get out of this unbalanced situation and get to where they have a balance.
The way that you do that is by attending to the little things in your life, the little details. Some years back we developed a little kind of an instrument called the personal craziness index. The way that you develop a personal craziness index is you list 30 different ways and different categories -- physically, it can be something like skipping your running, drinking too much coffee, things like that. It can be driving, like if your car has little dents in it because you're always kind of bouncing off things because you're in a hurry and you haven't changed your oil; it's not having your laundry done, it's your telephone calls not returned, it's all those things! What I'm talking about is all those little things, you see, that are signs that you're out of control.
Gestalt therapists talk about gestalt using the German word gestalt, which means "field of experience." In other words, people have patterns in their lives that they pursue and, what's a true pattern in one part of your life will also be true in another part of your life. So, if it's characteristic of your life that you find that you're always late to appointments, you're always rushed, you meet your friends, you say, "Boy, I'm really glad to see you. You're so important to me. I don't have time to talk, but we'll get together real soon!" That the way we make love, the way we talk to our friends, the way we maintain our friendships, the way that we work, that they will have the same patterns to them.
So, part of recovery then is to find little things that will be symbols to let us know that we are beyond the pale. And what the craziness index is a list we make all those different kinds of things. The personal craziness index is called the picky. The short version is called the quickie picky. Now, with the quickie picky you take seven, seven of the signs that you live every day, you do kind of an inventory of the things that you do that you know you're beyond the pale. There are things that are really very costly to you. It is attending to those little details.
It's when we lose perspective on these ordinary things that we have trouble.
But there's another side of it. It's not just that we attend to the here and now details, it's also that we need to take a look at the visions that we have of our life. It is also our visions of the future, which sustain us, and we need to think of our images. One of the things that I know that I've had to deal with in my own life and I think is fairly common for most of us, is that occasionally we'll have self-hating thoughts, self-destructive thoughts, thoughts that aren't helpful.
Recovering people are often coping with those kinds of thoughts every day. A way to deal with a self-destructive thought that comes back over and over again is you need to have images in your life that you can replace the self-destructive thought with. So you have an image of your future that is different that you replace that destructive thought with and you follow your images.
So, one of the things that's very important interpersonally is to get that affirmation. I believe that the most important skill that recovering people can do is go out and learn how to consult with others. To get them to give you input on your life. Like, for example, when you do a Step, you don't just do a Step in a group. What you do is you talk to people about doing the Step, you share. You say, "What do you think about this?" You have breakfast with them, you get consultation, and with that comes the affirmation. And you build a support network. It is the most important part of your recovery - building that network.
The next system that has to be dealt with is the family system. This may sound like a very strange comment, but in many ways we live in a culture in which it's very hard to be a family. In earlier times people used to work together, kids would learn their jobs and go through their learning process by learning in the context of the family.
In fact, it wasn't until the church came along and took kids out of the family and put them in schools to prepare them for religious life that the first major breech occurred in family life. And today what we do is we have an assembly line in education. We put all the first graders with all the first graders, all the ninth graders with the ninth graders, graduate students with the graduate students, and in many ways it's a very cumbersome way to learn. 'Cause learning can be exponential when you have people of different generations together.
What's important is that families need to also be together as part of that learning process. One of the greatest stresses that families experience is they don't have what we call shared, common experience and intimacy is based on shared, common experience. What we do is we put these kids in schools, we're literally warehousing them because we don't want them on the labor market yet, what would we do with kids who were doing something meaningful? You know? And, I think that's a problem for kids. Because kids want to learn, but they want to learn things that are useful for them. You put them in these schools and literally the family doesn't know much about what's going on with them. Dad goes off to his job; Mom goes off to her job and they don't know much about each other.
What has happened is we've split families apart. One of the things that corporations are learning, interestingly led in our culture by our military...it is the U.S. Air Force and the U.S. Navy that is piloting experiments, corporate experiments to help to build family life. To pull people together and why? Not because general officers are altruistic, I mean, typically in the old days general officers had the attitude that if we had wanted you to have a family, we would have issued you one. But what they've learned is that there is retention and productivity that gets improved when you attend to family life.
If you think of your own life and you think about work and how your family has impacted on work, you'll get what I mean. It is a challenge, you see, to be a family, to spend that kind of time together. We absolutely need to be able to do that. Now, for recovering people, not only do they need to start spending time and really invest in their family, there are two major challenges that families have to make.
One is that in recovering families what they do is they often lose perspective about what was it like to live with me? They're real clear about what it's like to live with the other person. But, what's it like to live with me? It requires a major shift in terms of looking and taking responsibility for yourself in your family. I mean, what is it like to be around me? We have an exercise that we use with chemically dependent families in which we have co-dependents and addicts and their kids come together. What they do is they first write down the words that come to mind when they think of the other.
So, the alcoholics think of their spouses and they say nag and critical and sometimes they'll put caring and the co-dependents will put things like irresponsible, you know, not trustable, and incidentally, on the co-dependent list is never an encouraging word usually. The kids talk about parents and they do this thing...until you get to the little kids. Little kids will say things like sad, it hurts, it's painful and the parents then listen to those words and there is not a dry eye in the room because, they see what they've done!
Then we ask them to go back and say, "Okay, what did you do to contribute to the pain in your family." One of the principal ones is trying to control everybody. To control all the outcomes...to control the other persons and, that's the fundamental task that families have to deal with is to see themselves differently and to give up that control.
We need to see that by looking at the challenges of our family life that we not get stuck in the victimization or the victim stance - that the reason that I am the way that I am is because of how my parents treated me. That may be true, and you need to be angry with that and deal with it, but you need to move on beyond that and face the challenges.
The other system that becomes very important now is the social system. The social system is all of those larger organizations we are part of and some of the most basic that we know of like, for example, those financial systems. As sex addicts, for example, we know that 48% of them are overextended financially. We know that 26% of them get into compulsive spending.
And, I'm absolutely convinced that Maslow was right; that it's very hard to be self-actualized and doing noble and virtuous things when you can't pay the rent. Can't do that when you're preoccupied with money. I think, and I've seen this happen over and over again, that money is an absolute metaphor for where people are emotionally. If they don't have any financial margin, they will not have any emotional margin. If they're overextended financially, more than likely, they're going to be very overextended emotionally.
Money becomes a metaphor. One of the things that recovering people have had to do often is to reorganize their finances in order to have, even if they're on a budget and limited and they're picking off little payments, that they live within their means.
Another area, part of the social systems, is where you work and what your job is about. Sometimes people's jobs are not healthy for them. I know that in sex addiction it is routine for people, even in the definition of their sobriety, which they need to take a look at what their job is about.
One of the things, for example, is male therapists who have been sexual with clients, for example, women clients. Part of sobriety is that they can't see women clients anymore. They can work with men, but they not see women, at least they don't see women alone. Or, for example, nurses - a nurse sex addict who acted out in a hospital - hospitals are not a safe environment, so she has to find some other way to use her medical knowledge.
People have to make very hard choices about those larger systems that they live in. They need to be in things that support their recovery. You know, the Big Book of Alcoholics Anonymous uses a phrase, which is really quite extraordinary; it talks about going to any length for recovery. In many ways the stories that I'm talking about, these are people who had to make choices that were going to any lengths.
Despite our knowledge about recovery and about addiction and what have you, the next system that we have to deal with is still a problem because you see it is the cultural system. It is that large system that all of us participate in. You see, in many ways, for recovering people, whatever the addiction that you have, whatever your co-dependency stuff is about, you live in a culture, which is hostile to what you're trying to do. In many ways it doesn't understand what it is that you're trying to do, the kinds of changes you're attempting to make and there is one way to deal with that. And that is become part of a subculture.
In many ways, those 12 Step programs like AA and Al-Anon and Sexaholics Anonymous and S-Anon, Overeater's Anonymous and O-Anon, they are small subcultures that you participate in. You become part of the life of that culture, where you have people who support you in the goals, for your health, because as consumers of health information you want to be a healthy person. So, you need to surround yourself with people who are committed to the same thing.
The phrase that is often used is "working the program." Now, what does that mean for those who are outside and don't understand. What is working the program? Well, some people might think, "Does it mean going to meetings?" Yes, going to meetings is part of it, but it is a much larger thing. It is getting a sponsor; it is working on Steps; it is going on retreats; it is working a learning process; it is being in training; it is every day, using meditations, doing reflections, working, working on your recovery. That is working a program. Going to a meeting is simply a celebration and a sharing of the progress that you've made. And so, for people outside of the 12 Step communities, you'll hear people say they're working a program, that's more than just going to a meeting.
In many ways you think of joining something that is committed to your health and every day asks you to reflect on, like any good training program should, what gives your life value? What an extraordinary gift. What do you do? What do you do in your life? A daily discipline that you live? That's what I'm talking about.
In many ways, the marital arts are literally a path, if you will, to a spiritual life. It's a way to reflect on human behavior. Many times I think in America we have all the techniques down, but we didn't bring in the other part, which is that part about spirituality. It's about growth, it's about learning. One of the things they teach about in martial arts is they talk about how you hold your body. Like, I don't know if you've noticed how men walk, for example. Men walk as if they have a telephone pole strapped to their back, stomach in, like that. Ever seen men walk? But, in their being tough what happens is they're really very vulnerable.
Who survives the car accident...the baby that's sleeping or the drunk? The people who get injured are the ones who see the accident coming and they try to...what? Control the outcome. What they needed to do was to go limp, because it is in their fluidity, see, that they have stability and strength and so it's an important life lesson that we have.
One of the things if you have an attacker, somebody who is going to come at you, what you can get into which is a very familiar family situation, it's called "a power struggle". And it looks something like this. They get into a discussion where who's in control and you say things like, "I'm the right person and you're the wrong person." Okay, you fight with me like that. I'm right, you're wrong. "I'm right, you're wrong." "No, no, no you're the most wrong person I've ever met in my whole life. How did I end up with such a wrong person?" "No, no no! You're the wrong person! I know you're wrong. I know it in here." Does that sound familiar?
There are whole marriages organized on that principal. And you see, what the martial arts teach is that if the person pushes and I don't push back, there is no battle. And in fact, if this person is attacking me, what the martial arts person does, is first of all get out of the way. I'm always going to end up looking from the vantage point of my attacker. Remember what I said to you about shifting perspective in the family. That's what a First Step is about. What is it like to live with me? What is it like to be around me?
What happens, however, is you don't have time or you can't get out of the way and so the person that's coming at you, for example, my therapist is he's coming at me and he's got this strength. So rather than getting into that power struggle, I come in and he wanted to go that way, I'll help him. I'm a good guy. He wanted to go that way. All right? Then he decides, no, he wants to pull back, he wants to go that way. That's fine because what I'll do is help him anyway he wants to go. Now, what's important about that is that as we do that, you see, what a therapist will do is people who live in the extreme like addicts and co-dependents, they'll do that kind of stuff because it's a little bit like creating a balance. He gets to be balanced by learning not to live in the extremes.
A great metaphor to use is to see what happens in families because families make kids crazy by putting them in what we call double binds. Which means you give a kid two choices -- both of them bad, wherever you go you have a bad choice. Therapists will do this to you, too. I'll tell you a secret on therapists. Whenever a therapist says, "Well, it seems to me you have two choices...", you know you're in trouble. The other thing that therapists do is they make it look like it just came out of their head. What you don't know is they just spent an hour and a half in supervision the day before figuring this out. They come out with this double bind...where you have a choice that you know you won't do and the other one is good for you. That's what they do.
It's important that we see that these basic things are very much part of the recovery process. This is why the difference works. If you think of imaging and what I said to you about imaging earlier, we do become our images. We've learned this in sports medicine. When somebody is to improve their sports performance what he or she do is they image themselves doing something different.
In management, it's more than management by objectives, it is a corporate vision. We've learned about self-fulfilling prophecies, especially in education, that if a teacher expects that students are going to do well and is confident of that, they will do well. They expect that they'll do poorly, that's what they'll do.
Now, if you think of recovery and you think of people and I'm sure that you've heard of people walking around and saying, "I don't know what they want. I don't think I can ever get this done." If they believe that, that is how it will be for them. Our images have the capacity, literally to bring on the reality. So, what we image out there for ourselves has a power to bring that reality forth. And, so we absolutely have to sustain our images and every martial arts artist knows that and visualizes themselves doing things. That is one of the ways that we change.
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