Final Research Project, Bates

Narrative and Myth-making Bates � of �1 20

Bates"IDS Capstone"IDS4934-14Summer CW01"Friday, July 18, 2014""Final Research Project: Narrative and Personal Myth-Making Within Alcohol and Drug Addicted Recovery Communities!"Section I - Introduction Stories of personal transformation are universal, grabbing our attention, not letting go.""Interestingly, in recent years, personal transformation through the retelling of the protagonist’s own story has become a major theme in works of literature, film and music; in these, characters don’t change because of external events, but because they come to see themselves in a new and different light… they retell their own stories and in so doing, transform. !"This storytelling motif — personal transformation as a direct result of narrative recreation — is a reflection of post-modern philosophy’s fascination with worldmaking and reification, and is the major theme of Shrek, The Musical. In Shrek, every major character (including the villain) play out this same plot, including the “Storybook Creatures” who open the musical, singing about how they “never get a fair shake:”""

“ Story of My Life,” Shrek: The Musical"[Guard] (Spoken)"Alright, when I call your name step forward. Pinocchio, the puppet.""[Pinocchio] (Spoken)"I'm not a puppet, I'm a real boy."(Nose grows and he laughs)""[Guard] (Spoken)"That's your patch of mud down there.""[Pinocchio] (Spoken)"Oh, dumped on a swamp. Man, I tell you sometimes being a fairytale creature sucks pine sap.""[Pinocchio] (Singing)"Life is disappointing,"Woe is what I know."Outed by my nose,"That's just how it goes,"For poor Pinocchio."Story of my life,"


Always doomed to fail."Cheated by a fox,"Swallowed by a whale."That's the story of my life, oh yeah,"That's the story of my life."(“Story of My Life” Cast)""

As the musical draws to a close, each and every character retells their own story — constituting many stories within a single story — and as a result, each knows happiness. They are engaging, on stage, in narrative reconstruction.""Among psychologists and mental health professionals, the idea of narrative therapy or narrative reconstruction is gaining momentum; among addictions researchers, it is an old topic, but one little understood; among philosophers, it is a post-modern thought, accepted by some, denied by others; among sociologists, it is still in the emergent phase. This simple idea is central to my research paper: how retelling stories can help people (in my example, men and women suffering from chemical addiction) to know happiness. ""Section II - Background/History Since its beginning nearly eighty years ago, Alcoholics Anonymous has assisted millions of alcoholics in redefining their life in such a way that they can reenter society. Similarly, Narcotics Anonymous does the same thing for its members. Both societies are involved in assisting their members to reformulate their life stories in such a way that hopelessness gives way to optimism, that past events are recast in the light of living with a progressive illness (not as a succession of moral failures) and that spirituality — an unclear term, never clarified —plays some part in the ongoing drama of life. These two groups have been studied widely, with mental health professionals, philosophers, sociologists, and many others analyzing the recovery process in an attempt to either supplant the twelve step method or to understand it better so they can assist those in process achieve successful outcomes. This goal is important, for among addicted and in recovery individuals, success is by no means guaranteed, as Ford Brooks, Jan Arminio, and Kadie-Ann Caballero-Dennis write in "A Narrative Synthesis Of Addictions, Surrender, And Relapse: Confirmation And Application:”""

…for every person entering recovery, there are ample numbers who still suffer or relapse despite monumental efforts to discontinue their use. This continues to pose important questions for addiction counselors; ‘‘What contributes to relapse?’’ and ‘‘How can potential areas of vulnerability to relapse be identified?” (Brooks et al. 376)""

As previously mentioned, one of the most interesting areas of inquiry to emerge in the last two decades regards narrative formation, the theory that as people recovering from addiction re-engage with society, they must (in order to be successful) learn to retell their stories — to reform their narratives — creating stability where before there had been none. Leading researchers have become convinced that somehow it is within this process, within this explanatory self-narrative, that addicted persons are able to achieve and sustain long-term sobriety as Katerina Flora writes in "Recovery From Substance Abuse: A Narrative Approach To Understanding The Motivation And Ambivalence About Change:”"


…narratives allow each individual to unfold one or more “explanatory schemas” concerning his or her recovery, giving meaning to the “painful” recovery process and to the forthcoming successful or unsuccessful therapeutic result. (Flora 313)""

This paper is an exploration of that process."

Section III - Justification of Interdisciplinary Approach “Narrative” is an intrinsically interdisciplinary term, used in multiple disciplines and in multiple ways. It can refer to the self/societally-constructed world (sociology), as narrative therapy (psychology), narrative medicine (addictions therapy), world-building formation and transformation (philosophy), and spiritual narrative-making (religion) among many, many others. No single discipline can hope to provide a complete understanding of the process or its application, none can even provide a universally applicable definition or circumscribe the entire scope of the research problem. While we accept that a generally accepted definition is impossible, for consistency, this study adopts Flora’s interdisciplinary definition: ""

A narrative contains facts that connect to a particular theme, unfolds in time, and has a certain plot. A story is presented as a chosen sequence of specific facts or circumstances that are more important or realistic than others. As the story unfolds, the narrator is called on to choose specific information that advances the story, as opposed to other information that will not.” (314 Flora)""

Since post-modern philosophy has had a tremendous influence on each of the fields considered throughout this research, it is important to note how that philosophy has contributed and changed the fundamental approach of various disciplines and scholars to the idea of narrative. ""Leading postmodern thinkers teach that humans are in a constant process of narrative-creation and re-creation. Nelson Goldman and Ernest Becker are two of the most influential of these voices, arguably the co-grandfathers of narrative theory. Becker was one of the first to claim that human realities were (and are) self-created, writing in The Birth And Death Of Meaning: An Interdisciplinary Perspective On The Problem Of Man that:""

The world of human aspiration is largely fictions, and if we do not understand this, we understand nothing about man. It is largely symbolic creation by an ego-controlled animal that permits action in a psychological world, a symbolic-behavioral world separated from the present moment… (Becker 33)""

A few years later, in Goodman’s groundbreaking work Ways Of Worldmaking, he describes the processes by which people create realities and narratives:""

Much but by no means all worldmaking consists of taking apart and putting together, often conjointly… of composition and decomposition, of weighting, of ordering, of deletion and supplementation, of deformation… insofar as a version [of the new world] is verbal and consists of statements, truth may be relevant. But truth cannot be defined or tested by agreement with ‘the world’; for truths differ for different worlds … notoriously nebulous. (Goodman 12, 14,17)""


While Goodman and Becker greatly added to the discussion, a still more important theory of postmodern thought was to come slightly later. This theory agrees that humans are in the process of world-building, true enough, but what makes the world-building and the associated narrative reconstruction so interesting is that the worldbuilders are intentionally unaware they are doing so. Intriguingly, this theory notes that the inhabitants of the newly created world — the new narrative — quickly forget the story now inhabited is one previously self-created. This concept — known as reification —is one of the most important and relevant contributions of post-modern thought to the question of narrative formation, especially within addicted communities. as Peter L Berger and Thomas Luckmann note in The Social Construction Of Reality: A Treatise In The Sociology Of Knowledge, writing that:!"

Reification is the apprehension of human phenomenon as if they were things, that is, in non-human or possibly supra-human terms. Another was of saying this is that reification is the apprehension of the products of human activity as if they were something else than human products… Reification implies that man is capable of forgetting his own authorship of the human woel, and further that the dialectic between man, the producer and his products is lost to consciousness. (Berger and Luckman 36-37)""

Narrative formation has thus trickled down from philosophical ivory towers and infiltrated numerous fields across disciplinary boundaries. ""The interdisciplinary foundation for this research paper is therefore the following: men and women — in our case, men and women in recovery from addiction — are unaware that the narrative structure imposed upon their lives has the power to create or deny potential for happiness and fulfillment, that the stories they tell themselves either contribute to or diminish basic human flourishing. Nowhere is this relationship between narrative and outcome more clearly seen than among those addicted to chemical substances, for a poorly formed narrative can lead to jails, institutions, and even death. ""Addiction is a subject studied by almost every major discipline: from biology to governmental affairs, from criminology to sociology, from psychology to religion, it seems that everywhere one looks there is yet another voice with a slightly different view, a new set of terms, a new set of theories, a new set of, well… everything. This research paper seeks to help those disciplinary voices to sing in chorus, at least for a short while and perhaps only on a single topic. ""But sing they shall.""Section IV - The Most Relevant Disciplines The major disciplines I consider in this paper are psychology, addiction therapy, sociology, philosophy, and religion. Among these five disciplines, there is no single understanding of narrative formation, even among the disciplinary “masters” of each; in fact, there is rarely broad agreement. ""Our pressing problem is, in part, because there is no consensus. For example, within psychology, there is a broad understanding that some sort of spiritual experience is necessary for recovery from addiction to have any lasting effect. Psychologists are happy to put together


measuring tools to quantify self-reports (Hill and Pargament 3; Rowan et al. 81) but, strangely, are resolutely loathe to define this “thing” they’ve determined absolutely necessary. ""Further, Gabriel Segal has done excellent work studying the “disease model” of alcoholism and addiction, unearthed major problems on both sides of the debate. In her work "Alcoholism, Disease, And Insanity” in the quarterly Philosophy, Psychiatry & Psychology Segal describes one of the biggest challenges of quantification: some men and women fit the diagnostic criteria for a lifelong mental health disease, a progressive decline further down the slope towards “insanity and death” and others — people who had fit the same criteria on a given date in their past— later? They simply don’t. ""Another example of disciplinary confusion: within sociology, spirituality is discussed at length — Spiritual but not Religious groups are the fastest growing segment of the religious population and an area of endless fascination to Sociologists of Religion— but no one has been able to lay out a single definition about which there can be consensus, no single definition others within the field can agree on (Zinnbaur et al. 549; Chalfant 115). Such sociologists investigate the social dimensions of addiction and crime as well as the twelve step groups that support the addicted, but as far as investigating the spiritual narrative of the individual members of those groups? Not yet. ""The disciplines this paper focuses on each have in common a post-modern fascination with narrative and narrative creation as a discovery of meaning. I am investigating the relevant issues, the interaction and potential integration of key theories, and the ways and means by which narrative creation can promote both an initial adoption of a recovery lifestyle and the sustaining of that lifestyle over an extended period of time."

Section V -Literature Review Insights

From Psychology: ""The Experience Of Addiction As Told By The Addicted: Incorporating Biological Understandings Into Self-Story.”!"An interdisciplinary team worked together to write the first article reviewed for this paper; "The Experience Of Addiction As Told By The Addicted: Incorporating Biological Understandings Into Self-Story,” published in Culture, Medicine & Psychiatry. It was authored by Rachel Hammer of of the Mayo Medical School and of Seattle Pacific University along with M. J. Dingel of the University of Minnesota; J. E. Ostergren, and K. E. Nowakowski, both of the Mayo Clinic Biomedical Ethics Research Unit; J. E. Ostergren, of the School of Public Health at the University of Michigan; and finally B. A. Koenig, of the Department of Social and Behavioral Sciences at the Institute for Health and Aging, at the University of California.""The researchers were attempting to discover how self-narrative changes and alters when the narrators are exposed to formal theories about their condition. Their interest revolved around the many ways that addiction is understood (as a brain disease, as a social-constructed illness, as a psychological, physiological problem, as a sin — a moral


failure of the deepest variety — and in terms of the AA model, the adaptive/constructionist model). In the process, the researches wanted to""

…explore how people who are addicted view their addiction against the framework of formal theories intended to explain their condition.…[adding]to the ‘‘cultural stock of stories’’ that narrate the problem of addiction… (Hammer er al. 714)""

To accomplish this, they interviewed 63 people at five treatment centers. This was followed by close narrative analysis. Though the researchers were aware that utilizing test subjects indoctrinated by their rehab into a “disease model” would tilt their research, they proceeded anyway and rectify the situation (to an extent) by finding ""

…treatment sites varied in their approach to substance use. Most offered a combination of group or individual therapy sessions and pharmacological treatments, including methadone and drugs such as acamprosate and nicotine replacement therapy. Several programs used audiovisual aids or treatment strategies that emphasized the biological components of addiction. One used a brief educational film that highlighted the disease model of addiction; a second treatment site included a large display of living zebra fish used to study the genetic basis of nicotine addiction. ( Hammer et al. 719)""

Their main curiosity was in how patients “buy into” the narrative model taught at their respective rehabs, rather than how patients build their own (the adaptive/ constructionist model). This portion of the research yielded predictable results. When patients were not given the opportunity or support in forming their own narratives of what happened and why, they merely adopted the philosophical stance of their treatment center:"

Treatment centers employ their own dominant narratives in explaining addiction, and clients’ frameworks for understanding addiction are shaped by the language and ideology of their treatment milieu. Our participants who spoke of addiction with a genetic/biological understanding were primarily, but not exclusively, under treatment in two treatment centers that explicitly teach a biological model of addiction as part of treatment.…Or to the contrary, if focused inordinately on the psychosocial narrative, a treatment center may overwork to re-author a personal narrative or improve the quality of family dynamics as the solution for addictive behaviors, and possibly underestimate the extent to which the substance use has re-authored the physiology of the patient.” (Hammer et al. 729)""

However, this was not a long-lasting narrative and rarely was sustained once the patient left the rehabilitation center. To the researcher’s surprise, they discovered that while the treatment patients receive at a given treatment center does highly contribute to the style of narrative that they assume, it is by no means the only contributing factor, nor necessarily the most important:""

People bear templates of DNA and experiences alike whereupon the epiphenomena of their unique biochemistries, cultures, and willful souls are entangled. Just as geneticists and molecular biologists labor to witness the patterns and anomalies written in the


libraries of genomic testimony to being, so clinicians and therapists witness the motif and novelty in their patients’ accounts of illness—accounts told, imaged, and assayed.” (Hammer et al. 730)""

All of this leads the authors to suggest research and treatment professionals stop attempting to find a “grand, unified theory” of addiction and move towards narrative-based medicine, one in which the patient’s OWN understanding of their condition is the basis for ongoing interaction. In other words, they suggest addiction professionals adopt the adaptive/ constructionist model of used in Alcoholics and Narcotics Anonymous.""“What Is Narrative Therapy And What Is It Not? The Usefulness Of Q Methodology To Explore Accounts Of White And Epston's (1990) Approach To Narrative Therapy.”!"The second paper reviewed for this project was not interdisciplinary, but rather written by a team of clinical and research psychologists composed of Jennifer Wallis, of Berkshire Healthcare National Health Service Foundation Trust; Jan Burns, of the Department of Applied Psychology, Salomons Campus, Canterbury Christ Church University; and Rose Capdevila, Faculty of Social Sciences, The Open University.""The researchers were seeking to understand how the oft-contested field of narrative therapy and medicine were practically utilized. They surveyed hundreds of practitioners and came to the conclusion that there exists no dominant model, no pervasive understanding to analyze, probably, they theorize, because:""

Research into narrative therapy is at a comparatively embryonic stage. Few studies exist that would be considered as ‘good’ evidence for the effectiveness of narrative therapy within the traditions of therapeutic outcome research. Some of the reasons for this may relate to the type of research valued by narrative therapists and problems with positivist ‘evidence-based research’. ( Wallis et al.488)!"

The working definition for narrative therapy they conclude with will be the basis for understanding throughout the rest of the paper, but it is important to note that even when good researchers attempt to understand how psychologists understand narrative therapy, they come up confused at best. This article demonstrated that within the discipline of psychology, different researchers have come to a confused blend of conclusions. Some are convinced that stable narratives are important and that narrative-based therapy plays some part in effective treatment. The working definition we will follow is:""

“… ways of understanding the stories of people’s lives, and ways of re-authoring these stories in collaboration between the therapist / community worker and the people’s whose lives are being discussed. It is a way of working that is interested in history, the broader context that is affecting people’s lives and the ethics or politics of this work.” (Wallis et al. 488)""

However, these ideas are not universal. Wallis and her team unearthed the uncomfortable reality that all who practices “narrative therapy” have a slightly (or vastly) different way of doing so:"

Narrative therapy and how it is carried out remain unclearly defined, which limits studies of the efficacy of this approach (Wallis et al.486).This study also illustrates a pluralism


that has influenced the debate around ‘what is narrative therapy’ for some time.(Wallis et al. 495)”""

The authors do little more than prove no one is entirely sure what they are doing when they engage in “narrative therapy.” Therapists and social workers have so many different ways of understanding their treatment modalities that cohesiveness within the single sub-sub discipline is impossible.""“Recovery From Substance Abuse: A Narrative Approach To Understanding The Motivation And Ambivalence About Change.”!"The last article written from a mainly psychological approach comes from Dr. Katerina Flora, a a clinical psychologist, professor and researcher at the Panteion University of Social and Political Studies in Athens, Greece.""Flora interviewed 46 clients (a relatively tiny sample) at a single rehabilitation facility outside of Thessalonica, Greece and then two people analyzed the data, searching for trends, interpreting it with a great deal of subjectivity:"

Analysis centered around the structure, plot, and main concept of the narrative, with particular attention paid to tone, any pauses, the arguments developed, and the general tenor with which the interview was conducted. (308)""

In all this, Flora’s operating philosophy is that narrative is deeply involved in adaptive/constructionist interaction. On this, Flora writes that:""

The primary function of narrative is to turn disorder into order. By telling a story, the narrator tries to organize the narrative to convey a message; that is, the meaning of the story. The actual process of putting things in order is completed through organizing a series of events in a plot. (Flora 307)""

The author illuminates the central role of narrative transformation in long-term, stable sobriety, proving that:"

“…narratives allow each individual to unfold one or more “explanatory schemas” concerning his or her recovery, giving meaning to the “painful” recovery process and to the forthcoming successful or unsuccessful therapeutic result.” (Flora 313)""

While Hammer et al. provided us with a working definition of narrative therapy, Flora provides us with a working definition of Goodman-style, worldbuilding narrative:"

“A narrative contains facts that connect to a particular theme, unfolds in time, and has a certain plot. A story is presented as a chosen sequence of specific facts or circumstances that are more important or realistic than others. As the story unfolds, the narrator is called on to choose specific information that advances the story, as opposed to other information that will not. The main goal is …for the clients to discover for themselves through conversation the hopes, desires, and so-far-unidentified potential hidden in their past stories… the “revision” of the stories and the lives of people.” (Flora 314)""


From Addictions Research and Studies ""A Narrative Synthesis Of Addictions, Surrender, And Relapse: Confirmation And Application."!"The authors come from the disciplines of education (Brooks) and psychology (Armino). Prior to their research, they conducted a thorough literature review of extant material before embarking on their study, a standard narrative analysis with multiple levels of double-checking for accuracy and agreement. This research had two working assumptions: the individual narrative is always in the process of change (because people don’t stay the same) and, like Flora, they assumed the postmodern concept of narrative construction rather than reflection of objective truth:""

We elected to illuminate the experience of surrender via narrative research partly because it assumes that people are always in the process of change. Surrender too assumes change. Also, we selected this methodology as it is appropriate for listening to previously silenced, oppressed, and ordinary voices that we believe people with addictions are. Narrative researchers, ‘‘make themselves as aware as possible of the many, layered narratives at work in their inquiry space. They imagine narrative threads emerging.” Aspects of these layers include how speakers construct events through story telling; they do not simply retell events. ( Brooks and Armino 379)""

The authors did not present contrary positions or refute possible objections. Instead they focused on one type of addiction narrative to the exclusion of all others. This biased understanding of addiction resulted in only one kind of narrative being considered, one the authors termed the “grand narrative,” proving that identity development and associated narrative transformation are necessary ingredients in long-term recovery, writing that: “What is helpful for clinicians to realize is how powerful the cognitive distortions are and the impact it has on identity and self-worth” (Brooks and Armino 386).""All of this is important, the author’s contend, because the adaptive/constructionist model indicates narrative-building as an important part of stability in recovery:""

For those who chronically relapse, the narratives illustrated how the unconscious aspect of denial returns so insidiously and surreptitiously so as to not be detected by the addicted person. ( Brooks and Armino 387)""

"De Profundis: Spiritual Transformations in Alcoholics Anonymous."!"Alyssa Forechimes is professor of Psychiatry at University of New Mexico and a practicing psychologist with expertise in empirically supported clinical treatment. Her research focuses on behavioral treatments for addiction including motivational interviewing and other brief interventions; effective methods for disseminating and teaching evidence-based behavioral treatments for addiction, mental health, substance abuse, and health care providers. In De Profundis, Forechimes is analyzing the process that twelve step programs provide their members for attaining narrative self-transformation.""Forechimes doesn’t spend much energy or ink considering those who deny the reality/ efficacy of the spiritual experience. For the author, is enough that the addicted person believes. She


assumes that the goal of narrative medicine, therapy, and analysis is to help the addicted person to reformulate their life story through adaptive/constructionist means, preferably through the mechanism of twelve step recovery groups.""This process, which Forechimes claims is absolutely vital for stability in recovery, she has has named De Profundis; latin for “out of the depths.” She describes it as both a process and an explanation:"

The sequence offered describes how spiritual transformations transpire. The sequence begins with hitting bottom, recognition of inability to control the problem. A feeling of contrition follows, describing not only sorrow for the present state, but also desire for a new way. The final step is the act of surrendering one’s will to a higher power. The de profundis sequence sets the process of spiritual transformation in motion, offering stabilization to sobriety. (Forechimes 511)""

In all this, Forechimes is not attempting to prove that the spiritual narrative described in the De Profundis Sequence is objectively true, but rather demonstrates through case history and interview that it must be believed to be true for the alcoholic/addict in recovery to maintain anything like long-term sobriety. It is yet another example of narrative formation and reformation, with acceptance. She pulls the disparate threads of the psychologists already discussed together, writing that:""A.A. teachings acknowledge that alcohol recovery is not defined by abstinence; recovery is defined by a transformed and sober life. Perhaps spiritual transformations are the distinguishing factor between abstinence and sobriety.... These discrete, life-changing spiritual-transformation experiences deserve to be understood more completely because they seem to reveal the innermost workings of what makes A.A. such a successful program. Sobriety is intertwined with spirituality in a way that necessitates a spiritual transformation for successful recovery. In a profound realization, one recovering alcoholic admitted, “I came here to save my ass. And then I found out it was attached to my soul. ( Forechimes 516).""From Philosophy and Religion "Taking Mentality Seriously: A Philosophical Inquiry Into The Language Of Addiction And Recovery." ""Allison Mitchell, writing in Philosophy, Psychiatry, & Psychology, takes the opposite view of Forechimes. She is a philosopher with a strong interest in Wittgenstein and narrative formation, though I could find no other credentials. She is included in this portion of the research for the sake of intellectual honesty. My own bias became apparent quickly while reviewing her contribution for she seems to demonstrate a lack of understanding about both the mechanism of addiction and the process of addiction therapy. She steadfastly refuses any process that involves either a De Profundis-style search for narrative reformation utilizing a spiritual approach, nor the surrender and adaptive/constructionist approach suggested by Armino and Brooks. ""Instead, she assumes a moral/ cognitive orientation of full responsibility, writing that:"

“…the thought and behavior involved in drug dependence is associated with a certain pre-theoretic conception of the self that finds philosophical expression as


a grossly simplified form of materialism. Addicts tend not to take mentality seriously: They do not understand themselves as minded beings capable of self-awareness and development through intentional action. Recognizing the practical implications of accepting this philosophically unconvincing view, I argue, encourages a modification of self-conception that is instrumental to the process of recovery from addiction.” ( Mitchell 211)""

This, of course, is a gross misunderstanding of addiction as a mental disorder and reveals a bias against twelve step programs. That bias becomes clear when she reaches the conclusion of her paper, in which she suggests that the recovery community develop their own system of twelve step programs that eliminate the need for the De Profunids sequence, surrender and spirituality in general, though she admits such programs are “practically effective” (Mitchell 219).""Why revise something that is “practically effective?” Because, she writes, that even if it is unclear that such things are workong, it is better that other, unproven, untested opportunities are tried (as long as they don’t include elements she finds objetctionable:"

“Consider the following reasons we may want to proceed with such modification: First, revising the language of the twelve-step process will enable us to develop an alternative picture of rehabilitation and thereby appreci- ate the multiplicity of possible recovery routes. Second, twelve-step programs leave little space for individual creativity in the modification of self-conception; they picture “the addict’s nature” and then attempt to persuade those individuals to accept the aptness of that picture. (Mitchell 220)""

Had Mitchell focused on gaining greater understanding of narrative through Wittgensteinian analysis, much could have been gained, her world could have been a valuable source of insight were it not for her insistence that:""

“If we accept the same starting point as the twelve-step programs, we may gesture toward an alternative picture of recovery that does not require the renunciation of autonomy or agency and need not invoke the notion of a higher being.” ( Mitchell 221)""

Mitchell tells us more about herself —and her own refusal to accept another’s narrative — than she does about either narrative therapy within addictions recovery or the meaning-making power of narrative."""The Truth Will Set You Free, Or How A Troubled Philosophical Theory May Help To Understand How People Talk About Their Addiction.”""Patricia Ross is Clinical Pharmacy Specialist in Ambulatory Care and Anticoagulation Management; Adjunct Assistant Professor, at the University of Maryland School of Pharmacy, and writes widely on issues of philosophy and medicine. Her contribution also appeared in Philosophy, Psychiatry, & Psychology.""The author is critiquing a view commonly held: that a story told indicates a story believed, commonly known as the Wittgensteinian Analysis, such that:""


“…every act of self-expression, whether it is verbal or written narrative, reveals something about the conceptual framework with which the author is working. Thus, one can learn about the author of a narrative—one can acquire a sense of how that individual conceives of him- or herself—by looking at the language that is employed to talk about and describe him- or herself.” ( Ross 228)""

She challenges the view based on the fact that much of the language used in narrative expression is assumed from culture and environment, and is used sub- and un- consciously.""Whereas some attempt to teach addicted individuals to see themselves (to tell their story, their narrative) through the lens of strict material philosophy — a view that says the material world is the only real one, behavior is explainable in mentalistic terms, etc — Ross is interested in finding the stories addicted people are already telling themselves. This interest comes from Ross’ assumption that right knowledge does not indicate right action. ""

The first aspect relies on the belief that conceptual change—believing the right things—will change one’s behavior. But this is a problem that is considered in great detail in moral philosophy, as well as being a well-studied aspect of human psychology. In particular, empirical research has shown that beliefs (either currently held beliefs or newly accepted beliefs) do not necessarily provide motivation for action.Counseling intervention that relies entirely on altering the prejudice individual’s beliefs is ineffective. (Ross 230)""

Ross agrees with Martin Weegman and Ewa Piwowoz-Hjort; she believes that narratives are written backwards, not forwards. Powerful, life-changing narrative structures are formed after the events: behavior comes before conception, not conception before behavior: ""

It seems that only when the addiction is not in control of one’s life that one can begin to alter one’s self-conception, especially in terms of autonomy. Thus, any intervention that requires a conceptual change before a behavioral change seems doomed to failure. Therapeutic intervention must first stop the behavior, and as a result of that begin to develop a different self-conception. ( Ross 231)""

In this, Ross is communicating the same ideas as many of the psychologists and all of the addiction researchers, just using different words. She is saying that narratives are constructed and that through this process of worldbuilding, the addicted person can adopt a new way of living, one without the use of alcohol or drugs."""Refuat Ha-Nefesh U’Refuat Ha-Guf: Spiritual Dimensions Of Addiction Recovery.”!"Richard L Eisenberg was a rabbi for 25 years before switching careers and devoting himself to drug and alcohol recovery counseling. His work is scholarly and peer reviewed, with multiple references from Jewish religious thought and society, addiction treatment, the source texts of AA and NA, and philosophy.""Though Eisenberg is somewhat biased (he recounts the story of how his brother’s addiction played a key role in his career change) he attempts to integrate Jewish religious thought with the philosophical tenants of AA, NA, and recovery therapy. As such, his paper is intrinsically interdisciplinary."


"Eisenberg contrasts sharply with thinkers in the vein of Allison Mitchell, who believe that the purpose of addictions therapy is to correct the incorrect thinking of alcoholics and addicts, moving them from the idea that they don’t have control over their substance abuse to a new model which says they do. This educational model is parallel to the moral model, which Eisenberg describes as:""

“The moral model of addiction can be understood as “the belief that people abuse alcohol [and other drugs] because they choose to do so.” This approach implies that chemical dependents, by abusing drugs, are choosing an immoral path that causes harm to themselves and the people within their familial, social, and professional networks. The moral model causes negative and unproductive attitudes toward the addict. A well-meaning family member or friend might say, “You’d be sober if you only tried harder.” This type of statement reflects an attitude that places blame and moral judgments upon the addicted person…. it is my view that our attitudes about addiction, as long as they remain morally based, weaken our ability to be truly helpful to chemical dependents. This holds true for family members, friends, and professionals alike. (Eisenberg 95-96)""

Eisenberg adopts an interdisciplinary approach, believing that: “Understanding chemical dependency as a biopsychosocial phenomenon also helps frame the way we apply Jewish concepts and values to our discussion of addiction recovery” (97). This is key. He expands definitions and concepts, so that one can be understood in the light of the other.!Eisenberg identifies four important concepts from the Jewish religio-spiritual tradition to frame and understand concepts from the twelve steps of recovery. The author believes that it is in learning to tell the story of addiction and recovery through this new language (using new words with altered and expanded definitions) that integration and ultimately, greater health and success is found. The last two paragraphs of his essay demonstrate how he accomplishes this herculean task in his own interdisciplinary effort at seeking answers:""

“Finally, the deep humility that comes from one’s feelings of powerlessness—over the drug, over other people, over changing the past—is the emotional predisposition that leads to enlightenment. Walking humbly with God is the way the person recovering from addiction or co-dependency retains a hold on Eternity…. This trust in turn engenders faith, hope, and love. The person of faith enters the gates of Eternity, the light of spiritual truth, through his disposition of humility. It is no different for those of us who are in recovery. As we are continually reminded of our powerlessness in Step 1, we develop the need to fully trust in our Higher Power in Steps 2 and 3, a trust that keeps us fastened in the Now and deters us from dwelling on a troublesome past and an uncertain, possibly worrisome future. One day at a time, we find that our faith, hope, and love of God and one another keeps growing. As we journey along the road of recovery, we know that the disease of addiction no longer has power over us; rather it is the power of the Eternal that sustains us, strengthens us, bears us through our days of darkness and lovingly carries us into light, faith, and serenity.” (Eisenberg 103-104)""


Eisenberg is himself a case study in narrative reconstruction and reformation, in worldbuilding and reification: he has redefined the limits of his existence and history using the language of the helping profession and within the confines of his chosen spirituality.""It was quite beautiful.""From Sociology "‘Naught But A Story’: Narratives Of Successful AA Recovery."""It is appropriate to end this disciplinary exploration within the field I am most comfortable: sociology. ""Authors Martin Weegman, an addictions professional and psychologist at Queen’s Mary Hospital and Ewa Piwowoz-Hjort, a sociologist at Sundbyberg University in Stockholm, Sweden, base their research style and methodology from a viewpoint — an interdisciplinary space — between three disciplines: Sociology, narrative psychology, and addiction treatment and medicine. They describe their methodology as as:""

Interpretive phenomenological analysis (IPA)… performed on nine transcribed interviews of participants who were continually sober from alcohol/drugs for a minimum of nine years (abstinence mean = 14 years). The method was used to discern themes and identify the concepts of recovery [that the]…participants had found helpful. (Weegman and Piwowoz-Hjort 273)""

The authors make a number of assumtions. They assume that all humans are meaning making, story making animals and that those stories have the power to alter individual enjoyment of life, that those stories are in the constant process of revision, and that revising process can be facilitated through the adaptive/constructionist model of therapy:"

Narrative psychology suggests that such appraisals are not merely cognitive re- adjustments or epiphenomena, but help to ‘make up’ people, so to speak, implicating subjects in new forms of identity and trajectories. Narrative approaches can consider not only the individual, idiosyncratic story but how stories deploy and incorporate pre-existing discursive resources and traditions. Hence, such approaches are a potentially strong analytic resource, allowing an in-depth understanding of both the idiosyncratic and culturally constructed aspects of a person’s story and self-account. (Weegman and Piwowoz-Hjort 274)""

Once again, we witness proof that humans write stories backwards - the maps are formed after the events that they describe:""

Most participants spoke to a distinction between admitting problems around their drinking and lives and an emotional, attitudinal shift which involved a deeper process of ‘acceptance’. Paradoxically, for these people, it could be said that they were becoming alcoholics in the act of stopping, which enabled them to re-appraise their pasts. In describing a kind of gateway to recovery, one person re-construed her ‘rock bottom’ from a ‘negative, cracking-up experience’ into ‘the positive beginning of my experience’. (Weegman and Piwowoz-Hjort 277)"


"In their conclusion, Weegman and Piwowoz-Hjort explain their discovery: stories and story formation, of narrative construction and reconstruction demonstrated by addicts and alcoholics are typically more “extensive and elaborate” than in the non addicted population. This greater level of “sophistication” may provide a valuable glimpse into the myth-making process:""

Life stories express a sense of who we are, of identity in the making, the where we have ‘come from’ to the where we have ‘got to’ … [the narratives] are revisable and tell a great deal of our connections or group-self, to those sustaining others and networks upon who we depend. Previous research has addressed the link between ‘coherence’ and recovery… The stories thus suggest that in order to get going on the way to recovery, people need to form a credible model of their problems, which can be used to guide their attempts at recovery. (Weegman and Piwowoz-Hjort 280)"

Section VI - Identify conflicts Within Psychology:""It is evident that, as far as disciplinary unity is concerned, mental health researchers have arrived at the greatest number of conflicting conclusion and subsequently proposed an immense number of conflicting theories. This is due, in part, to the evolving nature of the discipline and in part on the multivariate nature of the disease, effecting (as it does) the individual on physical, emotional, psychological, mental, and societal levels. Some mental health professionals — though by no means all — have noticed the following as significant: the most consistent members of long-term recovery have some sort of spirituality at the center of their narratives, though there is no consensus on how this preferred state can be facilitated and no generalized acceptance that spirituality (whatever that means) is to be desired or sought. The mental health researchers considered stress the wide variety to be found in narrative formation and subsequent analysis, coming to the conclusion that there are lots of stories being told and as a result, are unable to chart a course forward: ""

Experiences are the human conduit for affiliation, and though in this paper the experiences as told by the addicted may seem disorderly or in disagreement with one another, perhaps this is an important aspect of addiction that should not be glossed over in favor of a unified framework. Addiction is protean, such that if we try to reduce its character to one nameable form, with one ‘‘unified theory,’’ we will have failed to address it in its entirety.” (Hammer er atl. 732, italics added)""

Within Sociology:""Within the discipline of sociology, disagreements are few because research is scant. However, the small amount of work that has been completed supports a theory of narrative construction that sees positive attributes in formerly negative situations, sees the addictions professional as one who helps the addicted to formulate a new way of seeing the past — of recognizing within past events a glimpse of an alcoholic/addict history — and generating hope for the story by recasting the patient in the role of hero as opposed to victim. Sociologists, of course, can always find someone within the field of psychology/psychiatry to be in conflict with.""


Of course they can; the entire discipline is suffering multiple personality disorder on this issue.""Within Philosophy/ Religion"" "Like Psychology, within the ranks of philosophers, one finds a multiplicity of voices. This is to be expected, as the essay by Allison Mitchell demonstrates. The field is full of researchers and thinkers more concerned with the ethics of suggesting a “higher power” and a “spiritual way of thinking about their stories” than the efficacy of doing so. Indeed, a good example is Mitchell’s essay; a third of her paper devotes itself to why she feels addictions professionals should eschew a successful approach in order to avoid ideas she finds distasteful. Other Philosophers and religious leaders have no such qualms and focus on the universal nature of spiritual journey narratives, agreeing with most of their fellows, most sociologists, and again, a segment of the psychologists."

Section VII - Common Ground Addictions research was not listed in the previous section because in terms of disciplinary conflict, there is not much internal/ external disagreement. Why? Addictions Research is inherently an interdisciplinary field, with voices from the other disciplines already considered, present and speaking with one another. ""Within the ranks of Addictions Research we find the beginning of what might be termed interdisciplinary common ground: agreement that narrative re-formation is an important part of long-term recovery (a therapized version of Goodman’s worldmaking), an assumption that these narratives need to contain elements of victim-to-victor transformation, as well as a significant spiritual element. This is not to suggest that there is no conflict.""Addictions Research begins with an acceptance of the disease model of addiction and an acceptance that for whatever reason the twelve step model of narrative transformation works. When other disciplines challenge either the first or second assumption, conflicts arise, in part because Addictions Researchers are more familiar with the efficacy of both systems of thought and are “boots on the ground,” utilitarian in their outlook."

Section VIII - Interdisciplinary Understanding Two things became clear during the research process:""While broad agreement exists that narrative reconstruction is important, the ways and means people go about doing so is little understood and for this reason, any further research must begin by looking to this vital issue. It is clear that all people (both within and without the addiction community) are involved in retelling their stories; how do they go about doing so? The disciplinary approaches of Narrative therapy, narrative medicine? These fields of inquiry are sure to yield interesting results that could then be incorporated into a broader schemata. The primary disciplines must do more research before secondary interdisciplinary study has much chance of being effective.""Likewise, it is clear that twelve step programs — in some unidentified way — facilitate narrative reconstruction. Some call the process adaptive/ constructionist interaction/therapy, though that designation is neither clearly defined nor widely accepted."


"Here, an entire range of things are yet to be found and studied. How do the twelve steps of AA or NA contribute to (or force) the reconstruction of narrative and thus, identity? Is it the process or the community or some combination of both? Do rehabilitation facilities support or interfere with the process and in what ways? These are areas of study that would need to be explored for any significant interdisciplinary contribution to be found.""What this paper has made apparent is that narrative reconstruction can lead to wholeness, can lead to healthy lifestyles, can lead to human flourishing and successful relationships. For by transforming our stories, we — in some unknown way and by some unknown mechanism — transform ourselves.""Conclusions!We began by considering Shrek, The Musical.!"It will be remembered at the beginning of the plot, every major character in Shrek is suffering because how they are understanding their own stories — Shrek is convinced that ogres can’t be happy because that’s just the way it is, Fiona is convinced that the only real romance is the one that conforms to the picture that she has been told and has believed, the “storybook creatures” are convinced that they are doomed to a life of suffering because “that’s what fairytale creatures do; We wish upon a star…”""The last scene of the musical is a demonstration in Goodman-style worldbuilding, in narrative reconstruction and in retelling; Shrek doesn’t have to be lonely. Fiona doesn’t have to have Prince Charming. The storybook creatures don’t have to accept abuse.""All of this happens —comedically and naturally —through a process of challenge and adaption to new circumstances. Within the lyrics we can easily find a beautiful picture of narrative reconstruction. ""Goodman would have loved it.""“This is My Story,” Finale to Shrek, the Musical!"[Fiona]"I waited all my life, lived it by the book,"Now I know that's not my story."You take me as I am, love me as I look,"Standing here in all my glory.""I am sweetness, I am bratty;"I'm a princess, I'm a fatty;"I'm a mess of contradictions in a dress."I am sassy, I am sappy;"When I'm with you I am happy;"This is my story.""


[Shrek]"You laugh at all my jokes even though they're crude,"You don't mind that I'm not classy."We make a perfect pair, radiant and rude,"So in love and much too gassy.""[Both]"We are ogres, we are scary.""[Cast]"We are donkeys, we are hairy."We have bold and brand new stories to be told."We will write them, we will tell them;"You will hear them, you will smell them."This is our story.""( Cast “This is Our Story”)"""""""""""""""""""""""""""""""


Works Cited Becker, Ernest. The Birth And Death Of Meaning: An Interdisciplinary Perspective On The Problem Of Man. (2nd Ed.). New York, NY, US: Free Press, 1971. Print. ""Berger, Peter L, and Thomas Luckmann. The Social Construction Of Reality: A Treatise In The Sociology Of Knowledge. New York: Doubleday, 1966.""Brooks, Ford, Jan Arminio, and Kadie-Ann Caballero-Dennis. "A Narrative Synthesis Of Addictions, Surrender, And Relapse: Confirmation And Application." Alcoholism Treatment Quarterly 31.3 (2013): 375-395. PsycINFO. Web. 1 June 2014.""Cast Recording. “Story of My Life.” Shrek: The Musical. Comp. Tesori, Jeanine; Writ. David Lindsay-Abaire; Directed: Jason Moore. Dreamworks. 15 Oct. 2013. DVD.""Chalfant, H. Paul. "Stepping To Redemption: Twelve Step Groups As Implicit Religion." Free Inquiry In Creative Sociology 20.2 (1992): 115-120. Print.""Eisenberg, Richard L. "Refuat Ha-Nefesh U’Refuat Ha-Guf: Spiritual Dimensions Of Addiction Recovery." Conservative Judaism 1-2 (2009): 94. Project MUSE. Web. 14 July 2014.""Flora, K. "Recovery From Substance Abuse: A Narrative Approach To Understanding The Motivation And Ambivalence About Change." Journal Of Social Work Practice In The Addictions 12.3 (2012): 302-315. Social Work Abstracts. Web. 14 July 2014.""Forcehimes, Alyssa A. "De Profundis: Spiritual Transformations in Alcoholics Anonymous." Journal of Clinical Psychology 60.5 (2004): 503-17. Web.""Goodman, Nelson. Ways Of Worldmaking. n.p.: Hassocks [Eng.] : Harvester Press, 1978.""Hammer, Rachel, et al. "The Experience Of Addiction As Told By The Addicted: Incorporating Biological Understandings Into Self-Story." Culture, Medicine & Psychiatry 36.4 (2012): 712-734. Academic Search Premier. Web. 14 July 2014.""Hill, Peter C., And Kenneth I. Pargament. "Advances In The Conceptualization And Measurement Of Religion And Spirituality: Implications For Physical And Mental Health Research." Psychology Of Religion And Spirituality S.1 (2008): 3-17. Web.""Mitchell, Allison. "Taking Mentality Seriously: A Philosophical Inquiry Into The Language Of Addiction And Recovery." Philosophy, Psychiatry, & Psychology 3 (2007): 211. Project MUSE. Web. 14 July 2014.""Ross, Patricia A. "The Truth Will Set You Free, Or How A Troubled Philosophical Theory May Help To Understand How People Talk About Their Addiction." Philosophy, Psychiatry, And Psychology 13.3 (2006): 227-231. Philosopher's Index. Web. 14 July 2014.""Rowan, N. L., et al. "The Higher Power Relationship Scale: A Validation." Journal of Social Work Practice in the Addictions 6.3 (2006): 81-95. Web. ""


Segal, Gabriel M. A. "Alcoholism, Disease, And Insanity." Philosophy, Psychiatry & Psychology 20.4 (2013): 297-315. Academic Search Premier. Web. 1 July 2014""Wallis, Jennifer, Jan Burns, and Rose Capdevila. "What Is Narrative Therapy And What Is It Not? The Usefulness Of Q Methodology To Explore Accounts Of White And Epston's (1990) Approach To Narrative Therapy." Clinical Psychology & Psychotherapy 18.6 (2011): 486-497. CINAHL Plus with Full Text. Web. 14 July 2014.""Weegmann, Martin, and Ewa Piwowoz-Hjort. "‘Naught But A Story’: Narratives Of Successful AA Recovery." Health Sociology Review 18.3 (2009): 273-283. Academic Search Premier. Web. 14 July 2014.""Zinnbauer, BJ, et al. "Religion And Spirituality: Unfuzzying The Fuzzy." Journal For The Scientific Study Of Religion 36.4 (n.d.): 549-564. Arts & Humanities Citation Index. Web"

Final Research Project, Bates

Documents

Transcript of Final Research Project, Bates