Tuesday, December 19, 2006

Why the "why" of addiction may not matter

Knowledge of the psychological "why" behind a behavior such as addiction may be neither possible nor useful, suggests psychiatrist Sally Satel in a thought-provoking essay in today's N.Y. Times.

Memories of childhood are notoriously unreliable, Satel points out, and one's effort to construct a chain of causation from a childhood event, such as the death of a parent, to a present behavior such as addiction, is likely to be a patchwork of guesses, speculation, and invention.

Moreover, she says, even a plausible story of psychological causation rarely changes current behavior. Satel has known many patients who continued in their addiction despite having an "aha" moment about the psychological origins.

In some patients, the quest for "why" serves to delay the hard work of making changes in current habits, relationships, and patterns of behavior, Satel says. The priority should be on changing current behaviors now, and figuring out the "why" afterward, she says.

Satel's argument dovetails with the poor results that psychoanalytical therapies (therapies focused on "why") show in addiction treatment, as reported in the Hester-Miller handbook. Her forward-looking approach recalls the principles of Solution Focused Therapy. Satel doesn't reveal any awareness, however, that addiction has physiological roots stemming from the impact of addictive substances on the brain.

A nice bit of psycho-chatter that mostly agrees with Satel, is here, by Laura Young. I like Young's title, "The path is made by walking." It's from Antonio Machado:
Caminante, no hay camino /se hace camino al andar.
Traveler, there is no path / the path is made by walking.
I quote the same poem in "How Was Your Week?" to illuminate the idea that each person makes their own path to recovery.

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