Meaning Research Archives » International Network on Personal Meaning

The Role of Wu-Wei in Flourishing

Tim Yu — Thu, 11 Jul 2024 01:41:40 +0000

A “flow” state occurs when one is fully, competently engaged with a challenging task to the point of forgetting oneself and the passing of time. In contrast, a state of “Wu-Wei” is defined by two dimensions: (a) Fully focusing on the present without any task or goal in mind, and (b) in perfect harmony with what is naturally unfolding at the moment. This can take place while walking in the woods, fishing by oneself, or practicing Qi Gong or Yoga.

Wu-Wei also result in a state of self-transcendence by forgetting oneself and the passing of time, but through a different path of “action without action” and characterized by the emotion of peace and harmony (i.e., mature happiness rather than feelings of excitement). Wu-Wei is primarily situated in the default mode network of the brain.

Personally, I can accomplish more through Wu-Wei than action because most of my impactful insights and life-changing decisions came from mindful meditation or biblical contemplation. I also have experienced mature happiness through Wu-Wei rather than pleasurable activities because not only can I have a blessed time of inner peace and deep joy in communion with God, nature, and others, but surprisingly also have chaironic happiness.

References

Clough, R. B. (n.d.). The daoist wu wei love of rocks and walden. Academia.edu. https://www.academia.edu/24153106/The_daoist_wu_wei_love_of_rocks_and_walden

Clough, R. B. (n.d.). Wu wei – Augustinian-Daoist transcending through humility. Academic.edu. https://www.academia.edu/24152170/Wu_wei_Augustinian_Daoist_transcending_through_humility

Moleski, M. (2012). Attending to mysteries: instilling Polanyi’s epistemology with the wisdom of Wu Wei. Academia.edu. https://www.academia.edu/4302659/Attending_to_Mysteries_Instilling_Polanyis_Epistemology_with_the_Wisdom_of_Wu_Wei

Tinery, J. (2014). A meditation on the art of not trying. The New York Times. https://www.nytimes.com/2014/12/16/science/a-meditation-on-the-art-of-not-trying.html

Wong, P. T. P. (2011). Positive psychology 2.0: Towards a balanced interactive model of the good life. Canadian Psychology/Psychologie canadienne, 52(2), 69–81. https://doi.org/10.1037/a0022511

Wong, P. T. P. (2012). Toward a dual-systems model of what makes life worth living. In P. T. P. Wong (Ed.), The human quest for meaning: Theories, research, and applications (2nd ed., pp. 3-22). New York, NY: Routledge.

Wong, P. T. P. (2020). Made for Resilience and Happiness: Effective Coping with COVID-19 According to Viktor E. Frankl and Paul T. P. Wong. Toronto, ON: INPM Press.

Wong, P. T. P., & Bowers, V. (2018). Mature happiness and global wellbeing in difficult times. In N. R. Silton (Ed.), Scientific concepts behind happiness, kindness, and empathy in contemporary society. Hershey, PA: IGI Global.

Xing, Y., & Sims, D. (2011). Leadership, Daoist Wu Wei and reflexivity: Flow, self-protection and excuse in Chinese bank managers’ leadership practice. Management Learning, 43(1), 97-112. DOI: 10.1177/1350507611409659

This article was drawn from: https://www.meaning.ca/isepp/rifs/

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The Theory of Positive Disintegration

Tim Yu — Sat, 27 Jun 2020 14:05:36 +0000

In the last INPM newsletter, I introduced Kazimierz Dąbrowski and briefly reviewed the positive psychology approach he used in defining mental health. The healthy personality is traditionally defined by adjustment to one’s social and cultural norms (how well one fits in) and, in today’s world, being happy by being able to satisfy one’s basic needs in culturally acceptable ways. In the traditional model, one is either adjusted (conforms) or maladjusted (does not conform).

In the positive approach, however, personality is defined by the presence of autonomy, uniqueness, authenticity, and psychological growth (often construed as self-actualization), and by the ability to master one’s environment. Dąbrowski emphasized a self-aware and self-chosen personality, including a unique hierarchy of values, aims, and goals based upon one’s essential characteristics and one’s creation of a personality ideal for oneself. This approach to defining personality complicates the traditional binary assessment categories of being either adjusted or maladjusted.

Dąbrowski created a new model of adjustment that considers the wider variance of a positive approach and creates a more subtle and nuanced approach to adjustment. He proposed two types of adjustment and two types of maladjustment.

Positive adjustment. Adjustment to what ought to be, to one’s personality ideal, a mastery of oneself and conformity to what one believes one ought to do in life. Positive adjustment allows one’s higher sense of self to guide behavior and how one treats others in society. Good behaviour for the right reasons.
Negative adjustment. A robotic acceptance and conformity to one’s social and cultural mores without any deep reflection or modifications based upon one’s own personality characteristics. This form of adjustment reflects Nietzsche’s “herd personality.” As Dąbrowski used to say, “To be adjusted to a sick society is to be sick.” Good behaviour for the wrong reasons.
Positive maladjustment. In personal development, an individual will often come into conflict with his or her society. When one sees “what is,” one must often reject it based upon one’s inner sense of how the world “ought to be.” This maladjustment occurs on two levels; on a social and macrolevel as just stated—when one rejects “what is” in favour of “what ought to be.” The second level is a personal microlevel where one evaluates and rejects what is “less myself” and accepts or works to develop what is “more myself.” In this way, one moves closer and closer to one’s personality ideal. The idea of positive maladjustment requires a closer examination of maladjusted behaviour. Is the behaviour simply maladaptive, or are there deeper motivations that make the maladaptation positive and developmental? For Dąbrowski, positive maladjustment is a vital component in the developmental process of an individual. Bad behaviour for the right reasons.
Negative maladjustment. This reflects what we traditionally conceive of as antisocial and criminal behaviour. Bad behaviour for the wrong reasons.

These four approaches to adjustment are also helpful for us in understanding Dąbrowski’s developmental process of positive disintegration. Consider the example of Mary, a well socialized young woman (displaying negative adjustment) but who is very unhappy with life. Life just doesn’t seem to be turning out the way it ought to be. The main problem is religion: Mom and dad were strict adherents to a religion.

As a child, Mary attended services regularly with her parents and, as a teenager, was a volunteer at the Church. But now, after going to university for a year and living on her own, Mary didn’t feel right attending church for some reason. She had gone on her own many times, but it just didn’t feel the same. During that first year of university she had met many people and formed some good friendships; she had long discussions about all kinds of topics with her new friends. She began to question her faith and came to realize that she had been emulating the faith of her parents and that her deep beliefs were different. She wasn’t quite sure how they were different; she just knew they were. She decided not to go back to church (positive maladjustment).

This decision caused an existential crisis for Mary. She felt lost because she didn’t feel connected to the faith that she had relied upon, and yet she didn’t have a clear answer in terms of exactly how she felt about her beliefs. It was a confusing situation to be in, a feeling she described as “having lost the past without yet seeing the future.” She also had a crisis brewing in terms of her relationship to mom and dad — how was she going to tell them? They would probably disown her!

On summer break, Mary summoned her strength and sat down with her parents, telling them that she had the most frightening thing in her life to tell them. She blurted out how she felt and had to risk her relationship with her parents to be true to herself. Mary was shocked when her mother said, “Yes, I myself had the same experience. When I was a child, my parents raised me in a different religion, and it took me a long time to decide how I felt and where I should go with my faith. I ended up meeting your father at this new church, and it became a central part of our lives and, later, your life.” Mary looked over and to her relief, her father was nodding his head in the affirmative. Her mother went on to say that as an adult now, Mary had many decisions that she would have to wrestle with and make many decisions with only her feelings to guide her. Her mother emphasized that religion was one of those things that could not be decided logically or by information—it was not a decision about what kind of car to buy—faith was one of those things that you have to feel from within. Mary shared her confusion and again, her mother was empathetic and supportive. Her mother’s advice was not to be in a hurry, but to consider many different possibilities and see which seemed to fit her personality and her feelings least, and to see which fit her best in order to help her decide. Clearly, after their conversation, Mary was on her way to creating a personal and unique value hierarchy that would come to reflect who she is and how she feels. In other words, she was on her way to positive adjustment.

As this vignette illustrates, often the comfort and stability of one’s day-to-day life comes into conflict with one’s development. The conformity and commitment one takes for granted may have to crumble for the sake of one’s development. This is a stressful and chaotic experience, one that must be resolved through growth — through the development of a replacement foundation upon which one can build one’s life.

The successful navigation of this type of crisis is what Dąbrowski called positive disintegration.

In Dąbrowski’s vision of development, an individual will typically go through a number of partial disintegrations, of varying degrees of intensity, on different dimensions. Each partial disintegration and subsequent reintegration on a higher level contributes to establishing a secondary integration based upon positive adjustment. In some cases, disintegrations may be more global and impact many aspects of a person’s life all at once. For Dąbrowski, mental health involves a transition from one’s first primary integration (characterized by negative adjustment to external standards and mores), through the process of positive disintegration, ultimately culminating in a secondary integration (characterized by positive adjustment to one’s personality ideal).

In our next column we will examine the difficult question: Why don’t more people develop autonomy?

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Burnout Among Healthcare Workers During the COVID-19 Pandemic

Tim Yu — Sat, 27 Jun 2020 13:59:00 +0000

After months of the tedium, irritations, and uncertainties of the COVID-19 pandemic, the media and healthcare organizations are talking more about the pandemic’s mental health toll on healthcare workers.

Burnout

In addition to various stressor-related injuries, such as symptoms of acute stress, “burnout” is one of the most common complaints of healthcare workers. Freudenberger (1974) was among the first to scientifically explore the problem. Borrowing the term “burnout” from those with severe addictions to drugs, he described the negative effects on staff members from working at a New York City free clinic. Within two decades, thanks to Freudenberger’s popularization of the term and the influential work of Christina Maslach (1976), who had come across the term from healthcare and social workers, the condition was applied to teachers, lawyers, and others who complained of stress, fatigue, and exhaustion related directly to their work.

Today, “burnout” is one of the most talked about problems for frontline workers in COVID-19 media articles, healthcare publications, and in workplace conversations. In healthcare settings, research indicates that burnout appears to be associated with working long hours at a job where empathy is required. Rebecca Clay (2020, June 11) likened it to compassion fatigue, a term coined by traumatologist Charles Figley. She quotes Figley: “It was an occupational hazard of ‘any professionals who use their emotions, their heart’ … and represents the psychological cost of healing others. ‘It’s like a dark cloud that hangs over your head, goes wherever you go and invades your thoughts’.” And it is unlikely that we’ll stop talking about it anytime soon; like COVID-19, “Burnout can be contagious” (Maslach & Leiter, 2016).

Healthcare workers tend to discuss burnout as if it were a definitive thing, well-defined and agreed upon by the experts. The reality, however, is that most countries do not admit it as a mental disorder. And those who do are not in agreement on what it is (Heinemann & Heinemann, 2017, January-March). Freudenberger (1974) reported physical symptoms of burnout as exhaustion, fatigue, frequent headaches, frequent gastrointestinal disorders, sleeplessness, shortness of breath. Affective symptoms included frustration, anger, suspicion, omnipotence or overconfidence, drug use, cynicism, and depression.

Some researchers interpret burnout as a one-dimensional construct equivalent to exhaustion, but others see this as too simplistic. Maslach and colleagues developed the Maslach Burnout Inventory, now used in 93 percent of burnout studies, which is based on three factors: emotional exhaustion, negative perceptions and feelings about patients/clients, and crises in professional competence because of emotional turmoil.

In 2018 the World Health Organization (WHO) accepted burnout as a real phenomenon and not just another name for depression or anxiety. But it did not propose burnout as a medical condition. WHO’s 11^th revision of its International Classification of Diseases lists “burn-out” under “Factors influencing health status or contact with health services.” It defines burnout in line with Maslach and colleagues as: (1) feelings of energy depletion or exhaustion; (2) increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and (3) reduced professional efficacy.

Thus, burnout is not, in itself, a mental health disorder. However, it makes a person vulnerable to depression, anxiety, trauma, and other mental health complications.

Stressors Attached to Burnout

Studies of COVID-19 have described a small catalogue of stressors can that burn out healthcare workers. These stressors include worries about bringing the virus home to their family, worries about daycare for their kids, feelings of isolation when their families distance themselves out of fear of infection, lack of sufficient personal protective equipment, lack of ventilators and testing equipment, lack of policy direction in life and death decisions (eg, who gets one of the limited number of ventilators), worries about working with colleagues who are making mistakes because of burnout, poorer job performance, disinterest in patients/clients, and exhaustion.

Mainstream Efforts to Reduce Burnout

So what can we do for healthcare workers who are complaining of burnout? The World Health Organization (2019, May 28), for example, focuses on burnout prevention measures such as ensuring sufficient personal protective equipment for workers, offering direction to staff in making difficult decisions, rest, diet, exercise, and social support from colleagues and managers. These are no doubt useful practices, but studies of burnout suggest they are likely insufficient.

The research on mental health for frontline workers during the COVID-19 pandemic is, obviously, preliminary. Still, it offers some interesting conclusions. Medical staff at one Chinese hospital said they would not participate in any psychological interventions for themselves. “Individual nurses showed excitability, irritability, unwillingness to rest, and signs of psychological distress, but refused any psychological help and stated that they did not have any problems” (Chen, et al., 2020, February 18). The hospital workers said they didn’t fear infection once they were working, and they worried more about their families. Their biggest reported struggle was dealing with patients who were unwilling to follow the rules on isolating.

In a meta-analysis of 19 controlled studies exploring interventions to prevent physician burnout (Panagioti, Panagopoulou, Bower, et al., 2017), there was little evidence that any of them worked. Solutions have largely targeted the physician, proposing exercise classes and relaxation techniques, snacks and social hours for decompressing, greater access to childcare, hobbies to enrich free time, and ways to increase efficiency and maximize productivity. The study data, however, suggest that these solutions do not address burnout. The actual problem, according to the authors, is that the reconfigured institutional system did not align with the personal values of the healthcare workers.

This conclusion reflects more recent pandemic studies that the best protective factor against burnout is to ensure workplace practices mirror employees’ personal values. Greenberg, Docherty, Gnanapragasam, and Wessely (2020) highlight “moral injury” as the biggest mental health issue for healthcare workers in the pandemic. “Moral injury, a term that originated in the military, can be defined as the psychological distress that results from actions, or the lack of them, which violate someone’s moral or ethical code.” Moral injury is not itself a medical condition; however, its presence is a vulnerability to negative thoughts about self or others, “as well as intense feelings of shame, guilt, and disgust.”

Burnout & Meaning

The idea that burnout is the consequence of a workplace that does not reflect employees’ personal values means that burnout is far more complicated that merely working a lot of hours under difficult conditions.

Burnout may be the consequence of a loss of meaning. For example, burnout profoundly affects identity (Schaufeli, Leiter, Maslach, 2009). Studies had shown that those who were affected by burnout typically began as idealists in their profession, with certain goals to achieve. Only after repeatedly being frustrated in achieving their goals did they become disillusioned, wondering why they signed up for the career. Thus, burnout was, in large part, an identity crisis.

If burnout affects identity, it also appears to affect the purpose of working in the healthcare field. It’s instructive to realize that some workers do not experience burnout. Early research had shown no complaints of burnout in monasteries, Montessori schools, or religious care centers—professions in which staff members felt a calling. Burnout appeared to be attached to professionalized and bureaucratic organizations, with their focus on rules, unions, and red tape.

In their article on responses to the pandemic by medical students, Gallagher and Schleyer (2020, June 18) reported that some students felt a moral injury because they could not provide care at the level they were trained for because of lack of personal protective equipment or ventilators. But many students who seemed to view medicine as a calling had a more positive perspective: “I feel lucky to be working during this time.” “I feel underutilized.… It’s so hard to be a student and not help when you feel morally and ethically inclined to do so.” “I’m excited to be able to make a difference, but I’m just as scared as everyone else.” This sort of purposeful endeavour—keeping an eye on the big picture—appeared to help students remain optimistic and engaged in their careers.

Hartzband & Groopman (2020) looked to Self-Determination Theory (SDT; Gagne & Deci, 2005) to help frontline physicians during the pandemic. They argued that increasing an individual physician’s intrinsic motivation in the workplace would be a protective factor against burnout. SDT proposes that the key to intrinsic motivation is autonomy, competence, and relatedness—the consequence of which is a more meaningful work-life.

What these examples show is that those who do not succumb to burnout appear to enthusiastically commit to the purpose of their work. This greater perspective likely allows them to avoid being bogged down in the mundane tasks and long hours of routine, and overcome moral struggles such as a lack of PPE. As Langle (2012) suggested, “A wider perspective can help imbue suffering with meaning” (p. 234).

References

Chen, Q., Liang, M., Li, Y., Guo, J., Fei, D., Wang, L …Zhang, Z (2020, February 18). Mental health for medical staff in China during the COVID-10 outbreak. The Lancet [online], 7, e15. Doi: 10.1016/S2215-0366(20)30078-X

Clay, R. A. (2020, June 11). Are you experiencing compassion fatigue? As psychologists continue to help those suffering from the impact of COVID-19, they should watch for signs of their own distress or burnout. American Psychological Association [online].

Figley, C. R., & Figley, K. R. (2017). Compassion fatigue resilience. In E. M. Seppala, E. Simon-Thomas, S. L. Brown, M. C. Worline, C. D. Cameron, & J. R. Doty (Eds.), The Oxford Handbook of Compassion Science. New York: Oxford. Doi: 10.1093/oxfordhb/9780190464684.013.28

Freudenberger, H. J. (1974). Staff burn-out. Journal of Social Issues, 30(1), 159–165. Doi: 10.1111/j.1540.1974.tb00706.x

Gagne, M., & Deci, E. L. (2005). Self-determination theory and work motivation. Journal of Organizational Behavior, 26, 331–362. Doi: 10.1002/job.322

Gallagher, T. H., & Schleyer, A. M. (2020, June 18). “We signed up for this!”—Student and trainee responses to the Covid-19 pandemic. New England Journal of Medicine, 382, e96. Doi: 10.1056/NEJMp2005234

Greenberg, N., Docherty, M., Gnanapragasam, S., & Wessely, S. (2020). Managing mental health challenges facing healthcare workers during covid-19 pandemic. British Medical Journal [online], 368. Doi: 10.1136/bmj.m1211

Hartzband, P., & Groopman, J. (2020). Physician burnout, interrupted. New England Journal of Medicine [online]. Doi: 10.1056/NEJMP2003149

Heinemann, L. V., & Heinemann, T. (2017, January-March). Burnout research: Emergence and scientific investigation of a contested diagnosis. Sage Open, 1–12. Doi: 10.1177/2158244017697154

Langle, A. (2012). Suffering—an existential challenge: Understanding, dealing, and coping with suffering from an existential-analytic perspective. In P. T. P. Wong, L. C. J. Wong, M. J. McDonald, & D. W. Klaassen (Eds.), The positive psychology of meaning and spirituality: Selected papers from meaning conferences (pp. 223–236). Birmingham, AL: INPM, PurposeResearch.

Maslach, C. (1976). Burned-out. Human Behavior, 5(9), 16–22.

Maslach, C., & Leiter, M. P. (2016). Understanding the burnout experience: Recent research and its implications for psychiatry. World Psychiatry, 15(2), 103–111. Doi: 10.1002/wps.20311

Panagioti M, Panagopoulou E, Bower P, et al. (2017). Controlled interventions to reduce burnout in physicians: A systematic review and meta-analysis. JAMA Internal Medicine, 177(2),195–205.

Schaufeli, W. B., Leiter, M. P., Maslach, C. (2009). Burnout: 35 years of research and practice. Career Development International, 14(3), 204–220. Doi: 10.1108/13620430910966406

World Health Organization (2019, May 28). Burn-out an “occupational phenomenon”: International Classification of Diseases.

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Life Within Closed Rooms: Dealing with the Quarantine During the COVID-19 Crisis

Tim Yu — Wed, 22 Apr 2020 18:22:48 +0000

“But what does it mean, the plague?

It’s not above life, that’s all!”

Albert Camus, The Plague, 1947, p. 102

The world has witnessed several ‘plagues’ throughout history, and each time the effects have been global and devastating. From the infamous Bubonic Plague to the Spanish Flu, Asiatic Cholera to the more recent Severe Acute Respiratory Syndrome (SARS), pandemics are not just biological phenomena. They affect society at large, with widespread psycho-socio-economic impact (Davis et al., 2016). Today, we face yet another such global public health threat: the coronavirus disease 2019 (COVID-19). Caused by the novel coronavirus SARS-CoV-2, it is highly contagious with a fast human-human transmission. Originating as unidentified pneumonia cases in Wuhan, China towards the end of 2019, it emerged into a public health emergency of international concern within a month, which then developed into a pandemic in less than two months (World Health Organization, 2020). As international borders have shut down, economies slashed, travel restricted, and billions quarantined in their homes in an effort to contain the virus, the daily living structure has collapsed for humankind with unprecedented consequences. In just three months, the world came down to its knees, courtesy of a microscopic virus.

Countries have taken different measures to fight the infection. Nationwide lockdown is the most common among them. Such historical lockdowns have restricted any gatherings, group rituals, and travel based on the principle of social distancing as recommended by the World Health Organization (Piguillem & Shi, 2020). This has been the prime strategy against the pandemic in the absence of a ‘medical cure’ so far. The virus, however, has affected much beyond just public health. In today’s digitalized world, COVID-19 is literally an infodemic as every conversation, debate, or media-feed is bombarded with data and statistics related to it. Ironically, the virus has hijacked our daily life-threads much more than the respiratory system. This further tends to become a problem during the prolonged quarantine, where families spend more digital screen time, which further adds to the emotional isolation and loneliness (Cinelli et al., 2020). Adults find working from home a new challenge, children are deprived of friends and outdoor play, and the elderly are segregated and vulnerable. As the most important aspect of human life, a daily structure has been fundamentally disrupted.

Here are six strategies to glide through this crisis time, making the most out of the quarantine.

Discipline and communication—These are the key elements to cope with social isolation. Though sounding old-school, having an indoor structure during the day provides adequate balance to the activities of daily living and work, as well as recreational activities. Children need to be integrated into this routine. Working hours from home need to be regulated and consistent. Too much freedom in this regard has a risk to disrupt the work-life balance. The second aspect is communication. Sharing distress and having direct channels of interpersonal discussion between the family members helps dealing with the stress together. Those staying alone can virtually connect regularly with their loved ones. This helps to fight loneliness, boredom, and frustration.
Working from home and working for home—These two activities need a crucial balance for some. Prioritizing work and personal needs, having a separate and organized workplace, and preventing extension of work into odd hours of the night help create a ‘work-friendly mentality’, which can be difficult in the comfort of home. Though apparently lucrative, working from home can be a real challenge, especially for those doing it for the first time.
Staying away from the media—To quote Taleb (2012), “The difference between technology and slavery is that slaves are fully aware that they are not free.” The continual and relentless use of technology, especially social media, can snowball panic and have detrimental effects during this crisis. With the plethora of information going viral about COVID-19 each day, misinformation creeps in too. This contributes to mass hysteria, fear, and apprehension adding to the already prevalent public chaos (Cinelli et al., 2020). Unnecessary arguments about the disease can harm mental peace. Many have been browsing the internet late at night for COVID-19 news, hampering their sleep and rest. While it is important to have relevant updates about the pandemic situation, it’s better to keep this news gathering brief and time limited. The sheer bulk of numbers makes no sense to most people, so it makes sense to avoid barrage of data rather than adding to anxiety!
Social integration and connectedness—The quarantine was necessary, albeit unprepared for, though it has given a chance for certain things. What about using this time to have more personalized touch with our families, having fruitful ‘me’ time and engaging in family rituals such as games and prayers. Haven’t all these been long overdue? The ‘locked-down’ time can be used to revive lost hobbies, nurture forgotten skills, and mend strained relationships. Integrating the people associated with our lives such as security personnel, vendors, domestic helpers, and workers, and catering to their well-being, can help us feel that we are not alone in this. Social distancing is essentially a misnomer, which actually means physical Appreciating that we’re not alone in the pandemic generates hope, a powerful weapon during such times.
Boosting your immunity—This is vital especially against an infectious outbreak. Daily indoor exercises, such as Yoga or a brisk walk in the immediate proximity (definitely with adequate precautions), healthy diet, and sound sleep all contribute to the generic boosting of immunity. Chronic stress during such times can have harmful effects on our immune system, leading to fatigue, insomnia, mood changes, irritability, and depression (Dantzer & Kelly, 1989). Taking care of physical and mental well-being are essential to counter it. Simple techniques such as deep breathing, and Pranayama and relaxation exercises help to relax both the body and mind.
Taking care of the vulnerable—Children need age-appropriate understanding of the new restrictions, and it’s quite usual for them to get restless. This energy can be channelized into something productive academically or through board games. Incorporating children into family activities and structuring their day prevents too much indulgence in online games, which can be a potentially harmful addiction even beyond the pandemic. On the other end of the age spectrum, the elderly are often stigmatized and isolated (Banerjee, 2020). While taking care of their physical health, it is also necessary that we respect their autonomy and dignity, involving them in decision making. Daily physical activity is all the more important for them. Many seniors might not be well-versed in using technology and hence might remain unaware of the necessary precautions, which need to be carefully supervised.

Most importantly, we need to spend some COVID-free time during the day. The pandemic will hopefully eventually resolve, but certain positive habits we inculcate will persist beyond, and for the better. Helping others goes a long way and ‘holding hands in humanity’ can make us live better during this pandemic, stronger and more resilient than ever before. True, it is an un-apprehended threat, but, as mentioned in the opening quote by Camus, it is “life” that ultimately triumphs, and life reaches far beyond just COVID-19!

Dr. Debanjan Banjeree works in the Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.

References

Banerjee, D. (2020). How COVID-19 is overwhelming our mental health. Nature India.

Camus, A. (1947). La Peste (The Plague). New York: Vintage.

Cinelli, M., Quattrociocchi, W., Galeazzi, A., Valensise, C. M., Brugnoli, E., Schmidt, A. L., … & Scala, A. (2020). The covid-19 social media infodemic. arXiv preprint arXiv:2003.05004.

Dantzer, R., & Kelley, K. W. (1989). Stress and immunity: An integrated view of relationships between the brain and the immune system. Life sciences, 44(26), 1995–2008.

Davis, M., Flowers, P., Lohm, D., Waller, E., & Stephenson, N. (2016). Immunity, biopolitics and pandemics: Public and individual responses to the threat to life. Body & Society, 22(4), 130–154.

Piguillem, F., & Shi, L. (2020). The optimal covid-19 quarantine and testing policies (No. 2004). Einaudi Institute for Economics and Finance (EIEF).

Taleb, N. N. (2012). Antifragile: how to live in a world we don’t understand (Vol. 3). London: Allen Lane.

World Health Organization. (2020). Coronavirus disease 2019 (COVID-19): Situation report, 72. [as accessed on 20 April 2020]

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The Theory of Positive Disintegration

Tim Yu — Mon, 23 Mar 2020 14:05:31 +0000

When I studied psychology in university, one of my favorite courses explored theories of personality. At the end of the course, the professor said he was going to introduce one last theory that was unknown and quite complicated. It was important, he said, because it was a forerunner to the approach of positive psychology. He warned us that it wouldn’t make sense of first. After studying it, I realized how prescient it was, and I introduce it here.

The very name of the theory—the theory of positive disintegration—is confusing. What could be positive about disintegrating? Right away, I was interested in digging deeper. The theory was developed by a Polish psychiatrist and psychologist, Kazimierz Dąbrowski (1902–1980). Dabrowski had a challenging life, and his personal experiences shaped his studies and, later, his theory. In World War I, a major battle took place near the town Dabrowski lived in. After the battle he walked among the dead soldiers and said he was struck that some had frightened looks of horror on their faces, while others looked calm and peaceful. These images stayed with Dabrowski as he worked on his Masters in philosophy and studied the levels of reality presented by Plato, as well as the works of the major philosophers, such as Kierkegaard and Nietzsche.

Kazimierz Dąbrowski

Dabrowski wanted to be a professional musician, but during his studies his best friend committed suicide and Dabrowski decided to devote his life to understanding psychology. He went on to complete studies in psychology and become a psychiatrist under some of the most famous professors of the day in Europe. In the 1930s he began developing mental health programs in Poland with the financial help of The Rockefeller Foundation. Sadly, he was caught up in World War II and imprisoned by the Germans several times. Later, when Stalin took over Poland, Dabrowski and his wife were held in prison for 18 months, where he was tortured.

He said that his experiences during the war showed him both the lowest behaviors humans were capable of, as well as the highest. He could find no psychological theory that could explain this broad continuum of human behavior and set about to develop one. Although the government closely monitored his activities in the 1950s, he went on to observe exemplars of personality development to understand the factors contributing to growth.

Based on his observations, Dabrowski discovered that those who seemed to have had achieved the most growth as autonomous individuals also seemed to have had experienced severe and sometimes repeated personal crises in their lives. Of course, he found that some people who faced apparently impossible situations would be overcome and unable to recover—what we would call today posttraumatic stress disorder. But he found the biggest group to be resilient, able to bounce back to their initial pre-crisis level of functioning. And he discovered a third small group, who experienced major crises and who seemed to emerge the better for it. He went on to describe what he saw as the factors that were related to this latter group—what we would call today posttraumatic growth.

As I mentioned, my professor said the theory fell under the umbrella of what we now call positive psychology. Dabrowski said it didn’t make sense to him to limit diagnosis to only a list of problems or symptoms. Our understanding of mental health had to be based on criteria reflecting positive aspects of behavior and development. He based his criteria on Jahoda (1958), who outlined her basic criteria:

One’s attitude toward oneself (self-perception).
The degree of psychological growth, development, and self-actualization seen in one’s behavior.
The integration of one’s psychological functioning including, from above, one’s self-perception and behavior.
Autonomy as demonstrated by one’s degree of independence from social influence.
The adequacy of one’s perception of reality.
The ability to successfully meet life’s adversities and master one’s environment. (p. 23)

Dabrowski advanced a very strange and counterintuitive idea. Based on Jahoda’s criteria, the average person does not have a unique personality. Echoing “the herd personality” described by Nietzsche and the emphasis on the development of the self advanced by Maslow, Dabrowski was forced to the conclusion that the average person simply robotically follows the herd and, as he called it, displays a group personality. Autonomy is minimized, and fitting in and getting along is emphasized by both educational and governmental systems. Dabrowski (1972) defined personality as: “A self-aware, self-chosen, self-affirmed and self-determined unity of essential individual psychic qualities” (p. 301).

This definition created several problems. For example, how does an individual go from a homogeneous personality where one takes one’s values at face value from their social and cultural environment, without critical or deep evaluation, and end up creating a self-determined, unique and autonomous sense of self? Part of the answer is that the individual must break down his or her initial psychological integration and begin questioning social and cultural mores, and questioning their own basic psychological character. Dabrowski emphasized that the individual must create an ideal of his or her personality to aspire to. After loosening the initial integration, one can create a unique personality incorporating one’s personality ideal as well one’s unique hierarchy of values, aims, and goals in life. The outcome of the disintegration is growth and the creation of an individual’s autonomous personality—this is positive disintegration.

Another critical element mentioned by Jahoda and emphasized by Dąbrowski was that a major feature of the autonomous personality involves significant individual development and growth. Using a model of levels reminiscent of Plato, the lowest level of development is seen in the initial integration committed to simply accepting the values of one’s culture and “going along to get along,” an aspect that Dabrowski referred to as “what is.” He called this level of development unilevel, echoing the “flatland” described by Edwin Abbott (2006). At this level, reality exists on a single plane where decisions involve choices of equal value. You may choose to go left or you may choose to go right, but the choices are clearly on the same level. Based on his observations of exemplars, Dabrowski understood that the solution to most problems and psychological growth must involve the pursuit of higher levels—the vertical component. Dabrowski described the pursuit of one’s personality ideal as a quest toward higher levels of development wherein the “what is” is replaced by the “what ought to be.”

Dabrowski was not the first to make this suggestion; William James (1999/1902), for instance, pointed out that one’s inner experience is a “battleground” between the actual self (“what is”) and the ideal self (“what ought to be”). In this new multilevel view of reality, conflicts now arise between lower and higher choices: Do I take the low road, or do I choose the high road? These vertical conflicts disintegrate one’s unilevel perception of the world creating opportunities to choose one’s values, aims, and goals, and to determine the course and direction of one’s own development. This marks the beginning of true autonomous individual development.

The next column will dig deeper into this very challenging but very rewarding theory of personality development.

William Tillier is the author of Personality Development Through Positive Disintegration: The Work of Kazimierz Dabrowski (2018), published by Maurice Bassett.

References

Abbott, E. A. (2006). Flatland: A romance of many dimensions. New York: Oxford University Press.

Dąbrowski, K. (1972). Psychoneurosis is not an illness. London, England: Gryf.

Jahoda, M. (1958). Joint Commission on mental health and illness monograph series: Volume 1. Current concepts of positive mental health. New York: Basic Books. Doi: 10.1037/11258-000

James, W. (1999). The varieties of religious experience: A study in human nature. New York: Modern Library. (Original work published 1902)

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Boredom & Meaning

Tim Yu — Mon, 23 Mar 2020 13:57:15 +0000

The study of boredom is becoming quite fascinating. The American Psychological Association’s Dictionary of Psychology defines boredom as ‘‘a state of weariness or ennui resulting from a lack of engagement with stimuli in the environment” (VandenBos, 2007). Sufficient research has been published to indicate that boredom is a specific state of mind and not merely a version of depression or apathy.

For such a common emotion, however, it’s remarkable that psychologists are only recently paying attention to it. The relatively few psychological studies there are on the topic suggest adolescents are more bored than adults. Those who lack self-awareness and those who lack education seem to be more bored than their self-aware and educated neighbors. Research has found participants get bored with repetitive tasks that are either too easy or too difficult. Those who are extroverted or suffer from attention problems are more easily bored than the rest of us. Some brain scientists associate boredom with lower levels of dopamine stimulation, leading the bored to seek out excitement.

Attempting to make sense of boredom, psychologists have developed two general types of instruments to measure boredom. Farmer and Sundberg (1986) developed their Boredom Proneness Scale (BPS), which focused on a person’s habits and personality. The BPS measures trait boredom, the susceptibility to boredom. Others are interested in state boredom, the intensity of boredom in a given situation. The Multidimensional State Boredom Scale (MSBS; Fahlman, Mercer-Lynn, Flora, & Eastwood, 2013) makes 29 statements on immediate feelings arising from a situation, such as “I am stuck in a situation that I feel is irrelevant.” This instrument is more about feelings in the moment. It appears that trait boredom and state boredom are separate constructs.

The MSBS, interesting as it is, seems to include many people who are only temporarily bored; that is, they are bored with the situation. I suspect it is this situational boredom that has led any number of bloggers to suggest that we should cultivate boredom because it propels us to action. Even Nietzsche, in his autobiographical Human, All Too Human suggested that those of “rare sensibility” value boredom as a catalyst for achievement. It can provide an opportunity for thought and reflection. And it can also be a sign that a task is a waste of time—and thus not worth continuing.

The BPS is perhaps a more intriguing instrument because it measures something in the person. Those who are bored in the moment look to remedy their uncomfortable state by doing something more meaningful. Yet such a strategy would likely not be all that successful if the person was prone to boredom, regardless of the situation.

So, one of the curious issues is why some are more bored than others, regardless of their situation. Perhaps a key piece to the puzzle lies in the argument that boredom is a modern phenomenon. Spack (1996) wrote the history of boredom as presented in literature. She makes a convincing case that boredom did not exist before the late 18^th century, as the age of Enlightenment was giving way to the Industrial Revolution.

The author suggested that before this transition, people were engaged in constant activity to feed, clothe, and house themselves. In a sense, they were too busy to be bored. But it seems more likely that the reason for this lack of boredom had to do with their sure belief that God was in Heaven and there was a plan for us all. Westerners increasingly challenged the traditional notion of God in the 19^th century, and Nietzsche declared in 1872 that we have killed God—a death that replaced an absolute with an anxiety-provoking void.

Today, boredom appears to be on the rise. Some hypothesize that it is the direct result of a metaphysical void in the West. Others blame our inability to deal with free time, such as people who pursue activities merely to fill the time—watching a lot of television comes to mind. Others say the loss of personal control is the real issue in boredom: doing work and play that has little personal meaning.

Goodstein (2005) proposed that boredom has an existential quality. She proposed that it “corresponds more precisely to the French ennui, an existential perception of life’s futility. Ennui is a consequence of unfulfilled aspirations.” Coughlan, Igou, van Tilburg, Kinsella, and Richie (2017) argued that boredom, “a state associated with a sense of meaninglessness, leads to a psychological search for meaning in life” (p. 455). Eastwood, Frischen, Fenske, and Smilek (2012) also pointed to an existential component of boredom. “An inability to know what will make one happy can lead to a more profound existential boredom. Not knowing what we are searching for means that we lack the capacity to choose appropriate goals for engagement with the world.”

Perhaps Frankl had sensed that some people were more easily bored than others when he wrote that boredom was the hallmark symptom of the existential vacuum, of a life that lacked personal meaning.

References

Coughlan, G., Igou, E. R., van Tilburg, W. A. P., Kinsella, E. L., & Richie, T. D. (2017). On boredom and perceptions of heroes: A meaning-regulation approach to heroism. Journal of Humanistic Psychology, 59(4), 455–473. Doi: 10.1177/0022167817705281

Eastwood, J. D., Frischen, A., Fenske, M. J., & Smilek, D. (2012). The unengaged mind: Defining boredom in terms of attention. Perspectives on Psychological Science, 7(5), 482–495. Doi: 10.1177/1745691612456044

Elipdorou, A. (2014, November 3). The bright side of boredom. Frontiers of Psychology. Doi: 10.3389/fpsyg.2014.01245. Retrieved from https://www.frontiersin.org/articles/10.3389/fpsyg.2014.01245/full

Fahlman, S. A., Mercer-Lynn, K. B., Flora, D. B., & Eastwood, J. D. (2013). Multidimensional State Boredom Scale (MSBS). Assessment, 20(1), 68–85. Doi: 10.1177/1073191111421303

Farmer, R., & Sundberg, N. D. (1986). Boredom proneness—The development and correlates of a new scale. Journal of Personality Assessment, 50(1), 4–17. Doi: 10.1207/s15327752jpa5001_2

Goodstein, E. S. (2005). Experience without qualities: Boredom and modernity. Redwood, CA: Stanford University Press.

Heshmat, S. (2017, July 16). Eight reasons why we get bored. Psychology Today. Retrieved from https://www.psychologytoday.com/ca/blog/science-choice/201706/eight-reasons-why-we-get-bored

Hutchins, A. (2016, January 31). The good and the bad of boredom. Maclean’s Magazine. Retrieved from https://www.macleans.ca/society/life/the-interview-john-eastwood-on-the-good-and-bad-of-boredom/

Koerth-Baker, M. (2016, January 18). Why boredom is anything but boring. Scientific America. Retrieved from https://www.scientificamerican.com/article/why-boredom-is-anything-but-boring/

Spack, P. M. (1996). Boredom: The literary history of a state of mind. University of Chicago Press.

van Tilburg, W. A. P., & Igou, E. R. (2012). On boredom: Lack of challenge and meaning as distinct boredom experiences. Motivation and Emotion, 36(2), 181–194. Doi: 10.1007/s11031-011-9234-9

VandenBos, G. R. (Ed.). (2007). APA dictionary of psychology. Washington, DC: American Psychological Association.

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Psychedelics as an Aid to Addiction Recovery

Tim Yu — Mon, 23 Mar 2020 13:46:24 +0000

In the early 1950s, Bill Wilson, creator of Alcoholics Anonymous, discovered that under the influence of LSD he had a spiritual experience. What attracted him to continue using the drug was that it catalyzed the same experience he had had detoxifying at Towns Hospital in December 1934—his famous “white light” spiritual experience. Although drinking two quarts of low-grade whiskey a day for years (Prohibition had made alcohol illegal in the United States until December 1933), Wilson never drank again after his spiritual awakening. The two events may have indeed been very similar. The concoction used at Towns Hospital to detoxify alcoholics contained belladonna, a hallucinatory drug.

Today, Johns Hopkins University, NYU, Imperial College London, and others are studying the efficacy of using psilocybin, LSD, ayahuasca, ibogaine, and other drugs to help those addicted to substances. These efforts are part of a growing research movement showing promising results using psychedelics (and drugs such as MDMA and ketamine) in the treatment of mental disorders, including anxiety, depression, and posttraumatic stress disorder (Weir, 2020).

The origin of psychedelic therapy for addiction stems from the 1950s in Weyburn, SK, Canada. From 1954 to 1960, psychiatrist Humphrey Osmond and his colleague, biochemist Abram Hoffer, gave LSD to 2000 alcoholics at the Weyburn Mental Hospital. Although Osmond initially used LSD to help the alcoholics “hit bottom”—an idea he got from Bill Wilson—he discovered that this didn’t happen. Instead, the patients reported having spiritual experiences. Results were impressive: 40 to 45 percent of the patients abstained from alcohol for at least a year, an outcome that was far superior to any treatment at the time (or today).

Modern psychedelic research has confirmed the Weyburn reports. Studies using the hallucinogen psilocybin as an aid to therapy for alcohol addiction have shown the drug reduces the mean number of drinking days and heavy drinking days by half (Bogenschutz, Forcehimes, Pommy, Wilcox, Barbosa, & Strassman, 2015). Using psilocybin to aid smoking cessation produced 80 percent abstinence at 6 months (Johnson, Garcia-Romeu, Cosimano, & Griffiths, 2014), a far better success rate than our current smoking cessation programs, which report less than 35 percent abstinence.

Of course, much more research is needed, but the collection of outcome studies thus far suggests that psychedelic therapy may, in fact, be superior to our mainstream addiction therapies.

So, what’s going on with this psychedelic-assisted therapy? Is it merely some effect of the drug on the brain? Scientists who reduce the impact of psychedelics strictly to brain chemistry offer us little help, mainly because they’re still unsure of the drugs’ effects. Even their hypothesized answers do not account for the profound influence of culture, environment, and mindset that are fundamental to the experience. Multicultural studies have shown, for example, that the experience of, say, an initiate in the Gabon Fang tribe using ibogaine is wildly different from the experience of a Dutch woman using the same drug (Rodger, 2018).

What is consistent in the research is that participants explain the agent of change as a spiritual experience. Sadly, many psychologists and neuroscientists still cringe at the mention of spirituality, preferring to see it as a tangential idea [construct] best left to new-age parapsychology or an epiphenomenon of no real value. But there is sufficient evidence that this spiritual experience seems to be at the core of the success rates in treatment, and participants report that the visionary experience is precisely why they volunteered to ingest the drug. Even the nicotine study mentioned above reported: “Smoking cessation outcomes were significantly correlated with a measure of mystical experience on session days, as well as retrospective ratings of personal meaning and spiritual significance of psilocybin sessions.”

The precise nature of the experience remains a mystery, but its result is not. Regardless of the details of the experience, participants consistently report that during the experience, they changed how they made sense of themselves, the world around them, and their mental health. And, most importantly, they report that this change in perspective continued months and years after the therapy.

Pollen (2018) wrote the best-seller, How to Change Your Mind, which has become required reading for anyone interested in the science of psychedelic therapy. The book’s title reinforces that the result of the psychedelic experience is a change in mind, a change in perspective, a new way of making sense of oneself, one’s place in the world, and one’s mental health. Pollen described a single mom in her 30s who took part in the smoking cessation study mentioned above: “She had a ‘humbling’ realization that ‘everything in the universe is of equal importance, including me’…. ‘It put smoking in a whole new context. Smoking seemed very unimportant’.” A 64-year-old woman who was part of a psilocybin trial for alcoholism reported that she had a vision of being a tiny kid in a helicopter flying around Jesus on the cross. “He just sort of gathered me up in his hands, you know, the way you would comfort a small child.” She felt this vision was teaching her to accept herself: “I spend less time thinking about people who have a better life than me. I realize I’m not a bad person.” The result was rather than go on frequent two-week binges on hard liquor, she only goes on a one-day binge on wine or beer once in a while.

We don’t know why this change in perspective takes place, only that it does. It seems to have something to do with helping the participant change perceptions and responses that were rigidly held (Rodgers, 2018). This idea is reminiscent of the LSD studies in the 1960s, in which professionals were invited to take LSD and then work on a business, scientific, mathematical, or engineering problem that had baffled them for months. Under the influence most professionals were able to see the problem and the data in a new way. Based on this new perspective, many problems were solved and patents secured (Harman, McKim, Mogar, Fadiman, & Stolaroff, 1966).

Clients I work with often ask me about psychedelic therapy for addiction. I tell them it’s very similar to the meaning-focused therapy they participate in at our facility. Our goal is to help them find new ways of making sense of themselves and relationships, and pursuing goals that resonate with their personal values. These appear to be the elements of the visionary experience. Perhaps what sets psychedelic therapy apart is that confronted with the hallucinations, participants experience a “reality” that feels more potent and real than normal waking life. Hendricks (2018) suggested the agent of change was developing a sense of “awe.” Like the astronauts who were profoundly affected by seeing the Earth at a distance—the first people to have this perspective—participants in psychedelic therapy seem to be profoundly changed when their thoughts/unconscious become visible.

References

Bogenschutz, M. P., Forcehimes, A. A., Pommy, J. A, Wilcox, C. E., Barbosa, P. C. R., & Strassman, R. J. (2015). Psilocybin treatment for alcohol dependence: A proof-of-concept study. Journal of Psychopharmacology, 29(3), 289–299. Doi: 10.1177/0269881114565144

Harman, W. W., McKim, R. H., Mogar, R. E., Fadiman, J., & Stolaroff, M. J. (1966). Psychedelic agents in creative problem solving: A pilot study. Psychological Reports, 19(1), 211–227. Doi: 10.2466/pr0.1966.19.1.211

Hendricks, P. S. (2018). Awe: A putative mechanism underlying the effects of classic psychedelic-assisted psychotherapy. International Review of Psychiatry, 30(4), 331–342. Doi: 10.1080/09540261.2018.1474185

Johnson, M. W., Garcia-Romeu, A., Cosimano, M. P., & Griffiths, R. R. (2014). Pilot study of the 5-HT2AR agonist psilocybin in the treatment of tobacco addiction. Journal of Psychopharmacology, 28(11), 983–992. Doi: 10.1177/0269881114548296

Pollen, M. (2018). How to change your mind: What the new science of psychedelics teaches us bout consciousness, dying, addiction, depression, and transcendence. New York: Penguin.

Rodger, J. (2018). Understanding the healing potential of ibogaine through a comparative and interpretive phenomenology of the visionary experience. Anthropology of Consciousness, 29(1), 77–119. Doi: 10.1111/anoc.12088.

Tupper, K. W., Wood, E., & Johnson, M. W. (2015). Psychedelic medicine: A re-emerging therapeutic paradigm. Canadian Medical Association Journal, 187(14), 1054–1059. Doi: 10.1503/cmaj.141124.

Weir, K. (2020). Trip of a lifetime. Monitor on Psychology, 51(2). [online]. Washington, DC: American Psychological Association.

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‘Hitting Bottom’, ‘Turning Points’, and Positive Change

Tim Yu — Fri, 03 Jan 2020 17:26:36 +0000

In the previous newsletter, fellow INPM board member and friend Mega Leung wrote an article about tragic optimism from the context of trauma. Viktor Frankl not only defined the term but exemplified it as a Nazi concentration camp survivor. As Paul Wong (2001) stated, “tragic optimism is predicated on the defiant human spirit, the belief that what cannot destroy me makes me stronger” (para. 15). Tragic optimism is a defining feature of existential positive psychology.

My current research concerns the experience of men who self-reported as having undergone personal transformation leading to their recovery from drug and alcohol addiction. The study participants, who had completed a treatment program, demonstrated that positive change followed a period of great adversity. I did not set out to find tragic optimism, but it appeared in participant stories anyway. Data analysis is ongoing so my findings are preliminary. Given that, all seven participants reported “hitting bottom” as an initial step to engaging in self-reflection, followed by one or more “turning points” leading to enduring, positive change. I share my findings below after a brief overview of the terms “hitting bottom” and “turning points.”

“Hitting Bottom”

In the Big Book of Alcoholics Anonymous (AA), hitting bottom is a metaphor that represents the initiation of self-reflection: “We didn’t wait to hit bottom because, thank God, we could see the bottom” (Alcoholics Anonymous, 2001, p. 279). AA understood hitting bottom as a culmination of negative events: People “have to be pretty badly mangled before they really commence to solve their [alcohol] problems” (p. 43). A systematic review of the term hitting bottom found no operationalized definition (Kirouac, Frohe, & Witkiewitz, 2015). Research has variously described hitting bottom as “dramatic events” (Sobell et al., 2001), an “existential crisis” (Coleman, 1978; Kemp, 2009), as a “crossroads” (Klingemann, 1991, 1992; McIntosh & McKeganey, 2001), an “epistemological shift” (Bateson, 1971/1992; Shaffer & Jones, 1989), and a “transformation” (White, 2004; White & Chaney, 1992).

“Turning Points”

Hitting bottom appears to be insufficient for personal transformation. Anthropologist Gregory Bateson (1971/1992) recognized that an individual can have multiple experiences of hitting bottom: “That ‘bottom’ is a spell of panic which provides a favorable moment for change, but not a moment at which change is inevitable” (p. 451). Participants in my study not only hit bottom but experienced an additional step, equally as critical to their personal transformations. I use the term turning points in reference to these moments in which participants’ sense of self appeared to have transformed. In his research on chronic illness, social psychologist Anselm Strauss (1962/2002) described turning points as “certain critical incidents that occur to force a person to recognize that ‘I am not the same as I was, as I used to be’” (p. 67). A study by Prins (2008) of Dutch heroin addicts found a strong link between recovery and identity. Turning points that led to permanent abstinence occurred when a person’s identity had developed to point where he or she could deal with life’s challenges without resorting to heroin. Radcliffe’s (2011) study of women with addictions found that pregnancy served as a turning point, which facilitated the development of a “normal, unremarkable and un-stigmatised motherhood” identity (p. 984).

Research on Adversity and Positive Change

The idea that positive change follows adversity is not new, and others besides Viktor Frankl have written about it, often alluding to its emotional element. Psychiatrist Kazimierz Dabrowski (1964/2016) used the term disintegration in his theory of positive disintegration to describe human development as an emotionally difficult but, ultimately, positive process. Dabrowski described the process as one in which individuals transformed from automatically responding to instinctual urges to consciously choosing beliefs, values, and goals. Tedeschi and Calhoun’s (1995) posttraumatic growth model describes the process of positive change that individuals undergo after experiencing a life-altering event. Personality psychologist Dan P. McAdams (2006) examined redemption, a theme found in all the world’s major religions. His concept of the redemption sequence, defined as a “bad or emotionally negative scene turns suddenly good or emotionally positive” has been applied in numerous studies on addiction recovery. Fowers, Richardson, and Slife (2017) described suffering as “part and parcel of living as a finite being, essential to humanity, potentially reorienting, and possibly even redemptive.” To lose sight of our human frailties and experiences of suffering is to “risk losing sight of who we are” (p. 16).

Findings from My Research

Based on participant data, it appears that, in the case of addictions, people hit bottom as a result of two independent but overlapping circumstances. First, there are the negative consequences directly associated with problematic substance use, such as marital breakup, job loss, and failing health. Second, there are the deeper emotional and relational issues that existed prior to their problematic substance use. Participant stories demonstrated that hitting bottom can be understood as the recognition that alcohol and drugs were (a) no longer working as an emotional self-regulation strategy and (b) a poor substitute for a meaningful life and meaningful connection.

Participant data revealed important differences between hitting bottom and turning points. Hitting bottom uniformly involved negative emotions and the frustration of cognitive, emotional, and relational processes. Turning points, on the other hand, involved both negative and positive emotions and the successful employment of multiple, overlapping processes.

Participant data also revealed two types of turning points: an initial turning point and facilitating turning points. Initial turning points typically involved the experience of fear, shame, or both, followed by a sense of relief and other positive emotions. Interestingly, all participants identified an encounter with their peer group in treatment as their initial turning point. Participants also identified facilitating turning points, which occurred after their initial turning points. Facilitating turning points often involved positive emotions, such as love and awe. The majority of facilitating turning points involved individual counselling sessions. Other facilitating turning points included group meditation, quietly reflecting alone at the beach, exercise, group psychoeducation, and reading.

Conclusion

If participant data is any indication, positive change can follow periods of personal adversity. Space does not allow me to go into detail but suffice to say that addiction was not the only source of suffering for the participants who volunteered for my study. As I mentioned above, deeper emotional and relational issues were also at play. I believe the human capacity to turn a negative into a positive is where an existential positive psychology approach is most needed therapeutically and has the greatest potential for positive change.

References available upon request.

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Addiction Therapy and the Pursuit of Meaning

Tim Yu — Fri, 03 Jan 2020 17:10:19 +0000

At the facility where I work, we define addiction as a result of living a life that lacks personal meaning. The solution is, thus, obvious: Help clients begin the process of pursuing a meaningful life. But how to accomplish this? We’ve been working for more than a decade answering that question. One conclusion we’ve come to is that focusing directly on the pursuit of a meaningful life doesn’t work very well. We have to go about the task indirectly.

Approaches that Don’t Work (with Addiction)

Over the years we’ve examined many approaches that the literature suggested might help clients pursue a meaningful life. Below are some examples.

Restoring meaning. Many psychologists who use meaning-oriented therapies have little experience with an addicted population. They often talk, for instance, about a client’s suffering as a “loss of meaning,” and see therapy as a vehicle for “restoring” or “reconstructing” meaning. Yet addiction psychologists have pointed out that those suffering from substance use disorders typically have never felt their lives were meaningful. It’s not a matter of once having meaning and then losing it. Rather, those suffering from addiction—with rare exceptions—have never had sufficient meaning in their lives to begin with. Restoring meaning does not make much sense to them.

Yalom’s existential therapy. In the book, The Psychology of Meaning, Zafirides, Markman, Proulx, and Lindberg (2013) looked to Irvin Yalom as a practical guide to help clients pursue a meaningful life. Yet Yalom, himself, singled out alcoholics as different from his other patients. His one attempt to conduct therapy with a group of alcoholics left him questioning if he had provided any help.

Spiritually focused therapy. Those suffering from addictions are fascinated by spirituality, and more than 1500 research articles have shown increases in spirituality are positively correlated with addiction recovery. Yet treatment programs based directly on religiosity/spirituality (RS) research have had little or no statistically significant effect on outcomes. Perhaps the most sophisticated RS program is Miller, Forcehimes, O’Leary, and LaNoue’s (2008) 12-session, manualized Spiritual Guidance program for alcoholics based on empirical studies of spirituality among the addicted. The program had no effect on outcomes. White (2008) wondered, among many other questions: “Does the essence of spiritual experience get lost in efforts to artificially define and replicate it within a professional treatment intervention?” (p. 443).

In our facility, we also discovered that a focus on spirituality had little effect on how well a client did in recovery. Sadly, a spiritual focus often resulted in a spiritual bypass, a term coined by Welwood (1984/2000) to describe clients who used spirituality to bypass what they needed to work through, such as their fears.

Versions of logotherapy. There are several meaning therapies developed for addictions, and most are based on Frankl’s logotherapy, such as Crumbaugh, Wood, and Wood’s Logotherapy: New Help for Problem Drinkers. The key stage in their 5-stage program is dereflection. Dereflection is one of Frankl’s therapeutic techniques and, according to Crumbaugh, Wood, and Wood (1980), “is the core of the logotherapeutic process of searching for meaning and purpose in life” (p. 103). This technique helps the person shift focus from failures and shortcomings to abilities, successes, and aptitudes. The shift is necessary if one is to find new goals and “discover tasks that will bring him into sufficient relationship with the ‘significant others’ in his life” (p. 103). Unfortunately, logotherapy, like most addiction therapies, has not produced any inspired results in outcome studies.

12-step model of spirituality. Alcoholics Anonymous (AA) interprets a meaningful life as a connection with what it calls a higher power or God. Harry Tiebout, a Connecticut psychiatrist, provided a clinical interpretation of the AA program, which aligns with how AA, itself, defines spirituality. According to Tiebout, “The so-called typical alcoholic is a narcissistic egocentric core, dominated by feelings of omnipotence, intent on maintaining at all costs its inner integrity.” But, he concluded, the alcoholic who followed the AA program was able to tame this defiant individuality and grandiosity because the program helped them “truly accept the presence of a Power greater than himself.” The acceptance of a higher power forced a new perspective on life, one in which the alcoholic was no longer the center of their own universe.

Yet outcome studies based on recovery through AA have shown little effect. It may be that AA’s version of spirituality is too limited, created as it was by middle-class, middle-aged, white men in the 1930s in the northeastern United States, with no intellectual background. The outcome studies may also confirm Hoffman’s (2017) argument that imposed or artificial forms of meaning rarely lead to a personally meaningful life.

What Does Work

Our inductive research (Thompson, 2016) at the center found that clients entering treatment had poor self-awareness, weak relationships, and goals that were given to them by the external world. Meaning therapy as practiced at the facility helped clients begin to reverse these factors. Clients gained a more sophisticated understanding of their values, beliefs, strengths, limitations, how they made choices, the meanings they ascribed to their suffering, and other issues of self-awareness. They also developed authentic relationships with peers and staff at the center, though this positive relatedness did not necessarily extend to families or friends.

The research also showed that pursuing personally meaningful goals in treatment didn’t work very well. The vast majority of clients were baffled by the very idea of pursuing a meaningful life. One client put it this way: “How can I set goals or figure out what I want from life if I don’t even know who I am?” Another client pointed out that that the only thing he felt confidant about was what he didn’t want from life, because his life was largely a series of miserable experiences. But he had no idea what he did want to do or accomplish.

Yet the therapy had an effect on their pursuit of meaning. Essentially, it helped clients recognize that their suffering had purpose. They recognized that how they lived their lives—the choices they had made and goals they pursed—did not resonate with personal values and beliefs. Although most were angry at themselves for wasting so many years in active addiction, many said they were “grateful” to have suffered because it forced them to appreciate the value of living. Clients who played with the idea of becoming addiction counselors typically interpreted their suffering as a requirement to help others who were suffering.

What was most noticeable was their belief that if they could begin doing things that matched their values, then they could live—for the first time—an authentic life. They knew this new life would take years of work to gain self-awareness and connect with others, but they had confidence that they could achieve it.

References

Crumbaugh, J. C., Wood, W. M., & Wood, W. C. (1980). Logotherapy: New help for problem drinkers. Chicago, IL: Nelson-Hall.

Hoffman, L., and Paige, J. (2017). Varieties of suffering and meaning: Clinical implications. Proceedings of the 2016 Meaning Conference. Journal of Existential Psychology & Psychotherapy, Special Issue. Toronto, ON.

Miller, W. R., Forcehimes, A., O’Leary, M., & LaNoue, M. (2008). Spiritual direction in addiction treatment: Two clinical trials. Journal of Substance Abuse Treatment, 35(4), 434–442. Doi:10.1016/j.jsat.2008.02.004

Thompson, G. R. (2016). Meaning therapy for addictions: A case study. Journal of Humanistic Psychology, 56(5), 457–482. Doi:10.1177/0022167815585913

Welwood, J. (1984/2000). Toward a psychology of awakening. Boston, MA: Shambhala Publications.

White, W. L. (2008). Spiritual guidance, addiction treatment, and long-term recovery. [Editorial] Journal of Substance Abuse Treatment, 35(4), 443–444. Doi:10.1016/j.jsat.2008.05.010

Zafirides, P., Markman, K. D., Proulx, T., & Lindberg, M. J. (2013). Psychotherapy and the restoration of meaning: Existential philosophy in clinical practice. In K. D. Markman, T. Proulx, & M. J. Lindberg (Eds.), The psychology of meaning (pp. 465–477). Washington, DC: American Psychological Association. Doi:10.1037/14040-023

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