Subconscious Processes to Overcome Iatrogenic Addiction: A Case Analysis

Abstract

One of the basic premises of humanistic psychology is that personal choice can be aligned with self-growth and responsibility, actualizing one’s potentialities among other characteristics. The case study below exemplifies an artist’s journey of choice out of addiction to a physician-prescribed benzodiazepine medication. The case demonstrates that some addicted persons can self-withdraw and recover without physician or other traditional assistance. The semi-structured interview reviews this self-transformation phenomena. Application of an intra-personal behavior change model serves to deconstruct the interviewee’s remarks and explain her psychological journey to self-renewal. Use of key concepts by current and established humanistic psychologists (such as Carl R. Rogers and Viktor E. Frankl) enhance the analysis of transformation. The deconstructed interview offers a detailed understanding of the intra-personal world of many persons recovering from substance addiction. The article contributes to the culture change needed among both healers and clients alike, by offering a deeper glimpse into the hazards and struggles addicted persons confront to become drug-free. The final section of the paper offers suggestions for research and mental health practices. Overall, the artist’s journey to recovery is a tribute to human growth and to the power of humanistic psychology to engage the human spirit.

Keywords: addiction, case study, recovery, self-transformation

The most terrifying thing is to accept oneself completely.
—Carl G. Jung

This article addresses self-recovery from addiction trauma to an iatrogenic (physician-prescribed) psychoactive medication through case analysis of an interview with an artist. The article represents a preliminary exploration of self-withdrawal (recovery without assistance) as an under-appreciated idiosyncratic method. Rather than a competitor to other recovery theories and approaches, or a sole prescription for recovery, the essay should be considered an offering and supplement to existing practice.

The paper deconstructs an interviewee’s personal journey into and out of addiction. Qualitative methods and perspectives from current and established thinkers such as Carl R. Rogers, Viktor E. Frankl, and others enhance our understanding of the artist’s self-transformation with use of subconscious processes. Future research questions and mental health practices are mentioned at the end of this essay in an effort to inspire additional inquiry.

Methods

This paper undertook a qualitative approach to assess the participant’s perspective. In the words of Herbert Blumer “…any methodology for understanding social behavior must get inside the individual in order to see the world as the individual perceives it…the method emphasizes intimate understanding rather than the inter-subjective agreement among investigators, which is a necessary condition for scientific inquiry to have worth” (as cited in Carter and Fuller, 2016, p. 934).

Hence the current essay engages in empathetic understanding to deeply assess the interviewee’s view of addiction and recovery. This is achieved by using a deconstructed approach to the interviewee’s comments. Remarks between selected interview paragraphs add an interpretative dimension to the individual’s statements by aligning well-accepted change and humanistic psychological theory to the dialogue between interviewer and interviewee.

Case Importance

In the spirit of the #MeToo movement, this paper exemplifies how one woman overcame trauma from relationship abuse and iatrogenic medication addiction. The interview-based case is important for many reasons. First, it exemplifies Freud’s (1940) concept of Nachtraglichkeit (afterwards), trauma induced from multiple events separated by time. Innumerable women face trauma as a result of abuse from men, followed by the additional trauma (shame) when speaking of it with family, friends, and personnel from medical and legal organizations.

Trauma can have lifelong consequences, as women who voice their experience can testify. Currently, well-known figures such as Harvey Weinstein, Jeffrey Epstein, Antonio Brown, Kolbe Brandt, Brett Kavanagh, and many others have been accused of abuse or found to be abusive. According to Freud, trauma is retrospective—yet one author adds, “Trauma is a residue of the past, but terror is a portent of the future” (Clague, 2019, p. 202). With both past trauma and future terror (secondary trauma) in mind, numerous victims are prescribed mood-altering drugs to dampen pain, memories, sleepless nights, and overall mental disruption from their experience. Many victims become addicted.

Trauma, and terror of the future, decreased our case interviewee’s ability to produce art—a severe dysfunction for any professional unable to practice their craft. The artist’s addiction produces additional trauma when a second and then a third overdose results in her near-death and produces terror of her own future death if her addiction continues. Substance abuse recovery is further traumatizing, as it involves severe physical and psychological withdrawal reactions, even when the effort is ultimately successful, as in the case of the interviewee.

How typical is this self-recovery case? While strong data is elusive, self-transformation from addiction is far more commonplace than officially reported (Kelly, 2020). The case presented is representative of innumerable instances of renewal for which research is needed. The recovery process as deconstructed in this interview details how the intra-personal recovery process occurs. This hitherto minimized solution may benefit other individuals who seek recovery, as well as practitioners, by offering a reminder of the value of the self-restructuring process for behavioral change. Moreover, it is critical to discuss the recovery process, using any method or approach, given that the Center for Disease Control estimated that 64,000 deaths from drug overdoses took place in 2016, with over two million Americans estimated to abuse prescription pain relievers (Weil and Dollar, 2017).

Recovery Using
Subconscious Processes

I contend that withdrawal from any addictive substance is always self-withdrawal because those addicted must ultimately take the recovery journey on their own. Invaluable support for treatment is often gained from one or more of one’s family members, friends, a therapist, a physician, or a therapeutic community. Yet, those who engage in recovery must have a firm, repeated, and lasting desire to be “clean.” Those who practice self-withdrawal engage in a political act too, because they are not affiliated with mainstream treatment approaches. The case interview below demonstrates this is possible in some cases.

We begin with comments about behavioral change in general and then move to a theoretical overview of what intra-personal (subconscious) and inter-personal processes the addicted individual confronts to produce successful recovery. The term “subconscious” is defined herein as thinking processes that are not in one’s current awareness. This essay contains speculations adapted from leading thinkers in humanistic psychology, which the case interviewee uses without conscious awareness.

Subconscious Behavior
Change Model

Change is a broad term at the core of psychiatry, psychology, sociology, social work, public health, health education, and other disciplines. Often neglected in change discussions is the alteration of self-concept as part of any transition. While no change effort is guaranteed to be a success, the following steps outline common stages of self-transformation. An individual may start and stop, regress, and then move forward again through time with these phases. The steps are applied below to the interviewee’s journey from withdrawal to self-recovery.   

Intra-personal change processes (a Transtheoretical Model of biopsychosocial intentional change) typically follow six steps (Prochaska, DiClemente, & Norcross, 1992; Steward, 2006).

1. Pre-Contemplation. A person is not interested in change and are satisfied with their status-quo.
2. Contemplation. The person considers a change but does not embrace it; this step signifies dissatisfaction with the status quo, yet an unwillingness or inability to marshal resources to change.
3. Preparation/Exploration. A person weighs more deeply the pros and cons of change: their options, motivation, confidence, and possibilities for action and success.
4. Action/Reorientation. The person begins the intra-personal change journey, embraces needed change, deals with personal resistance, and a tendency to regress back to old ways. There is continuous renewal of desire for action and reorientation to a different intra-personal state.
5. Embrace a New Equilibrium. The person practices the new change, and with success creates a new internal lasting homeostasis, or renewed identity. 
6. Monitor/Re-affirm. The person continues to monitor their self-change and resist regression to previous behavior while strengthening their resolve for positive behavior. Change involves risk and many change efforts fail in total or in part.

The interview below demonstrates successful intra-personal change using the above change principles.

Case Interview Analysis

Trauma resolved is a gift from the gods.

—Peter A. Levine

The woman interviewed below is a lifelong artist (a painter) who is single, age 63, from an upper-middle class background in Beverly Hills, California. She explores her journey into and out of addiction in an informational interview format. She was given an open-ended prescription to a benzodiazephine (diazepam) and became addicted. She was interviewed in a non-therapeutic manner to share her experience in hopes of assisting others (Haas and Green, 2017).  

The comment sections below “deconstruct” the interviewee’s remarks by adding relevant interpretations and contributions from noted psychologists.

Interviewer: I understand you have recently completed a self-motivated recovery from a physician-prescribed medication which had addictive properties, and that you kept a diary of your experiences as a creative strategy during the process. Is this accurate?

Interviewee: Yes. I’d like to say first, why I decided to take myself in hand and go through the self-withdrawal alone if I could manage it. 

Journal writing, more recently called “written exposed therapy” (Harvard, 2018) is a recognized method for reflection, self-care, and overall empowerment for behavior change. This practice often builds resilience. The power of writing should not be under-estimated. Here, the interviewee has a record to refer to about her self-withdrawal experience, which proves valuable for her reflection during the interview. Journal writing also exemplifies what Stanford psychologist Daryl Bem (1972, p. 36) calls “self-perception theory”—that is, we learn more about ourselves and what we believe by observing our own behavior.  Journaling illuminates self-perception during the process of writing, as well as during reflection afterwards. The resulting self-knowledge by the act of journaling, and then reading the journal afterwards, supports behavior change efforts.

Costello (2018, p. 3) writes that “journaling in whatever format is essential” to promote wellbeing. By writing and reading her journal, the interviewee reviews her desire (and ultimately her successful path) to recovery. Journaling is an active process for the interviewee, and helps her integrate her actions with her withdrawal efforts. The interviewee reflects on her inner movement from contemplating change (Step 2) to preparation/exploration (Step 3), during which she began weighing pros and cons and assessing her motivation and confidence to proceed. She had moved past pre-contemplation (Step 1).

Interviewee: You see I am an artist, a visual artist. I specialize in surrealistic-erotic art. Some artists take drugs to aid their creative process. I happen to be the other sort.  I agree with Anaïs Nin, who wrote in Collages that drug-induced imagery was no additional help to her because her visual imagery was as intense without drugs as it was with them, perhaps even more so (Nin, 1964).

Interviewer: If that is your position, as a successful and well-known artist, why were you on drugs in the first place?

Interviewee: My physician prescribed me what turned out to be an addictive drug in order to help me after having gone through a traumatic sleep experience. My nightmare frightened me to a point of fear so great that I was afraid to close my eyes until dawn broke.

Help from physicians, due to trauma, is certainly common and appropriate in many cases. Yet, treatment for anxiety-induced trauma or any condition by a physician should also include regular communication with the patient to assess effectiveness, and eventually to remove a medication as soon as appropriate.

Interviewer: Are you saying that the physician then prescribed a drug for sleep?

Interviewee: Yes, for sleep and for reducing my anxiety. I felt that I needed deep rest, and my physician agreed, so I was given a prescription with an open-ended refill. It never occurred to me to ask either the physician or the pharmacist whether this was an addictive drug, nor did they apparently feel it was their responsibility to tell me that it was. After twelve years of taking the drug to relieve my insomnia, I discovered that the prescribed dosage no longer worked. Three times, in a half-drugged stupor, I ingested far more than I should have taken. On the third overdose episode I became ill on the day following, and finally, deeply shaken by the recognition that I could have overdosed unintentionally, I decided to begin the process of self-withdrawal.

The interviewee reports a significant moment in her journey from addiction. She decided to change her behavior, starting with self-withdrawal. This is a “teachable moment,” a dramatic event which often brings about individual change in order to address dysfunction, if not disability or death. Her comments exemplify the action/reorientation phase (Step 4); the interviewee began the intra-personal change journey and fully embraced the need for change.

The artist’s decision further exemplifies the social-psychological theory of  “self-completion” (Wicklund and Gollwitzer, 1982). This theory states that in our own eyes we often feel incomplete. We aspire to complete our new (or previous) self-definition, our sense of being a valued self. Yet, our present self falls short of what we desire—hence, dissonance results. The gap between desire (being drug-free and a fully functioning artist) and reality (the third medication overdose) produce in the interviewee the energy to embark on self-withdrawal.

The interviewee’s third drug overdose illuminated the artist’s profound awareness of her potential death. In the words of Switzer “…the most obvious concrete threat to one’s self-affirmation is death. When a person becomes aware of non-being through the anticipation of death, the anxiety which is latent is now aroused and subjectively experienced” (1970, p. 154). Switzer continues by stating “…anxiety is potentially present in every life moment. It permeates the whole of man’s being when we act contrary to our self-affirmation and potential, guilt and anxiety result” (1970, p.154).

Perhaps this existential self-realization is what contributed to the interviewee’s personal decision to change. The interviewee’s statement of the hazards of her third overdose align with her realization of her anxiety and her determined need to recover from addiction.

Interviewer: What did you do to prepare for withdrawal?

Interviewee: I had no idea that I would again be caused sleepless nights, yet some inner insight or wisdom led me to shop, to purchase large amounts of storable food, which would enable me to stay at home if necessary. I was careful to tell only my boyfriend and my mother what I intended to do, and I told them only because I felt I might need some kind of help or support from them. It was important to me, if I were to fail, to have as few people know about it as possible. I didn’t need anybody on my back accusing me that I had been too weak to succeed.

The interviewee recognized the potential value of social support from others. She also wished to limit who she informed to avoid the potential stigma of failure if self-withdrawal was unsuccessful. The shame of addiction, need for recovery, and challenges that recovery entail are significant barriers to self-renewal. As a professional person, she accepted the need to protect her public reputation. She continued to embrace change (Step 4) as she actively began to prepare for the intra-personal change journey. She also dealt with personal resistance and gathered interpersonal support (from her mother by telephone). She actively attempted to reorient the self, change her addicted identity, and seek congruence between her desired future and her past and current behavior. With a cognitive behavior therapy (CBT) approach in mind, we can observe the interviewee integrating three core aspects of CBT: her cognition/thoughts, her emotions/feelings, and her actions/behavior.

Interviewer: Can you mention the sequence of your experiences?

Interviewee: Well, first, I discovered that I did sleep. But that sleep was a hell of nightmares that lingered through my waking hours, and into the day. I was dizzy, and sometimes nauseated, frequently unable to eat. I experienced spatial distortions, auditory and visual hallucinations, intense depression, anger towards all, even those I most loved. I clung to my diary writing in my first week experiencing an isolated madness. I would not know today exactly what my experiences had been if the diary record was not there to help me recall it.

Interviewer: What does the record tell you about these first days?

Interviewee: I suffered anxiety, trembling; my vision was blurred, and my sense of time was twisted out of shape. I was highly nervous and very paranoid. For example, at one point I was certain that my boyfriend would murder me. What I discovered as I went along was that my feelings, after a period of irrational intensity, began to shift moment by moment through alternating stages of being in the near present and moving back to exaggerated angers about people and incidents in my recent past.

Interviewer: Did you have unpleasant physical sensations?

Interviewee: Yes, I had early sensations of being bitten and stung by insects I could not find when I turned on the lights to look for them. Mostly the effects were psychological.  One of the most devastating nights was the one in which I understood how easily I could commit suicide. Also, I was most frightened when I understood that it appealed to me to do so. Well, I’ll also say some of these feelings I ventilated in telephone conversations with a friend whom I had not told I was going through drug withdrawal, but who turned out to be a patient listener to the flood of crazy meaningless words. My mother’s patience was also a great help to me, but it took me a long time to stop seeing my boyfriend as a potential killer. Mostly my only contact with him was by telephone. After the first week life became easier. Not easy, but quite bearable. I began to want to see people again. The record shows that, physically, I experienced a short-term sore throat, went blind in one eye for a day, and had paralysis of my right arm for two days. I found I could not spell properly and that my handwriting often became illegible. It seemed to me there was a hearing impairment too, that is, what I said to others or what others said to me was distorted. At times, I could hear certain sentences clearly, but other sentences would just disappear. Losing the sight in one eye was so stunning that I called my ophthalmologist and was seen by him immediately. He found nothing wrong and told me to see my internist. I then told my internist about my withdrawal and he explained to me that the eye problem was just a freak side-effect of the withdrawal process which he hoped would never happen again. I asked him if there was anything he could do or give me to help with the discomfort of withdrawal, and he answered “no.”

The interviewee’s statement about her boyfriend being “a killer” is characteristic of a delusional disorder. Later in her journey, the statement “I began to want to see people again” demonstrates her desire for what the eminent psychologist Carl R. Rogers (1961) would call movement toward “congruence” in one’s being. She wished to exercise her renewed sense of self and identity as a creative, productive artist and a social being. She exemplified Step 5 via her embrace of a new equilibrium. During this time, she practiced the new change and worked toward a new internal homeostasis. She began closing the intra-personal gap mentioned above between an addicted vs. a drug-free self, between ego and ego-ideal.

Interviewer: Is that all your physician said to you?

Interviewee: No, afterwards he remarked that it would take about three months to be chemically free of the drug. I must say that it does not take as long as three months to be chemically free of the symptoms. Possibly it takes forever to be psychologically free of the desire for oblivion on those sleepless nights that occur in everyone’s life, but especially on the devil’s nights for those of us who have been addicted to sleeping potions prescribed by well-meaning physicians.

Interviewer: All this sounds like you opened up Pandora’s Box. Did anything of benefit emerge from this?

Interviewee: Yes, the most important revelation emerged slowly. It was that living strictly in the present is key for me, not only during drug withdrawal, but also as a focus to be maintained for the future. Today, of course, that notion is tempered slightly by my understanding that I must also consider the future, but not attempt to live it before it has arrived. Anticipation cannot only be exciting, but it can also be riddled with anxiety-producing visions of unhappy outcomes.

The interviewee continued to apply Step 5 as she embraced a new drug-free self-equilibrium, attempted to create internal homeostasis, and improved self-management of the immediate present.

Interviewer: What big stage came next?

Interviewee: The day came when it became imperative to vacuum, straighten the house, dust. It was so urgent a need that it had no connection with the requirements of my living conditions. It was a sudden need to have everything perfect. I began to feel increased energy. I felt I wanted to break out in some respect. I wanted to dance, to sing!  I wanted to read, too, but I found that concentration on the printed page was not easy. I began to feel exhibitionistic, wanted people around me, wanted to look pretty, to have fun, use the excessive energy that began pouring through me with my artistic painting as well. I had an incredible desire for lots of new clothes, now!

The interviewee exemplifies Step 6 (monitor/reaffirm) by reaffirming and strengthening her resolve to be drug-free. Renewed self-perception is reinforced with new behavior. Her subconscious application of CBT principles mentioned above are successfully integrated.

Interviewer: Was there any point at which you didn’t think your experience was worth it?

Interviewee: There was never a point at which I believed the experience was not worth it. There were times when I felt that I as a person was not worth it, such as the evening during which I contemplated so seriously self-destruction. As I began to see people again, to be sociable, I received reinforcing comments about how well I looked, about the new variety in the tone of my voice, and even, at times, about a new lyricism. And, importantly, I learned to sleep.

Here, perception of others is being incorporated into her renewed sense of self (identity). In the words of Erik Erickson (1956:57), one’s sense of identity “is never gained nor maintained once and for all. Like a good conscience, it is constantly lost and regained…”. Erickson continues by saying human beings hold “an unconscious striving for a continuity of personal character.” The interviewee’s current behavior is congruent with Erickson’s views, as well as with self-completion theory (a happier, creative person who is active and artistic in the world).

Interviewer: So, these were positive outcomes.

Interviewee: Yes, learning to sleep and not being hung over all day from overdosing. If I had been able to take the minimal amount which had been prescribed for me, no one would have known. The decision to withdraw was mine and it came about strictly because my need for more and more medication in order to sleep became frightening to me. I know it could lead to a possible unintentional overdose, and, if not, I knew I would be hung over the whole next day from whatever dose I did take. I suppose that it is unreasonable to expect that a drug will maintain the same efficacy taken over a long period of time that it had in the beginning, and therein lay the danger for me. Dependency is another factor which must be considered, and each of us understands the heavy implications of that.

Interviewer: Now that the experience is behind you, how would you evaluate your present attitude about prescription drugs with mood altering effects?

Interviewee: A drug whose purpose is not curative, and is not necessary for the maintenance of health, needs to come under question by the patient. The patient must take responsibility for asking the prescribing physician about the addictive nature of the medication and for how long it should be taken. The doctor’s responsibility is to tell the patient when a drug is addictive. The pharmacist as well should tell a patient whether or not the drug prescribed is of an addictive sort. If necessary, legislation should restrict the number of refills of all addictive, not curative, medications such as sleeping pills and tranquilizers. We as patients are too much in awe of our physicians (who often appear to us as authority figures) and we passively accept their directions without question. It is our responsibility not to be intimidated.

In the above statement, the interface between patient behavior and health care providers is illuminated, which exemplifies a “systems perspective” on addiction. The politics of physician prescribing (marketing, sales, financial incentives offered by insurance and pharmaceutical firms, etc.) must be mentioned as one factor in the massive overuse, addiction, and death in today’s society due to legal drug misuse (Pearl, 2013). Some of our major healthcare institutions compromise the Hippocratic adage primum nil nocere—“First, do no harm.” Client and provider education are needed to reinforce the potential hazards of addictive prescriptions, as well as stronger FDA oversight. The interviewee’s growing maturity is exemplified by her acceptance of responsibility for repeated prescriptions and medication refills. Overcoming of emotional-psychological addiction to a mood-altering prescription is another element worthy of mention in the artist’s recovery.

Interviewer: Let’s look at this in relation to your profession as an artist. Are there any aspects of the withdrawal process which now are expressions of creativity on your own part?

Interviewee: Yes, in the larger sense I see all healing as a creative process. Certainly the resurgence of subdued energies enabled me to become more productive as a visual artist. That is, I produced more drawings, painted more, and did so with even greater intensity. With each artistic work I explored deeper realms of my potential, and thereby learned more about life. I found that even the possibilities for writing expanded in a particular way by the journal record I kept during the withdrawal. My path to recovery, however, may or may not be available to everyone. I can only speak for my situation—and try to educate others.

Interviewer: Isn’t there another sense in which you achieved creativity, namely in taking the initiative for producing your own healing by choosing to go through the experience of withdrawal in the first place?

Interviewee: Well, yes, there was the sense of development and the extension of one’s own power, a power that involved one’s total being. The ability to translate fears and anxieties into the positive production of writing, poetry, drawing, and even song. The power to recreate in one’s self not only the feeling of internal balance and beauty, but also to create an external appearance that can be perceived by one’s self and others, is surely a creative power of the highest order. The new self, so created, becomes as important an addition to the quality of the human landscape, as does the artist’s creation of another work of art.

A double consciousness emerges with the interviewee’s final comments. We read about the movement away from her addicted self-concept toward her return to a previous drug-free self-concept, which embraces her artistic creativity and mental well-being. We witness an artist who renews her life as part of her recovery by again practicing her craft of erotic drawing and painting. This assists in her self-transformation—her renewal of self-concept and self-direction. In addition to the act of painting itself, let us explore how the artist’s deeper transformation took place by applying concepts from two modern-day seminal thinkers in psychology.

Application of
Carl R. Rogers’ Work

Carl R. Rogers (1961), would see the artist’s withdrawal and post-recovery state as an example of “congruence,” where her inner and outer lives are now aligned for emotional growth. Congruence means overlap of self-worth, self-image, and ideal self-concept. Incongruence means a large separation between these three aspects. Rogers’ (1989, p. 135) hypothesis is that human beings have a core motive to self-actualize, to fulfill potential, and achieve “human-beingness.” As Rogers states, “…the individual has within himself or herself vast resources for self-understanding, for altering his or her self-concept, attitudes, and self-directed behavior and that these resources can be tapped” (1989, p.135). Rogers’ client-centered (or non-directive) approach is constructed on core trust in a client to release their “actualizing tendency” for growth and development. This philosophy contrasts with traditional therapies (and many current therapies), which are based on a distrust of the client, who requires specific goals, assessments, and monitoring (Rogers, 1989, p. 136-137).

Going beyond human potential philosophy, Rogers writes extensively on three core conditions (attitudes) that often promote a climate of growth. The first of the three conditions is congruence, which is mentioned above (being genuine, real). Rogers refers to congruence as “the feelings and attitudes that are flowing within” (1989, p. 135). The second is unconditional positive regard: being positive, non-judgmental, and accepting. Third is empathic understanding, which involves deep listening, “…one of the most potent forces for change that I know” (Rogers, 1989, p. 136). The interviewee in my view has internalized (albeit unknowingly) being real and forthright with herself (congruence), practicing positive self-regard, and having empathetic self-understanding for her condition and recovery effort. Hence, while the three conditions describe the relationship between therapist and client, I suggest an expanded view of Rogers’ client-centered or person-centered approach.

Current research supports qualitative contributions to successful behavior change by noting the value of being authentic (congruent), that is to live according to one’s deeper self. With application of Rogers’ concepts, we see the interviewee embracing self-compassion. She does not reprimand herself with statements such as “I’m a failure,” or “I’m stupid and weak.” Also, she does not leverage external treatments, such as physician supervision, medication-assisted treatment, individual therapy, cognitive behavioral therapy, or participation in a therapeutic community like Alcoholics Anonymous or Narcotics Anonymous (each of which has proven value in many cases). Instead of the above treatment methods, the interviewee subconsciously follows Serena Chen (2018), Psychology Professor at UC Berkeley, Ronald Siegel (2019) of Harvard, and others who advocate self-compassion, being kind to oneself concerning our human weaknesses, seeing failure as part of the human condition, and not allowing negative emotions to dominate desire for self-improvement. The interviewee exemplifies this power of self-compassion in her withdrawal and recovery. Now, let us review another contributor to the humanistic psychology tradition whose work can be applied to addiction self-recovery.

Application of
Viktor E. Frankl’s Work

 Psychiatrist Viktor E. Frankl, Viennese psychiatrist and founder of logotherapy (therapy based on uncovering meaning for a client), highlights the power of delivering oneself over to a life purpose. Frankl’s thesis is that life trauma can be transformed when one’s core mission is uncovered. Frankl criticizes both Freud and Alfred Adler by writing “Freudian psychoanalysis centers its motivational theory on the pleasure principle…whereas Adlerian individual psychology focuses on a will to power” (1967, p. 71-72).

The focus of logotherapy, instead, is for each individual to discover their own core motivational force, or will to meaning, “striving to find and fulfill meaning in life” (2000, p. 85). The hope in logotherapy is to transform our attitude about current dysfunctional circumstances, to restructure the self, and to move forward in living. This is accomplished via the uncovering of one’s own personal meaning. In the words of Frankl, logotherapy is often focused on a person “doing a deed or creating a work” and thereby finding meaning to transcend one’s current dysfunction and/or life circumstance (2000, p. 141). Frankl also argued that we are “not free from conditions be they biological or psychological or sociological in nature” but we “always remain free to take a stand toward our conditions,” i.e., to choose our attitude toward them, “to rise above the plane of somatic and psychic determinants of our existence” (1967, p. 3). In short, we are capable of taking a stand for ourselves.

Despite logotherapy being a facilitative therapy method with a single individual client and therapist, Frankl writes an astounding and rarely noticed statement: “We must not forget that even self-administered logotherapy may be helpful to change the life of professionals” (2000, p. 130). The interviewee’s repeated drug-induced state created what Frankl would call an “existential vacuum,” or frustration in life purpose. “Self-transcendence is the essence of existence. Being human is directed to something other than itself” (1969, p. 50). The essay herein embraces Frankl’s views. The artist’s third near-death overdose re-awakens her purpose and inner drive to continue her artistic work. The interview demonstrates the artist’s “will to meaning,” her striving to find and fulfill purpose. Significantly, her journey was not prescribed or obtained by any professional. Her journey for self-recovery was inner-directed. The application of theoretical comments from Rogers and Frankl offer us two unique perspectives that enlarge our understanding of the journey away from addiction and toward self-reconstruction.

Research Implications

A partial list of pertinent questions for future investigation follows:

• What successful self-recovery methods now exist?
• Has the creative act of artist expression played a positive role in drug recovery?
• What self-recovery routines are successful, yet not found in research literature?
• What self-talk takes place within those who succeed in long-term recovery?
• What changes in self-concept or identity take place in the process of successful self-recovery?
• Does self-withdrawal and recovery differ with different psychoactive prescription substances?
• How sustaining is self-recovery versus recovery using other methods?
• What is the nature of self-motivation?

At least one current researcher explores self-motivation as one of the most valuable yet difficult skills to learn (Fishbach, 2018). Further research into this area in the field of addiction may offer new insights into paths to recovery.

Implications for
Mental Health Practitioners

This essay reminds practitioners that the client experience of telling their story to an empathetic listener may well serve to help sustain recovery. Herein, our interviewee reminds herself of her journey and the strength of her resolve through the interview. As noted above, no attempt was made to offer therapeutic comments or insights by a professional. Just as journal writing by the client had value, a highly supportive deep presence, deep listening, and focused questioning by the interviewer had value by allowing the interviewee to voice her success—both to herself as well as to the interviewer. I submit that while questioning and listening is central to therapeutic practice, use of open-ended deep looking and deep listening to a client, without a solution focus, is an underreported aspect of the healing dialogue. Moreover, practitioners can remind clients of the behavior change step model outlined above to assist them in their recovery and/or reflection on their recovery. Having the mental health practitioner voice theoretical concepts and comments by Carl Rogers, Viktor Frankl, and others may also be useful to clients who are receptive. Both of the above points can aid recovery and/or sustainability of behavioral change.

Final Remarks

This essay contributes to the scant amount of material on self-recovery from iatrogenic harm which results in psychoactive medication dependency. Moreover, recovery can be a life long process. The individual in this case study reviews her journey into and out of addiction in a non-therapeutic interview setting. The interviewee reports her self-motivated actions to recover and to re-engage in her long-standing professional artistic creativity. The paper applies salient aspects of an intra-personal behavioral change model to the interviewee’s responses, deconstructing the addiction self-renewal process. Subconscious processes are used to explain the interviewee’s recovery. Insights, including Carl R. Rogers’s three core prerequisites for therapeutic change and psychiatrist Viktor E. Frankl’s theory of logotherapy, help deepen our understanding of the interviewee’s journey to remission.

No claim is made by the essay that self-recovery is recommended to overcome all addiction. My hope is not to alienate, but rather to promote engaged conversation about an understudied method of drug withdrawal and self-renewal. Given the gravity of the addiction epidemic today, every effort to perpetuate information about successful withdrawal—and the role of physicians, pharmacists, and pharmaceutical firms to influence addiction—should be aired and researched. The interview and commentary of this paper offer us a positive example of the endurance of the human spirit in the face of the significant challenge of addiction recovery.

References

Acknowledgements

I wish to thank Judith Frank, Gloria Nagel, and Stephanie Evans for their encouragement and editorial suggestions on early drafts of this paper. Special thanks to Marc Pilisuk.