Do you ever have one of those moments? You’re scrolling, more or less aimlessly, through an often-inane social media feed when you stumble across a post and think, “Hmm, that’s actually quite profound; it resonates with me.” I have those lightbulb moments fairly often, though sometimes they can also arrive with relentless and monotonous regularity. That’s a welcome and often beneficial consequence of being prone to thinking about things.
Different versions of the quote below are currently circulating on social media. I’ve seen it, in one form or another, on LinkedIn, Facebook, Instagram and TikTok. It is presented variously as an original thought, guidance from a close friend or confidant, or—most often—as “advice from my therapist,” particularly, though not exclusively, in posts from American content creators.
Healing is so hard because it is a constant battle between your inner child who is scared and just wants security, your inner teenager who is angry and just wants justice, and your present self who is exhausted and just wants peace. (Various)
Some versions expand on the idea with a deeper reflection or explanation, along these lines: “There are three versions of you living inside one body, each fighting for something different, while you are still expected to function like a normal human being and manage a war nobody else can see.” The passage resonated with me because it helps illustrate some familiar thought patterns: those often experienced by people navigating addiction treatment services while searching for their effective, sustained and successful pathway through recovery.
As many who know me will know, I do not personally subscribe to the dominant “disease model” of addiction, which is so often linked to ideas of “effective” recovery. So it’s unsurprising that I find some of the quoted language problematic. For example, the word “healing” suggests, to me, that addiction is being framed as an illness to be treated, rather than as a pattern of choices shaped by circumstance. Before the usual dogmatic objections start flying, let me try to explain what I mean.
I’ll begin with the familiar argument about “choice.” Sometimes, for entirely valid reasons, the choices we make can feel almost dictated by other people and by the situations that we find ourselves in. When no real alternative seems available, and no other credible route appears possible, escape can start to feel like the only option.
I understand that; I really do but, from my experience of working in this area of healthcare, adopting that mindset—and the treatment models built around it—rarely leads to sustainable long-term change. Too often, people are described as being “in recovery” rather than actually “recovered”, many still carrying their unresolved experiences and circumstances with them. Those factors that contributed to their difficulties in the first place. Despite [rightly and deservedly] “celebrating” where they are now.
“…if we only treat the part we can see, we may never reach the reason it became necessary in the first place.” (Jason Shiers, The Infinite Recovery Project)
A problem does not disappear simply because we deny it ever existed—or because we decide, or are encouraged to hide from it, with the hope that it will fade with time. Avoidance is very different from confronting an issue directly and trying to resolve it. Too many people affected by addiction and other forms of social distress are surviving only by “white-knuckling” their impulse to reach for their chosen crutch, or by relying on yet another prescription that offers more of the supposed miracle solutions supplied by big pharma.
None of this cures the so-called illness. Much of it is simply another social sticking plaster: a convenient short-term clinical or social Band-Aid applied by people who are physically, psychologically, socially, and often financially constrained. The problem is then compounded by underfunded public healthcare providers operating with limited resources inside a system that is visibly fracturing. Worse still, many of these issues are rooted in the practices of commercial entities, particularly – but not exclusively – within the American model of healthcare, which pathologise psychological pain, in order to profit from rising levels of physical and emotional distress. “Don’t worry, we’ve developed another pill for that,” says the smiling snake-oil salesman, already thinking about his next bonus.
Nothing positive comes from pathologising our trauma experiences as mental disorders and personality disorders. (Dr Jessica Taylor, victimfocus.com)
I understand the commercial and economic pressures that underpin many public services, and not least addictions treatment modalities, and the delivery systems for those services. I really do. Because I have had to search for resources to support individuals – and wider social struggles – that is an increasingly more difficult position for any publichealth or public service provider. It is especially hard to tell someone, “I can’t help you,” because the system will not allow it—whether because of limited resources, procedural rules, budgetary constraints, or even more worryingly, a system that is constrained by short-term thinking, and/or dogma. What I have always struggled to accept is any pursuit of financial advantage (or profits) at the expense of people. Which is an impulse that seems to underpin so many [American] commercial business models. That’s something that has never sat comfortably with my own moral compass.
“There comes a point where we need to stop just pulling people out of the river. We need to go upstream and find out why they’re falling in.” – Desmond Tutu
However, many of the problems we keep facing today seem, to me, like they are mostly rooted within that short-term thinking; and the malaise which dominates leadership across organisations, public services, governments, and the societies they are meant to serve. We have built systems – and people working within them – which are shaped largely by prevailing American business models. We have encouraged—and rewarded—an increasingly common and deeply troubling “Fuck you Jack, I’m all right” mindset. This type of attitude, although reflected to some extent in almost all systems and business models, finally appears to be attracting waning support. And figures at the top of business and political life are belatedly starting to notice, especially in America. But that’s another story to be expanded upon on another day.
Another driver of our prominent short-term thinking is the tendency of each new generation to believe it has reinvented the wheel, perhaps most visibly within – again predominantly American – cultural and commercial contexts. Once an old idea is repackaged as a “new” invention or so-called life hack, it is often commodified and monetised almost immediately. Much of its subsequent commercial success seems to rest on limited awareness of history, geography, or earlier achievements. The insularity of some systems, and of some individuals within them, can encourage a narrow worldview, making it easier to overlook the fact that many supposedly new ideas were commonplace long before modern America existed. This helps explain the emergence of a new kind of online “healthcare” industry: one built around the not-so-humble social media influencer.
Shocking, perhaps, but these digital tendencies are actually not confined to America. They appear elsewhere too, including in the UK, where they can affect public services and some important aspects of our healthcare provision. With this in mind, it’s probably wholy understandable when I find the sarcasm-laden words of the author and coach Ian Callaghan resonating and running through my head, especially when I’m considering the impacts of the modern “life hack” and influencer phenomenon:
“Social media has spent years telling everybody to be authentic, but only recently clarified that authenticity must use an approved phrase, a fashionable font, a trending audio track and exactly the same emotional arc as sixty thousand other allegedly unique people.” (Ian Callaghan)
Ian is probably correct when also he points out; “Individuality has become line dancing for people with ring lights” as opposed to them personally doing the required work on their own personal issues.
At this juncture, whilst I continue to ponder the situation, I’m not suddenly reaching for the “Happiness” that a pack of five classic cigars allegedly contained, back when they were famously advertised on TV by Gregor Fisher, late of Rab C Nesbitt fame. No, I’m struggling not to adopt a monologic tone and utter something about Hamlet suffering from his “slings and arrows of outrageous fortune”. Because “to be, or not to be” is a lynchpin within the solutions for many of these issues; something which has long been one of my strongest drivers for my lifelong work ethic, and the desire to support others less fortunate than me, prior to my retirement. OK, so none of this is my problem any longer but that doesn’t mean that I can’t keep pondering the situation.
It seems clear to me that we will continue to feel the consequences of all this short-term [financial] self-interested – often digital and binary – thinking for some time. In fact, I am not sure that we can ever fully escape it, at least not within my lifetime, that ship has sailed. And certainly not while we remain so focused on the digitally enhanced immediate rewards of the present. Nor will we move beyond it while we continue to measure our personal, institutional, and social worth through the metrics of financial wealth, perceived status, or the presence of power to influence or restrict other people’s choices.
Constantly chasing the dopamine hit, continual short-term thinking, profit-driven models, and status-based measures of worth are all impacting upon the more humane solutions, and for almost everything now; both for us as individuals, and for our collective futures. We need to start shifting our attention upstream: to focus more upon prevention, earlier interventions, trauma-informed support, stable housing, meaningful work, community connection, and social inclusion. But I also hear and understand the simplistic counter-arguments – “that’s all easier said than done” – but remember; nothing changes when nothing changes. You can’t use the same route [solutions] that you’ve always used if you don’t want to arrive at the same destination, with the same outcomes.
Governments and leaders need to address causes, not just symptoms. Systems need to be designed around people rather than money alone, with services that respond more effectively to social traumas of individuals: poverty, isolation, shame, and often the distinct lack of agency that often sits behind those people’s struggles. We cannot keep trying to medicate our society out of the harms we help create. Instead, we need sustained investment for all our public services, including person-centred, properly funded health and social care, and systems of community support which are not limited to crisis response.
The time for simply thinking about drawing back from profit-driven harms, created by current business and healthcare models, has long past. We can’t keep on commodify distress and monetising wellbeing. Any and all future success requires us to keep challenging current public service business models, while measuring success differently: valuing stability, dignity, connection, autonomy, and peoople’s overall quality of life. Which, particularily in respect of addictions treatment services means, we move on from merelly quantify success by drug/alcohol abstinence, the absence of problematic behaviours, service discharge rates, system productivity data, or those short-term financial savings. Additionally, the workforce also need the time, resources, supervision, and flexibility to respond more humanely, rather than simply manage rising demand by fire-fighting chaos and/or ticking an interventions box on some patient / client record; because they’re all rushing around from one crisis to the next. And, despite most personal desires for providing high-quality person-centred care with empathy, many are stymied by the frameworks which they’re obliged to operate within.
Unless we can develop longer-term, people and community-centred thinking – which is not driven solely by financial gain or loss – many of our public services will continue to falter and fail. And sadly, as we are already experiencing across many areas of public service – like the NHS and Emergency Services – we will all continue to feel the profound impacts and consequences of those failures.
And so “to sleep: perchance to dream… for in that sleep of death [not yet I hasten to add] what dreams may [yet] come” true?
Dave's Bankside Babble 