Wisdom Recovery, Part III: The Culture is the Competence: Evolving the Practice of Treatment and Recovery

This is the final article in a three-part feature on wisdom recovery published in this magazine, prepared by a newly created group of individuals with decades of experience in the world of healing and recovery. The focus of The Wisdom Recovery Group, is “to bring true balance back into the center of recovery and healing work,” according to Lee McCormick, founder of the Ranch in Tennessee and director of The Integrative Life Center, an outpatient program in Nashville. He is joined by Will Taegel, PhD, dean of the Wisdom School of Graduate Studies; Mary Faulkner, coauthor of The Spirit Recovery Medicine Bag; Holly Cook, LPC, executive director of the ILC; Gordon Dveirin, EdD, a consultant in organization and human development; and Joan Borysenko, PhD, one of the founders of the field of mind-body medicine and a noted researcher and author of sixteen books in the field of health and healing.

What is Organizational Culture?

Any culture we’re immersed in, including the prevailing clinical culture for the treatment of addiction and recovery, is likely to be like water to a fish: utterly pervasive in how it conditions our perceptions and behavior, yet largely unconscious.

Culture is the interior commons, the group identity we implicitly share with those we include whenever we say “we.” It’s our interpretive framework, the perspective through which we view our familiar world. It is a lens that, for the most part, we’re looking through rather than at, until we step away and begin to reflect on what our shared assumptions actually are and how they affect the content and outcome of our work.

Getting Perspective

What is the commonly shared perspective that underlies our communal “we,” the “we” in the treatment profession? What are the underlying agreements, meanings, values, and commitments that constitute that “we” and define how we understand our collective role in relationship to our clients?

Our view of the client-provider relationship and in particular the underlying value proposition—how we mutually define and measure recovery—is key. It’s what the culture as a whole communicates to its clients about how they’re regarded, creating an implicit psychological contract that defines our roles vis-à-vis one another.

Culture is both our medium—the water that we swim in—and also our message. The meaning of that message is the response we’re getting. Perhaps no other factor, not even the increasing sophistication of new treatment modalities, accounts more for the relative success or failure of treatment programs in terms of their clients’ recovery.

The invisible power of the culture in defining treatment outcome merits testing since change at the level of context rather than content may hold the possibility of a real breakthrough in the likelihood of measurable successful treatment outcomes.

Courageous Conversations

A good way to begin seeing the strengths and limitations of the culture we’re embedded in is to step outside of it. From that external vantage point we can then reflect about its core purpose, principles, practice patterns, and impact on clients.

We can make the invisible water of culture more visible by sitting with our colleagues and asking what the poet David Whyte calls “courageous questions” about our meanings, our callings, and our commitments (Elmhirst, 2006). This is what our Wisdom Recovery Group has been engaged with in regards to the core limiting beliefs, agreements, and underlying assumptions of the addiction treatment profession.

The Wisdom Recovery Group’s focused inquiry into what’s working or not working in the treatment of addiction, based on our combined decades of experience, reveals some significant cultural blind spots. Bringing those blind spots to light could lead to new, potentially transformative pathways for treatment and recovery.

I’ll recap some of our insights in a moment. But as Will Taegel and Joan Borysenko stressed in their article in the June issue of Counselor, the discoveries that you and your own colleagues make are what’s most important. Together we can move toward evermore conscious and caring competence in our field by engaging in a regular practice of organized reflection. Together we serve over 1.8 million human beings who are addicted to behaviors or substances that hold them prisoner. We can and must learn more about how to help free them.

This process of deep questioning and deep listening, of focused group inquiry into the core concepts, values, and definition of care guiding our overall practice, and especially about how we and our clients measure success, can yield real breakthroughs and benefits—the recognized fruits of becoming a learning organization.

Cultures of Memory versus Cultures of Inquiry

The evolutionary shift from a business-as-usual culture of memory, guided by the inherited lessons of the past, to a culture of inquiry intent on learning its way into a more promising future is an urgent and obtainable goal. The emergence of new and important clinical modalities in recent years—new insights from neuroscience, epigenetics, nutrition, and other sciences—holds promise, yet appears to be stalled at a disappointing plateau in affecting long-term recovery rates.

Our Wisdom Recovery Group addressed the question: Is there a limiting core belief or agreement, specifically about who the addicted person is and about what his or her recovery means, that underpins the practice of addiction treatment and keeps it from achieving optimal effectiveness?

Does the profession communicate, wittingly or not, a belief that addiction, even when no longer active, is at best a latent pathology, an ever-enduring identity like original sin? Once an addict, always an addict? Recovery, from this point of view, can only be seen as abstaining from addictive behavior and returning to conformity with social norms, however afflicted those norms may be.

Isn’t this view of recovery like defining peace as simply the absence of war? Has the traditional treatment culture, by holding addicts in the frozen past of their habitual identity, limited the potential of at least some clients? Despite the skillful work of many individual therapists, it is easy to inhibit a client’s fundamentally human impulse toward transcendence. The powerful, but often unacknowledged drive toward becoming whole, real, and uniquely oneself is a call to freedom and creativity. When this drive is acknowledged and encouraged, as well as modeled in the culture, all aspects of treatment work together synergistically.

A Historic Context

The Wisdom Recovery Group’s emphasis on potential rather than pathology, and on eliminating the cultural biases that often mask potential, can be appreciated by a trip back in time, looking at the historical context of treatment for physical and mental health issues.

French philosopher and historian of ideas, Michel Foucault, provides a fascinating lesson in culture in his book, Madness and Civilization (1988). In medieval Europe, leprosy was a terrible and widespread disease that the crusaders brought back with them from the Middle East. As a result, leprosariums existed in almost every town of adequate size. Their function was to quarantine lepers.

Madness, however, in contrast to leprosy, was seen as a journey between this world and the next—a state of partial transcendence like Ophelia’s in Shakespeare’s Hamlet. To symbolize this mystical journey, mentally ill persons were placed on the “ships of fools” that wended the waterways of Europe, from one pilgrimage site to another.

By the eighteenth century, the Age of Reason, leprosy had all but disappeared from Europe and the once well-endowed leprosariums were left empty. Almost as if to preserve and occupy this niche in the social structure, madness was then declared an aberration of reason, and the mentally ill were cast into places of enclosure, the asylums and prisons, along with criminals.

The defining stigma that merited quarantine had changed, but the niche of confinement in the overall social structure remained the same. Unfortunately, the journey of transcendence and the recognition of those who, however erratically, were obeying their impulse toward it, were simply lost sight of. There ceased to be a recognized alternative to the sleep of conformity to convention that psychologist Erich Fromm called “the social unconscious” (1941/1994). That conformity was depicted in the movie The Matrix as the effect of the blue pill.

Rationality alone, as a valid mode of knowing and acting in our disenchanted world, reigned, and still reigns, supreme.

By the 1960s, the British psychiatrist, R. D. Laing took another tack, particularly in his treatment of serious mental disorders like schizophrenia. He used the graphic illustration of a journey around the clock. Laing positioned the state of being that society defines as “normal” at the number nine on the clock. This was the condition that Laing called the “sane schizoid” state—a divided self split between its inner truth and the outer conformity required to get its basic needs met (Laing, 1967).

By moving away from this “normal” state and heading around toward the opposite side of the number three on the clock, the schizophrenic person, far from being a deviant, was actually, in Laing’s view, on a healing journey. The client was obeying an impulse toward true sanity, the recovery of an undivided, unwounded, never permanently damaged state of being.

With this powerful change of metaphor, Laing reframed the therapeutic purpose from trying to push the patient backward toward nine to helping them find their way forward into wholeness, authenticity, and creative self-expression, which only some of his patients achieved. Nonetheless, the context of wholeness may inform a new kind of culture in treatment and recovery—a culture medium in which a variety of treatment modalities can be coherently brought to bear for maximal effectiveness.

Physician and addiction specialist Gabor Maté writes about the recoverable essence, the original wholeness he has observed in some addicts in “moments of reprieve, moments when the truth of a person arises and insists on being recognized despite the sordid past and grim present” (Maté, 2010).

Human Identity and Development

What the two historical examples you have just read about demonstrate, is that human identity, how we define it, and how we encourage its evolution for our clients matters greatly for the kind of treatment culture we create.

If personal identity is seen as closed, conflating the person with their pathology as in “once and addict, always an addict,” then the purely clinical relationship to that person is one that educator and philosopher, Parker Palmer, calls “role-to-role” (2007). And how can a role truly see, value, and encourage the development of another role?

If, on the other hand, the unique essence of each person is acknowledged and met, the encounter is what Palmer, in contrast to role behavior, calls “soul-to-soul” (2007). This translates into becoming present to the other in such a way that they can become more present to themselves, to the ever-present mystery that resides within them, and to discovering in that mystery—in the power and sanctity of their own innermost heart—the guidance and insight that lights their path forward and frees them from the grip of addictive behavior.

In the process of human development, all of us face the same choice. We can walk the circle of habitual repetition or break out onto a new path of freedom that leads beyond the known to the discovery of who we really are and why we’re here.

The distinction between the circle and the path, and how the archetypal tension between the two plays out in the Buddha’s path toward freedom and enlightenment, is beautifully described in British scholar Stephen Batchelor’s bestselling book, Living with the Devil (2005).

A culture that understands recovery as the movement from the circle (of habit) to the path (of self-realization), and that embodies the kind of deep relationship to one’s own inner self and to the other’s that facilitates that movement, can be called a “culture of presence.”

Most mental health training now recognizes the important of mindful presence; in essence, the fact that we are the medicine when we ourselves are present. Joseph Martin, MD, former dean of Harvard Medical School, put it this way: ”I have come to believe that it is through the establishment of a unique doctor-friend-patient relationship that most of the healing occurs, whether helped along by surgery, acupuncture, or regular doses of approved medicines” (Wetzel, Eisenberg, & Kaptchuk, 1998).

Widening the Lens of Recovery

My point here is not to question the validity of ever-improving clinical practice in the treatment of addiction, or to advocate a spiritual bypass of such afflictions as adverse childhood experiences, genetic, and epigenetic factors or neurological imbalances. But clinical practice does not require a purely clinical worldview by the practitioner. What happens when we widen the lens?

As our colleagues Will Taegel and Joan Borysenko mentioned in their article in the June issue of Counselor, Dr. Larry Dossey, a renowned physician, scientist, and author outlined what he calls the three eras of medicine. Era one deals with the physical level of reality and has led to the advancements in medicine, diagnostics, and surgery that have saved and prolonged countless lives. Era two has emerged from ever-greater understanding of the mind-body connection. Era three is based on an even larger and still growing understanding of the role of consciousness itself, the ultimately unitive, transpersonal, and quantum field of possibility from which all that’s becoming manifest emerges. To embrace and value all three levels is to “include and transcend” each stage in service of creating a truly integrative practice (Dossey, 2000).

Eras one and two are well accepted. It is Era three that is still in the process of being integrated into health care. The established culture of addiction treatment is naturally a reflection of the larger, externally focused, and dogmatically materialistic culture we all share and call modernity. This culture, unlike our most progressive scientists for many decades, regards the material world of surfaces without depth, which philosopher Ken Wilber calls “flatland,” as ultimate reality (2001). This is like saying that the visible fruit of an invisible tree is real, but the tree itself, the mysterious and living source of becoming, is not real—an attitude best defined as “cynical realism.”

Michael Lerner, the editor of Tikkun Magazine, speaking at the 2004 Parliament of the World’s Religions in Barcelona, described modernity as a fundamentalism based on three central dogmas: materialism, reductionism, and individualism. Materialism is the belief that only matter is real. Reductionism is the belief that all that’s real, however complex, can be best understood by reducing it to its lowest common denominator, such as atoms or brain cells. The emergence of love, a symphony, consciousness itself, even the whole course of evolution from the Big Bang to beings like Michaelangelo and Mother Teresa, poses the problem of defining the higher spheres of human development in terms of the lower. Individualism is the belief that the highest good a society can aspire to is the complete self-gratification of the individuals within it, all of whom share that sense of separateness that Einstein famously called “an optical delusion of consciousness” (as quoted in Ricard & Thuan, 2004).

The modern, “scientistic” (ideological as opposed to scientific) worldview we now take for granted as our cultural norm, began by differentiating ourselves from nature in order to gain a leverage point outside of it, and by differentiating the individual from the collective in order to free our diverse expressions of uniqueness. This cultural advance lost vitality when differentiation devolved into dissociation, the loss of our sense of interrelatedness with the web of life.

This soul-deadening culture of collective dissociation is what now so destructively fails to see that nature of the universe, in the words of ecologist and Catholic priest Thomas Berry, “as a communion of beings, not as a collection of objects” (1996).

From Scientism to Wholeness

Physician and addiction specialist, Gabor Maté, MD, writes:

A sense of deficient emptiness pervades our entire culture. The drug addict is more painfully conscious of this void than most people and has limited means of escaping it. The rest of us find other ways of suppressing our fear of emptiness or of distracting ourselves from it . . . Human beings want not only to survive, but also to live. We long to experience life in all its vividness, with full, untrammeled emotion . . . For the addict the drug provides a route to feeling alive again, if only temporarily (2010).

The cultural context of addiction described by Dr. Maté in the above quotation is the backdrop for the illuminating insights he shares in his fine book, In the Realm of Hungry Ghosts (2010, p. 39). The “hungry ghost”—a Buddhist teaching—is a creature with a belly so infinitely vast in the spiritual emptiness it contains, and with a mouth so tiny, that no matter how much it eats from what’s outside, for no matter how long, it can never be full.

Filmmaker James Cameron vividly portrayed how our materialistic, externally oriented modern culture suffers from this same, obsessively addictive condition in his movie, Avatar (2009). You may remember the plot. Predatory space invaders arrive and hover above a virgin, utopian planet. Its civilization is harmoniously balanced and interwoven with the diverse web of sentient life it inhabits, and it is organized around the sacred tree of life at its center. The members of this civilization are so attuned at the deep soul level that their customary greeting upon meeting one another is, “I see you.”

Audiences easily recognize the alien invaders as agents of the same rapacious and technically super-empowered consumer capitalism that threatens the life of our own planet today, the reptile brain writ large. The alien predators embody a notion of “development” that is simply a euphemism for endless greed and exploitation, an addictive, life-destroying appetite that by definition can never be satisfied and which is signified by the name of the material substance for which they are hell-bent on sacrificing the sanctity of life itself: “unobtainium.”

Of course Avatar is an extreme portrait of our materialistic culture with its external gaze—we call it “objectivity”—fixated on and objectifying outer reality while blind to the inner life that animates it. Yet, when the work of recovery is thought of as encouraging a return to social conformity, we need to be wary of what that actually entails: a movement away from the hero’s or heroine’s journey to become one’s authentic self.

Social conformity, especially in today’s despiritualized world where the doors of perception are usually closed, is what psychiatrist R. D. Laing, as mentioned earlier, referred to as the “sane/schizoid” state we define as “normal” (1967). It’s what the spiritual educator, Parker Palmer, in his book, A Hidden Wholeness, calls “the divided self,” painfully split between the truth of its deep inner experience and an outer world that demands conformity in exchange for safety and acceptance (2009).

Unfreezing Our World and Humanizing Our Work

Complexity theorists now see all of nature including human nature as a dynamic balance of two great forces, which the British scientist Rupert Sheldrake calls “habit,” the preservation of form over time, and “creativity,” the emergence of the possible into the manifestly new (1982).

If the treatment profession is devoted to balancing these two forces in its clients, hoping to restore the flow of their creative vitality, then it makes sense to do so for itself. This is a matter of unfreezing the limiting beliefs ingrained in the culture of memory that has defined the field for generations. The shift toward a culture of inquiry is the necessary step toward evermore conscious competence, ongoing learning, and the real possibility of quantum breakthroughs in the quality of care.

Let me briefly take as an example of the collaborative shift from habit to creativity the cultural transformation just beginning in another human service field, public education. The emerging changes are a response to a changing environment, new capabilities, and the need for much better outcomes in terms of fully human development. It’s often useful to learn by looking beyond one’s own field, and in this case one that, like the addiction treatment field, hinges for good or ill on the adequacy of its view of what it means to be human and how to best facilitate optimal human development.

Educator Seymour Sarason, in The Culture of the School and the Problem of Change (1982), took an anthropological view of how our schools were functioning, with their stubborn resistance to change. He saw that the most pervasive lesson that schools taught was not the result of particular teachers, curricula or books. Rather, he saw in the “behavioral regularities” of the school, in the outward expressions of its culture, what amounted to its implicit or tacit curriculum of drilled outer conformity.

The behavioral regularities included students sitting in rows, passively listening to teacher talk, and only occasionally asking questions, even these framed to elicit not active reflection but merely rote recall of the “right” answers. Outward conformity to external standards, pass or fail, and performance rather than expression were the overarching lessons from the culture that was itself the competence for creating that outcome, and its effect was far more pervasive than the work of those individually gifted teachers who encouraged reflection and original thinking.

In our increasingly complex world of accelerating change, social diversity, and intensified human interdependence, we need to teach and learn new competencies. Resilience, critical thinking, mindfulness, collaboration, and social and emotional learning are requirements for fully human functioning.

Educating a fixed person for a fixed position is yesterday’s news. A new kind of culture dedicated to human development is being called for and slowly emerging. That culture is warm and relational, with respectful boundaries—an authentic community helping young people to gain a sense of deep connection to their own authentic selves, to other people, and to transcendent meaning and purpose.

A report to the nation in 2003 by the Commission on Children at Risk entitled “Hardwired to Connect” noted that while these essentially spiritual needs for deep connection are fundamental to human well-being, they were not being met. Students were, and are, still being left alienated, disconnected, and unengaged by an impersonal, largely nonrelational culture. The report contained some stark and frightening statistics. For example, 21 percent of our precious youth were already addicted to substances, mentally ill or both, and 25 percent would not enjoy a “productive adulthood” (Commission on Children at Risk, 2003).

Defining Recovery as Restoring the Flow of Human Development

The core of culture is not its observable externalities, such as the practice patterns we see in typical addiction treatment centers. Rather, the core in both education and in addiction treatment consists in the underlying view of what it means to be human.

Recent advances in neuroscience and published research studies from other scientists support the findings of the Commission on Children at Risk about the cost of neglecting the requirements for healthy human development and, by implication, the concerted need to address those deficits when they show up later in life.

Lisa Miller, PhD, director of clinical psychology at Columbia University Teachers College, supported by scientific findings including her own, writes:

Spirituality is an untapped resource in our understanding of human development, resilience and illness, health, and healing. The absence of support for children’s spiritual growth has contributed to alarming rates of childhood and adolescent emotional suffering and behaviors that put them at risk. Knowledge of spiritual development rewrites the contemporary account of spiraling rates of depression, substance abuse, addictive behaviors and other health concerns (2015).

Of course Dr. Miller, like other scientists today, defines spirituality as one’s sense of deep connection to a life larger than one’s own, whether conceived as God, nature, the universe or transcendent reality.

Dr. Maté’s In the Realm of Hungry Ghosts has a superb chapter on the spiritual aspect of human development entitled “There is Nothing Lost: Addiction and the Spiritual Quest” (2010). He also writes on the need to free the addicted person’s innate capacity for creative expression:

The gods, we are taught, created humankind in their own image. Everyone has an urge to create. Its expression may flow through many channels . . . The point is to honor the urge. To do so is healing for ourselves and for others; not to do so deadens our bodies and our spirits (2010).

Creating an Integrative Culture of Recovery

The core concept needed to create an effective culture of recovery is a full picture of optimal human development and fully human functioning. Ideally this vision would be as vivid as Leonardo da Vinci’s circular mandala of the perfectly proportional man that became the emblem for the European Renaissance, only this time including the deep interior essence, our true nature, as well.

What does it really mean to be fully and nobly human, to be our best and most authentic human selves? We can see that it must be a multidimensional view, embracing cognitive, emotional, spiritual, and other lines of development. This is the line of inquiry we need to pursue to bring the field of treatment to its own highest potential.

What are the requirements for affecting real recovery and how, both in the short term and longitudinally, should we be measuring it? Without applying the robust and meaningful outcome metrics available in academic settings today, we have no way to continuously improve outcome. Well-validated scales to measure potential, purpose, resilience, stress hardiness, mood, and other important dimensions of healthy humanness already exist. Both individual practitioners and treatment settings need to use these measures so that we can track progress to improve our outcomes and be of greatest service.

Dr. Peter Levine, who wrote the foreword to In the Realm of Hungry Ghosts, is a world-renowned expert on posttraumatic stress and its treatment. He understands the flow of our life energy as a stream that is constantly charging with stimulation from our environment and discharging through our various modes of expression. When that expression is blocked by events that we cannot adequately respond to, the stream cannot continue to flow freely. It becomes a whirlpool that has its way with us and blocks ongoing development.

The metaphor of a blocked stream can be extended beyond trauma to include any repeating pattern, habit or contracted sense of identity that keeps our lives from flowing into the full expression of our aliveness, creativity, and engagement with all the wonder, beauty, and suffering of this precious world.

By evolving cultures of inquiry and authentically-lived communities of practice that focus on unblocking the flow and allowing the blossom of human development to flower, we can transform the field of treatment and recovery. The culture will become a competence that transforms not only our clients, but ourselves, our organizations, and the larger culture in which we all live.

References

Batchelor, S. (2005). Living with the devil: A meditation on good and evil. New York, NY: Riverhead Books.

Berry, T. (1996). Thomas Berry. Retrieved from http://www.thomasberry.org/

Cameron, J., & Landau, J. (Producers), & Cameron, J. (Director). (2009). Avatar [Motion picture]. United States: 20th Century Fox.

Commission for Children at Risk. (2003). Hardwired to connect: The new scientific case for authoritative communities. Retrieved from http://americanvalues.org/catalog/pdfs/hwexsumm.pdf

Dossey, L. (2000). Reinventing medicine: Beyond mind-body to a new era of healing. New York, NY: HarperOne.

Elmhirst, K. (2006). Thought leaders: David Whyte on courageous conversation. Retrieved from http://www.hr.com/en/articles/thought-leaders-david-whyte-on-courageous-conversa_eaj1hqw2.html

Foucault, M. (1988). Madness and civilization: A history of insanity in the age of reason. New York, NY: Vintage.

Fromm, E. (1941/1994) Escape from freedom. New York, NY: Holt Paperbacks.

Laing, R. D. (1967). The politics of experience and the bird of paradise. London: Penguin.

Maté, G. (2010). In the realm of hungry ghosts: Close encounters with addiction. Berkeley, CA: North Atlantic Books.

Miller, L. (2015). The spiritual child: The new science of parenting for health and lifelong thriving. New York, NY: St. Martin’s Press.

Palmer, P. J. (2007). The courage to teach: Exploring the inner landscape of a teacher’s life (10th anniversary ed.). San Francisco, CA: Jossey-Bass.

Palmer, P. J. (2009). A hidden wholeness: The journey toward an undivided life. New York, NY: Jossey-Bass.

Ricard, M., & Thuan, T. X. (2004). The quantum and the lotus: A journey to the frontiers where science and Buddhism meet. New York, NY: Broadway Books.

Sarason, S. B. (1982). The culture of the school and the problem of change. Boston, MA: Allyn & Bacon.

Sheldrake, R. (1982). A new science of life: The hypothesis of formative causation. London: J. P. Tarcher.

Wetzel, M. S., Eisenberg, D. M., & Kaptchuck, T. J. (1998). Courses involving complementary and alternative medicine at US medical schools. JAMA, 280(9), 784–7.

Wilber, K. (2001). A brief history of everything. Boston, MA: Shambala.

Positivity and Well-Being

Sculpturing Frozen Moments