Patrick Casement speaks to Sobriety Films

Sobriety Films speaks to eminent psychoanalyst Patrick Casement about what his half century of practice has taught him about addiction and what he has seen behind the ‘addictive process’.  From bricklayer to social worker, Casement has had an extraordinary career and is now one of the world’s luminaries of Psychoanalysis.

No stranger to trauma, he has faced two near death experiences. Given a 3% chance of survival from cancer, he overcame the odds and made a full recovery at the age of 77.

And following a breakdown in his mid twenties, which he describes as: ‘when old ways of being had to fail en route to a breakthrough (Learning From Life, 1994) and a failed suicide attempt, his journey into the therapeutic arena began.

“Learning Along the Way”, his latest book, made it to the top 24 Best New Psychotherapy Books to read in 2019.

 Some Thoughts On Addiction by Patrick Casement

You ask whether Learning Along The Way is now my favourite book.  I regard it as the book which best represents the culmination of my 50 years of clinical work, but my favourite is still Learning from Life: that is the book which best traces the links between my life experiences and the development of my approach to clinical practice.

Now, what of my experience of working with addictions?  I have worked with many people who have been, in some way, caught up in addictive behaviours, but I have not had much direct experience of working with active alcoholics.

Nevertheless, I hope it may be useful to share some of my clinical observations around the problems of addiction.

I have always tried to listen for the communication expressed through behaviour.  What, perhaps, is being indicated in this?  What is being avoided?  What is being looked for?I have also found it useful to think of trauma as “that which cannot be borne alone.”  So, who might it be that is most being looked for, but often not being found, when someone is trying to silence the pains of trauma?

And that trauma has often been that of being left with distress, often as a child, with no one seeming to recognise this or seeming to be genuinely reaching out to help with it.

Furthermore, I have noticed that it is always an addiction to a substitute that is most looked for and most needed.  But substitutes never satisfy, they never actually meet the needs being expressed.  So the hope builds that, perhaps, more of whichever substitute is being looked to might work better: but it never does.  So the continuing search for what is missing, for what is needed, becomes addictive.

Key in all of this is the essential difference between needing and wanting.  An addict has usually developed such a dependence on whichever addictive substance, or addictive behaviour, that wanting may develop into needing.  But whatever the addiction may be, and however intense the sense of needing might be, all of that just further masks what the primary unmet needs may be.

I too have dipped into addictive behaviours, sometimes needing to remind myself that “one may seem ok but two can feel not enough.”  I have found that useful when needing to break a returning habit.

However, we should never forget that this glib saying can also be a serious indication of the fundamental difference between a borderline alcoholic and the irreversible alcoholic, whose whole system has been irrevocably changed by that poison.  Some people, who tend to drink too much may be able to get better control of their habit by firmly not going beyond a single drink.  For them, that might provide a basis for remaining in control of a tendency to drink too much.  But the true alcoholic must never forget the dangers that lie in the potentially fatal idea of “only one’.  For them that will always remain nothing but a devilish invitation to step over the precipice yet AGAIN.  Always, be warned.

So what, most basically, is needed but not being found?

I think the answer here is for a person, an OTHER, who could come to meet the distress and yearning that remain unmet and yet is being expressed indirectly through the addictive behaviour.

This searched-for Other is a Someone who could be there for that which cannot be borne alone, able to bear the unbearable alongside the person in distress; and also able to bear the rage that may be directed at him or her.  That Someone may then be used to represent whoever has previously been experienced as having most failed the addict.

But this requires the therapeutic Other to survive, without collapse or retaliation, the prolonged rage that may be central to the addict’s continuing search, a rage that has usually been harboured against those who’ve been experienced as having previously failed the addict.

None of this is ever straight forward.  There may also be a further complication which I came to think of as the pain of contrast.  What I have frequently noticed is that when a therapeutic Other is found, this discovery may also be exceedingly painful.  Why is this?

I’ve learned from patients that it can be excruciating to find some of what has been experienced as missing, now getting a glimpse of how it might have been if the good experience of now had been available before when it had been primarily most needed.  This pain of contrast can too readily lead back to addiction – trying to dull this pain of contrast, being reminded of what had been missing or had been lost.

No wonder that the treatment of addiction can be so fraught, for the would-be therapist as much as for the addict.

His next book ‘Credo? Religion and Psychoanalysis’ will be available on 5th March.