Mourning in 12-Step Process

 Mourning in 12-Step Process
Elias Tamene, PsyD, LPC
Both Alcoholics Anonymous and Narcotics Anonymous seem to facilitate addicts to engage in the process of mourning. The mourning process may be undertaken in earnest with the spiritual engagement specifically related to the concepts of letting go, forgiveness, and making amends (Narcotics Anonymous Members, 2008). Letting go. The fundamental object that one must let go of entails the drug, along with the feelings and thoughts associated with this drug. The fundamental spiritual practice around letting go may help the addict stay in the present by working through challenges around denial or anger. This concept further refers to the addict’s ability to let go of false pride, grandiosity, and inflated ego, which are often employed as a defense against feelings of shame and narcissistic rage. Effectively working through the process of letting go is a critical and time-consuming journey. Of course, letting go may also refer to good times, when the addict experienced pleasure derived from the drug and/or the ritual associated with getting high. Narcissistic rage is a reaction to narcissistic injury of a real or perceived threat (Freud, 1920) that impedes the process of letting go. Addicts resort to rage to ward off a sense of powerlessness and vulnerability through defiance and chronic anger, thus reflecting a specific form of narcissistic impairment (Dodes, 1990). The crucial first step in the 12-Step process is for the addict to accept his or her powerlessness over the drug and understand how addiction has caused his or her life to become unmanageable. A loss must be acknowledged if it is to be mourned. Forgiveness. This concept refers to addicts’ ability to lessen or give up resentment, rumination, and any claim of redress, including the wish for retribution. Forgiveness of self and others who have caused injury is a spiritual practice that one masters in Step 8: “Made a list of all persons harmed, and became willing to make amends to them all” and “By the time we reach this step, we have become ready to understand rather than to be understood” (NA, 2003, para. 8). In this step, the addict increasingly acquires the capacity to experience vicariously the psychological state of another person. This step is akin to the depressive position in Klein’s (1959) psychodynamic formulation, where some level of integration is demonstrated. The addict incorporates the capacity to view positive and negative qualities in the same person. Forgiveness is a long process. The act occurs on a dimensional scale, as addicts may need to renounce hostility and renew relationships as part of moving forward. The ability to engage in forgiveness involves a higher level of functioning where there is more integrated internal representation of the other. Hence, the loss is more fully understood and processed. Making amends. This concept has to do with an act of reparation as a consequence of increased awareness of hate and sadism. Reparation is the primary mechanism in Klein’s (1959) theory, by which a patient learns to reduce depressive anxiety or guilt. Klein (1959) stated, “Feelings of guilt, which occasionally arise in all of us, have very deep roots in infancy, and the tendency to make reparation plays an important role in our sublimations and object relations”. Hence, making amends is an important undertaking if the addict desires to restore severed relationships and become a fully accepted member of a community. In a mature, integrated psychological state, the addict is able to better tolerate anxiety for a genuine connection with others. The mourning process includes the ability to feel genuine remorse. The addict must mourn the loss of the life he or she might have lived, but did not due to the self-sabotaging effects of drug misuse. Addicts may also need to mourn a childhood that may have ensued as well as previously unprocessed losses. In addition, the nature of addiction is such that addicts likely engage in all manners of deceit, manipulation, and stealth, often targeting immediate family members. Hence, making amends may also require an increased capacity to tolerate negative affect (that is, the negative response they could potentially receive from those they are asking for forgiveness). Psychic pain is often palpable in the narratives shared in the 12-step group. The working through of this pain and suffering, with the support of the other appears to fit the conceptual developmental model of mourning “along with its aggressive constellations”. Alcoholic and Narcotic Anonymous’ spiritual practice, group mutual support, and the various aphorisms used in the recovery lexicon (for example, “We are here for a reason not for the season”) are meant to encourage members to develop the ability to regulate emotions, increase insight, and enhance the capacity to delay gratification. Through sharing narratives about events and people that trigger destructive activity, members learn practical tips for abstinence from the group. In due course, members come to realize that they do not need drugs to escape from unwanted thoughts and feelings. Some members reported that their spiritual awakening grew as they started sharing personal struggles with addiction, especially when accompanied by emotional displays in sobbing, and expressions of regrets and sorrow. For instance, a member shared the same story over the course of several meetings. The last time he shared the story, the depth of the emotional pain felt intense and palpable to the group. Presumably this member was able to access a wide range of emotions to become increasingly in touch with his feelings. Just as in an analytic group, “no attempt is made to be therapeutic” at NA – a less demanding, non-directive approach was utilized to prevent defensive regression. The leader often provides “minimal verbal nourishment” to encourage addicts to verbalize areas of specific distress. Minimal group pressure in the group and the selective recollection of memories are a response to the addict’s contacts functioning. The AA/NA group serves multiple functions. Members’ feelings of rage may be amplified at optimal level, without destroying the group. Some may experience vicarious relief when common group frustrations are discussed. The group culture provides a “holding environment” where negative emotions are safely processed. The group provides a conduit where “toxic emotions” may be ritualistically discharged in the context of the 12-Step practice and principles. The slow and repetitive discharge of these distressing emotions seem to facilitate the mourning process. The group also provides containment when addicts are engaged in exploring distressing feeling states. The “safe space” created is an important venue to demonstrate support. This could be provided by a gesture of affirmation with a nod when members are speaking, and even occasional thunderous applause when a member tearfully reveals sensitive information. Therefore, mourning occurs in affective “working through” of both positive and negative feelings associated with drug use.