Addiction Treatment Under the Gaslight

by Thaddeus Camlin, Psy.D.

contradictions of addiction treatmentSome of the most powerful groups I’ve been a part of have been on the topic of the ‘Gaslight.’  Derived from the title of a 1944 Ingrid Bergman film in which Bergman’s character leads his wife to believe she is going mad, the term gaslight grew into a potent psychological concept.  In the film, Bergman’s character makes the sound of footsteps and adjusts the brightness of gaslights, pretends he knows nothing of the changes, and his wife is left only to conclude that she must be losing her mind.  In psychology, the gaslight concept is primarily applied to contradictory messages children receive from parents from which children draw the natural conclusion, ‘there must be something wrong with me.’  Today, some unnerving gaslight elements can be found in the treatment of addiction.

Four types of parental gaslighting have been identified, and you can read about them in more detail in a great piece by Jonice Webb, Ph.D.  For this article, however, let us consider how some of the inherently contradictory messages people sometimes receive in addiction treatment can lead people to erroneously conclude that there must be something fundamentally wrong with them.

1. Individualized care vs. You’re all the same.

Terminal uniqueness is a term that abounds in addiction treatment, meant to imply that a person thinking she or he is different is deadly.  However, it is widely understood and often advertised by treatment centers that individualized care is the standard in mental health treatment, often captured in the popular phrase ‘meet the client where they’re at.’  Individualized care would mean that a client who wants to moderate or utilize harm-reduction methods would be helped with such methods not placed in an abstinence-only program.

2. Treatment works if you work it, but I worked it and it didn’t work.

Many people succeed in traditional treatment.  Many people give a good faith effort in traditional methods of addiction treatment and do not get desirable results.  For those who do not get desirable results, the message that treatment works if you work it implies that clients are responsible for the failure of treatment.  Blaming clients for the failure of treatment leaves them wondering, “what did I do wrong?,”  when the truth is that the treatment approach probably wasn’t the right fit.

 3. You have a lifelong disease but symptom reduction is failure.

Somebody with HIV whose symptoms are reduced to a manageable range is considered a treatment success.  Somebody who drinks a 5th a day and has a failing liver who switches to smoking cannabis every night is considered a treatment failure even though his liver heals.  If the message that symptom reduction is failure doesn’t add up, fret not, that’s because it is inherently contradictory. 

4. You have to do it for yourself but look at how much you hurt your family.

Well, which is it?  Am I changing for myself or my family?  The best answer is probably both.  At times when we hate ourselves changing for ourselves isn’t much of a motivator.  However, when we are oriented to something or someone outside ourselves it can give us a reason to endure suffering.  Self-actualization comes from self-transcendence, not from living for ourselves.

Certainly, there are other contradictory messages out there in the world of addiction treatment, and if you think of a few send them our way!  The four messages listed here are inherently contradictory, however, when they are repeated by ‘experts’ consistently people in treatment could easily (and often do) start to question themselves with thoughts like, “what am I missing?…  I must be doing something wrong…  what’s wrong with me?…  I must be really messed up…  etc.”

As Dr. Webb points out in her article on the gaslight, gaslighting leads to people feeling deeply ashamed, denying who they are, feeling like they’re constantly on shaky ground, not trusting themselves, believing that they’re unreliable, that there is little room for mistakes, that they are not allowed to be a regular human being, that weaknesses must be hidden, that they are a burden to others, and that they do not matter.  I would argue that addiction treatment is best when it aims to foster the antithesis of all the aforementioned feelings that can stem from the gaslight – treatment that helps people to feel proud, embrace who they are, stand on solid ground, trust themselves, be reliable, free to make mistakes (aka be human), believe they are a source of joy in the lives of others, and know that they matter.

If you or a loved one are in need of compassionate, effective addiction treatment, we can help. Give us a call.