Addiction is messy; it’s often ugly and scary. Are we disgusted, fearful, curious or sad? What causes us to react in the ways we do? Countless times I’ve seen the derisive looks of others aimed at my son as well as questioning looks sent my direction. To better establish a foundation from which to shatter the stigma of addiction, we need to understand a bit about shame, stigma and addiction. This is not an exhaustive discussion; it is intended as an overview only.
Addiction by definition:
- Addiction is defined as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. It is considered a brain disease because drugs change the brain – they change its structure and how it works. These brain changes can be long lasting, and can lead to the harmful behaviors seen in people who abuse drugs. Source: www.NIDA.gov
- …is a chronic neurological disease….characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm and craving. The issue is not the quantity or even the frequency but the impact. Source: In the Realm of Hungry Ghosts: Close Encounters with Addiction, Gabor Mate’, M.D.
- Addiction was first defined as a disease by the American Medical Association in 1956 and it has taken a full half-century of research and treatment for even medical and psychological professionals to shed old beliefs. So perhaps it should come as no surprise that society at large has difficulty seeing an old disease in a new way. Source: Addiction: Why can’t they just stop? HBO Documentary in collaboration with the Robert Wood Foundation, NIDA, and NIAAA.
Shame – positive and negative aspects:
- Can be a positive means to teach the values of family and community such as polite behavior, proper clothing, etiquette and the role of education within a family’s perspective.
- Is attached to behaviors, not to the person. Example: Burping may be seen as a negative behavior but doesn’t mean the person is bad. Instead the behavior is discouraged. In some cultures burping at the dinner table is a compliment to the cook.
- When we shame another it can be to:
- Teach family/community mores
- To feel better than, more superior
- To separate ourselves and exclude the offending person(s)
Stigma by definition:
- A mark of disgrace or infamy, a stain or reproach, as on one’s reputation.
- A mental or physical mark that is characteristic of a defect or disease such as the stigma of leprosy or addiction.
- Archaic – a mark made by a branding iron on the skin of a criminal or slave. Source: Random House Dictionary 2010
Stigma at its simplest is when someone judges another on a personal trait – leprosy, physical disability, sexual orientation, mental illness, skin color, obesity, poverty as well as positive traits such as beauty or wealth. Stigma is deciding someone is “bad at the core”…less worthy of consideration or understanding …and therefore less human.
In an episode of 70’s sitcom Happy Days, Fonzie (played by Henry Winkler) is visited by his elderly grandmother. He makes fun of her diminished capacities. With fading eyesight, hearing, and her hobbled walk, she is not amused and confronts him. He is made to put pebbles in his shoes, cotton in his ears and wear thick coke bottle glasses. Quickly his ridicule turns to empathy. He has momentarily walked in her shoes and realizes that, in time, he too will have to deal with the effects of aging.
Here we have the callousness of youth. More often we have ingrained societal norms where stigmas are encouraged and the status quo goes unchallenged. What is behind Fonzie’s ridicule? He clearly loves his grandmother. Does he see what lies before him and is unwittingly afraid? Fear plays a large role in the tenacity of stigma – fear of being imperfect.
Shame and stigma – the difference is important. Both are complex; put them together and the issues rise exponentially.
- Shame comes from the inside where one blames the self for not being able to change – the color of skin, being Jewish, having diabetes, a mental illness or an addiction. Read more…
- Stigma is that which is applied from the outside in… society stigmatizes one for being a certain religion, for having a different color of skin, for getting a disease, for suffering a mental illness.
- Stigma is most often the cause of shame. Read more…
“Shame is the universal psychological propellant behind addiction” says Kristina Wandzilak of Full Circle Intervention. “This sense of being flawed, of having no worth is a universal haunting of the soul.” Stigma undercuts the value, the right of a person to exist, to share in the same hopes and dreams of all who draw breath. Read more…
A recent book review on NPR noted the role of freed slave, Mary Elizabeth Bowser, as a spy for the Union during the Civil War. Educated after being freed, she was strategically placed as a household maid in the Confederate White House. In the stigma of the times Mary was perceived as an “it” invisibly serving meals and cleaning house as President Davis went about his business. Assumed to be ignorant, she freely moved about the premises reading papers on Davis’ desk, writing summaries and passing messages along to the Union. Only after the war did Davis realized the source of leaks from within his household.
Countless times I’ve sat with parents as they lamented the addiction of their children. We, too, are the product of our environment, our upbringing, and learning.
“This doesn’t happen in our family,” a well dressed woman repeatedly said to me. Over and over this phrase seemed to hypnotize her as she stared off into some distance scene. Gently coaxing her to say more, I learned about the family’s background. She described high levels of education, stellar careers, high income and so it went. Pushed further I asked, “Why are you here at a conference for parents whose children have died?” Startled, she turned with eyes and jaw tightening in anger to tell me of the death of her thirty-three year old son. He had overdosed on a mix of alcohol, prescription drugs and cocaine.
“This doesn’t happen in our family; we’re educated and well respected”, she repeated weakly. As kindly as possible, I replied, “Apparently it does and I am so very sorry for your loss.” Her demeanor crumpled as she began crying. Her beloved son had died three years before. She hadn’t yet told others the real cause of his death. In her belief system, education and money were all antidotes to such loss. She let the stigma of addiction blind her to her son’s decreased functioning; his unexplained absences from work, and from family events. He was highly educated, smart, loved…and therefore safe.
Conditioning, love, fear and bias can blind us to what is showing up right before our eyes. Fear of the possible implications of changed behavior can stop us in our tracks.
Antidotes to denial:
- Get educated on addiction and its complexities
- Don’t let stigma create self-doubt and shame in you or your loved ones
- Don’t isolate yourself or family – you are not alone
- Join a support group
- Speak out against stigma
Stigma kills…not just on the front page of the news but in our communities, in our families, and in our homes.
