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An Existential Theory of
George B. Greaves, Ph.D.
Existential psychology deals primarily with the phenomenal and emotional state of individuals, with a person's experience of the quality and meaning of his or her life, and of means and methods of therapeutic intervention, both verbal and nonverbal, which can lead to an enhancement of an individual's life state. Within the framework of existential theory, human beings are seen to be motivated primarily to satisfy and sustain basic needs and to fulfill certain aspirations (Maslow 1954). The payoff for such satisfaction and fulfillment is a sense of personal wholeness and well being (Maslow 1962; Rogers 1962). The failure to secure basic needs and self-enhancing aspirations leads to a sense of dis-ease and despair, which, in turn, gives rise to activities, both destructive and productive, aimed at reducing such dis-ease and despair. My existential theory represents an attempt to understand and account for destructive patterns of drug use within the framework of existential psychology (Greaves 1974).
Ever since the 1920s, clinicians and researchers studying drugdependent and drug-dysfunctional persons have commented on the pathological personality patterns of such individuals and have offered various taxonomies to describe the range of personality disorders seen. This line of speculation received a major boost with the publication of Pescor's work in 1943, based on a very large sample of drug-addicted persons at the then new Federal narcotics rehabilitation center in Lexington (Pescor 1943a).
The prevailing impression one gathers from a reading of this literature is that certain individuals, as a result of aberrant or unhealthy personalities, represent high risks for drug dependency if they are exposed to certain psychoactive drugs. In other words, in any N sample of individuals under identical stimulus conditions, there is not an equal chance that any given individual will become or remain drug dependent. Rather, there are systematic and identifiable personality factors which interact with the drug-taking behavior that leads to dependency. This apparent phenomenon has traditionally been called "addiction proneness" (Gendreau and Gendreau 1970).
Critics of the notion of addiction proneness have argued that the very methods which drug researchers have used have guaranteed the results. Thus, the kinds of people who wind up in prisons, hospitals, and drug programs to be available for study are exactly those who have a higher incidence of aberrant personality traits: the young, the minorities, the poor. But later studies which have tapped other samples, and studies using matched-sample control groups, have tended to quiet the critics. Among physician addicts, for instance, the familiar elevation in the psychopathic deviancy scale of the Minnesota Multiphasic Personality inventory (MMPI) was found, as in other addicts, although such an elevation in the Pd scale is not typical of physicians in general. Similarly, I found that middle-class adolescents who were drug dependent resembled other adolescents who were hospitalized in a psychiatric hospital but were very unlike their adolescent peers residing in the same city (Greaves 1971).
Those researchers currently working within the area of addiction proneness are no longer content to document addiction proneness but are now working on specifying the personality variables at work in specific kinds of addictions, usually defined in terms of the abuser's drug of choice. Major distinctions have been drawn, for instance, between the personalities of those who prefer heroin and those who prefer amphetamines or barbiturates as drugs of dependency (Greaves, in press; Milkman and Frosch 1973).
Although I have been one of the contributors to the literature on one's drug of choice as a function of personality variables, my main interest has remained with the general phenomenon of addiction proneness. For a clue as to why persons come to abuse drugs, I first turned to the phenomenon of mind-altering or mood-altering drug-use behavior, of which abuse is an extension.
William James was the first to state explicitly and explore the existence of altered states of consciousness within the Western phenomenalist tradition. Writing in the Principles of Psychology, James observes:
Our normal consciousness, rational consciousness as we call
While James fell short of stating that individuals have an innate drive to experience these altered states, he did state that the popularity of alcohol derived from its ability to stimulate such states:
It is the power of alcohol to stimulate the mystical conscious-
It remained for Andrew Weil, another Harvard physician, to state James' hypothesis explicitly:
It is my belief that the desire to alter consciousness period-
If James' hypothesis is true--that there are naturally existing alternative states of consciousness, and it seems almost certain that there are--then several hypotheses seem readily to follow:
1. Such alternative states serve an adaptive purpose to the organism.
2. It is natural to pursue such states (Weil 1972).
Children, due to their relative lack of rational enculturation, are more readily in touch with some of these states (Fraiberg 1959; Weil 1972).
The use of drugs is one way to facilitate access to these states (Weil 1972).
I would further hypothesize that-
1. Some adolescents and adults are less able to access altered states of
consciousness due to intervening anxiety states and other pathological states;
2. Such persons make use of drugs beyond the motive of accessing
such states, using them rather to restore themselves to a state of being by which they are able to access both usual and alternate states;
The taking of drugs in an attempt to rectify an abnormal state of personality is a form of automedication, and forms the cornerstone of all drug dependency; and
4. If persons could access altered states to a more normal degree,
i.e., in the ways persons with normal personalities do, they might use drugs, but would not abuse (be dependent on them.
The automedication hypothesis is, of course, not new (Wahl 1967). Alcoholics have been thought by many to be "treating" themselves chemically for depression, heroin addicts have been described as "numbing" emotional pain, and so forth.
What characterizes the theory proposed here is the specific range of variables believed to lie at the personality and emotional core of all substance abusers. These variables were derived from three sets of empirical observations. As originally set forth, these were as follows:
The first observation is that drug-dependent persons seem
The second of my observations has been that drug-dependent
straight world; almost nothing is seen as exciting. They
The third observation, and this may be the primary factor
In summary, "persons who become drug dependent are those who are markedly lacking in pleasurable sensory awareness, who have lost the child-like ability to create natural euphoria through active play, including recreational sex, and who, upon experimentation with drugs, tend to employ these agents in large quantities as a passive means of euphoria, or at least as a means of removing some of the pain and anxiety attending a humorless, dysphoric life style" (Greaves 1974).
Based on this work and subsequent clinical experience which tends to confirm it, I have been an outspoken critic of drug-treatment programs based on asceticism, privation, and harsh behavioral treatment. Such programs, by their nature, tend to promote dependence on passive forms of euphoria, undermining the very purpose for which they were allegedly designed. As originally put:
The therapeutic implications of this present set of contentions
sources of pleasure; and away from humanism, which
We emphasize the importance of the drug dependent person's acquiring a job as a condition of his rehabilitation, when very little evidence supports the contention that having a job is a decisive element in successful withdrawal from drugs. Instead of conceiving of drugs as the enemy and seeing drug abstinence as a great struggle against the enemy, to be hopefully brought about through great striving and strictly regimented behavior, we need to adopt a human growth and need-fulfillment model. We need to help persons to become the agents of their pleasure, not the passive recipients. We need to provide body-sensory awareness programs, meditation, expressive art therapy, psychotherapy. We need to turn our clients on to music, dancing, fishing, camping, boating, photography, and sex. ... We need to help clients to realize that not only is it all right to pursue actively a wide range of pleasurable experiences, but how to. Yet none of the five major treatment modalities overviewed by Ball (1972)--a) detoxification, b) maintenance, c) individual and group psychotherapy, d) therapeutic communities, and e) religious communities--effectively, in and of themselves, come to grips with the dysphoric underlay of drug dependence.'
During the past several years, drug abuse treatment programers, using these and other ideas, have placed increasing emphasis on "alternatives" to drug-abusing behavior. The jury is still out as regards the outcome benefits of this approach, though preliminary results are encouraging.
As a general theory of drug dependence, the existential theory does not deal with special risk populations except to comment that inherent in special subpopulations are the factors that give rise to personality maldevelopment, situational stress pathology, or unusual opportunity (such as availability or peer support), which give rise to abuse.
'Reprinted with permission from G. Greaves, "Toward an Existential Theory of Drug Dependence," Journal of Nervous and Mental Disease, 159(1974):263-274. Copyright © 1974 by The Williams & Wilkins Co., Baltimore, Md.