A Focus on Ideals

It is difficult to imagine two mental disorders that individually, and especially in combination, lead to such demoralization and loss of ideals. In the PTSD field, this loss of ideals has been written about, for example, in Janoff-Bulman’s (1992) work on “shattered assumptions” and Frankl’s (1963) work on the “search for meaning.” As one patient said, “I feel as though everyone is born good but the world destroys that. I keep thinking, ‘What is the meaning of being alive?’ and I can’t come up with an answer.”

Trauma can raise an existential dilemma: Having experienced suffering and evil, do survivors remain sunken at that level, continuing to trade in distrust, destruction, and isolation (toward both self and others)? Or do they rise above it and create a new dialogue of honesty, integrity, connection, and higher values? These contrasts recur as themes throughout various literatures on trauma, whether of Holocaust victims, war veterans, crime victims, or child abuse survivors (Frankl, 1963; Herman, 1992; Shay, 1994). Some research has found that trauma survivors who are able to create positive meanings from their suffering fare better than those who do not (Janoff-Bulman, 1997). And many patients report feeling more upset about a loss of ideals, such as trust, than about particular external conditions, such as poverty or lack of a job.

With substance abuse, there is also a loss of ideals. Life has become narrowed in focus, and in its severe form one is living “at the bottom”—surrounded by people who cannot cope, pushing away reality, losing connections to normal life (job, home, relationships), lying about substance abuse, unable to face emotional pain. It is striking that the primary treatment for substance abuse for most of the 20th century, AA, is the only treatment for a mental disorder with a heavily spiritual component. The AA goal of living a life of moral integrity is an antidote to the deterioration of ideals inherent in substance abuse.

Thus this treatment explicitly seeks to restore ideals that have been lost. The title of each topic is framed as a positive ideal—one that is the opposite of some pathological characteristic of PTSD and substance abuse. For example, Honesty combats denial, lying, and the “false self.” Commitment is the opposite of irresponsibility and impulsivity. Taking Good Care of Yourself is a solution for the bodily self-neglect of PTSD and substance abuse. The quotation in each topic is an attempt to be inspiring, and the language throughout the treatment emphasizes values such as “respect,” “care,” “integration,” “protection,” and “healing.” The hope is that, by aiming for what can be, patients will summon the motivation for the incredibly hard work of recovery. If they are being asked to give up substances, something better needs to be offered in their place.