‘Several studies have shown that a belief in the disease model of addiction increases the probability of relapse. And that shouldn’t be surprising. If you think that you have a chronic disease, how hard are you going to work to get better?’
Marc Lewis (2016)
I was interested to read this last week. And of course it does make complete sense. The way that we construe our situation must (surely), just in a common-sense sort of way, impact on the actions that we see as relevant and appropriate to take and therefore on what we do. The chronic disease model suggests incurability, suggests life-long problems and may serve to disempower the client, implying that drinking or drug-use are the domain of the expert. And clearly if we imply that the condition is chronic, ‘once an alcoholic always an alcoholic even you’re not drinking’ then we could reasonably speculate that this is likely to reduce hopefulness and expectation.
So how problems are framed seems likely to be significant. Charles Snyder (1994) in his book The Psychology of Hope writes ‘people without hope have no goals, see no alternatives and can neither find nor sustain their motivation for action’. There is surely nothing mysterious or magical here. Hope is a pre-requisite for people to take action. Why would we try to do something different if we do not believe that change is possible? To do so would be simply foolish, a waste of effort with inevitable failure at the end of a tunnel from which no light shines.
Steve de Shazer (1991 p66) picks up the same point from a different angle when he writes ‘It is, of course, easier to develop a solution to a "normal difficulty" than it is to develop a solution to a "very pathological problem that has roots deep in my infancy”.’ And here, it seems to me, that he is referring both to the worker and the client. If we co-construct with the client a ‘very pathological problem’, apart from keeping ourselves in work, we are unlikely to be doing anything very useful. We will certainly be making change less likely and any intervention longer and more costly and time-consuming, since expectation and hope will be reduced. At the very least everyone is likely assume that intervention will need to be commensurately lengthy to deal with a ‘problem that has its roots in my infancy’.
I remember many years ago being referred an adolescent boy and the description that had got attached to him, and which all the professionals around the boy seemed to repeat, was ‘we think that one day he will kill somebody’. Even this thought, although obviously important to take account of, if harboured naively, with no thought as to its possible effect, might actually make the feared tragic outcome more likely. We know that most people tend to scan the world to look for evidence to support the rightness of their conclusions. So it is reasonable, particularly in such a situation where the framing both invites and requires vigilance and observation, that the adults around the young man would pay careful attention, watching out for further evidence of risky and out of control or cruel behaviour. On observing such behaviour it is virtually inevitable that they would either knowingly or unknowingly bring this to the attention of the young man who increasingly is invited into the idea of himself as a ‘murderer-to-be’ with all the adults around him hyper-sensitive to the evidence that would support the framing. Even the smallest element of the ‘pattern’ occurring will seem significant to all. But of course from a Solution Focused point of view we would wish to do the exact opposite. Watch out for signs of the future that we would wish to build (while naturally at the same time and continuously taking account of risk). This would involve all those same professionals, in addition to monitoring risk, watching out for signs of ‘safety behaviour’, and making sure that the young man knew that they had noticed such signs. Small elements of the ‘danger pattern’ within this perspective can be re-framed as evidence of the young man’s ability to stop difficult situations spiralling out of control, (with risk of course also being monitored). The concerned adults will need to become observers of things that don’t happen, the times when the young man could have got angry and did not and if those observations are to be ‘leveraged’, then they need to be drawn to the attention of the client. In this way the young man can build a new sense of self, the idea ‘yes I do get really angry and actually I have ways of controlling that anger’. This view of self has a very different potential future and impact when contrasted with the ‘murderer-to-be’ view. And ironically, and somewhat counter-intuitively, paying careful attention to ‘signs of safety’ is likely to reduce the risk.
So the way that we think, the way that we make sense of what is going on around us, will have ‘real world’ (as if our thoughts are not real), consequences. Solution Focused practitioners train ourselves to be aware not just of what we say but also of our thoughts, not just of what we do but also of the way that we discipline our attention and noticing.
By the way the referral of the young man mentioned above never turned into a first meeting. What a shame.
Marc Lewis is the author of The Biology of Desire: Why Addiction Is Not A Disease (2015: New York: Public Affairs)
de Shazer, Steve (1991) Putting Difference to Work. New York: Norton.
Marc Lewis (2016) ‘Is addiction really a disease?’ London: Observer Newspaper: Inner Life: 24 July 2016
Snyder, C. R. (1994) The Psychology of Hope New York: The Free Press (Simon & Schuster)