We Are All at Least a Little Lost and Off-Putting: On Transformation

September 25, 2013
Edward J. Khantzian, MD

Volume 30, Issue 11

We avoid a basic aspect of human existence-namely, we are all a little lost and not knowing, and we had better accept this. In reminding our patients that the worst fate in life is not to suffer-but to suffer alone-we also remind ourselves.

As I approach my 80th year in life, I have come to the conclusion that we avoid a basic aspect of human existence-namely, we are all a little lost and not knowing, and we had better accept this. This is so whether it is the brash young man this morning who challengingly cuts in front of me to turn left when I thought I had the right of way at a 4-way intersection; an academic pundit who presumptuously affirms what addictive illness is or is not about (a matter that I have studied and pondered about for over 5 decades); the interminable standoffs of entrenched politicians unable to come to terms to make our society work better; or the chilling remoteness of the privileged, famous, and wealthy.

Instead of facing this fundamental reality, we posture in ways that counter the feelings of loneliness, uncertainty, and powerlessness that are so basic to our nature. Some strut with attitudes of invincibility, which, for example, can be the lot of high-performing athletes. The intellectually gifted speak with unfettered certainty about whatever is on their minds. Those unfortunate among us have endured childhood trauma, deprivation, and neglect; in adolescence and adulthood, they may adopt uncaring and troubling solutions of violence, the gang, or addiction to express or hide their vulnerability and the inescapable distresses and pain that are so much a part of life.

Maybe it is because I am a first-generation American, born shortly after my parents came to America. Perhaps it was because of and despite the trauma my parents had experienced in the first genocide of the 20th century in Turkey and, later, the great financial hardship when they came to America. They nevertheless remained unassuming, loving, and optimistic. I appreciated the pain and suffering they endured, but I also drew comfort and hope from them for a brighter future and a better world. But there always remained a part of me that was a little unsure and uncertain.

For all I know, the young man who cut me off was simply oblivious to me and in a hurry, but I suspect not. The academic who rigidly sticks to his ideas about the nature of addiction is simply blinded by adhering to a certain perspective. The politicians who squabble are simply motivated by ideological convictions. And who knows what the rich, wealthy, and privileged really consider and experience about their “special” lot in life? In all of this there seems to be so much mean-spiritedness. Whatever attitudes, beliefs, or postures such individuals assume, they likely are so inclined because they draw some comfort or satisfaction from what they do or how they think and behave. But they also pay a price. Feeling secure and so empowered has its advantages but it comes at the cost of setting oneself apart and being less apt to find commonalities and connections with others, a fundamental and necessary aspect of mature human adaption.

Dr Ernest Kurtz, a student and scholar on the wisdom and benefit of 12-step programs, draws on the lessons of existential philosophers to instruct that acceptance of human limitations is the beginning of sanity for us as humans and the beginning of sobriety for alcoholics. A main lesson I have learned studying addiction is that we are less pleasure seekers (a myth commonly linked to addictive behavior) and more comfort and contact seekers. In the short term, addictive drugs and behaviors create the illusion of well-being and relatedness. This goes back to the beginning of life. Scholars of infant development have amassed a large body of evidence indicating that the infant is governed not so much by pursuit of pleasure or “oral gratification,” but more by the quest for comfort from and contact with his or her primary caregiver.

The human tendency to posture insensitively, arrogantly, imperially, and all-knowingly precludes us from facing and dealing with the lonely, confusing, and inescapably painful realities of human existence. I commonly remind my patients, especially in group therapy, that the worst fate in life is not to suffer; the worst fate is to suffer alone. It boils down to the challenges of creating in our own lives, and in society in general, multiple contexts, groups, and arrangements-therapeutic and otherwise-that foster meaningful and comforting connections and contacts with each other.

Individuals in recovery have learned this lesson well. Their AA meetings succeed in removing the offending agent (the alcohol) and, more importantly, the fellowship fosters personality growth that transforms them into more mature, caring, and altruistic people. Wouldn’t this suit us all better as individuals and as a society?

Disclosures:

Dr Khantzian is Clinical Professor of Psychiatry, Harvard Medical School in Boston, and President and Chairman, Board of Directors, Physician Health Services of the Massachusetts Medical Society in Waltham, Mass. He is in private practice and specializes in addiction psychiatry.