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There’s Existential Crisis, and Then There’s Heroin Addiction

June 7, 2016

Have you ever obsessed over these questions: “Why am I here?” “Does my life have meaning?” If you have, you may have been experiencing an existential crisis.

A form of anxiety marked by obsessive meaning-of-life ruminations, an existential crisis can amplify any anxiety or depressive disorders it comes into contact with. In George Dvorsky‘s exploration of ways to cope with existential crisis, he paraphrased Canadian psychotherapist Jason Winkler’s definition:

An existential crisis is all-encompassing and can permeate every aspect of a person’s life. It can manifest in many different ways, including a loss of meaning, a feeling of deep disconnection from people close to them, despair and dread of existence (e.g. a lot of “what’s-the-point” thinking).

Most research looking at the issue today refers to ideas Irvin D. Yalom developed in the 1980s and codified in his book Existential Psychotherapy. According to Yalom, there are four lines of thinking around which existential questioning coalesces:
  • Death (Why exist if only to die?)
  • Freedom (What to do with so many choices – and all so arbitrary?)
  • Isolation (I’m different; I’m an island; we are all separate and alone.)
  • Meaninglessness (How can an arbitrary life, subject to erasure at the end, hold any meaning?)

Contemporary therapeutic thought seems to pack existential crisis into other disorders such as depression. It’s bundled in with the fallout from the sort of life experiences known to throw life and its meaning into question – such as the loss of a loved one. Another view packs existential questioning off as part of a particular life stage, for example, “mid-life crisis” or “the growing pains of adolescence.”

But as a way of thinking, existential crisis can have unique ramifications. Researcher James T. Webb, PhD, cautions that extreme existential thinking in adolescence, especially when coupled with depression, can become a cocktail for suicide. He advises close monitoring.

Happy therapist talking with a rehab group at therapy sessionExistential crisis has been more extensively covered as a literary or philosophical phenomenon than as a psychotherapeutic disorder. You won’t find “existential anxiety” defined in the DSM-V, and the body of research on it dating after Yalom’s work is far from extensive. But recently, psychotherapy has posed some intriguing questions for further exploration.

For example, there’s the possibility that existential anxiety is a tendency or leaning that is part of one’s nature. Dvorsky calls attention to Winkler’s suggestion that “some people may be psychologically predisposed to an existential crisis.” Winkler goes so far as to say:

“I sometimes believe that there is a mysterious force—I don’t even know what to call it—that establishes an ‘existential orientation’ (much like a sexual orientation, a gender identity, or even a personality ‘type’) that leads certain people to be naturally oriented to question existence deeply and to have an unsettled emotional response to these questions and observances.”

Perhaps in the near future, a look at the human genome might be able to account for the “mystery”?

In any event, if the thought patterns of existential anxiety sound familiar to you, you may also be encouraged by Webb’s observation, based on his area of study – gifted children: the tendency toward existential crisis is common among children and adults who are considered “gifted.”

He suggests that giftedness lends itself to existential questioning.

James Webb produced the following chart from work by Jacobsen (2000) and Streznew:

ski (1999):

Therapists are also seeing an uptick in existential crisis, post “mid-life,” among those of retirement age. This is an age group that will naturally see more of the events that Yalom and others have cited as triggers for existential anxiety, for example, the deaths of friends and family, heightened sense of aloneness (as dependents move on), and the loss of both social connection and “meaningful work” at retirement.

James F. Tenney, MS, Psy.D., clinical director of American Addiction Centers’ Desert Hope treatment center has likewise noted increasing vulnerability to substance abuse among the retired demographic. This stage of life may encourage looking back and reflecting on one’s life.
“As Katharine King told me,” Dvorsky paraphrases, “it’s often difficult for us to confront the guilt associated with not living our lives as fully as we believe or know we could—and the more advanced we are in the life course, the more complicated this becomes.”
King refers to these emotions as existential guilt.

Such existential anxieties coupled with opportunity – generally, no one is monitoring (much less overseeing) the newly retired – increase the temptation to intoxicate. It may just seem easier to numb rather than explore the physical or emotional pains that come with age. Many resort to alcohol. Others are introduced to opioids or other prescription medications as a result of aches, pains, and surgeries. And from there the noose can tighten.
At Desert Hope, James Tenney encourages clients of retirement age struggling with addiction to rediscover “flow.” Flow is a state of full, focused engagement or absorption in what one is doing. In sports it has been called “being in the zone.” This fully engaged state may be a more common occurrence in younger years because over time, one loses touch with activities that inspire passion and therefore promote entering flow.


treatmentIn his work, Beyond Boredom and Anxiety: Experiencing Flow in Work and Play, Mihaly Csíkszentmihályi cites some interesting components of flow, apart from focus, such as
  • distorted sense of time
  • loss of self-consciousness
  • merging of action and awareness.

At least one study suggests that these components of flow can be documented by observing electrical activity moving to certain areas of the brain during the flow state. The study took Csíkszentmihályi’s components of flow and applied brain-imaging techniques to subjects within a gaming context and documented that brain activity does move in different areas.
In addition to cultivating flow situations, another common approach to helping those vulnerable to existential anxiety is encouraging or facilitating the building of connections. These can be physical or social connections, depending on the individual. Support groups, hobby groups, and church groups all help people establish social connections. Finding ways to experience physical connection, such as asking for hugs or high fives or scheduling time for massages, can also be important. In addressing isolation, these approaches also work well for addiction relapse prevention, since isolation is symptomatic of drug abuse and relapse.

Therapists descended from Rollo May (who evolved from Heidegger), along with contemporary clinicians who borrow from spiritual traditions, including non-Western traditions, may bring in solutions involving mindfulness. Practices around mindfulness can include everything from noting one’s negative self-talk to taking somatic inventories to becoming more aware of (or naming) the input arriving at your senses in each moment.

And then there’s heroin addiction

“When you realize

I can’t quit. This is a terrible life. I’m stealing to get the fix that I needit’s just a horrible life to live

then the thoughts come:
I no longer want to be on this earth.” – Jason

If you’ve ever been in this place the way Jason explains it in his podcast for the AAC alumni series “Far From Finished” – you know it is one very dark night of the soul. For Jason, that was heroin addiction.  In some ways, Jason’s statement shares similar language with depression and existential anxiety. Straight and sober relatives might hear existential angst in Jason’s words, and they may even identify or empathize with his seeming search for the meaning of life.That would be a mistake. By the time Jason is asking himself why he’s here, the chemistry of drug use has already hijacked the neurotransmitters in his brain. At this point, both Jason’s brain health and his brain growth have been arrested by heroin.

Jason is in a place very familiar to those who have been addicted to heroin. Josh, another AAC alum in the series, described this desperate place as “somewhere beyond caring.” It’s an irrational place, a skyscraper ledge between life and death, where you’re balancing on one foot while reaching for a drug. As our alums tell it, you don’t care about people, about your health, or even about whether you live or die.

When Jason talks about being addicted to heroin, he says, “ I was truly lost.”

We know heroin addiction is a disease that locks like tentacles into the functioning brain, and it’s very difficult to shake. Addiction also comes with emotional cravings – wanting the drug more than just about anything else in life is addiction’s signature. Heroin is particularly good at it, and has one of the worst withdrawals. For that reason, heroin addiction also comes with a heavy relapse rate. Relapse becomes part of the journey, and someone trying to kick heroin is well served to acknowledge this. It’s better not to make too much of the relapse, but focus on returning to the recovery.

“I’m a chronic relapser,” Jason admits in his recovery story.

Addiction to heroin is hard to beat and those who need recovery do not want to hear fairy tales. Their dark night of the soul may share things in common with the dark place of existential crisis, but escaping that darkness takes a different recovery path. Mainly, the sufferer of existential depression has no high to chase. With addiction, the substance, its promise, is always calling, no matter how many positive connections or thoughts the user embraces.


Consulting With Expert.Many people think that detox, kicking the drug, is the hard part. And perhaps in terms of physical withdrawals, this is true. But being clean does not shield someone from any number of co-occurring horrors, including depression, anxiety, and aloneness. Sometimes it’s the same existential questions that were life threatening to the drug user who suffered from depression as an adolescent. The drug or alcohol may have curbed the need for answers. But most of a user’s unaddressed issues remain frozen in time during use, so to speak. The questions can be hiding just under the surface of an addiction and will be waiting for the person long after the addictive substance has left the system. When the drug is clear and a person gains some psychological space, the same meaning-of-life questions can swarm into the void, catch the former drug user by surprise and hit their recovery hard.

Awareness of all these surprises is why12-Step groups celebrate every day an individual stays in recovery. It takes vigilance. With existential angst, therapy stemming from mindfulness, observing and letting go thoughts, can be one useful tool in the toolbox. There are many tools and a good aftercare plan keeps people in touch with their resources.

But despite the challenges, American Addiction Centers alums are proof that many people are out there, putting together days, weeks, months, and then years of sobriety. What keeps Jason from relapsing this time? What keeps someone just out of detox moving forward in a new life of recovery? There’s no magic bullet, but yet, they do it. As you listen to the “Far from Finished” stories, as the speakers reveal their paths to recovery, you may realize that sometimes it’s not about seeing a way forward; it’s about not wanting to go back. Any port in a storm. Before therapy offers an enriched new life, it can simply offer steps away from “going back.” Sometimes, the newborn in recovery just has to take that positive goal, the light at the end of the dark night, on faith until life starts to look and feel like something new. But, as you listen to recovery stories like “Far from Finished,” you see that finally, it does.

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