Welcome to an immersive journey through the captivating history of Addiction and Mental Health Treatment. In this enlightening podcast episode, our expert panel, Clare Waismann, M-RAS/ SUDCC ll, founder of Waismann Method® and Domus Retreat® along with her co-hosts, David Livingston LMFT and Dwight Hurst, LPC, uncover the layers of the past to shed light on the transformative path that has shaped our understanding and approach to these crucial treatments. Get ready for an eye-opening experience!
Join us as we delve into the depths of time, unveiling the significant milestones and paradigm shifts in addiction and mental health treatment. From ancient beliefs and societal taboos to the emergence of evidence-based practices and holistic care, we paint a vivid picture of the evolving landscape.
Discover the seeds of understanding planted in the early diagnostic manuals, where the roots of self-medication and the intricate relationship between chronic drinking and mental disorders began to take shape. Witness the transition from moral judgment to a compassionate perspective that recognizes addiction as a multifaceted issue rooted in biology, psychology, and environmental factors.
Explore the historical backdrop of recovery communities, where individuals sought solace in self-sustaining towns, fostering self-improvement and personal growth. Today, the focus is on integration, addressing family dynamics, and empowering individuals to embark on a fulfilling journey of recovery.
Dwight Hurst, LPC: Welcome back to a podcast to answer your questions on addiction, recovery and mental health by Waismann Method Opioid Treatment Specialists and Rapid Detox Center. I’m your co-host. Dwight Hurst, joined as always by Clare Waismann and David Livingston. Today we are talking about the history of treatment, both mental health and addictions treatment. We’ve got obviously between the three of us, we’ve got some experience working in there and we’ve seen some things happen and you know, you can go back in time. I guess that’s how history works, right? You go back in time, but you can go even further back and we can talk about some of those elements of how where treatments are at now and I guess how it got there, as well as what people used to do. I think that’s general enough. We can almost say anything, right?
David Livingston, LMFT: It opens the door.
Dwight Hurst, LPC: I always like to get a measure of what our own sort of reactions are to the question when I hear this, it made me actually it made me think about what do I know about the history of treatment? And I went back and mined data out of an old podcast that I did on another show with a historian and a history podcaster. We talked about some of the history of mental health. And I had I did a relisten because this was years ago and found some interesting bits there because my first thought is like, what did people do and and why? That’s my first. What are your impressions when you hear that idea of what is the history of treatment?
David Livingston, LMFT: Let me start by saying I’m definitely not an expert on the history of addiction and treatment. So I’m sure there’s a whole lot I don’t know. And Dwight, I’m sure you can fill in a lot given your earlier discussions. But, you know, as far as I’m aware that I mean I think that that really that AA brought about an awareness and an initial approach to the treatment of addiction. You know a lot of it through Alcoholics Anonymous you know and then it’s expanded. And from what I’m aware of, that was really one of the primary and most substantive approaches and where people went to for a long time. And beyond that, I think they probably went to their doctors. And I don’t think there was a lot of treatment and I don’t know a lot about this. So I can be wrong, but I’m not aware of even the, you know, the mental health community really paying attention to it at the level that certainly not like it is now where it’s a major part of of treatment. But so that said there’s a lot of overlap okay that and there’s a lot of overlap with compulsivity and a lot of other things that have been treated for a long time. And maybe that’s something we can sort of talk about a little bit as well since it overlaps. But I’ll I’ll leave it at that.
Dwight Hurst, LPC: It is one of the biggest parts of addiction treatment history that I always think about is how the criminal justice system got involved. Because we, you know, we as a human race, I guess, or a treatment community, medical community really didn’t have a lot of tools or understanding of how to measure things with especially things that if the main organ at that’s being targeted or focused on is the brain, you know, we’ve had leaps and bounds in the last few decades of how to analyze different parts of the brain and see things. But because addiction ties in with behavioral problems, I think that’s where it was relegated a lot to the police. Right. As you say, going into the doctor or, you know, and you go back far enough when we didn’t really have treatment, it was only in the, especially in the US and some other areas, there was there wasn’t really any treatment before the 1800s and it was in the later 1800s. They started developing anything and I think we could. I mean, there’s a lot that was, let’s say, lacking there at first in what we’d see today and consider to be treatment. But yeah.
Clare Waismann, M-RAS/SUDCC II: Unfortunately still lacking. You know, we are in 2023 and it’s amazing not just the lack of treatment or accessible treatment, but the lack of understanding of what substance use is. So I think you touched where any history of this condition, if it’s this condition, if it’s mental illness or addiction that is, you know, so often related, is truly the evolution came from knowledge, from understanding a bit more of neuroscience. How our brains function and how substances can affect not just their function, but the nervous system as well. When you speak about addiction in relation to crime and how it became almost people view as the same issue one and the other, I think, is because, again, people did not understand why people behaved that way, why they couldn’t stop themselves from abusing whatever substance. So they kind of put themselves in the same room, held each other’s hands so they could try to at least stay away. And again, one day at a time. It’s it was truly, truly and it’s still in a lot of places is a torturous way of dealing with this issue, I think, not just with depression, even, not just with substance use, with so many other mental health issues. Medicine has come such a long way where we can treat people, where we can block physical cravings, where we can reverse a lot of the mental conditions that lead people to use substances. So I think it all starts with diagnosing.
Dwight Hurst, LPC: Yes.
Clare Waismann, M-RAS/SUDCC II: Self-medicate.
Dwight Hurst, LPC: Even just tying it in with illness. And I think people who are especially young people nowadays, you know, as there has been more and more emphasis on addiction and the disease model and understanding the connection of self-medication and mental illness, people may take it for granted that that’s what it is. But it was, you know, but it was not always understood that way. And, you know, funny enough, when you go back to some of the early mental health, they had some knowledge that the brain in the head did something. And I don’t want to make you know, I don’t I don’t like when people try to make people who lived a long time ago sound dumb. I mean, they just didn’t know. Right. But they realized it did something. And there were some theories that basically that mental illness was caused by and I don’t mean to be silly, but a bonk on the head, sort of if you got your head, you know, injury and at the same time, so that was, you know, progressive in a way for back then, but also what we consider to be very regressive that was still treated as a moral, you know, hard work. And, you know, whether it was churchgoing or whether it was whatever it was becoming a better person, you know, great aspiration and part of health. But, you know, that was considered it was treated as a moralistic failing, even though there was some thought that there might be a physical component.
Clare Waismann, M-RAS/SUDCC II: If you think about it. And in some cases, they even use exorcism, right? To deal with mental illness.
Dwight Hurst, LPC: Exactly. It was thought of to be satanic possession for and I won’t say that that’s completely gone, but I would say mostly in the mainstream. I don’t hear people usually saying that. I’m not going to say that it doesn’t cling on somewhere, but and you go back even further, even other considered physical I mean, you go look in the Bible, it talks about, hey, this guy is blind. What did he do wrong? You know, not to not to go to the way, way back. But, you know, a lot of things were treated that way, that you were possessed by a demon or by the devil or something like that. And exorcism practices sometimes were very physical and killed people. Which is kind of the same as trying to go through your own either self-medication can kill people with addiction or even trying to go it alone, you know? Right before we hit record, Clare and I were just talking about the basement bucket blanket is what I call it, mode of of detoxification, where someone just sits there and tries not to use and gets really sick and hopefully lives. But that’s not a guarantee.
Clare Waismann, M-RAS/SUDCC II: Yeah. No, I was actually speaking about that. I truly believe that people, you know, they’re just starving for an answer, for a solution, not just on addiction issues, but also mental health issues. And unfortunately, there isn’t. There is not a single answer for everybody. There is a combination of factors that disrupts the nervous system response, and it could be from childhood experiences, biological factors, environmental factors, DNA. So it’s really going back to that proper assessment, that individual assessment and then going from there, it could be a combination of treatments from therapy to medical detox to medication or some kind of chemical imbalance. So there is unfortunately, there is no answer, but there is a combination of very effective treatments that can actually reverse a lot of the conditions that we see people self-medicating for.
David Livingston, LMFT: Yeah, that’s right. Right. So like you said earlier, Clare, it begins with a comprehensive diagnosis because you have to you have to figure out is what’s driving the compulsivity. Is it psychogenic, is it biological? Is it have to do with your environment per se? Is it And then and then you can start to break all of those things down immensely. So we are at the root of a compensatory system. You know, human beings can compensate one way or another. And so a lot of what addiction is is a compensatory system. So if you’re if you can’t sleep and then all of a sudden you’re introduced to an opioid and all of a sudden you can sleep well, you found something to compensate for the anxiety that comes with lack of sleep, the fatigue that comes, the dysregulated, nervous system and all, and and on and on. And often people don’t seek out a sleep study or a remedy that is non-addictive or things like that. And they’ve kind of found something and they can then they’ll end up addicted to it or something. So it can be as simple as that. It’s often more complicated. Sometimes people just are introduced to it recreationally and they end up liking it, and that can be another component of it.
David Livingston, LMFT: So you, you, you have to diagnose it. And I think that historically there’s been a lot of shame and a lot of it’s been you know, and like you were saying, Dwight, about the legal system getting involved, I mean, it was very punitively addressed. I mean, there’s a number of people who went to jail for marijuana and now I know it’s not federally legal, but it’s legal in a ton of states. And you think about the damage. And so I think there is an evolution in us understanding we’re just dealing with some chemicals and people compensating for something that needs to get dealt with and diagnosed and then, you know, and and and then you can put together a comprehensive treatment. I think most of what inhibits that from actually succeeding is people don’t stay in treatment or feel enough confidence that there is a comprehensive approach that’s ongoing until things truly get worked out. And we’re, I think, better at diagnosing than we are or than we are actually at treating. Often and so so any rate. And I think that’s been the case for a while.
Dwight Hurst, LPC: You know, I fully agree. One of the things I, I went over to my bookshelf and thank goodness it was still there. It shows everybody how often I clean out my bookshelf, I guess. But from that, that podcast did way back when. There I have a copy, a reprint of one of the first diagnostic manuals. And you just triggered my memory here, as you’re saying that it’s from 1918. It’s called the Statistical Manual for the Use of Institutions for the insane. And you know, when you get to this idea of we’re better at diagnosing than treating. It’s interesting to see the little seeds of what eventually becomes our understanding. So they have what I found about addiction is they have a diagnosis here, what they call alcoholic psychosis, which is an interesting terminology, which I would say neither of those probably meant the same thing to them that they mean now, neither of those words alcoholic or psychosis, at least they were understood differently. But it says some of the interesting things in here. It says that diagnosing alcoholic psychosis, as they called it, should be restricted to mental disorders arising with few exceptions in connection with chronic drinking. So you can see where they maybe had it backwards of what you’re saying. First of all, is that chronic drinking, you know, the overindulgence in alcohol as it’s put here, is often found to be. Here we go. Here’s the more here’s what ties in “merely a symptom of another psychosis…”
Dwight Hurst, LPC: So back then, they knew that there was some regard for self-medication and at the same time, they couldn’t help but call it later on. They call it a slowly developing moral volitional and emotional change in the chronic drinker as one of the symptoms which once again, we can see when we talk about some of the things now modern, there’s little seeds of that there, but it still brings in this kind of like there’s a moralistic perspective that’s still there that ties in a lot with shame. And opiates, by the way, were not even addressed. It says opium and derivatives as a footnote that it’s possible people might use that or abuse cocaine bromides, chloral or et cetera. Anyway, So it’s interesting to see where they started to get some seeds of something going on with the brain physically, and there’s some form of self-medication and then the treatment just eventually we see where, as we said it, it diverged into just I don’t know, I mean, kind of it diverged into that. And then, of course, you get the behavioral problems, you get the shaming, you get the exorcisms, you get the and then eventually police interventions and things, things like that, particularly for those that couldn’t afford to just keep their loved one at home and monitor them, which if you happen to have a family that had the wealth and resources and cared to keep you home, otherwise you were kind of in trouble. So that’s a whole big bite there that I just took of the history. But I thought that was very interesting.
Clare Waismann, M-RAS/SUDCC II: No, it’s interesting. You know that thing, you know who came first, the chicken or the egg? I think there are both circumstances where people will be self-medicating with substances because there is a misdiagnosed or undiagnosed issue. And there is the times when their nervous system did change due to substance use. So it can happen either way.
Dwight Hurst, LPC: I once worked at a place where we were discouraged from diagnosing bipolar disorder, and I don’t really agree with this, but we were discouraged from diagnosing bipolar disorder until someone had a certain amount of time off of methamphetamines because it mimicked it so well. Now, I don’t think that’s always the best way to go about it. I think a diagnosis can be made at least a symptomatic diagnosis “pending” can be made while someone’s still using. And it sometimes is very important. But it was interesting the acknowledgment and this is a few years ago, right, of like, oh, well, you know, some of the substances might be being wrongly classified and then, you know, so even just in the life of a career now, I think we’ve seen a lot of differences take place. Right?
Clare Waismann, M-RAS/SUDCC II: Yeah. You know, there’s even brain scans, You know, often patients will call and say, oh, I just did a brain scan and it’s all over the place. And of course, it is you’re using a tremendous amount of drugs. There’s chaos in your nervous system and lead. You know, often there are issues that made you start the drugs in the first place. So, yes, the good news is that people are seeing it more as a physiological issue and not a personality issue.
Dwight Hurst, LPC: Yeah. One of the interesting and this will be interesting when we look at modern residential or inpatient stays, which are generally fairly short and you guys notice that with Domus. But back in… this was somewhere in the mid-1800s and so they started to have actual recovery communities where they would actually build little towns. One of the first ones was actually a town called Pilgrim Asylum in New York. And it was very it was self-sustaining. The people operated there’s, you know, businesses, bakeries. They had their own fire station, fire department. In fact, they were responsible, apparently, for sewing and putting together their own straitjackets, which were used then when people were in a, you know, a psychotic episode. And so they were they had to do everything themselves. And but one of the one of the sides there is that people would live there for years, if not their entire the rest of their lives. And so at the same time that they were encouraged to have a life and they would read, they would fish, they would go on nature walks. They were encouraged to be healthy. At the same time, they were pushed over in this area and said, yeah, you go over there now, we don’t want to have you around normal people. And so you look at that compared with nowadays where I think we look at those treatments, at least the preferred method of treatment is to say those are short-term things to get back to your life, integrated with your life.
Clare Waismann, M-RAS/SUDCC II: Don’t you think that’s how it should be?
Dwight Hurst, LPC: Oh, I mean, it makes sense. I mean, yeah, I’m much more a fan of not pushing people off to the side, but I think socially that still happens, right? But hopefully, the treatment is designed to get you back into your life and well, I guess that’s one of the reasons why we now do treatment. That’s another change, is that we’ve relatively recently, you know, you could say I mean, decades and decades ago started to treat the family system, that there’s often problems inherent to the relationships that can be triggers for relapse. Right. And other things like that, too, where when someone comes in, if their loved ones are like, get fix this person’s problem, you know, a lot of treatments, modern treatments are going to say, you come in to you, hey, step in to the office with us sometimes and let’s look at the whole system, not just labeling the person as a problem. Right.
Clare Waismann, M-RAS/SUDCC II: If the family can be the reason for a relapse, so is work. So is the girlfriend, so is a friend. And I think we have to concentrate on treating the patient and make giving them the strength they need to walk the healthy path they’re looking for, regardless of circumstance and how to deal with frustration or sadness or any unwanted feelings without relapsing.
David Livingston, LMFT: Right. So, I mean, you know, part of it is you’re bringing up Dwight is age dependent. If you’re talking about someone who’s younger or a child or something, then the family system is really a bigger part of it. And because they’re dependent on that system largely until they’re older, but because we work primarily with adults almost entirely, what it becomes a there are triggers in the world always, which isn’t to say that you shouldn’t get away from them or minimize them or make sound judgment in terms of the pressures or the things that are upsetting to you. But so that’s from the outside. From the inside. You also have to develop a capacity to tolerate ambivalence and be able to understand that within this world there’s things that we love and hate and that will never change. So part of it is sort of moving at a certain pace. So let’s say someone’s got a severe anxiety disorder, okay, then you add a trigger or whatever that might be for them onto that, that can push them to the point where their ability to compensate in terms of their ego structure and what they can manage is starts to feel compromised. So it’s really like we were talking about before, it’s really kind of specific to the resources the individual has externally and internally, how much they can tolerate. And that varies a lot. And then really, I think people don’t stay in treatment long enough. I really don’t think so at all. And in fact, the evidence is that when you stay in treatment much longer, you the effects and the prolonged effects are much better because there’s a lot to get worked through. It’s like learning anything. And so, yeah, I’ll leave.
Dwight Hurst, LPC: I mean, it’s an old fashioned concept to say that once you get off the stuff, off the sauce or off the drugs, then you’re good. Right? And I mean, there is that that idea. And it mostly I see that nowadays existing in the minds of non professionals, thankfully, who don’t know as much about it. Right. But but I think it helps the focus what you’re describing puts the focus more on okay if I let’s assume I’ve been clean or not using, not relapsing for a period of time rather than leave treatment, often it would be recommended to stay. At that point I have to start talking about something else. So we start to I mean, if we haven’t already, we have to start talking about now, what with my health, right? And we’re going to address those underlying mental health issues. And, you know, and a lot of times many of us find that and that attending to our psychological health. I mean, that’s just another system. I should attend to my cardiovascular health right? I should attend to all aspects of my my medical needs. And then I think it puts that emphasis on, oh, I’m getting some treatment for things. I’m maybe medicating appropriately, whether you mean metaphorically with behavior or literally getting medication prescribed to me, not self-medicating anymore. I’m getting professional advice and feedback on that. And so you’re right. I think you’re absolutely right, is it takes the emphasis off of just the substance as being the one thing that has done everything to me. Right.
David Livingston, LMFT: It’s been so overdone that the substance is is the substance is the is the thing that I say this all the time in our discussions, but it is the compensatory mechanism. It’s not the issue per se. And that’s a great relief. So once you’re off, you know, unless you feel exceedingly vulnerable to relapse early on and so forth, in which case you do have to pay attention to that and take a bunch of steps. And that can get complicated because there are some people who’s the way they’re built internally are at risk of impulsive and compulsive behaviors at a far greater level than others are. And that’s often no fault of their own. It’s just how they’re organized internally. And so when that’s the case, you take different measures. But but, you know, regardless, you you want to the goal is to help to build a life you really like. So you want to protect it. And so you don’t need to compensate. And if it is the things that as you start to feel confident that the things that are causing the compensation or the need for compensation are getting better, you’re on your way. And that should be the focus, whether it’s biological, psychological and your environment in some way to be differentiated.
Clare Waismann, M-RAS/SUDCC II: I think. Dwight What what? I don’t know. David. I, um, I think what you’re, what you’re saying that I’m listening is instead of sustaining recovery, that is, you know, the normal approach in the addiction field is working on a productive and happy life. You’re not sustaining anything. You’re adding to it. You are the other term we can use you just adding to the quality of your life and making something that you really like to be part of that I’ve just I see it instead of a a baseline or a straight line, I see it as an improvement as every day being better for yourself.
David Livingston, LMFT: Right? Absolutely. That there’s that your needs are going to persist forever. So when they say addiction model or the disease model, what I hear and I hate the word disease in this because I think it I think in one way it makes people feel like, okay, I’m not responsible for this, but in another way it confuses the fact that our needs are not a disease. And yet they they will go on forever. And so what we have to do is realize that fact and then get them met in a varied and and varied ways that feel right enough to us. So if they’re getting mad and a whole bunch of ways, then then all of a sudden our life feels good to us. The desire to compensate goes way, way down. So that’s a treatment when I think of a disease is and I’ve said this before, like if I get a cold, the cold is happening to me, okay? Our needs are happening to us. My need to my need to eat will never end. Okay am I need to drink will never end. My need to have good companionship will never end. Okay. And my need to exercise, play, sleep. All these things, these needs never end. I don’t like the word disease because they’re not a disease. They’re the lifeblood of all of us. But as these things are getting met well enough and we’re feeling good in our life, then what’s the need to compensate? So anyway, repeat myself.
Dwight Hurst, LPC: A really good point. When you know and I think it also goes to show the evolution we’re talking about. Right? Because going back to, you know, it’s funny, this old manual of diagnoses about, I don’t know, 75% of it is instructions on how to collect data. So there was a certain acceptance of not knowing what was going on. That was true then. And I think we look at that and we see an ongoing evolution where, you know, it was groundbreaking to say embrace a disease model, as we put it. And you’re you’re bringing it, I think, to that next step in evolution, which is to say, why don’t we just talk about our needs, right? Which, yeah, that’s it. I can totally understand, as you’re saying, that it is less shaming and also not just not just from an emotional perspective, but practically speaking, I think I plan out my my treatment planning or my my health sustaining behavior differently if I look at it as I have needs. And that’s okay then if if I have a disease. So that’s very that’s very interesting. As you say, that hadn’t looked at it that way.
David Livingston, LMFT: Yeah. The world of psychology and so forth has always sort of been trying to navigate and, you know, for good reason, because all this stuff is connected between the, you know, biological and, you know, the, the your your family of origin and, you know, your environment and all of these different factors within sort of then your own needs, which is really more of your psychology per se. So, you know, there’s all these factors going on, but but they’re not that hard to break down and see clearly. It’s really possible.
Clare Waismann, M-RAS/SUDCC II: Shifting your perspective, seeing yourself through a new lens.
David Livingston, LMFT: If you’re in treatment and you don’t know why you’re using drugs, that’s not a good thing. You should. Absolutely. If you’re in treatment, you should absolutely start to get a clearer and clearer and clearer and deeper idea of why you are. It should be clarified. And if you’re just thinking, well, I have a disease, you’re not getting to what you need to because your needs are not a disease and they will continue forever.
Clare Waismann, M-RAS/SUDCC II: And that’s what happened to most people sitting in treatment. You know, they they received the explanation that is a global explanation why I use drugs is the same reason why another 30 people here use drugs. And that’s so far from the truth. And it makes you feel so isolated and misunderstood. That might as well just walk away.
David Livingston, LMFT: Right? And what And then where am I moving to? Because we’re always going to want something. And we also want different you know, the brain likes different experiences. And so we’re going to want something and we’re going to need things. So, you know, let’s define what those are. Therefore, build a life. That’s right. To to what we want. Not easy, but that’s why it takes a while.
Dwight Hurst, LPC: And we’re going to leave it there for today. Thank you so much for tuning in. We are always endeavoring to bring you the cutting-edge and best information that we possibly can on the world of treatment, mental health recovery and opioid detoxification. You can add to our program by sending us your questions. Send them to [email protected]. Go to opiates.com. To learn more about Waismann Method or follow us on any of the socials at opiates. This show is a product of Waismann Method opioid treatment specialists and is produced by Popped Collar Productions. Our music is the song Medical by Clean Mind Sounds. And this week, as always, I’m Dwight Hearst for Clare Waismann and David Livingston. We want to thank you once more for tuning in and remind you to keep asking questions because if you ask questions, you will find answers. And whenever you find answers, you can find hope. Have a great day. We’ll be back soon.