Michael Jackson’s death has kept the problem of addiction in the news recently. An estimated 30 percent of Americans suffer from alcoholism at some point in their lives, as well as addiction to drugs, sex, gambling, relationships and the internet. Addiction involves a lack of control over a persistent behavior in spite of negative consequences. As a psychiatrist who has incorporated the use of conscience in clinical work for more than 30 years, I have found “real conscience” the best guide to prevent and to heal addictions.

xavierThe term “real conscience” is used to distinguish conscience from another judging faculty within us, the “superego” (borrowing a term from Sigmund Freud). People often mistake superego for “real conscience.” Conscience judges good and bad or right and wrong using reason and the spirit of the Golden Rule, which involves utilizing empathy with compassion and love. Superego judges good and bad by what the person picked up and internalized from family and society.

Individuals who had family or social influences supportive of addiction would tend to have superegos approving such behavior. The social influences of many people, especially men – and therefore their superegos – oppose seeking psychiatric treatment.

A very interesting biblical story illustrates the difference between superego and conscience:

A group of men caught a woman committing adultery, took her to Jesus to test His judgment, and reminded Him that she should be stoned to death according to the law of Moses. Jesus did not respond to this superego judgment of theirs but calmed them – who must have been fired up by sexual, aggressive and religious feelings – by being calm and bending down and writing on the ground.  Then Jesus asked the sinless one among them to cast the first stone. They left one by one silently, each convicted by his own conscience.

Note the entirely different process and outcome when they used conscience versus when they used superego. This is the only place in the Gospels where the word “conscience” is used. St. Paul used the word “conscience” 30 times in the New Testament. He referred to conscience as “the law written in the heart” and cautioned people that faith would be destroyed by rejecting conscience.

The superego can be too harsh, loose or just reasonable depending on the social conditioning. Harsh superego tends to cause excessive guilt and shame. One major reason many people do not work on the fourth step of Alcoholics Anonymous’ twelve steps – taking moral inventory – is because they feel too much guilt/shame from their superegos when they face their wrongdoings. Many people get into addiction for relieving guilt or shame caused harsh superegos. Some others have the opposite problem: they have loose superegos that do not cause enough guilt or shame to motivate them to change for the better. Conscience also produces guilt/shame, but it is in therapeutic dose, enough to transform not to deform.

Step four of the twelve steps emphasizes that the cause of addiction is the result of instincts run wild – primarily the instincts for security, sex and society. I find it extremely useful for people to have a good perspective on human needs: biological needs such as food and shelter, esteem, power, pleasure, meaning, integrating the past and future direction.

Alcoholics Anonymous lists the “seven deadly sins” – pride, lust, greed, wrath, gluttony, envy and sloth – as the major human failings. Behind these sins are various human needs. In my clinical experience, comfort and pleasure are the biggest needs met by addiction. So the solution is to handle these needs properly – pursuing better alternatives – using the guidance of conscience with insights into human needs. Superego also has an important role, since we are social beings. The ideal is to keep superego under conscience.

Other steps include admitting powerlessness or loss of control over the addiction and admitting one’s wrongs to oneself, to the Higher Power and to another human being. Lying to self and others is common in addiction, and facing this tendency is crucial for recovery. Another important step is removing character defect. Character defect can be viewed as a pattern of handling needs out of tune with conscience. Recognizing the nature of the defect – such as the pattern of deception, and changing the bad habit – are crucial in overcoming addiction.

According to Alcoholics Anonymous, resentment is the number one character defect of alcoholics. I find all kinds of unhealthy feelings that go with addiction. Feelings give signal and motivation. For example, fear signals danger and motivates you to fight or escape from the danger.

Using conscience, we can judge whether to ignore or utilize the feeling. Other steps – like making amends, practice of taking moral inventory, prayer and meditation, and helping other addicts – are ways to live by conscience.

Let conscience be our guide to stay sober and strong.

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