The “Harmfuls” exercise pasted in below was sent to me by my friend Grace Fogarty. She currently lives in a residential substance abuse treatment program in which clients are required to own up to their personal responsibility for every bad relationship, accident, financial struggle and legal entanglement that they have encountered throughout their lives.

(The handwritten “No” was added by Grace.)

This sort of shame-based “treatment” is common in both residential and out-patient facilities despite no evidence showing that focusing on pain and failure lessens substance mis/use (see work by neuroscientist Carl Hart). To the contrary, these recitations reinforce feelings of alienation and degradation and easily shade into iterative displays of victim blaming and shaming (see Jill McCorkel’s Breaking Women: Gender, Race, and the New Politics of Imprisonment).

This is what Grace wrote to me when I asked her about the “Harmfuls” exercise:

“Almost all of the addiction treatment I have encountered refocuses the onus for an individual’s problems solely on the self.  And even the elements of conventional treatment that are less emotionally and psychologically punitive, still fail to address the larger contexts influencing and compounding the distress people experience.

I’m hearing women talk about other programs in which they had to read their harmfuls aloud to the entire house.  Again, we revisit the Protestant idea of public confession as the way one achieves a righteous life, and that is even the real aim in the first place. 

Many of us are forced to be here as a condition of parole. Some of us are forced to be here in order to regain custody of our children. Many of us are here because we fled abusive relationships with men. And many of us are here because it is an alternative to life on the streets. 

One of my dearest friends here in the house [treatment facility], who just spent a year in MCI Framingham, and who is earnestly and determinedly working to rebuild her life after repeated trauma and loss, broke down in tears one night as a direct result of having to do harmfuls.  She came into my room so distraught, I thought something had happened to her daughter.

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It is beyond absurd to me that women in programs like mine are made to confront the worst events of their lives on paper in order to progress through the program and earn greater levels of freedom. [That is, privileges such as use of the phone, having visitors, etc.]”

Current research interprets addiction as a “disease of despair” — a response to feeling hopeless in terms of ever being able to make a decent living, get away from abusive domestic partners, own a nice home, have a shot at the American Dream. Recitations of weaknesses and failures in exercises like the “Harmfuls” place blame solely on the individual rather than on the social, political and economic policies that set so many people up for despair in the first place. 

Grace continued:

“Imagine the psychological unburdening that could occur if people were given a wider lens through which to understand their hardships?!?  The social context. The political context. The historical context. The economic context. Gender, race, criminalization, etc…

And then, after we’ve talked about all of this, we can transform the master narratives based in powerlessness and shame into those of activism and the (radical!) notion that we can change our lives and our world.  We have power. Our lives and voices matter.  

The hallways of the program are adorned with images of people who stood for social justice, who suffered for their beliefs, whose contributions to movements for racial equality and civil rights remain priceless.  But we never speak of them. How on earth should the women in the program be expected to connect these figures with their own struggles and see hope within?”  

Unlike the “Harmfuls” and other shame-based treatment approaches, newer strengths-based models encourage people who struggle with substance mis/use to identify, nurture, claim and proclaim their value and achievements. While no treatment program can change the underlying structural violence that causes epidemics of substance mis/use, good strengths-based programming can provide opportunities for people in Grace’s situation to see themselves — and be seen by others — as worthwhile human beings whose lives have meaning and who are filled with potential for being a presence for good in the world. For that process to unfold, it’s crucial to remember the basis for all ethical healing systems: “First, do no harm(fuls).” 

For more on these ideas check out Johann Hari’s Chasing the Scream: The Opposite of Addiction is Connection and Gabor Mate’s In the Realm of Hungry Ghosts: Close Encounters with Addiction and my own Thinking Outside the Cell: Concrete Suggestions for Positive Change.