Understanding Existential Concussions and Addiction

Suffering is a part of life. Whether brought about by the “slings and arrows of outrageous fortune,” our own actions or those of others, or unpredictable natural or man-made disasters, suffering happens. Humans are remarkably resilient and seem able to tolerate all sorts of suffering. Many do believe along with Friedrich Nietzsche that what doesn’t kill us only makes us stronger.

Many of the classics in western literature are tales of meaningful suffering. We tend to devour these perhaps because we love how people are able not only to make sense of their suffering but then transform it so that it serves a higher purpose. (Charles Dickens’s A Tale of Two Cities is a prime example.)

However, there are times when a person cannot make sense of her suffering. This is the sort of suffering that Nietzsche identifies as intolerable and life destroying. In the throes of this sort of suffering, a person experiences an existential concussion.

What is an Existential Concussion?

An existential concussion is both a cause and consequence of acute suffering that is characterized by a lack of meaning. These concussions have degrees of severity and some combination of the following manifestations is common:

  • Compromised decision making ability
  • Significant impairment in perspective such that one is not able to inhabit alternate view points
  • Disorientation in the world such that one does not know who she is, where she belongs, or how she fits in the world
  • Difficulty in transforming one’s suffering into something meaningful
  • Despair that one has no freedoms and no possibilities
  • Absence of meaning and value in one’s own life that expands to nihilism about there being any meaning and value in the world
  • Destruction of the primary framework in which a person orients her life

Existential concussions can occur in a variety of ways but all of them involve a separation from the primary framework that has provided a person with adequate conditions for making sense of all her experiences, including suffering.

Addictions themselves are causes and consequences of existential concussions. Consider a person of faith who suffers a tragedy. Her faith had been the axis around which her life revolved to explain both good fortune and loss. Having that axis tilt might cause a mild to moderate concussion. Having that axis ripped out suddenly would cause a severe existential concussion. Knock out the axis and everything it held in place will fall.

In this case, the framework of her faith no longer provides viable conditions for making sense of what has happened. Nothing in her faith provides explanation or amelioration and so the sufferer may reject part or all of the framework. If enough time passes, the person who has lost her faith may become incomprehensible to herself and to those with whom she shared a faith. She is alienated from herself and others, which exacerbates the effects of an existential concussion. This alienation may fuel addictive behavior.

As an addiction progresses, one often begins to trade away—even in small amounts—some of the commitments and principles that have been crucial to his sense of self.-Peg O’Connor

One’s addiction may also cause an existential concussion. As an addiction progresses, one often begins to trade away—even in small amounts—some of the commitments and principles that have been crucial to his sense of self. He may slowly start to do things he promised he would never do. Trade away too many of these and a person may no longer recognize herself. She may look in the mirror and see a stranger. This disorientation may become alienation.

Addiction and Ambiguous Loss

The addiction/existential concussion of one person may also contribute to the existential concussion of others. Many existential concussions involve what psychologist Pauline Boss calls “ambiguous loss.” Boss offers two categories of ambiguous loss. The first is when a person is physically absent but psychologically present, such as a soldier missing in action and presumed dead or a child who has been kidnapped. An active addict who abandons his family may also fall into this category. He’s both not there and he’s there, which affects the family dynamics in uncountable ways.

An active addict parent who attends primarily to his use may fall into this category. He’s both there and not there.-Peg O’Connor

The second type of ambiguous loss is when a person is physically present but psychologically absent, such as a person with dementia or someone suffering from significant mental illness. An active addict parent who attends primarily to his use may fall into this category. He’s both there and not there. His presence and his moods define the family dynamics.

Ambiguous losses do not fit easily into our patterns of grief and loss. A person is either alive or dead. One is either single, married/partnered, divorced, or widowed. Dichotomous categories are always the most rigid. Each time a person hits the rigid limits of these categories, she may become a little disoriented and full of more despair.

Consider the varying ways that different illnesses and the suffering of individuals and their families are regarded. In a poignant Slate article, “Food Comfort,” Larry M. Lake describes a “tsunami of food offerings [that is] an edible symbol of our community’s abundant generosity,” when his wife is diagnosed with breast cancer. The outpouring of concern took many forms—rides to appointments, cards, and telephone calls. The family’s suffering was acknowledged, recognized, and shared, which contributes to be it being meaningful.

There is no such acknowledgment ten years later when Lake’s daughter is admitted to a psychiatric hospital with bipolar disorder following years of alcohol and drug abuse. Clearly his daughter is ill, but it isn’t the right sort of illness that elicits a community’s acknowledgment. No one brings you dinner when your daughter is an addict.

Clearly his daughter is ill, but it isn’t the right sort of illness that elicits a community’s acknowledgment. No one brings you dinner when your daughter is an addict.-Peg O’Connor

People whose experiences of loss fall into the cracks and fissures of frameworks keep hitting jagged edges. No wonder they are concussed and find themselves on a precipice.

Are there ways to prevent existential concussions? Not even the best padded helmet is sufficient to the task of preventing all concussions. But we can effect changes in the conditions that make existential concussions more likely and severe. One way to do this is to continue to expand our understanding and acknowledgment of types of suffering, especially those that relate to ambiguous loss. We can also work against the stigmatization of groups of people, which has happened to some degree with certain types of addictions.

Recovery from addiction involves making or finding meaning that begins to orient a person in her life and the broader world.

Some people will do very well in a program that provides an easily recognizable framework, such as Alcoholics Anonymous. Some desire different frameworks that make no references to powerlessness and higher power, such as Women for Sobriety and Rational Recovery. Other people will prefer a therapeutic model. Others will want an explicitly faith-based model. Yet others will eschew “ready made” frameworks in favor of ones that are of their own construction. But even these draw from deeply social and shared meanings and values.




Pauline Boss, Ambiguous Loss: Learning to Live with Unresolved Grief (Cambridge, MA: Harvard University Press, 2000).



Photo Source: istock

The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of Rehabs.com. We do believe in healthy dialogue on all topics and we welcome the opinions of our professional contributors.

What Are Your Thoughts on this Topic?