Substance Abuse and Soul Work

August 15, 2010

by William F. Smith, MHC


For Your Meditation

Neuroplasticity: The brain's ability to reorganize itself by forming new neural connections throughout life.  Neuroplasticity allows the neurons (nerve cells) in the brain to compensate for injury and disease and to adjust their activities in response to new situations or to changes in their environment.

~ from

A Prayer of Invocation

Wondrous Spirit, we are gathered here today in your name.  In the sanctuary of this moment, we recall that you have said we are temples for your spirit.

O God, we thank you that we are reverently and wonderfully made.

We stand before you feeling our imperfections, even as we know that is not the way you see us.

We stand before you created in your image and frightened by its implications.

In our fear we come before you.

We come here to be filled with your grace and goodness and energy. 

Help us be open to your presence through the singing or the text or the fellowship of these brothers and sisters, all of us your children. 

Help us to find meaning, O God, in what we are about to hear and witness.  Let it take root in our hearts that we might know you are ever present within us.  Amen.


Ancient Testimony     Genesis 1:26-27

God said, “Let us make a human in our image according to our likeness and let them rule over fish of the sea and over birds of the heavens and over beasts and over all the earth and over all creeping things on the land.”

God created the human in God's image, in the image of God, God created it; male and female God created them.


Modern Testimony:  from Addiction and Grace:  Love and Spirituality in the Healing of Addictions, by Gerald G. May, M.D (New York: HarperCollins, 1988) p. 16

Because of our addictions, we simply cannot—on our own—keep the great commandments.  Most of us have tried, again and again, and failed.  Some of have even recognized that these commandments are really our own deepest desires.  We have tried to dedicate our lives to them, but still we fail.  I think our failure is necessary, for it is in failure and helplessness that we can most honestly and completely turn to grace.  Grace is our only hope for dealing with addiction, the only power that can truly vanquish its destructiveness.  Grace is the invincible advocate of freedom and the absolute expression of perfect love.




I remember my first course in psych and religion at Union Theological Seminary—Foundations of Depth Psychology.  In the first class the professor said, “We are all neurotics.”  I was highly indignant.  This was definitely not true of me: I was perfectly sane, I had no mental problems; I was deeply offended.  I came to see during that class that I was indeed neurotic (big surprise to all of you), as was everyone in the class; indeed, as is all of humanity.  I have come to understand during coursework and even more during clinical work that mental illness does not have an on/off switch: click, you're sane, click, you're not.  Mental illness is a continuum, and the question is not if I am mentally ill; rather, the question is how am I mentally ill and is my illness sufficient to inhibit or even prohibit my ability to function in the world today.

The DSM, the manual for diagnosing mental illness, does not have a category for neurosis.  Instead, there are a number of options for the categories of neuroses and disorders (like addiction) that are gradually being better understood as we begin to form a more enlightened view of what mental illness is and how it can be treated.  You may have thought from the title of the sermon that you would be hearing about my work with substance abuse patients—my Monday-to-Friday, “pay-the-rent” job—especially because I asked Peter to put MHC (Mental Health Counselor) next to my name in the bulletin.  I am not here to talk about them; I am here to talk about us, all of us in this room, to share here part of what I have learned about mental illness in my work with substance abuse patients, primarily in terms of addiction (which is the reason for the modern testimony).

A recent factor for me in considering this meditation has to do with the functioning in my own brain.  As most of you know, I had a stroke on the 21th of December.  I am very happy that I have no apparent neurological damage, but it was and is pretty scary.  And you can imagine that I want to learn as much as possible about what happened and what is happening within me because of this incident.

There is significant research to show how stroke victims can recover by learning how to change the neural pathways within their brains.  The living you and I do every day reinforces our own neural pathways, as it does for substance abuse and mental illness patients.  Helping people change those pathways is as difficult as it is for us change our own.  As I work to figure out how my brain actually functions, I am also learning how I can help my patients, because I am seeing how to help them change their brains.  This relatively new theory that the brain can change is called neuroplasticity, the idea challenging the traditional belief that the brain is fixed when we become adults, that brain injuries are permanent and that's just how it is.  Neuroplasticity says that as we live, we continue to re-enforce, change, and develop our neural pathways.  Hence the meditation quote in the bulletin.

My research following my stroke has led me to look at addiction more flexibly.  I have come to see that everyone has addiction possibilities and it is with God’s grace that we handle our addiction potential.  Our brains are always changing or adapting: neuroplasticity.  One of our patients said recently that she was learning to be the person she was born to be.  Now one of my foundational beliefs is that we are all of us created in God’s image, imago Dei—the ancient testimony.  Here is the journey for today: we are created in God’s image—does that include these addictive proclivities?  Is the person we are born to be already an addict?  Are we created to need God’s grace?  (It is at this point I began to realize I wasn't writing the sermon I thought; there is a great lesson in the interaction between substance abuse and soul work, but this isn't that sermon, one I hope to present in the future.  The Spirit led me to choose these three ideas: neuro­plasticity, addiction/mental illness, and imago Dei.)

To repeat, then: the question is how do I reconcile this perception that we are created in God's image, that we all have mental illness, and that our brains are never fixed and are always adjusting, which sort of suggests then that the image was blurry to begin with or perhaps that God is not very clear.

I suppose, speaking theologically, the first part of this puzzle is to consider what I actually mean by imago Dei, image of God.

Historically, we humans have taken the big Gods—you know, not the little gods in the springs and the woods, but the big ones that have power over large areas and great numbers of people—and we have anthropomorphized them.  They look, to a greater or lesser degree, like us.  We have taken our understanding of what God might be and put that understanding into our own image.  I get stuck here all the time and so try to make the image of God less of a picture and more of a goal or idea or concept.  In other words, when I say we are created in the image of God, I am actually saying something along the lines of, “We are recognizably created by God because one can see God's artistry in our creation.”  An example of what I'm saying could be something like how we recognize paintings by Monet because it is recognizably his style, likewise the music of Bach, the writing of Shakespeare.  We are recognizable as being created by God because our creation fits God's style.

I am not able to let go of a more literal sense of this idea of being created in God's image, though.  I somehow feel that there is within me, within each of my patients, within each of us, something that is more than recognizable as being created by God, something that is akin to being connected to my parents genetically.  My genes come exclusively from my parents.  Part of my thinking here is that there is something like that also in my personal creation.  There is something in me that is unique and exclusive to my creation by God.

This is, of course, somewhat ludicrous when I think of the vastness of God, a vastness so truly incomprehensible that I can only barely grasp the concept.  How could I presume that something like that could be contained in something as finite as myself, or in any of us?  My answer is to consider what is in me as more the potential of the image of God, rather than a frameable, put-on-the-mantle likeness of me.  The image is less the genetic makeup of my height and eye color and hair, or lack thereof.  The image is perhaps something more like character, or perhaps even potential for character, instead of the person that struggles some days just to get through the day.  I propose that even that image is enormously huge compared to the tiny finiteness that is me.

But I feel that this idea begins to work with the facts that I see around me and the world as I am coming to understand it.  St. Thomas Aquinas (you will rarely hear me quote one of the Church Fathers) considered how an oar appears to bend when it is put into water and yet is clearly straight when taken out of the water.  He did not propose to have the answer; rather, he opined that religion must change to match God's creation and not expect God's creation to fit into human understanding.  I need to figure out how to incorporate mental illness and neuroplasticity into my understanding of God's image.  How can I adjust or alter—probably stretch is a better word—my concept of imago Dei so it includes those undeniable facts?

It is pretty clear that I consider the image of God in mental—that is, non-physical—terms.  I would include emotions and spirit in the general category of mental.  I would also include them in the category of mental health.

As I stated before, mental illness is on a continuum.  There is no magic line where mental illness becomes a “disease.”  Different people have different responses to their mental condition, just as we each do with our physical health.  It is interesting to me that I have been more easily aware of physical illness on a continuum: whether I am or am not too sick to take some medication, to go to work, to go to the doctor.  I have grown up with the picture of mental illness as being the time when people need to be sent away, to be committed.  Not so.  I am, as a side note, intrigued that I have not worried about physical ailments as somehow challenging humans as having been created in God's image.  Regardless, how do I allow for having been created in God's image and having mental illness?  May I suggest that we all have addictions as one of our personal expressions of our mental health?  You may wonder what qualifies as an addiction: if something controls your thoughts and your actions, you have an addiction.  Suppose you always have orange juice before you leave your home in the morning, and one day you are pressed for time and have left home and are on the way to do whatever, and you realize you have not had your OJ.  If you go home in order to have your juice before starting your day, you are addicted; if you are able to say, “Shoot, oh well, I can have a cranberry at the deli on the corner,” you do not have an addiction.

Two factors characteristic of people who abuse substances are 1) I want what I want when I want it; that is, instant gratification; and 2) I don't want to have bad feelings.  I suspect most of us can identify with both of these.  One tactic with addicts is helping them learn the value of delayed gratification.  I work hard at school and struggle through classes and graduate and then I can get a job where I make a pretty decent salary.  Another goal is helping them learn that good feelings accompany bad feelings: if I don't allow myself to have bad feelings, I pretty much don't allow myself to have good feelings, and I suffer.

In John 8, there is a passage where Jesus tells the people around him that the truth will make them free, that sin is their master because they do what sin would have them do, instead of what God would have them do.  This, to me, sounds like addiction: we do not do what would be good for us and for those around us; instead, we feed our desires for immediate gratification and to avoid feeling bad.  How is it that the image of God, the person, chooses sin/addiction over doing what is right and appropriate for God's plan?  Am I indeed suggesting that sin and addiction are synonymous?

I think this is where we are really starting to get to the heart of the matter.  Did God create us so that we would need grace?  Wouldn't that mean that grace fills something that is somehow lacking from God's image?

I propose that the imago Dei is almost completely metaphorical.  All of God's creation is in God's image.  All of it is out of what I would call, for lack of a better term, God's imagination.  I say to you that God's image is more than anything I can even begin to perceive.  I say to you that my understanding of imago Dei has much more to do with the potential of what I can be than with who I am; I say to you that it is more of what I can become with my life than what I am at the beginning of it.  I propose that the total potential in the life of a baby is greater than any of us has made of it.  We have many choices and that means we have many chances to go wrong.  This is where mental illness/addiction and grace play a part.

I offer to you that our human bodies are limited to this world (duh!) and that they are really not capable of all the potential we have as God's image.  I would further propose to you that mental illness—be it addiction, schizophrenia, manic depression, what have you—is really no different than our physical ailments.  In fact, more and more of the knowledge gained from the research working with neuroplasticity suggests new ways to alleviate the symptoms for what had seemed before to be insoluble problems within the psyche.  Just as we are learning more about how to heal the other organs in our bodies, we are learning more about how to heal the brain as a physical object instead of a collection of mystical connections and hunches.  Just as the transfer of blood from arteries to veins was originally viewed as miraculous, we are getting to the point where we begin to understand the brain from its physical perspective (he said optimistically).  As we are learning to look at the physical components in our brains, we are learning how they can be helped in much the same way that our hearts and lungs and other viscera can.  And this is where grace comes in.

I offer to you that grace is not because we are born in God's image, it is the gift that allows us, nay, encourages us to hope and dream and move forward in our lives.  I offer to you that grace is the underpinning of our quest for justice and art and peace.  If we were merely left with the potential for disaster and breakdown that is inherent in our physical being, we would give up.  It is grace that helps us find the energy to try to achieve our potential, the imago Dei for us as individuals and for us as a species.

It is through and with grace that we continually readjust our world view for a more inclusive and loving view of the creation around us, animal and not.  It is through and with grace that we are learning how to handle physical illness so that people can live healthier, more satisfying lives.  It is through and with grace that we are learning how to help people live with and through mental illness, so they can come closer to living their potential.

When my patient says that she is becoming the person she was born to be, she is reflecting that she is starting again to work toward the potential that is always inherent in us as human beings.  She is showing us how her brain is re-thinking its understanding of who she is and what she can become; her neural pathways are developing new ways of functioning, so she has a better chance of seeing the beauty in her life and in the world around her.  And this is grace.

I offer to you that the chance to see the beauty around us is the greatest way in which we are created in God's image, a chance that comes from God's grace.  I offer that hope is how we can transmute that grace into an energy that allows us to move forward with our lives and to do what we can to make God's realm a reality in our hearts and in our souls and in our minds, just as we work to realize our portion of God's creation in the world around us.

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