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I’ve been looking at Thinking, Fast and Slow by Daniel Kahneman, winner of the Nobel prize for his work in cognitive science. It’s a pretty good book, and while some may say it’s a bit of a dry read, for a brain doctor it’s a page turner. I’ve had a lot of fun with it.

Readers of this blog will find Kahneman’s System One and System Two familiar. He describes System One as intuitive and automatic, almost effortless. Think 2+2 = 4 kind of effortless. His System Two is purposeful, deliberate and requires a good bit of effort. Think 367 X 422 = whatever that is; you work it out.

While System One includes the automatic life saving actions that we see coming from the mid-brain, it also includes the learned automatic activities of the expert. For instance, a new driver who’s car skids is not likely to turn into the skid and refrain from breaking. It takes a while for non-intuitive actions to be learned well enough to become automatic in System One. But what’s important here is that such non-intuitive actions can be learned and can be made automatic. If may be our first nature to panic in a skid, but it can become our second nature to turn into the skid and not touch the brake.

Kahneman’s insights teaches us some things about recovery. Early on, we are operating with System One telling us that we really need to use because our life is in danger if we don’t. If it has the chance, System Two can disagree and point out what will really happen if we use. However, remember that System One is designed to take over in a life and death emergency. So the old idea of “just think it through” has to give way to practice thinking it through until thinking it through becomes second nature. That means that beginners can’t “just think it through,” and they need help practicing just thinking it through until it becomes second nature. During treatment that help may need to be daily, and then daily contact with a recovery community can take over after the acute phase of treatment has ended.

Let me drive this point home. Someone with addiction who goes to treatment and is still highly symptomatic will be likely to seek out quick relief from those symptoms unless stopped. Traditionally, that is accomplished by putting them somewhere where they cannot use until the symptoms pass. Unfortunately most people remain symptomatic and find “allowed” drugs (overeating, nicotine, etc) during their residential treatment. Consequently, the thinking it through has been learned at a lower level of crisis (symptoms partially treated with some dopamine raising activity or drug) than the brain may deal with in the future. When the crisis rises later through aging and progression of the illness, stress, trauma, or other factors, the person’s System One will revert to the older learned behavior that existed before “thinking it through.”

And if you’re saying to yourself, “I’m so practiced at this recovery stuff that I could not possibly reach a point of symptoms or crisis that could make me forget it,” let me tell you about Air France Flight 447, the Rio to Paris flight that crashed in the mid-Atlantic with the loss of all aboard.

Pilots learn to the point of it becoming second nature that, if the plane stalls, rather than pull back on the stick to go higher, you should push forward on the stick to go lower, gain speed and recover from the stall. This is practiced over and over again until it becomes what they do automatically. What seems to have happened on Flight 447 is that a situation arose in which practicing doing the non-intuitive thing wasn’t practiced.

The plane was in level flight at high altitude and the speed indicators became clogged with ice. That situation wasn’t part of practice. So over a 15 minute period, during which the automatic stall warning yelled the word “stall” some 75 times, a co-pilot maintained a pulling pressure on the stick and kept the nose of the plane up almost all the way to the water. Here’s the kicker. He never told the other co-pilot or the captain that he was pulling on the stick. So even surrounded by more experienced people who might have told him what to do, he kept doing an intuitive thing, so sure he was right, that he didn’t need to tell others what he was doing.

The story of flight 447 teaches me two things. First, we’ll never be practiced enough at recovery to go it alone. Second, whenever we find ourselves in a disturbing situation, an inventory of our thoughts and actions that we share with someone else is the place to start. If that co-pilot had said, “I think we’re really not in a stall and I’m pulling back to maintain altitude,” the captain would have probably said, “In that case, I have a suggestion for you.” Well, not really. He would have given a direction, not a suggestion, but that’s not the point.

The point here is that we need to practice our recovery behaviors in all situations over and over again until they become second nature. On top of that we can never be comfortable that we’ve achieved some level of expertise, but rather continue to practice, not only the behaviors we’ve learned, but the process by which we’ve learned them. So, whenever we’re disturbed, for instance at 40,000 ft losing altitude and don’t know what to do, we should find people we trust and tell them everything we’re experiencing and doing and, most importantly, listen to the suggestion that arises.

© Howard C Wetsman MD FASAM 2012

This entry was posted on Sunday, June 24th, 2012 at 9:07 pm and is filed under Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.