Cracked: Putting Broken Lives Together Again - Drew Pinsky, Todd Gold (2004)

Chapter 15

LINSEY THINKS SHE’S fat. Or that she’s getting fat. Or that she might get fat. Whatever it is, the girl is obsessed about her weight—which, I find out, became a concern after she read up about Seroquel, a medication I prescribed for her agitation, and learned that weight gain is a possible side effect.

The two of us talk in a corner near the nursing station, where she corralled me after her morning group.

“I’ve also been vomiting my food lately,” she says. “I can’t help it. I don’t want to get fat.”

This is an important moment. I don’t want to overreact. From a medical standpoint, Linsey appears okay. Her skin turgor is appropriate. She’s well hydrated. She doesn’t have any hair banding (subtle, alternating, one-inch-long bands from the scalp to the ends of the hair) or other signs of an out-of-control eating disorder. Her vital signs are normal. Her labs are normal. She’s been doing well with peers.

“I really want to do what you guys are telling me,” she says. “But I’m frightened about my eating. I don’t want to take my Seroquel anymore.”

“Don’t you think it’s helping?” I ask.

“Yes, but I’m freaked out it’ll make me fat. I’ve been spitting it out.”

Her face is a round pillow of anxiety. I snag Alexi as she walks by and wave the three of us toward the empty examining room. Linsey stares out the window as I bring Alexi up to date on the situation. I don’t have to explain my concern. Even with her medical management, Linsey is spitting out her pills and not following directions. This is willful self-sabotage. It’s anathema to the process of recovery.

Why? It means her disease is still in charge and dictating her care. It doesn’t feel that way to Linsey, of course. She feels scared and in danger. Her brain is telling her to rely on her own devices for survival. Don’t listen. Don’t trust anyone, including the doctors, nurses, and counselors. Why should she trust us when all the important people in her life have violated her trust?

“We’re trying to find something to help you with these mood swings and agitation,” I say. “I’m going to change your medication from Seroquel to lithium, which shouldn’t make you gain any weight.”

“But if I do?” she asks.

“We’ll try something else.”

“What if there’s nothing else?” she says in a panicky tone.

“The goal is to get you off everything, and we’re almost there,” I say, looking intently into her eyes, kicking myself for creating a situation where medication became such a focus for her. “The thing you have to understand is that I’m here for you. Everyone here has your interests in mind. Our job is to support you. But you must trust us and follow our directions. That’s it. It’s up to you.”

“I know, I know,” she says.

“Take a breath,” I say.

She inhales deeply, and then exhales. Then she does it again.

“I’m a fucking freak,” she says. “Oh my God, I can’t believe what a frigging mess I am.”

Not long after she leaves, Alexi tells me to peek inside the room closest to the nursing station whenever I have time. No hurry. A short time later I look inside the room. Oh my gosh. Our chronic alcoholic, Mitch, is back. He’s laying facedown on his bed in a pool of drool. It’s disgusting.

“For some reason, I’m more concerned about him this time,” says Alexi. “So I put him right next to the nursing station.”

“You can see the muscular wasting and the thinning of his skin,” I add. “He’s too young to look so old and decayed.”

“The thing is, he’s so smart and funny.”

“I know.”

Mitch is one of the most frustrating patients I’ve had. His behavior is the same each time. Once aroused, he slowly pulls himself together, explaining his relapse in a fantastically complicated weaving of bullshit that eventually ends with some sort of excuse about why he relapsed. He blames his father, his boss, his wife. The poor choices he makes never have anything to do with him.

But then the games begin. Although his previous stay was unusually brief, I have a clear recollection of the time before that. After about ten days, I ran into him as he walked to lunch. His hair was well groomed, and he held his broad, chiseled chin up high. His tremor was gone, and his gait was steady. These were all signals that he was through detoxing—which only meant that we were in for his maneuvers.

He started in immediately, telling me that he’d done his second step and his sponsor said he was ready to go.

“Have you arranged a bed in Sober Living?” I asked.

“No, Drew,” he said in his usual ingratiating manner. “I don’t think I need all that. My dad had to pay for this hospitalization. I’d maxed out my insurance. I’m not about to ask him to pay for Sober Living, too.”

“Mitch, how many times are we going to go through this?” I say. “You simply aren’t going to get well without adequate treatment. That’s a fact. You’ve tried it your way how many times? It’s time to capitulate and let other people who know what they’re doing make some decisions. Right now your diseased brain is calling the shots. You’re going to relapse as sure as the two of us are standing here.”

Smiling confidently, he put his arm around my shoulder and let me know he had it all figured out. He told me I worried too much, and gave me some mumbo-jumbo about needing faith in the restorative ability of a Higher Power—as called for, he added, in the Big Book. He was referring to the Big Book of AA, which he’d coopted and garbled into something completely inaccurate. Listening to him, I had one thought: Disaster ahead. I knew we’d see him again soon.

Alexi reminds me of similar conversations she’s had with him in the past. “I don’t know how many of these relapses he has in him,” she says. “His body is showing the effects.”

“It’s a progressive disease,” I add.

“It’s so clear in him,” she says. “Each relapse is more intense.”

Someone standing on the outside of all this might well ask whether moments like this make me feel I’m not doing my job. Or why anyone should bother with that twelve-step stuff if it doesn’t work. Admittedly, sometimes it’s so frustrating I can’t stand it. I want to strangle someone like Mitch, even though I know better. His game infuriates me. Addiction is the only disease in which people need to be convinced that a) they have a disease and b) they need treatment. With Mitch, I’m at the point where I wonder if we’re actually enabling his disease just by letting him use us again and again to piece him back together.

So why bother?

Here’s why: Mitch is suffering from a life-threatening disease. So are all the others like him. It’s incumbent upon us to find a way to reach these people and offer them the opportunity to get better. No doubt my own codependency keeps me slugging away at cases like Mitch’s, perhaps longer than is good for him. But so what? What’s the alternative?

And there’s another factor at work here, one I find fascinating and poignant: I believe that addiction is a function of evolutionary pressures on populations. And where are the most severe biological burdens of addiction? In populations subjected to repeated genocidal assaults. Addicts tend to be descendants of the people who survive such extreme adversity. They tend to be smarter, more sensitive, and richer human beings. They move the species forward.

But there’s a cost, and that’s the disease they inherit. If we as a species had never learned how to distill spirits, extract anything narcotic from the poppy, invent benzodiazepines, and so on, these individuals would have a different constitution than the average person—but no disease. The switch in their brains wouldn’t get thrown if not for such powerful chemicals. As with any other disease, we have to ask what’s causing it and how we treat it.

To me, addiction is the predominant health issue of our time. Abuse, neglect, and abandonment—all are actions that interrupt the healthy development of an individual: These are problems that affect the whole of society. None of us is immune from the resulting problems, which include not only addiction but domestic violence, crime, homelessness, rising health care costs, and above all else individual emptiness.

That’s my biggest concern. Our culture has taken its great founding principle, the pursuit of happiness, and twisted it into an obsession with instant gratification, the quick fix, getting what’s mine. Just do it, indeed: The most successful creative figures in our culture, from the producers of reality TV to the editors of Maxim to the directors of music videos, have created an orgiastic mythos of sex, mayhem, and cool clothes. Want to know why spring break kids all act like they’re living in one big porn video? Ask the advertisers.

But none of this has anything to do with happiness. In truth, it’s just a setup for disappointment, frustration, and failure.

It’s why so many people complain about depression, or insist they just don’t feel good. Lacking adequate attachments, they feel empty. They try to feel better by grasping at the solutions the culture offers, only to find that those solutions turn into the problem; then they get caught up in a continued need for arousal, to escape their emptiness.

And even when the evidence of a problem becomes overwhelming, the human capacity for denial can hamper any individual’s chances of jumping off the treadmill of addiction. A recovering counselor once told me my favorite story about denial: He came home every night for years completely wasted from drinking, and in the morning his wife complained that he’d been abusive and angry to her. Since he didn’t recall a thing, he dismissed this as her problem. Then one morning she placed a tape recorder on the kitchen table and said, “Listen to this.” She pushed PLAY and he heard a voice that sounded like him ranting and raving at his wife. Afterward, he was livid. How dare she hire an actor to impersonate him!

Basically, people don’t know how they’re supposed to feel anymore.

Human beings feel best when they’re spending time face to face, particularly in times of adversity or when they’re feeling threatened. If nothing else, we learned that from September 11. We define ourselves by the way we relate to other people. We get deep, lasting, and meaningful satisfaction from giving selflessly to, and being present with, others. We develop trust. We feel better about ourselves and our world. This is what we’ve forgotten: Our decisions should be made on the basis of what’s most healthy, not what will satisfy me quickest. Live with integrity and a clear sense of right and wrong. Consider consequences. Listen to the inner voice of your instinct as carefully as a doctor checks your heartbeat. This is what I wish we all knew to do.

My patients can’t do that. Like so many others, they’re struggling with the effects of trauma suffered early in life, when they were still developing the brain mechanisms that allow them to relate to other people and the world in general. Their development was arrested at whatever age the trauma happened. Unable to trust, they grow up without a sense of self. They’re overwhelmed by feelings, unable to cope, always out of control.

So where’s the doorway out of this hell? Through acceptance of the disease, and through experiencing the pain and the consequences it has caused. The irony is cruel. It’s the most vivid part of a patient’s reality, and the one they want to most deny. The guilt and shame are profound. Their brains tell them to manage the pain by getting loaded. Then, when they find their way to us, we ask them to go back and experience that powerlessness, the very thing that sent them off the rails in the first place.

No wonder they resist.