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Addiction Visible/Invisible
By: Lana M. Ackaway, LCSW-R, NCPsyAv
The well-written article by Daphne Merkin entitled "Darkness Invisible" in the September 16, 2007 edition of The New York Times was disturbing. It wasn't disturbing due to its darkness. It was disappointing due to the misconceptions and insensitive comments regarding drug use/misuse. Drugs, to include alcohol misused-not only mask a depression-it can MAKE for depression and illuminate MELANCHOLY. Its use/dependency/misuse/alcoholism can, through psyche, soma, and behavior create, as Merkin quotes Chekhov: "I am in mourning for my life." Addiction is a way to mourn for being alive-for actually living to full potential -- via a never-ending depression. Allergy to alcohol-eventually produces (for some, earlier; for some, later) non-feeling states, inappropriate thinking and behavior, desperate acts, suicide-real-not imagined. Alcohol use/dependency/misuse/alcoholism/drug abuse is rampant-not only among the creative folk in film-in every walk of life-and with every socioeconomic class. It spares no one who suffers.
I treated Jan after her alcoholism relapse. She was 50 and sober 16 years when she relapsed. She "nibbled" (Merkin's language) on alcohol for about three years before coming to see me. Although intellectually having known better, Jan believed she could drink again. She was looking to keep drinking-even though she felt numb, dead, suicidal, empty and terrorized. She came to see me after a number of interviews with "harm reduction" psychotherapists (counselors who do not hold 'abstinence' as a priority to treatment.) She had lost her life and some of her work when she relapsed. She was unable to get close to anyone. Feelings of intimacy with her husband and children were long gone. Jan began with binge/periodic drinking-drinking small amounts on holidays, birthdays and other social functions. Over a handful of years, and life having made its usual twists and turns, e.g., she couldn't get a "showing" at a gallery, " a few mishaps with her car were "scary," an unexpected death in the family was "disturbing" to her, etc. Jan progressed into weekend nibbles which turned into a few 'bottles' a week and nightly trials.
Jan shared a DSM IV with Owen Wilson, Robin Williams and Richard Pryor. As an artist and sculptor, Jan created while she lived and worked. Still alive through her several year relapse that produced and avoided feelings of emptiness, darkness, solitude, sadness, depression and suicide (ideation and thoughts of killing or drinking herself to death, Jan was downtrodden. She was not hospitalized. She did not enter detox or rehab. Jan had many moods: She was depressed, melancholy, high, sometimes drunk, sometimes slightly drunk. Jan was hung over on most days -- not having enough substance through controls-or illusion of controls -- two/three drinks a night. She was never a real depressive-she experienced bouts of depression. Jan 'nibbled' on her choice of drug: alcohol. If she could have her mind, body, soul, emotions, and spirit, she would still be nibbling. This is not possible. Jan learned the hard way through her relapse.
Notwithstanding years in 12-Step programs that enabled her to have a career, a marriage, a decent enough personal analysis, Jan was surprised that she "couldn't stop drinking." She had long exited from any self-help group involvement. Jan would not emotionally understand this until a year into her second sobriety. At a certain point in the drinking of every alcoholic, he/she passes into a state where the most powerful desire to stop drinking is of absolutely no avail. This tragic situation has already arrived in practically every case long before it is suspected.
Jan's older sister died of alcoholism. Her death was classified as "suicide." Jan at that time was in mid-stages of active alcoholism. Jan commented, "I couldn't help her or myself." Untreated alcoholism is suicide.
This writer also relapsed after many sober years for a period of time where it was the "first" drink, not the "fourth" vodka. It was always the "first" drink; I am addicted to alcohol. I was suicidal and didn't appreciate the extent of my alcoholic despair, notwithstanding my then-analyst suggesting "medication," having missed the alcohol relapse in its entirety. He tried. His interpretation of "you're playing with fire," did not cut it! I had to melt down, black out, space out and begin to put miniatures in my office freezer...and not tell anyone. And, I was not drinking much. That was the problem. I was not having ENOUGH alcohol to reduce craving or satisfy the perpetual cycle of tolerance and withdrawal and the suicidal thoughts. My body was screaming, "Vodka!" and my mind was saying, "You're nibbling and in control of your drinking, you're OK...You're not a Bowery person--the neutered man with the dirty raincoat with a flask in his pocket." Absurdity. I do not suffer from depression - a smatter of anxiety, but not depression. I can get dark, but stay with the darkness/my feelings and not entertain them with a full orchestra…so long as I remain abstinent-as I have again for several years. (As an aside, one of my patients who hates her feelings states, "I will not entertain them--no orchestras for me--only through a string quartet!")
So, what happened? Jan showed up and I had problems treating her as her "nibbling" was too close to my own. She did stay for a few years...long enough to stop drinking and begin her journey. As I got honest, I began to treat her drug abuse and I faced my own relapse.
The physiological vulnerability that Merkin states is a "self-annihilating impulse" is not accurate for addicts. Addicts' behavior mimics a "self-annihilating impulse." Impulse issues or massive anxiety ran out with the borderline escalation of diagnoses for addiction many, many years ago. The heart of addiction, of course, resonates with human psychological suffering. Human issues of experiencing emotion are in the extreme: feelings are overwhelming and unbearable, or they are absent and confusing. Addiction resonates in an inability to control one's life. Addicts alternate between losing control of their behavior and substances and then, often at the same time, they exert multiple and varied attempts to gain and maintain control. Drugs (including alcohol) are compelling because they initially work but ultimately due to physical tolerance and evolving diminished psychological capacities, the attempts at self-correction fail. Suicide is a fatal alternative.
Relationships for the active addict are not possible. Clear thinking is not possible. Judgment is not possible. Self-care is not possible. Living is not possible for an addict. It's not easy living without drugs after any amount of years of abstinence. With some, life on life's terms, feels harder as one becomes more aware and open. It can be uncomfortable for some with a "smatter of anxiety."
Addiction/recovery "sagas" as Merkin gleefully comments as "boring" are attempts to master affects - to tolerate the darkness and the lightness with "props" (alcohol, other drugs, heavy prescription medication). Merkin's article attempts to dissuade her own "darkness," quite unsuccessfully. In this writer's opinion her being "flip" only highlights other possible issues/conflicts. Her references to talents mentioned, i.e., Robin Williams and Richard Pryor are appalling.
Merkin's reference to a "guy with everything" (Wilson) is judgmental. Suicide-while an act of hostility, which says, "I'll show you…" (whomever he/she wants to blame for his/her lot in life) is an attempt to evade any sense of real responsibility for self-care. So what's new here?
Depression, as Merkin comments, is not "chic." It may well sell in memoir. Merkin may need to write her own memoir. Addiction does not sell. Many do not stop drinking. Many relapse. Many wind up dead. My assessments, consults, chemical dependency Interventions, new potential prospects in colleagues' treatment rooms-is the 'real hard stuff'- at least as hard as depression. Addiction kills. I know of a rather 'known' analyst (not personally) at a recognized NYC Institute who lost two families, two homes, two children, his self-dignity, let alone not giving his patients/clients/students his help--he can't help himself, who yet after quarter of a century is still trying to control alcohol. How sad! I know a colleague whose ex-husband sits in an Institution with wet-brain--he couldn't control his drinking. How sad! Jan's sister-a talented surgical nurse-is dead! How sad! Addiction is denial for many. I too, almost died…again.
I'm glad to be alive. I can be caring, empathic, knowledgeable and loving. I am grateful for my life, some of my more important relationships, my profession, my depth of character, and an emotional and physical sobriety--which protects me from alcohol. It--so far--stays in remission. I never liked my family of origin. Addiction figures here as well!
Lana M. Ackaway, NCPsyA, LCSW-R, CASAC - lay Certified Psychoanalyst (Certificate in Lay Psychoanalysis, National Psychological Association for Psychoanalysis [NPAP], 1997), graduate Columbia University, MSSW (1982), and a graduate cum laude of Fordham University, College of Lincoln Center, B.A., Psychology, minor in Social Work (1981). NYS licensed Clinical Social Worker with an "R" Certification (highest), NYS Credentialed Alcoholism Counselor (1982). Ms. Ackaway is in private practice in Manhattan for over 20 years. She offers high-quality professional consultation to consumers who have not accessed or have had prior unsatisfactory experiences with psychotherapy or other mental health services. Ms. Ackaway also works with clients/patients in various stages of addiction recovery and core losses, to include the treatment of adult children of alcoholics. Her Chemical Dependency Interventions-creatively breaking "denial" barriers to accepting professional help-are known in the U.S. Lana Ackaway is working on a memoir about addiction.
Click Here to learn more about Lana M. Ackaway, LCSW-R, NCPsyAv.
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