Category: Connect

  • Opioid substitutes: Take as needed

    Opioid substitutes: Take as needed

    Last post I shared a conundrum with you. I’d written a chapter for a book for addiction doctors. But when I learned the title of the book I decided (after all that work!) to withdraw it. Was that the right thing to do? Your comments convinced me it wasn’t.

    My chapter urged practitioners to view addiction as a learned habit, not a disease, and showed show how the brain changes corresponding with addiction fit our understanding of learning rather than pathology. And it seemed compatible with a book that was supposed to “create space for clinicians to go beyond narrow guidelines….to reflect more of the ‘art’ of working within addiction medicine.” I thought my chapter would fit right in.

    Until I read the proposed title: A prescriber’s guide to methadone and buprenorphine for opioid use disorder. How could a “prescriber’s guide” advocate moving beyond conventional guidelines? At best I’d have to rewrite the thing. And even then, my whole argument for moving beyond the “disease label” starts to unravel when it comes to the prescription pad. (see last post for details) In sum, my chapter in this book would be a sellout! Not just a poor fit but a surrender to the opposition!

    That’s where you guys came in. I asked commenters to give me the benefit of your perspectives, and that’s what you did. There were good arguments on both sides, but a majority of you articulated good reasons why I should have left the chapter in.

    For example, Matt had this to say:  “I don’t quite understand why you would not offer your unique perspective to anyone, especially physicians, and especially since they asked for the chapter to begin with. There are so many physicians who would be exposed to your ideas who may have had no idea they existed.”

    For “my ideas,” read “progressive conceptualizations of addiction that step around medicalization.”

    Annette wrote that “your role is, undoubtedly, to EDUCATE. The world is shifting…Mental health advocates are talking openly about the impact of social, economic and political structures on our (fragile) mental health, so those of us who understand this need to keep educating.”

    But Shaun came up with the coup de gras: “I imagine two scenarios,” he wrote. “ONE: a well-meaning doctor who has learned it all from the book of NIDA, Chapter Volkow, TIP63: Patient has life-long disease of brain that compromises free-will. They will manipulate and lie. I will insist that they pee in a cup [and] have medication discontinued if they test positive… Chance of getting on with life, zero.

    “TWO: Having read Marc’s chapter, start by seeing a person who, for whatever reason, has learned to use heroin as a valid way dealing with life. Through collaboration and honest dialogue, with voluntary additional services that they may or may not request, I will prescribe their methadone without fuss and making them seem like I’m doing them the world’s biggest favour. I will…not wield [my] autonomy like a weapon…I would…’provide a scaffolding’ of methadone ‘to support a vision of future self,’ rather than use methadone as a straight jacket to constrict their right to breathe.”

    (I suggest you to read these comments in their entirety.)

    When I read Shaun’s comment I was still reeling from a psychotherapy session I’d had with Sally (fictitious name) a few hours earlier. I’d been meeting (online) with this fortiesh English woman for psychotherapy every week or two for about eight months, during which time I’ve tried to help her get on with her life, make peace with her demons and self-doubts, and keep her codeine habit within safe limits. This session she talked about her years of heroin addiction and hooking. It wasn’t the first time, but the level of detail, the pain she expressed so vividly, made me more aware than ever of the grinding inhumanity of the life she’d lived.

    How did Sally get into heroin? When she was 14, a teacher at the children’s home began touching her genitals. She wasn’t angry at the time, she says, but her perception of adults changed entirely from that point on. A couple of months later, a math teacher–she remembers him as being very old, with bad teeth–started making advances. This time, she threw a chair at him. She got kicked out of school for her troubles, and that’s when she got to know Mike, who introduced her to heroin.

    Sally had a pattern of running out of one children’s home and landing in another. She hated them all, she told me. Her parents came to visit her often enough, but they didn’t take her home with them. Maybe that was the problem. Her mom had told her she couldn’t handle her tom-boy ways. Sally liked looking for bugs under rocks rather than dressing nicely. That’s just Sally being Sally, the family concluded. And she became an outsider in her own home. By adolescence she’d often end up swearing at her mom, sniffing glue and hanging out with the wrong kids on the corner.

    So it was the usual culprits: inadequate parenting, child abuse, growing up without any real protection…Sally’s credentials for drug use would include a pretty high ACE score. But Mike was the catalyst.

    He started off as her friend, someone to love her and listen to her. Then he became her pimp, demanding that she go out and find money to score more dope. Her young body was all that stood between his well-being and withdrawal symptoms. He’d beat her up if she refused–broken ribs, a couple of teeth knocked out– except when he got worried about damaging the merchandise.

    Sally’s life stabilized after all. She went out at night, looked for men, got the money up front, until she had enough to score. Then went back to Mike and shot up. This went on for years. Her mother saw her once, sitting at a street corner, head lolling back, almost unrecognizable because she was so thin. But she just kept driving. That’s just Sally being Sally. Skeletal and bruised, waiting for a man degraded enough to look past the bruises for 20 minutes of warmth. That’s who she became. Until she was rescued by a man who got her off dope, as long as she’d never look at another man again.

    The real story of Sally’s addiction is so diametrically opposite anything resembling a disease. The web of social, economic, and familial factors, the absence of a social safety net, the play-it-safe inclination of child-welfare services that weren’t interested in the child’s version of events. That’s where the problem arose. So where was it to be solved? In a doctor’s office? In a methadone clinic?

    At least once a year someone would demand sex without pay or else they’d hurt her, badly, they warned. And she’d have to “service” this man anyway, get it over with as soon as possible, because the night was wearing on. There weren’t many hours left to find a paying customer. And she needed to buy heroin. Her stomach was already knotting, her muscles cramping, the nausea rising. She couldn’t face it, not tonight. She couldn’t face Mike empty-handed and she had nowhere else to go.

    Sally told me that she’d cry every day, even once her life had moved on. She just couldn’t process all she’d been through. Now, today, I couldn’t shake my own grief. That’s when I read Shaun’s comment. And that’s when I realized I should have submitted my chapter after all.

    The horror of Sally’s circumstances could have been prevented if opiate substitutes had been available, without prohibitive costs, without further degradation. She would have left Mike, would have left the street, if she could have found a way out.

    I’m not beating myself up about it, but I made a mistake. My reluctance wasn’t wrong. The “prescriber’s” shingle unfortunately strengthens the inclination to make OST (opioid substitution therapy) the goal of addiction treatment. It was my decision to withhold the chapter that was wrong.

    I should have contributed the chapter to help doctors see OST as scaffolding, a means to an end, rather than an end in itself. That way, the social-developmental roots of (psychological) addiction and the doggedness of physiological dependency could have been specified as parallel aspects of an opioid habit, distinct but convergent, making it all the more insidious. Both are real. Both may need to be challenged head-on. And there’s no universal formula for which should come first.

     

     

     

     

     

     

     

     

     

     

     

     

  • Do I have to think like a doctor to help heroin addicts?

    Do I have to think like a doctor to help heroin addicts?

    Hi again. I know I haven’t been posting much lately, but it’s time to get back on that horse. One thing I did in the interim was write a chapter for a volume on addiction. Which led to a strange conundrum…and some soul searching.

    But before getting to that, I’ll tell you what inspired me to keep blogging for now. First, I opened Google Analytics and found that I’m still getting 200 hits per day…even after weeks with no new posts. People remain interested in our alternative and progressive approach to addiction. Wonderful! Second: I met Sandy P at my father’s memorial in California last week. And she told me she not only still exists but she follows my blog. Amazing. Sandy was my brother’s girlfriend, and Abbie, her next-door neighbour, was mine, when we were in our late teens. (When I was first getting into drugs, Abbie was my salvation. Until I took off for Asia: no Abbie, lots of drugs.) Thanks, Sandy, for a sweet hit of nostalgia.

    Now about that chapter. I’ve had papers rejected by publications lots of times. It’s part of the rat race of being an academic, a researcher, submitting your best work to journals, waiting for the letter from the editor, finally getting that heart-stopping email and reading it and Oh Shit! They’re rejecting it?! Without even a “revise and resubmit!” Damn ignorant asshole editors. Too good for your shitty journal anyway… Then the anger and disappointment start to evaporate and you start thinking about what journal to send it to next. That’s the life of an academic. And that’s one reason I was glad to be done with it, and why, about eight months ago, I swore to myself I was done with academic writing.

    But I caved. A colleague in Toronto, an addiction doctor, urged me to write a chapter for a book for addiction doctors, to spell out my learning model of addiction, and how it reconceptualizes the data on brain change in addiction, for the benefit of…well, addiction doctors. Because, even though they’re doctors, they don’t necessarily buy the disease model of addiction. At least they don’t necessarily buy all of it, or maybe they’re uncomfortable with it, or maybe, just maybe, the field is changing. (This particular doctor specializes in ACT for his patients.)

    So I wrote the chapter. Took pieces from other work, revised them, wrote some new stuff, trying to make it accessible for all those doctors out there, because they don’t really understand human development very well and they sure don’t understand psychology very well. So, why not give them the benefit of my stratospheric perspective. (LOL) I spent a couple of weeks working pretty hard, sent it in, and soon heard back from the editor. Thank you for submitting your chapter for publication in “A prescriber’s guide to methadone and buprenorphine for opioid use disorder…” Which is when I said to myself, those ignorant editors! They got the wrong book. Or the wrong title. Or something. I can’t write a chapter that urges ditching the medical model for a damn prescriber’s guide!

    As mentioned, I’ve had my work rejected by numerous publications. But this was the first time I rejected the publication. Even after I’d done all the work. Even when they said Yes, we want it! I wrote back and said, I’m sorry but I can’t contribute a chapter to a prescriber’s guide, or to anything called a prescriber’s guide. Because if the whole point of the book is to get a better handle on prescribing methadone and buprenorphine, then GO AHEAD AND CALL IT A DISEASE! Why not?

    My colleague hadn’t told me that this “book for addiction doctors” would be entitled a prescriber’s guide to anything. Maybe he didn’t know. He emailed me after I withdrew my submission and said: Addiction doctors prescribe opioid substitutes to 95% of their opioid-addicted patients. Like: duh…didn’t I know that? Yes, I knew that, more or less. And I knew that opioid addicts are often in desperate need of opioid substitution therapy (OST). It helps them get off the street and sometimes stay off, it relieves the overwhelming anxiety of withdrawal, and it saves lives. As Maia Szalavitz often reports, it’s the only evidence-based treatment that saves lives. And of course that’s because heroin, especially when it’s laced with or replaced by fentanyl or its analogues, can be deadly.

    So why would I avoid being featured in such a book? Maybe I should have just swallowed my whatever and revised the chapter. All those words distinguishing physiological dependency from addiction (which I maintain is a psychological process)…they would have to go. And so would that pep talk about listening to the person, not the diagnosis, and using your counselling skills, your human skills, to reach beyond just prescribing. I’d have to shelve all that. I fully advocate the use of methadone and Suboxone. I agree with other progressive addiction specialists (e.g., Mark Willenbring) that they should be easily available wherever they’re needed, free of cost, free of line-ups, free of stigma. But I’ve got nothing to contribute to that argument. Right?

    Can we social-development-oriented “addiction specialists” refute the disease model and still advocate OST?

    I told myself I’m trying go avoid an awkward irony: that there’s maybe one good reason to call addiction a disease. In the US and Canada it’s the only way to get addicts their medicine, their heroin substitutes. I’ve thought about this lots. But I remain concerned and confused. Maybe “medicalization” is the best we can do for people who are in a real jam, on the street or close to it, hunting for heroin day by day. Yet it maintains, in fact it strengthens, the premise that these people are sick, and it sidelines all the familial, social, economic, and cultural forces that pushed them into that lifestyle in the first place.

    Somehow these two perspectives on opioid addiction have got to come together. At least in the present social climate. But I’m at a loss as to how to help that happen.

    Or maybe it’s simple. Maybe we just need one or two catchphrases to merge these two approaches: phrases like “harm reduction,” or maybe “working with the individual where they’re at.” In my next post, I’ll tell you about a treatment program in New York City where that kind of conceptualization governs everything they do. I gave a talk there two weeks ago, met some fabulous people, and learned how the field is changing. Stay tuned.

     

     

     

     

     

     

     

     

     

     

  • Addicted to symbols

    Addicted to symbols

    We usually talk about addictions to substances (opiates, alcohol, whatever) or behaviours (gambling, porn, etc). But that misses the point. Addiction is entirely psychological, and I think it describes an attachment to a symbol that goes with the feeling provided by the substance or behaviour. The feeling and the symbol are coupled, bonded, and that’s a big part of what makes addiction so hard to beat.

    Forget about “physical” addiction for now. I mean the withdrawal symptoms you get when you quit opiates. That’s not addiction; it’s chemical dependency. You also get withdrawal symptoms going off antidepressants or blood-pressure meds. And you don’t get any withdrawal symptoms quitting coke, meth, alcohol (unless you drink a huge amount) or, obviously, porn, sex, overeating, etc. You get psychological rebound, sure, but that’s not the same thing. It surprises me that people continue to confuse these different (but often overlapping) phenomena.

    Once we see that addiction is purely psychological, we can break it down, and the categories most valued by psychologists are “cognition” (perceptions, thoughts, images) and “emotion” (feelings, urges, etc).

    For some time now I’ve been thinking that the cognitive aspect of addiction is symbolic — entirely — it’s a representation of something. And the reason that symbol is so attractive, so strongly entrenched, is that it’s coupled with emotions like desire, excitement, pleasure, and relief (relief isn’t really an emotion; rather it’s the reduction of an emotion — generally anxiety). It is ALWAYS the case that cognitions and emotions hold each other in place. You think someone is blocking your goals, you feel anger: the anger highlights the image of this goal-blocking person, this shithead, and that image holds the anger in place. I’ve been writing about cognition-emotion coupling for decades….literally dozens of journal articles. But for now, let’s leave the academic abstractions behind and get down to lived experience.

    With addiction, you think this thing, this substance (let’s say a few lines of coke) is valuable and special. And you feel the excitement of anticipation — soon I’m gonna have some. Then you feel the buzz, and doesn’t that feel great? Which strengthens the image, the conception, that coke is valuable and special. See how the thought/image and the feeling (both before and during) fuel each other? Which is why it’s so hard to say No thanks, not tonight.

    So what does the addictive substance or act symbolize? To me, that’s the big question. The longer I practice psychotherapy with people in addiction, the more convinced I am that each person constructs his or her own scenario, vignette, drama, diorama — I don’t know what to call it — based on what went wrong or what went missing in childhood or adolescence. I introduced this idea last post, in terms of diving into the child self-narrative. Here I want to get into the details: what’s the narrative about?

    Example: Helen says she can’t stop snorting coke. What does the coke mean to her? Through talking and remembering in therapy, we discovered that it means something similar to what cutting meant when she was about 12 years old. Her parents weren’t interested in her as a person. They wanted her to perform, be this charming, cute girl, be quiet and unobtrusive because Mom is trying to sleep — because she’s depressed, as usual. So they dismissed and scorned her spirited, creative, and needy self. Helen submitted to the good-girl role…and she was achingly lonely. But when she went into her closet and cut little red lines in her forearm, she felt free, she felt vital, she was unobserved, she didn’t need or seek permission, she felt defiant, and most of all she felt in control of her own feelings. That’s what the cutting meant to her then. And that’s almost exactly what coke means to her now, decades later. She scampers into the bathroom, leaving the other ladies chatting over wine or coffee, and does a couple of lines. Again, she’s on her own, released, free, defiant, and in control of what she’s feeling. Now take that symbolic scenario she’s created, and graft it onto the feeling of the anticipation and then the feeling of the rush itself. That cognition-emotion linkage has been reinforced thousands of times. It’s not going to go away easily.

    Behavioural addictions like gambling and porn are no different. I’m the cocky guy who just might win big tonight, and won’t everyone be impressed. They’ll look at me with boundless envy and admiration (like they should have back in high school) as I strut down the corrdior with my armful of chips. Now couple that image with the sheer excitement of not knowing how the next hand will turn out. (That’s a big deal for gamblers.) The image and the feeling fuse — possibly forever.

    By the way: the feelings of excitement, defiance, energy, etc, that I’ve described so far have everything to do with dopamine. Maia Szalavitz calls it the thrill of the hunt. And what’s going on at the brain level is this: your nucleus accumbens and amygdala are stoked up on dopamine, so their connections with “association cortex,” where memories converge into vignettes and fantasies, form deep ruts…and those connections get strengthened every single time they get reactivated.

    A couple of my clients have combined drugs, sex or sexting, and/or porn into this incredibly artful (what else to call it?) ritual — a scenario in which they are desirable, desired, potent, free, and safe. The experience they’re addicted to is basically a fantasy of being both very good and very bad, nasty and safe at the same time — the dream fantasy of a child or young teenager. But here’s the thing: the components — the coke and the porn for example — are only valuable in how they contribute to this symbolic amalgam. What each offers, without that symbolic currency, is almost nothing at all.

    I’ll end with one last example: my own. I recently developed a painful condition called sciatica, and I’ll probably need lumbar spine surgery in a couple of months to carve away the bone that’s squeezing my sciatic nerve. Don’t worry about me: this surgery is extremely low-risk and has very high success rates. I look forward to getting it done. But meanwhile the pain is…well…painful.

    So I’ve got a prescription for some pretty powerful opioids. And as soon as I pop one or two, the whole symbolic vignette from my days of addiction returns. I get to make myself warm and safe, I get to be taken care of, like when I was sick as a child — come here, Mommy, I need you — and I get to control all that with these little objects — the pills — which are mine! (particularly handy if Mom isn’t feeling very connected). That symbolism is so much more powerful than the feeling the drug provides. Yet the drug does provide a feeling…a warmth in my stomach, a vague but familiar sense of pleasure. What I’m saying is that this feeling is pretty nice (though I know it will collapse into boredom soon enough), but its power lies in how it holds the symbolic scenario in place.

    I’m not worried about becoming addicted again. I’ve had three surgeries in the last decade (I’m actually incredibly old and held together by screws and picture wire). I went on and then off painkillers each time. I recognize the childhood fantasy, tailored, perfected, by years of efficient drug use. I recognize the feeling. Nice, but, as feelings go, if there were nothing else to it, I might prefer a back rub or foot massage. And I’m pretty much past being a slave to my attractions. I’ve had nearly forty years free of addiction.

    But man, do I ever get what it’s like, for my addicted clients, and for almost anyone fighting that so-powerful amalgam of thought and feeling: the fabricated scene, the sense of completeness, the revised reality, and the control you take (or at least hope for) — an entrenched (but fantasized) improvement over what it was really like to be young and scared, alone and helpless.

    …………..

    Please think of attending this one-day conference on novel and progressive ways to conceptualize addiction, highlighting harm reduction (and, in general, compassionate) approaches. It’s called Shifting the Addiction Paradigm. It will be presented by The Center for Optimal Living and partners, at the New School, New York City, June 7th. I’ll be a keynote speaker.

    ………….

    ALSO PLEASE NOTE: The bug that was trashing some of your comments is now fixed. Please comment!

     

     

     

     

     

     

     

     

     

     

     

     

  • Addiction and the return to childhood

    Addiction and the return to childhood

    I continue to be obsessed with this problem of incompatible self-narratives. So, permit me one more rant on the subject. In this post I want to tell you about the dissociation I experienced myself, during my days of addiction, and the child-like freedom it brought me. I also want to compare what I experienced then to what I’m hearing from my psychotherapy clients now.

    In re-reading my last two posts, I still see value in recognizing that we have discrepant versions of ourselves, discrepant self-narratives. And that trying to mash them together into a single coherent self-narrative can be more trouble than it’s worth (even though that’s considered the principal task of growing up). In fact, for addicts, it can be agonizing. It can generate much more stress than it resolves. And that’s simply more fuel for the addiction. Rather, I suggested that we try to accept each self-narrative, e.g., the “addict self” and the “good self,” on its own terms, and allow them to cohere in their own time.

    The most extreme version of separate, distinct self-narratives is what psychiatrists call dissociation. And the most extreme form of dissociation is a bonafide multiple personality syndrome. While multiple personality is very rare, dissociation is not. It can be quite common for people with addictions.

    When I was seriously addicted (during my 20s) I had two distinct selves — I can only call them that. By day I was an industrious graduate student in psychology. I was attentive in seminars and determined to excel — which I generally did. Then as the day drew to a close, my anxiety grew. Things were not working out in my marriage — my wife and I had radically different needs and expectations. I’d anticipate going home, dismissing my own needs, and catering to hers. Really I was going back to my “false self” — a term borrowed from psychoanalytic theory — which means being fake and imagining that the fake you is the real you. I tried being sensitive, solicitous, responsible, accommodating. I felt trapped in this role — a third self-narrative? I couldn’t see a way out. So I managed to change selves. I’d get those first glimmerings…why don’t I get some drugs and get high and of course hide it, not only from my wife but from everyone. It will be my secret — it’s always been my secret. Except when things went really wrong, like the time I woke up on a sofa in the student union lounge suffocating on what seemed poison gas. That unholy smell was burning upholstery. The sofa was on fire from the cigarette I’d dropped while nodding out. Or the times I got busted, fired, or kicked out of school.

    So much for war stories. You often pay tenfold for whatever freedom your addiction earns. I did. But the solution isn’t to ignore what it’s telling you — about yourself…or your selves.

    Here’s my point: when I switched to my drug-taking self, everything changed in my emotional world. I felt free and I felt real. I knew that I was in deep shit in my life, in my marriage, in every index of adult functioning. But! In this self-narrative, I was a bad boy who would get away with something, as I had before, as I would again, until…maybe until I got caught or until the rules changed. I willingly went after the freedom I gained from “being bad” — which is pretty much the label I attached to my drug-seeking.

    People dispute whether addictive drug-taking is a choice or a disease. For me, as you know, it’s a choice, but it’s not a rational choice. It can certainly be a compulsive choice. It can be a very effortful choice to stop, which means it can be a relatively easy choice not to stop. (Choice is momentary. Anyone who’s ever been addicted knows the feeling of surrendering to the impulse — the relief of it. But the fact of that relief does not contradict the fact that you’ve just made a choice.)  So what are we choosing when we choose to get high? Not just the feeling of the drug (or activity — as in porn, sex addiction and gambling) or the excitement of anticipation. We’re choosing freedom from the restraints of being who we’re supposed to be. We’re choosing to become the child and throw off the sense of being judged and held accountable.

    There’s a lot more to say about this choice. We know that most addicts had difficult childhoods of one kind or another; they could not be the children (or teens) they really were yet fit the world of adult expectations. In the dissociation of self-narratives that comes with addiction, we become those unruly children once again.

    I’ve got roughly 10 clients in online psychotherapy right now — all of them struggling with addiction or moving beyond it. For perhaps every one of them, the addiction is a portal into a revamped childhood. They each give up the “self-imposed” rule of abstinence for the release of using (or doing). Several are coke addicts for whom coke is the thrilling invincibility of the rebellious child. Two are porn addicts who find in porn a secret world where they can watch the forbidden and desirable…and pretend. Two are heroin users who give up the loneliness and boredom of adult life for the cookie jar of pure pleasure, stolen rather than earned. For another, it’s food. Why should I have to stop eating? Why should I obey?! For all these people — and they are people I like and respect — addiction isn’t primarily about the substance or activity. It’s a portal to another world, where they can be another self. And here’s the crux: that other self feels more real, at least for a while — I mean more authentic, more pure — than the obedient, responsible self they return to afterward.

    I wonder whether the “addict self” and the “good self” can only converge thoroughly, peacefully, when we allow ourselves to be greedy and selfish and needy or defiant, day to day, moment to moment, honouring the child who still lives inside us, at our core. When we grow to that stage (maybe with a little help from our “uber self” or our therapist or mindfulness meditation), when we achieve that degree of self-acceptance, then we won’t have to go to such lengths to feel comfortable in our own skin.

     

  • Reaching for our selves

    Reaching for our selves

    Hi all. I’ve been trying to write a post to follow up on the self-narrative post I put up last. I’ve found that a certain paradox stands in my way. The pull toward a coherent self-narrative is so strong. Partly because, from the outside, we look like a single person. And where do we learn how to see ourselves? From the outside. From the perspective of others. From our parents and caregivers, while growing up, starting in earliest infancy. Oh, isn’t he cute! (Not aren’t they cute!) These others who love me, they see me as a single person. So that must be what I am. Also, we feel like unified beings in the sense that we have one body. Just one. When any part of me is in pain, it’s my pain. It belongs to a unitary me. When I die, it’s all of me that dies.

    Picasso –self-portrait across the lifespan

    Yet the reality looks different from inside. There’s so much going on in “me”. Last post I observed that there seem to be multiple self-narratives. This is especially obvious, and maybe especially extreme, in addiction. The classic version is “the addict self” versus “the good self” or “caring self” or…what have you. When I was an addict, it was pretty straightforward. I was a good student by day, then I’d become Robin Hood when it got dark, stealing from the rich and giving to the poor — i.e., me! Each part had its own history, its own motives, and its own — highly contradictory — goals.

    Should we think of these as incompatible self-narratives, and view each as separate, with a sort of life of its own, yet worthy of acceptance and compassion? Should we stop trying so hard to unify them? Because sometimes…you just can’t. They simply don’t fit. And the effort to weld them together can be overwhelming, soul-destroying, can leave us feeling more fragmented than we already were. The infamous “dry drunk” is one victim of this misguided struggle.

    That’s what I suggested last post…along with an “uber-self” who’s pretty hard to define. Yet I’m not sure it’s right. Maybe we have just one, or just one main, self-narrative — this is who I am, this is who I was, this is who I want to become.

    Or who I expect to become — a very different way to frame a future self!

    Maybe the project is indeed (as the psychologists and philosophers claim) to make that self-narrative coherent. Maybe that’s the job. It’s just that there are aspects of the self, parts of the self, that don’t fit. Wanting to get high, choosing to get high, being determined, being defiant about getting high. (Even in the world of “normies,” there are parts that don’t fit the narrative.) Maybe it’s best so see these as strands of the self-story that truly aren’t compatible with the rest. Maybe they are “clips” (when we actually bother to see them at all), but not self-stories per se. In fact, maybe their incompleteness reflects this. Maybe those strands are “doomed” to remain incomplete.

    (By the way, if you doubt the diversity of self-images, cover one half of the face above, then cover the other half. Did you see the same person? Think about the two halves of your brain — they process things very differently.)

     

    Anyway, I’ve been thinking about this and trying to come up with something like a resolution. (I’ve always liked to create theories or models, but they have to be — guess what? — coherent.) I’ll let you know if I get any closer.


    Meanwhile, Isabel sent me this powerful and beautiful poem, so I (we) want to share it with you. It seems to show that desire, in reaching too far for completion, finds that which cannot cohere.

    Letting the Emptiness Become My Government

    Within me, the sipped, iced bourbon enacts
    the sense of a slow, April rain
    blurring and nurturing a landscape.
    Decades I’ve been pipe-dreaming of finding
    a life as concise as a wartime telegram.
    Ultimately, I’ve ended up compiling
    an archive of miscommunication
    and the faded receipts of secondary disgraces.
    In third grade, a friend’s uncle stole the two dollars
    from my pocket as I slept on their couch,
    and later he must’ve hurried into the night
    toward a flat in the nearby building
    where a newly minted narcotic promised
    to evict the misgivings from all riled souls.
    I told no one of the theft, letting the emptiness
    become my government, my friend’s
    mother counting her food stamps while we walked
    the late-morning blocks to a bustling grocery,
    within which she eventually smacked
    the hopeful face of my friend as he reached
    again for too costly a thing.

      by Marcus Jackson