Cross-posted with Recovering The Body.
Today I have a guest-post about self-compassion running on Jill Salahub’s very cool site, A Thousand Shades of Gray. I love following Jill everywhere—on Facebook, in her emails that arrive so often. Jill is a sister on the trail of questions we’re asking together. Thanks for including my work in this wonderful group of essays you’re collecting.
One lesson I’ve learned this year: hurting people I love is inescapable. Unless I decide not to have relationships.
I really don’t see myself as a hermit.
I’ve hurt a few people I love recently. Earlier this year I committed series of acts that gave another person tremendous feelings of hurt. Just yesterday I found out from one of my best friends that I’ve been saying some things that I had no idea were hurting her.
The first hurt is an example of making choices in the service of myself, my own best interests, that just happened to hurt another person. I knew they were going to hurt this person. I avoided taking the actions because I knew it would cause great pain. Day by day, if I were going to stay sober, I had to take the actions, and I was appalled to watch the pain happening, like waves rolling into the shore.
For some weeks I sat at the window watching the waves rolling by, my heart squeezing in empathy and doubt.
I second- (and third-, and fourth-) guessed myself. I didn’t turn back.
In the second example, I found out I’d hurt my friend yesterday only because I’d taken the risk of telling her something she’d said just that minute that had hurt me.
Her hurtful speech had occurred in conversation yesterday. But it turned out that, when I rolled over and showed my belly (when I, in Brené Brown’s parlance that Oprah is now making universal, “became vulnerable”), she bared her teeth and let me know I’d been saying things that had hurt her feelings for a while. And then when I yelped in surprise and pain, she rolled over onto her back. And there we were, two puppies on our backs in the dirt, paws waving in the air, yelping our hurt.
After rolling back up onto our feet and talking about it, we were able to chase each other and play again, as our dogs do on our morning walks.
“I’m being vulnerable here!” I said. “I have to practice what I read about!! I can’t just read it and not DO IT, right?”
(You’re such a loudmouth, my mind says.)
“If we can’t tell each other these things,” she said, “who can we tell?” A space in my chest opened in gratitude for a friend who is willing to engage in honest conflict. Not many are.
Still, I walked away yesterday morning with my throat choked up. Interesting that it was my throat. Was my body trying to squeeze the words I’d said back inside me? Trying to keep myself from ever speaking again?
Or was it just that the throat is the locus of the voice, and this is where the hurts had occurred—with our voices?
I’m learning that the body and mind are in conversation. They’re one, they’re intertwined somehow, and I’m beginning to think that the way they’re intertwined is through this conversation, a kind of discourse. What kind of discourse is it? How is it conducted? These are some of the questions I’ve been asking lately.
The mind tries to force the body to walk away calmly and get on with the day. The body is able to cooperate only so far before rebelling with some action: butterflies in the stomach; pain in the head; fatigue in the flesh. Choking in the throat.
When the mind ignores these statements by the body and tries to push the body through, the body protests in a louder voice. Nausea, inability to eat; cluster headache, chronic daily headache, migraine; chronic fatigue syndrome. An inability to speak up, a silencing of the body’s voice in critical situations. Such as true relationship.
Craving to drink, smoke, use something.
So the mind and body engage in a struggle for domination.
Dr. Sally Gadow, a Ph.D. nurse and leading scholar in health care ethics and the phenomenology of the body, writes about this struggle in a fascinating paper, “Body and Self: A Dialectic.” This paper itself (my friend pointed out yesterday) is an academic paper, so its expression is in the language of the mind, the intellect, and Gadow herself offers this caveat inside the paper. But I think what Gadow enacts in it is an effort to respect and give voice to the body.
To report from the body, which has long been one of my projects.
The struggle for domination is the second of four levels of development Gadow says have to take place if the body and mind are to transcend their “dualism,” their two-ness, and begin to work together as one to express each other’s interests. In this second level, “the two are not only distinct but opposed—each alternately master and slave.”
The second stage describes addiction.
The transcendence describes sobriety. Freedom from slavery.
Yesterday, driving home with my throat choked up, I thought about self-compassion. My mother trained me early to feel compassion for the pain of others. Hurting someone else without knowing it is one of my worst fears in sobriety. I used to numb this fear, as well as the reality that I’d hurt other people, with drugs.
“How will I know I’ve hurt you if you don’t tell me?” I asked my friend.
“You’re right,” she said.
The question underneath the choking is, Does my friend really love me?
Doubt rises up. If you’re going to get her to love you, my mind tells my body, you have to fucking SHUT UP.
(And stop swearing so much!! She said I swear too much.)
But anyone who knows me know my language can be strong, fierce. Is it just who I am?
To make things right, I know I have to change my behavior. But do I need to change myself?
Do I need to change to be loved?—an old, old compulsion.
Cross-posted with Recovering The Body
Dear People, I haven’t posted in a while because I’m wading knee-deep in writing this book about physical recovery. When I set up this blog over the summer I had it in mind to post three times per week, but writing a book AND posting three blogs per week is like running a restaurant that serves three-course meals in one room and short-order take-out in the other. I beg your patience.
So I’ve been collecting all kinds of interesting information about physical recovery. I’m working on a chapter that explains how drugs screw up the body and exactly what kinds of damage each class of drugs does.
So the other day I was studying damage to the body from stimulants. Coke and meth, and Adderall and Ritalin, their prescription variants. I find out that
with meth, dopamine shoots from baseline to more than 1,200 units, “something that’s about 12 times as much of a release of dopamine as you get from food or sex and other pleasurable activities.”
Quoting a source here. I find out cocaine users’ blood vessels will constrict, blood pressure will skyrocket. Studies show stimulant use is strongly associated with coronary artery disease and stroke.
OK, fine. But it all takes on new meaning when you meet someone who has been through it.
My friend Xenia is a 42-year-old single mom of three who for years, off and on, used coke and smoked crack. She got clean three years ago. We met up with a bunch of women friends this morning.
Xenia was talking about a little anxiety attack she’d had the other day. She has high blood pressure, for which she takes clonidine. (Good old clonidine: the faithful standby for dope-fiends in withdrawal. I think I still have a bottle of it somewhere.) She said that she hadn’t really been scared that day, that her blood pressure during that little panic attack was nowhere near what it had been when she was smoking crack. Back then, she said, it was 220/120.
“Your blood pressure was 220 over 120,” I asked. Making sure I’d heard right.
“Oh yeah, that’s what it was, for all those years I was smoking,” she said.
For All Those Years.
“Xenia,” I asked, “how the hell did you not have a stroke?”
“I don’t know,” she said.
Blood pressure of 120/80 or less is normal. Blood pressure of 220/120 is a hypertensive emergency. That’s when they wheel you into the emergency room and start pumping in drugs that lower your pressure. Because if they don’t, the pipes in your head will burst and your body will die.
How did Xenia not die?
I checked and the literature says that people who already have high blood pressure may have vessels that are used to big changes in pressure.
Or else—who knows why her brain never exploded? Who knows why I never overdosed? Who knows why anyone is able to get sober?
“What’s that metal stuff you stick in your pipe to filter the crack—steel wool?” another friend asked Xenia.
“Chore Boy,” I said. (Fkn know-it-all, I know. I’m sorry. But I happen to know a few other former crack addicts.)
“Yeah, Chore,” Xenia said. “Chore is copper. Steel wool is no good, it’ll burn right up—you gotta have copper.”
The things we do for drugs. Holy hell.
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Bathing sounds more simple than it is.
Many women have spent years, decades, making their bodies do what other people want or need them to do. When you have a baby, for example, you can’t decide you want a day off from nursing. And nursing is exhausting. Even if you’ve got a person willing to bottle-feed your baby and your baby agrees (which is by no means certain) to take a bottle, your breasts will continue to make milk, and that milk needs somewhere to go. Your milk-ducts do not listen to Siri saying you have an appointment in 20 minutes. A nursing mother is in her body: she has to empty her breasts. It’s just reality: biology is, for a while at least, destiny. As women we can choose to disconnect biology and destiny, but there are costs (the child’s growing immunity being not the least).
And then there are the other choices about what the body does. What work it does, and where. Who gets to decide about the body’s sexuality—when it happens, for how long, in what ways. For what purposes. We live our lives with other people for decades and the methods and purposes of pleasure evolve into something entirely other than what we started with. And we may never talk about it. We may just hope it works out, because we’re tired, there’s a stack of bills on the table, the kids are in bed, we take pleasure where we can get it—it is an age-old urge.
We fake orgasms and hide chocolate under the bed…
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So I’m responding to two emails I received in the past week: one from a stranger, and one from a friend.
This is gonna be a long post, so get your iced coffee and your orange-chocolate-chip biscotto (my favorite) and sit down.
The Stranger has been prescribed Percocet (oxycodone), OxyContin (also oxycodone), and the antidepressant Cymbalta (duloxetine) for the past six years.
The Friend has been taking a teensy dose of Klonopin, a benzodiazepine—an addictive class of drugs used as sedatives and muscle relaxants—for the past year.
Both of them asked me for advice.
(Before I go on, I have to remind y’all that I’m not a doctor. I just share experience here—please take what you need and leave the rest.)
The Stranger seems more confused than the friend. The Friend, who has seen his share of addicted folks but is not in any program of recovery and never before thought he was addicted to anything, reached out to me because he knows I write about addiction. And he knows I don’t bullshit.
The Stranger writes:
I think I’m an addict? Am I? Am I not? Why is it even important to know if I am or not? Well, to me it’s important because I am having a HECK of a time coming off these meds.
This person has been tapering off 60mg OxyContin plus 40mg Percocet—a total of 100mg oxycodone, which truthfully is not that big a habit. It’s not a tiny habit, a tiny habit is two or three Percocet (15mg) per day, but getting off 100mg oxycodone is eminently doable, even if you’ve been taking Oxy for six years.
So let me tell you about some of the things I’ve learned about how to tell whether you’re an addict.
It doesn’t matter how much we use, or how we use, or when we use (only after noon, only after 5 p.m., only after work, only after we put the kids to bed, etc.). It matters what the drug-use does to our minds.
Quitting 15mg versus quitting 100mg is like the difference between somebody who drinks two glasses of wine every evening and someone who drinks a bottle. Is the person who drinks just two glasses—but who cannot do without those two—NOT an alcoholic because she only drinks two? No. It’s what the two does to her. It’s how she thinks of those two glasses when she’s not drinking them, as well as when she is.
(BTW heavy drinking, for women, is usually defined as more than one drink per day every day.)
Both these people can quit their habits. The person who drinks only two glasses might have a harder time quitting because she thinks, “I’m only drinking two.” Or the person who drinks a bottle might have a harder time because her body has become more physically dependent and she’ll get sicker when she quits.
If they both stick it out, they’ll start to see benefits. It takes time. It takes a lot of days of sheer commitment not to pick up, and that itself takes a lot of support. For which I’d say, yeah, try a 12-step program, but give it a real shot: get a sponsor, take the steps, do what you’re told. If you’re really powerless over your drugs, wave the white flag (Step 1). If that doesn’t work, there are other ways of getting sober, but I know best what has worked for me and that’s what I talk about here.
Getting Our Drugs
Alcoholics can just go to the store and buy their drugs. We drug-addicts usually have to lie and cheat to get ours. Alcoholics wind up doing weird stuff AFTER they’ve bought and taken their drugs. For example, how do you hide all those empties—they clink when you try to drag them to the curb or the recycling bin, etc. … Drug-addicts usually aren’t faced with these kinds of questions (unless you’re shooting, which leaves tracks that you have to hide). Our questions are more about how to get the drugs in the first place.
If we’re using illegal shit, we have to commit felonies to buy it.
If we’re using legal shit, we also usually have to commit felonies to buy it.
I committed I don’t know how many felonies to get my drugs. A lot. More than 10. Enough, probably, to warrant a prison sentence, because I committed them over and over, over time. They all expired this summer, which made me feel free, in a sense, but in another sense I can never make up for having committed them in the first place. I talked to a lot of people about how to make amends for having committed felonies that put doctors and pharmacists and my own family in danger. They all said, Change your behavior and stop doing it. Tell other people not to do it. So:
Don’t. Change. Dates. On. Scripts. It’s fucking dangerous and can hurt more people than yourself.
The Stranger is not yet committing felonies. But she’s doctor-shopping. She’s been to four doctors other than her regular doctor to get drugs to supplement her regular scripts. More and more states are enacting doctor-shopping laws.
Let me tell you a story. When I started using legal drugs, I didn’t think I was an addict and I thought the amount of drugs I was being prescribed (45mg hydrocodone per day?—or something like) would last me frigging forever. I had spent the past two or three years trying to make thirty 10mg Watson-387 hydrocodone tablets last an entire month, and I’d always run out, because, of course, I Was In Pain, and the pain needed to be treated. When I scored ninety 15mg caps per month, I saw a road paved with those white-caps stretching to the horizon and thought life was finally perfect and I would be taken care of forever.
What happened was, in two months I needed 60mg per day.
By the end of that year I was being prescribed 150mg per day—ten 15mg caps. I would get a delivery of 300 15mg capsules each month. A delivery. The Man would come and deliver them. Personally, I think this qualifies as an official “shitload” of drugs, but just wait:
By the end of the next year another 120mg morphine (in the form of Kadian, a long-acting capsule) had been added to that, and in another six months I was given extra fentanyl lollipops. Pharmaceutical Tootsie-Pops. No: Dum-Dums, really. By that time I was a stone junkie, although I still had trouble believing I was, because I was still doing my life. Opioids don’t disable you the way alcohol and, say, meth do: I didn’t look drunk because I wasn’t drunk. I was just on a shitload of drugs, and when I ran out, I was incapacitated in every way.
And toward the end I always ran out.
“When I would run out of the meds early,” The Stranger says.
People who don’t have problems taking their meds don’t run out. People who do have problems taking their drugs do run out.
“But I hate being high!!!”
“I LIKE feeling normal and sober!” she writes.
Oh, sweetheart, pleeeze. I hated being “high” too. I just wanted to be normal. I just wanted to have energy when I wanted, be relaxed when I wanted, be accepted.
“I never drink (hate the stuff!) or smoke marijuana, and I’ve never done any hard drugs.”
Solidarity, sistah. <fistbump> I am a Top-Shelf White-Collar Addict all the way.
By the time I detoxed five years ago, I hadn’t seriously drunk alcohol in more than a decade. I “hated the stuff.” And I’ve never done any street drugs. Ever. Never smoked cigarettes, let alone weed. Never danced topless on any frat bars, never stripped for the dudes, never screwed around. I’ve never woken up in anyone’s bed I didn’t actually have a relationship with.
By the end I had a kid, for chrissake, and I Took Care Of Him, and I did a good job, not the best job I could have done, because I was a stone junkie.
If you like feeling sober, then quit sooner rather than later. You will only feel more and more sober. The feeling of extra energy I got from pills was fake energy. If you can exercise at all, your body will soon start producing its own endorphins and you’ll heal.
But you will not start to heal until you quit putting extra opioids into your body.
Anxiety and Fear
One of the most helpful things I’ve ever heard was from my first sponsor, who told me that I needed to call anxiety by its right name: fear. “Because anxiety can be medicated,” she said.
But you don’t go to the doctor and ask for pills because you’re having fear.
The Stranger mentions fear over and over again in her email. It’s a signal of addiction.
The Friend’s email had none of that fear. He was balls-out about his concern: “I believe I have become addicted.” Which is the thing that made me think he wasn’t addicted: we addicts tend to keep second-guessing ourselves. Even when we ask for help, it’s usually: “I think I MIGHT be addicted,” or, “Am I addicted?”
But who am I to know for sure? I don’t know how much fear or obsession he has or whether he’s running out of his tiny dose of Klonopin each month and changing dates on scripts to get more. (I’m pretty sure he’s not committing that felony; after speaking with him, I don’t think he’s even running out.)
This is one of the aspects of addiction that needs a lot more research. If we’re going to treat addiction as an illness, we need clear diagnostic criteria so that it’s not a matter of self-diagnosis or self-identification.
I’m not a doctor, and I’m not an addictions specialist, but I’m a mom and a woman and I wrote a book on pregnancy for which I did more than a little research, and my mind is made up about this: if at all possible, unless the mother’s life is threatened (which is to say, unless she’s already on a load of heavy drugs and gets pregnant and can’t detox without endangering herself and the pregnancy), women ought to get off their drugs if they want to get pregnant.
There are a lot of studies starting to come out about the “benefits” of buprenorphine over methadone in pregnancy, but most of those are for heroin addicts and/or methadone-maintenance patients who are already pregnant.
The Stranger has tapered down to 30mg of oxycodone per day. I hope that, before she gets pregnant—which she says she wants to do—she’ll quit entirely.
Because motherhood is damned hard work. And it’s best to do it sober. It is the single thing I wish I could go back and change: I wish I’d been entirely sober for my kid’s childhood.
Please don’t miss your kid’s.
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When I was a kid I used to pore through my mother’s art books she’d bought for the one term she’d spent as a fine art student at Carnegie Tech, now Carnegie Mellon University. On the bookshelf behind the end table next to the chair lived a red cloth-bound art-history volume that had black-and-white reproductions of great works of art throughout Western European civilization. Because at this time, African and Native American and “oriental” art didn’t count.
Of all the photos I pored over—even more than Michelangelo’s David (which I’m not sure was represented in its entirety, I think they must have cropped the photo at the waist, the way the network cropped Elvis on Ed Sullivan) I think I most closely studied the Venus de Milo.
At 10 or 11 I didn’t understand what I was seeing. I didn’t understand that all cultures formulate their ideas of beauty. I didn’t even half-comprehend the irony that as I was studying this photo, my own culture was coming up with these images of sexual beauty:
And then Karen Carpenter starved herself to death, and the first stories about anorexia started appearing in the Time Magazines that used to come to the house.
I found this amazing shot of the Venus de Milo today: …
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