I found out yesterday that one of my patients died on Easter Sunday by a drug overdose. It's never easy when someone you know dies, but it seems so much worse when that person was in your care and you could have virtually predicted his death.
This 30 year old man came for his third treatment episode last month. He was well-known within the institution where I work because he had been treated a few times there and had always come back following another of his frequent relapses. When I first saw him I felt strongly that this was going to be a tough case. He was a gentle and kind man without bitterness toward anyone, who always seemed to have something good to say about his relationship with you. Yet, deep down, there were signs of trouble and my antennae were vibrating the first day I saw him.
He had little trouble grasping the intellectual parts of a program of recovery. He knew he was biologically addicted to heroin and benzodiazepines, and he knew he was going to go through a range of physical withdrawal symptoms in the early part of his recovery. He also believed in the 12 Step program, but there was a tragic flaw in this belief system: He felt strongly that the 12 Step program works to help some people stay clean and sober, but somehow it would never work for him. And, he had a sadness about him due to this despair. On the last day we met for a private session on March 30 we worked hard for more than an hour to identify the sources of this negative belief system where he told himself he could never get well. We labored over his thoughts and beliefs about the events that happened in his life. We challenged those false beliefs with the truth. We identified that he felt sad and hopeless when he would cling to ideas about how he might never get clean and sober, and, while he wanted to remove these negative feelings from his life, he could not feel a change in his emotions for the better when he thought about changing these negative beliefs. In other words, he had a belief that no matter what he said or did, nothing would get better.
He also proved to himself that he was an excitement junkie...he loved the thrill of the chase to get his drugs and he loved the pleasure his heroin gave him. He even admitted to me that he loved the idea that this might someday kill him...there was an exhilaration that he felt every time he thought about using. No matter how hard we tried that day, he could not remove this from his mind or see a way to neutralize the tremendously damaging effects of such thinking.
At that moment, I knew he was in deep trouble. I asked him to review his anti-depression medications with his psychiatrist and he said he would. I asked him to surround himself with positive recovering people who had been where he was and turned themselves around. He said he would. And, I asked him to talk about this to anyone he knew who might help him shed the weight of this negative, self-destructive thought. He said he would.
He didn't do any of those things after leaving me that day. Instead, a few days later, he started to use again and he overdosed on Easter Sunday morning at his home.
I resist the temptation to think of what more I could have done to help him. I understand that there is only so much another person can do when you are confronted with the disease as strongly as he presented. But...I know what I felt that day when he left my office and, as unreasonable as it sounds, I wanted to hold him there that day, arrange for him to go back into primary treatment, and protect him from himself by wrapping my arms around him and assuring him it was going to be OK. I wanted to jump up and down and tell him that this negative thinking was only going to end one, bad way. And, because a man's life was at stake and I did not do any of that, I am left with regret, remorse, and anger.
Of course, over the span of 24 years as a counselor, it is not the first time one of my patients has died while in my care. I know this will all pass as I focus on the future and the people still in my care who may be at just as much risk for dying of the disease of addiction. But, it doesn't get any easier each time it happens. I immediately think of Chris, Wendell, Becky, Rose, Bob, and, most of all, Kristine whenever this happens.
I have also become a lot more rigid in my thinking about how to treat this illness. I vow to react more aggressively toward the obvious signs of relapse, and to not allow a person to lull me into believing that extreme sadness and hopelessness will somehow work itself out. And, I plan to do more meditating and praying for guidance in how to deal with this kind of case.
So long as I follow that way, I have nothing to fear.
Roger W.
Showing posts with label anger. Show all posts
Showing posts with label anger. Show all posts
Tuesday, April 10, 2012
Friday, April 23, 2010
How to cope with anger...
Deepak Chopra reputedly said "Every time you are tempted to react in the same old way, ask if you want to be a prisoner of the past or a pioneer of the future." These are very wise words for recovering people who can get trapped by old ways to handle familiar problems.
Just the other day I was talking to one of my patients about anger and how it can be measured on a scale from 0 to 10 where 0 is having no emotion of anger and 10 is the absolute, out of control behavior of rage. At the moment he placed himself at a 7 and said he was there most days. I told him it is no wonder that he so easily flips tables, pounds walls and physically attacks people given that he has very little room to experience and express the emotion of anger in his life...all he really does is express the behavior of rage. He said he understood and we worked on ways to lower his anger on the scale. He said he understood how to do that as he reported he had moved down to a 4 during our talk.
Within 30 minutes, this young man had a fellow patient in a headlock and was thrashing him about the room because he was reacting to that peer's comment about his ethnic heritage. A seemingly innocuous comment from someone threw him into a rage, and he reported he could not remember what he had done, but quickly justified his behaviors as necessary to "protect myself". Unfortunately, this young man was soon discharged from the treatment center and had to go back to the family that had taught him how to be so enraged.
I learned from this episode. We know that we are a species that has built-in sensors for when we think we are in danger and need to either fight it out or run like hell. This mechanism is a reflexive self-preservation response. I wondered for a long time why, since everyone has this capacity within our brains, all people do not turn to rage when provoked by some stimulation that looks to be life-threatening. After all, the world may not be necessarily a safe place these days, but few people defend themselves with all-out violence in order to protect themselves. I've concluded that what keeps most people in check about this is judgment...the capacity to make fine distinctions among events in their lives to decide what and how they will respond to people, places, things and situations that threaten them. This judgment is a thinking process. With it we are able to discern true danger from meaningless annoyance. Without it, we are subject to the unpredictable results of powerful chemicals coursing through our brains that are designed to save our lives. That young man gave himself permission (through his flawed judgment process long before this "attack" came) that it was alright for him to use rage to protect himself from the slightest aggravation. In other words, he had always reacted that way before so it was OK to react that way now: He was trapped like a prisoner in the past.
The AA Big Book teaches us that we cannot afford the luxury of a resentment, which is anger about the past that rules our present, much less rage. Addicts and alcoholics use resentment to fuel their use of drugs. "After all", we say, "if you had the problems I have, you'd drink too." We have a tendency to use old tools to fix new problems. We have a need to be on top and superior to those around us so we look 100% good, 100% of the time. And, when we fail at handling problems successfully, we lapse into a self-pity that justifies getting high to cope with the humiliation, shame and self-loathing. What a mess.
The fix for this is very simple, and I have written about this is an earlier posting here on February 15, 2010. When I accept life on life's terms as being exactly the way it ought to be at this moment, I obtain a serenity that allows me to suffer through what used to cause me to act out in rage. No longer do I see threats around every corner or in every person who slights me. No longer do I feel the need to protect my very life from the tiny wounds that life is able to inflict on any person today. And, no longer am I trapped in the past with old, worn-out ways of dealing with problems. Today, I've learned how to live as a pioneer in the future instead of a prisoner of the past. That is why I reach out to people and ask for help in dealing with many of life's problems. That is why I remain open to new solutions. That is why I am very unlikely today to just have simple insight into problems without the accompanying judgment to use the information I have been given. I feel better knowing that I have this capacity for it allows me to express the emotion of anger through my words rather than the behavior of rage through my fists. I am very grateful for this today.
All the best, Roger W.
Just the other day I was talking to one of my patients about anger and how it can be measured on a scale from 0 to 10 where 0 is having no emotion of anger and 10 is the absolute, out of control behavior of rage. At the moment he placed himself at a 7 and said he was there most days. I told him it is no wonder that he so easily flips tables, pounds walls and physically attacks people given that he has very little room to experience and express the emotion of anger in his life...all he really does is express the behavior of rage. He said he understood and we worked on ways to lower his anger on the scale. He said he understood how to do that as he reported he had moved down to a 4 during our talk.
Within 30 minutes, this young man had a fellow patient in a headlock and was thrashing him about the room because he was reacting to that peer's comment about his ethnic heritage. A seemingly innocuous comment from someone threw him into a rage, and he reported he could not remember what he had done, but quickly justified his behaviors as necessary to "protect myself". Unfortunately, this young man was soon discharged from the treatment center and had to go back to the family that had taught him how to be so enraged.
I learned from this episode. We know that we are a species that has built-in sensors for when we think we are in danger and need to either fight it out or run like hell. This mechanism is a reflexive self-preservation response. I wondered for a long time why, since everyone has this capacity within our brains, all people do not turn to rage when provoked by some stimulation that looks to be life-threatening. After all, the world may not be necessarily a safe place these days, but few people defend themselves with all-out violence in order to protect themselves. I've concluded that what keeps most people in check about this is judgment...the capacity to make fine distinctions among events in their lives to decide what and how they will respond to people, places, things and situations that threaten them. This judgment is a thinking process. With it we are able to discern true danger from meaningless annoyance. Without it, we are subject to the unpredictable results of powerful chemicals coursing through our brains that are designed to save our lives. That young man gave himself permission (through his flawed judgment process long before this "attack" came) that it was alright for him to use rage to protect himself from the slightest aggravation. In other words, he had always reacted that way before so it was OK to react that way now: He was trapped like a prisoner in the past.
The AA Big Book teaches us that we cannot afford the luxury of a resentment, which is anger about the past that rules our present, much less rage. Addicts and alcoholics use resentment to fuel their use of drugs. "After all", we say, "if you had the problems I have, you'd drink too." We have a tendency to use old tools to fix new problems. We have a need to be on top and superior to those around us so we look 100% good, 100% of the time. And, when we fail at handling problems successfully, we lapse into a self-pity that justifies getting high to cope with the humiliation, shame and self-loathing. What a mess.
The fix for this is very simple, and I have written about this is an earlier posting here on February 15, 2010. When I accept life on life's terms as being exactly the way it ought to be at this moment, I obtain a serenity that allows me to suffer through what used to cause me to act out in rage. No longer do I see threats around every corner or in every person who slights me. No longer do I feel the need to protect my very life from the tiny wounds that life is able to inflict on any person today. And, no longer am I trapped in the past with old, worn-out ways of dealing with problems. Today, I've learned how to live as a pioneer in the future instead of a prisoner of the past. That is why I reach out to people and ask for help in dealing with many of life's problems. That is why I remain open to new solutions. That is why I am very unlikely today to just have simple insight into problems without the accompanying judgment to use the information I have been given. I feel better knowing that I have this capacity for it allows me to express the emotion of anger through my words rather than the behavior of rage through my fists. I am very grateful for this today.
All the best, Roger W.
Subscribe to:
Posts (Atom)