Who Cares?



Call me weird, but there are few things I find as comforting as those warm blankets they put on you in the hospital.  I had to go to the emergency room recently for food poisoning, and the professional, kind, and attentive care I received included one of those blankets.  It was a small gesture that made me feel especially well cared for.   It makes me wonder — how do I show others that I care?  How do I know and protect the boundaries that divide caring, caregiving, and caretaking?  

Caring is defined as “someone who shows kindness and concern for others.”  Notice that doesn’t include any real action.  Kindness and concern can simply mean being present with an empathetic and compassionate heart.  Yet we often feel that we have to “do” something — as if our presence is not enough.  When sitting with someone who is expressing some difficulty, the most caring thing we can probably do is simply to be present and listen.  

Care-taking can be described as “someone who takes care of everything.”  Maybe this person believes that in order to be a good, caring person, it is necessary to be constantly active, performing, and doing for others.  A care-taker tends to be a very controlling person.  He or she steps in to get things done for adults who are quite adept at doing for themselves.  This is all done with the best of intentions, but care-taking is equivalent to enabling. It’s quite disrespectful to control the affairs of another person.  It’s always best to allow adults who are capable to do for themselves, to learn, and to grow in the process whether they make the right decisions or not.  This is not an easy concept for caretakers to grasp, perhaps because a caretaker feels inadequate unless doing things for others and probably truly believes that he or she is simply being a good person.

Caregiving is yet another animal, and it is defined as “someone who expresses kindness and love.”  This person does not control nor take on the responsibility of another person.  He or she might spend time with someone who is depressed, provide care for disabled people, or assist the elderly or children with tasks that they are unable to perform on their own (to name a few examples).  While caretakers take the power from perfectly able-bodied/minded individuals, caregivers give of their time and talent to those who are in need of them. 

Caregivers are typically very self-less people, but it is important to remember that we cannot care for others unless we ourselves are healthy and whole.  It is imperative that caregivers take time to rejuvenate body, mind, and spirit so that compassion fatigue does not set in.  Time to eat, pray, rest, relax, and plain old fun should be planned in the caregiver’s schedule.  These are not self-centered activities but rather self-caring ones.  I know it’s cliche, but as they say on airplanes — put the oxygen mask on yourself before you put it on those around you.  If you can’t breathe, you are worthless to everyone else.

I personally fall into the trap of giving of myself until I am empty, and what’s worse is that I don’t always take time for prayer to fill myself spiritually.  When I am spiritually, physically, and emotionally empty I am useless to the many people who seek advice, care, and my whole-hearted, healthy presence.  Self-care is something I have to practice daily — some days hourly — in order to be a strong, joyful, peaceful, willing, and caring person.  That is far from selfish; it’s actually caring for myself with others in mind.  Otherwise I pick up the phone and am emotionally unavailable to the person on the other end.   There are times too (or maybe it’s in certain relationships) that I am a care-taking maniac.  I interrupt my day and important activities, or my times of rest, to do things for people that they positively can do on their own.  On those days you would swear that I am the only one on the planet with access to the Internet, the telephone, or the bank.  You would also be certain that my cell phone is permanently implanted in my ear without an on/off switch.  By the end of a frantic day of caretaking I am usually exhausted, emotionally depleted, and extremely resentful.  Yet I am the one who felt the world just couldn’t spin on its axis if I wasn’t there to assist.  

So how would you categorize yourself?  Are you a caring person, a caregiver, or a caretaker?  Do you practice self-care?  Do you believe that your presence is enough?  Do you balance your time and not allow yourself to be taken advantage of?  One of my favorite quotes is:  “You are called to be a light, not a doormat.”  Being a caring person does not mean that you have to allow yourself to become worn and matted like a doormat.  Keep yourself fresh and renewed in body, mind, and spirit.  Maybe think of yourself like that warm hospital blanket that doesn’t do a thing but stay close and exude its warmth; yet it makes one feel safe and loved.  Remember, the blanket eventually cools and has to be warmed again or another blanket replaces it. Stay warm — it can be a very cold world.  


Love in Heaven and Hell

Saint Augustine said:  

“What does love look like?  It has the hands to help others.  It has the feet to hasten to the poor and needy.  It has eyes to see misery and want.  It has the ears to hear the sighs and sorrows of men. That’s what love looks like.”

If only love could be that simple. Alas, it is not -- especially when you love someone with a substance use disorder.  Helping hands and hastening to the needy can be detrimental when not carefully calculated.  Such behaviors could actually feed the addiction rather than the poor and needy, and that could prolong and exacerbate the problem.

I’ve said repeatedly that there are perhaps fewer relationships more complicated than those that involve an addicted loved one.  The confusion surrounding what is helpful behavior drives loved ones into all sorts of desperate actions in sincere and frantic attempts to do the right thing — the loving thing.  While a springboard of love can never be disputed, the actions that love exhibits can be.  In addiction, those actions are not necessarily what St. Augustine described.

I’d like to rewrite Saint Augustine’s quote from the perspective of those who love someone who is suffering from addiction:

What does love look like?  It has the hands to hold a loving mirror.  It has the feet to walk away in times of conflict.  It has eyes to see beneath the lies.  It has the ears to patiently withstand defiance.  It has the mouth to lovingly speak the truth.  That’s what love looks like.

Be strong.  Persevere.  Above all don’t forget that when you are in a relationship with someone in active addiction, you are dealing with a disorder — not your friend or loved one.  You must see past the outbursts, the lies, the manipulation, and the hysteria and confront the demon addiction.  Your responses may have to be firm and might even seem contrary to what you envision love to be.  You can be a solid, guiding, unyielding presence, while still loving.  You are likely to be met with resistance.  Stay the course.  In the end, love will have the last word.

Selective Stigma

Robin Williams’ struggle with addiction seems to defy the stigma that others with the same affliction endure.  The tolerance, understanding, and compassion that have poured forth following his death are beautiful examples of perhaps the way the world ought to respond to addiction in general.  Unlike the media’s response to other celebrities who ended up with mug shots or some other unappealing photo on television (Mel Gibson, Lindsay Lohan, and Charlie Sheen), Robin Williams’ addiction was arguably better understood and received, even while he was alive.  We admire and even respect the afflicted when they are rich, powerful, talented, and in proper attire, but if they fall too hard,  and we discover the person behind the mask (in a mug shot for example) — suddenly they are good-for-nothings.  When they die, we perceive the reality of their battle and feel sad.  They then become the tragic hero of the story whom we keep forever safe on the pedestal that death profited them.  Yet we are supposed to be the ones with our heads on straight.

Addiction is a powerful and sinister affliction.  Those who suffer endure unimaginable difficulties just trying to function on a daily basis.  Many have suffered some trauma or are struggling with mental illness that is so unbearable they need something or someone to “fix” it.  Many of us are “fortunate” in that we can take a drink or a prescription pill to ease the pain or calm our nerves, but those who are prone to addiction do not have such a “luxury.”  When they reach for a “fix,” it doesn’t stop at just one.  It becomes an obsession and compulsion that takes over and controls their thoughts, actions, personalities, and eventually their lives.  When they try to abstain, living in their own skin may again become unbearable until or unless they get professional help, support, and tools to survive.  It is a horrific journey, one that should be supported and not judged.

The next time you see the face of someone who has been caught in the throes of addiction on the news or standing on the street corner, put the face of Robin Williams in his/her place.  There is likely to be a shift in your attitude towards the individual.  Ask yourself, “why?”  What is this person doing that is so different than those celebrities who have died from complications related to addiction; those famous people you admire and respect?  Why the stigma?  And most importantly, what can you do to make a difference?  I’ve said it before, and I’ll say it again:  educate yourself if you want to help.  If not, at least cut the judging.  Express empathy and compassion as if it was Robin, Elvis, or Marilyn.  And do it before the person is dead.

I Before E ...

A friend of mine called a few weeks ago because she felt fairly certain that her son relapsed again. 

Prior to this recent one year in recovery, Joe was addicted to heroin for about three years, and he experimented with others drugs (including alcohol) before and after his involvement with heroin.

He faced death on several occasions by overdoses and by physical violence.

He has mental illness and a history of abuse - both extremely common in the disease of addiction.

His mom, Sue, has attended Nar-Anon meetings, has a sponsor, and has read much about addiction.

She has battled courageously alongside her son throughout these many years.

Sue knows the drill, but somehow this “cunning, baffling, and powerful disease” still manages to outsmart, perplex, and paralyze her every single time it rears its ugly head.

Sue mentioned that her son relapsed and was drinking alcohol.  I asked her if she was sure he wasn’t doing anything else, and she said that he told her he just had a few drinks.  Yet his behavior seemed to indicate that there might be more to the story.  She inquired, “Do you think Joe could be lying?”  Did I think Joe could be lying?!!  I responded, “Sue, you know the old one about ‘how can you tell if an addict is lying?  When his lips are moving.’  Short answer, yes, he can definitely be lying.”  That’s not to be contemptuous.  It’s simply the nature of the beast.  

So what makes an intelligent, knowledgeable, informed person so confused and unsure of herself when the disease flares up?  Why do parents, relatives, and friends often feel like the bad guy for even considering that their addicted loved one could possibly be using again?  Why do the tables get turned, and what once seemed so clear and simple suddenly becomes hazy and complex?  There is no cut and dry answer, but much of it has to do with observing and responding from our emotions rather than our intellect.  Remember the old spelling rule, “I before E except after C?”  Maybe when dealing with persons suffering from addiction we should keep that in mind.  Intellect before emotion except after checkup (aka drug test!).  

When someone is addicted to drugs, he is not going to admit to it.  He may have been completely honest, trustworthy, kind, and loving the week before, but once he is using again all bets are off.  You are not dealing with the person anymore. This is not easy to understand because the same person, with his familiar voice, face, etc. is standing in front of you.  The same person who, when not actively using, is supportive, loving, kind, and trustworthy.  We almost instantly feel guilty for even considering that this person could be lying (emotions speaking).  Yet if we stop and think, we understand that the brain is affected and the behavior is a direct result of substance on this organ which houses the personality of the afflicted.

The great paradox is that to respond lovingly, we must often use methods that we would never normally use with this person.  The intellect has to make the decisions, because the emotions don’t understand what is happening.  Keep them at bay or at least submissive to the intellect.  Don’t try to do it alone.  Get to a meeting.  Get a sponsor.  Take some classes.  Educate yourself.  Get support, and remember “I before E except after C" - as in the word "lies."

When Compassion Gets Confusing

So what exactly do love and compassion look like when you have an addicted loved one?  This is something that really blows the mind of most friends and relatives.  We are taught to be good people, to help others, to love and have compassion, but when we apply most of the usual acts of kindness to a person who is dependent on drugs, we may actually be hurting the person way more than we are helping.  To quote an addict now in recovery:  “My mother nearly loved me to death.”

I’ve heard compassion defined as being “to suffer with.”  There’s little doubt that friends and relatives suffer with their addicted loved one, so we in fact do have compassion whether or not we are doing anything at all. 

Dictionary.com's definition is:  a feeling of deep sympathy and sorrow for another who is stricken by misfortune, accompanied by a strong desire to alleviate the suffering.”  Ah, now we’re getting somewhere.  We “desire to alleviate the suffering” of our afflicted loved ones, and we believe that when their suffering is lifted we too will be free from our pain. 

That all sounds sensible enough.  We visit and comfort and care for the lonely, aged, sick, and dying.  We take injured people to doctors and hospitals.  When people are hungry, homeless, and naked, we feed, shelter, and clothe them.  So naturally we want to jump right in and do something for the person afflicted with the disease of addiction.  It’s what we humans do — we care.  Unfortunately, it’s not that simple when chemical substances are entered into the picture.  Now we’re not dealing human-to-human so much as we’re dealing human-to-chemical substance which has hijacked our loved one’s brain.  The words coming out of his mouth are not the words he would say if not under the influence.  The behaviors are not the same.  The desires are not the same.  The judgment is impaired.   Above and beyond everything, the afflicted person’s brain is telling him to “feed the baby” — the baby must survive.  The baby is the addiction.

Without truly understanding any of this, friends and family try to love the addict back to reality.  That seems like the human response, but that would be like loving a person into starvation.  Why are you eating?  I love you!  How can you do that to me?  It’s really funny, but it’s very true.  There are various ways to respond, and we will get to those in future posts, but for now we must try to understand that a lack of responding in the typical manners to a hijacked brain is not — is definitely not — a lack of compassion.  

Confucius said:  “ Wisdom, compassion, and courage are the three universally recognized moral qualities of men.”  Wisdom and courage are going to be much more useful when dealing with addiction.  “God, grant me the serenity to accept the things I cannot change; the courageto change the things I can; and the wisdom to know the difference.”

What's Love Got to Do With It?

I speak frequently with a woman named Jane who has been married to an alcoholic for close to 40 years.  A resilient sufferer, she just left her husband after all of those years of his on-again, off-again drinking and several attempts at rehab and recovery.  It’s been literally a lifetime of pain, chaos, and tragedy.  Her husband is still drinking heavily, taking prescription pills, and in the midst of his intoxication, he calls and emails obscenities at Jane which make her feel sad and guilty.  Jane is concerned that she lacks compassion, and she still believes the madness that her husband spews out at her in his drunken rages.  Things like:  it’s all her fault; look what she’s done to the family; his drinking is not an issue — Jane is the issue.  On and on it goes, often daily, and Jane believes it.  Surely she has done something wrong — her husband seems so certain of it.  If she just tried a little harder or loved a little more, her husband would stop drinking, and their marriage would be saved.  This is just a sliver of the picture of the family disease of addiction.

Jane called last week after reading an especially disturbing email from her husband which made her feel sad and caused her to relive the grief and loss of their marriage.  She said:  “I simply cannot believe that he cares more about drinking than about me and our marriage.”  This is a conversation we’ve had before, and Jane  has not yet learned to separate the person from the disease.  It’s not easy.  They don’t say that it’s “cunning, baffling, and powerful” for nothing.  It is.  It takes hard work and education to understand this thing and our reactions to it, but it’s so important to do the work to come to an understanding.  It’s important for peace of mind.  It’s important for physical health.  It’s a matter of life and death.

I explained to Jane that the situation with her husband is not a matter of caring.  It has ABSOLUTELY NOTHING to do with love or caring.  Her husband’s brain is being held hostage in a sense, and in his mind he does not have a problem.  That doesn’t mean that it’s true — it’s simply how his brain has been tricked by the alcohol and drugs.  When her husband drinks or takes drugs, one of the oldest parts of the brain (the limbic system) is very pleased.  This is the part of the brain that regulates such primitive behaviors as hunger, sex, pleasure, the fight/flight response, etc.  

Without getting into specifics of neuroscience (which I am hardly qualified to discuss), it is important to understand that an addicted person’s brain is telling him that he is doing something good when he drinks or uses.  The limbic system is responding “yes, yes!!”  This is what is needed!!  The very brain that would normally tell him that he is hurting the people around him and himself, is first and foremost responding to what it believes is good for survival.  This is an automatic, unconscious activity.  We eat when we’re hungry.  We drink water when we’re thirsty.  We don’t analyze this, we simply know it is what we need to do.  If someone told us our eating was a problem, there is no way we would listen to him.  We have to eat — our brain protects us and will not let us think otherwise. The person suffering from addiction is responding in much the same way.  He has absolutely no idea that there is a problem.  This is sometimes referred to as denial.  

I explained all that to Jane and left her with this:  IT’S A BRAIN THING!!!  IT’S A BRAIN THING!!!  IT’S A BRAIN THING!!!!  Did you get that?  IT’S A BRAIN THING!!!  It has absolutely nothing to do with caring, with love, with you or anyone else.  It’s not a conscious, premeditated, hurtful thing.  The addicted person  needs to be freed from captivity, and until you get your own head on straight you will simply be part of the problem and not part of the solution. 

Let's Face It

There is a lot of controversy both in and out of the field of addiction about whether or not it is a disease.  Never mind the fact that the American Medical Association has definitively classified it as such.  The nay-sayers are convinced that the classification was a conspiracy of sorts that the AMA conjured up to allow medical treatment for addiction to be paid by insurance companies, etc.  Neuroscientists have released various images of the addicted and non-addicted brain, but the viewers or “readers” of those images argue back and forth about exactly what they mean.  Each side is confident in its decision.  Whom are we to believe?

After years of reading, studying, and experiential learning from addicted loved ones, I believe the answer is quite obvious.  If you put a mind-altering, addictive chemical substance into your body for a significant period of time, your brain is bound to become diseased along with the other organs that may be affected (liver, kidneys, etc.).  For some people, this may happen sooner rather than later.  Each person is going to respond differently, and each situation is unique:  age, height, weight, family history/genetics, substance(s) used, duration of use, amount used, life dynamics, etc.  In my mind it is ludicrous to think that the brain will not become diseased, and it seems presumptuous to determine how slowly or quickly the brain should recover in any given individual.

Let’s take my friends for example. My friend “Sheila” has eaten everything and anything she ever wanted her entire life.  She is overweight, and she has never exercised.  My friend “Tony,” on the other hand, has always watched his diet, is underweight, and he has always been active and exercised at least to some degree.  Tony has high cholesterol and heart disease, but Sheila has neither.   Tony put much less into his body throughout the years that might have caused high cholesterol and heart disease, yet he is the one who got the disease.  Sheila technically should have clogged arteries, but she does not.  Why is that?  Genetics — and we have no problem accepting that.  Still I feel fairly certain that if Sheila were to ingest a pound of butter everyday, in time she too would develop high cholesterol and heart disease . 

Now let’s switch the “thing” that is being ingested to a alcohol or drugs.  There are people who can abuse substances for years and never become addicted (like Sheila in the example above).  They can stop at any time, so they don’t understand or “buy into” the whole disease concept.  Then there are those who are careful and drink or use less often, yet they become addicted / diseased (like Tony above).  These people obviously have a genetic predisposition or have otherwise acquired an affliction that they simply have no control over.  Tony stoppedeating trans fats years ago, but his disease still progresses.  The substance abuser with the disease of addiction can stop using, but his disease will continue to plague him.  And similar to Sheila hypothetically eating a pound of butter a day, if someone used or drank enough over a long period of time, they too would likely develop the disease., although some people can eat and drink as much as they want and never have problems.

As a society we don’t like any of this because unlike heart disease, addiction affects the brain and behavior of individuals.  Often that behavior is harmful to society as well as the addict.  We just want them to stop and make it all go away.  We don’t want to have to understand, treat, and have compassion for something that wreaks havoc with our minds, hearts, homes, jobs, wallets, communities, etc.  It frightens us because it involves an organ that houses the very makeup of an individual.  If it’s a disease, we’ve got quite an epidemic on our hands.  It would be much easier and more hopeful for all if we closed our eyes, hearts, and minds and truly believed that the individual could do this with sheer willpower.  Then we all wouldn’t have to be involved.  We could point, blame, and look the other way.  Instead, we must face it.

The Runaway Train

I heard some sad news over the weekend.  A young woman (former friend of my daughter) is shooting up heroin, stripping, and God-knows what else.  If that is shocking to you, then you need to come out of that cute little bubble that you are living in and into the real world where this is becoming commonplace.  It's hard to get accurate statistics, but one study recently showed "an estimated two hundred million people worldwide use illegal drugs."  That's not including alcohol.  Some have described it as "an epidemic" or a "runaway train."  It certainly is, and it's clearly out of control.

Who are these addicts?  If you think they are a bunch of low-class, uneducated hoodlums, you are deceiving yourself.  They are our neighbors, co-workers, children, spouses, parents, doctors, lawyers, teachers, clergy, dentists, nurses.... you get the picture.  They are people like you and me trapped in a nightmare of physical and psychological suffering.  That suffering spreads to their families, friends, and workplaces.  It's a battle -- a war -- and it needs to be treated as such.  You don't go into a war without an army and a plan, and you don't go into it in ignorance.  You need to educate yourself -- know your enemy.  Then you must gear up, assemble an army, gather your weapons, and fight the battle with all the passion and rage of a person whose freedom is being taken away.  It's unacceptable, and it must not win.  Whatever it takes -- it must be fought and destroyed.

Addiction is a disease -- like any other disease.  It is nothing to be ashamed of, and it can't be dealt with if it's hiding behind shame or fear.  It must be brought to the light of day, and its victims must be treated with the love and respect of someone with a disease.  But unlike cancer or diabetes, loved ones haveto understand this disease to know how to "help."  I hope you'll take some time today to educate yourself about this disease.  I'll attach a link at the end to get you started.  I also hope that you'll look around and really pay attention -- really listen -- because I'd be willing to bet a good amount of money that there is someone in your life who is suffering right now. 

 

Learn about addiction HERE