Friday, May 7, 2010

Dear Illness

Dear Illness,

I've been wanting to write you for a while. Not that we don't see each other often come by every day, sometimes several times a day, to let me know you're still thinking of me. Don't think I don't appreciate it! But I never really get to ask you the questions that bug me about you so much, and we never get anything really resolved. Don't take it personally, please.

For instance, I wonder what makes you so persistent. You know very well that I've tried to keep you away. It wasn't always like this. In the beginning, I thought we could have sort of a relationship. In hindsight, I guess I really knew it wasn't going to work out. I had my life to live, and were just so needy. I didn't want to take you in, but I didn't have a choice. In fact, I didn't even know you had moved in permanently until you were already here for some time. There were early signs, but I ignored them. After all, I was pretty young then! Not young enough that I had no idea of my own mortality, but young enough that I thought I was going to be in good health pretty much forever. You know how it went, though. You orchestrated it. First, shrugging off the minor discomforts that tweaked me here and there for years. And who knows which flare of nerves, which muscle twitch, with flash of random pain was you, and which was just the usual unexplained nonsense that everyone's body does? I was young! I wasn't going to deteriorate!

After some time, though, I noticed patterns. Just little things that happened in sequences that came to be familiar. There were the muscle aches, but who wouldn't think I was just sore from exertion? I was pretty active then. The mental fogs would come and go, but they didn't worry me until I noticed they came along with the muscle aches. I still didn't really think they were connected, and as long as I could function most of the time, I figured I'd just soldier through. Plus, as you know, I've been battling depression my entire life. It was easy to think that my problems were caused by the depression. All in my head, that is. I was young, after all, and in my prime of life; surely an illness couldn't be settling in and putting a claim on my well-being, could it?

The more and more you stayed, the more I tolerated you, though. I don't know why. Maybe I thought I deserved you. I hadn't been the most careful or moral person out there, so I thought that you were sent here for a reason. Like I needed to be punished for being a depressed whiner. But the depression...that was you, too, wasn't it? Not all of it, but you were setting me up. You were the cause and the result. The arthritis-like pain in my joints and muscles, though, and the exhaustion were part of the same deal. So I tried avoiding you. You know how well that worked out: if I could just exercise more, if I could keep up my spirits, maybe you'd take pity on me or help me get better. Since it was all in my head, you know.

I still don't know how my drinking fit into this. The pain was part of the reason I started drinking, but the problem started getting worse after I started drinking. I'll never know if I exacerbated you. See? Here I am, still blaming myself for the awful things YOU do. But I know that after I stopped drinking things got a bit better, but they never went back to the way they were. By the time the rest of it settled in--the shakes, the sweats--I knew there was something bigger than just psychosomatic illness. So I saw a specialist and asked him about all the other signals you'd been sending, major and minor: the sniffles, the tremors, the indigestion, the failing memory, the waking stiffness that never seemed to go away, the tender points. He told me your name, finally: fibromyalgia.

By then you'd started hitting me. It wasn't too bad at first, just little swats here and there to keep me in line. Some pain flare-ups, some queasiness, some weakness. Bouts of shakiness and rampant pain came after. I'd thought it was some sort of hypoglycemia or something, but the doctor assured me that you were doing this to me. I don't know if I could have ever kept you away, but by then, it was too late. You'd settled in. The feeling of having been beaten was daily. You never left me alone. Sometimes you'd shake me like a rag doll and I couldn't do anything but take it, and then I'd be useless for the rest of the day. Boy, does all that hurt. I can't even express it, except to say that at an attack is sort of like having your muscles sanded with sandpaper while suffering from hot and cold flashes and shaking, unable to keep a coherent thought in your head. What else could I be after that but defeated?

So here you are. I don't have any way to make you leave. Everything I try, even the best things I try, put you off a little bit, but then you're right back. You've been kind of leaving me alone lately, and I'm grateful, but now you're back and just as vicious as before. I used to wonder if I deserved you. Now I know I didn't do anything wrong, that it's you, not me. But I still can't get rid of you, and no one can make you leave. I'm managing as best as I can, getting some things accomplished and taking steps to work around you. But I'd rather not have to. I know you won't listen to me--you've got too much invested in me--but I can't stand you anymore. You've cost me enough pain and tears.

Please. Just go. Go. Away.

Wednesday, May 5, 2010

Why AA and I don't get along

Following is a letter written to friends about my feelings near the end of a class on drugs and behavior:

There are more chapters than one that address 12-stepping, but as with any time I try to focus on the 12 steps, I become frustrated and upset. How else can I put it? I just don't buy into the 12-step program. I think it works for a lot of people, but not for me, and probably for many others, too. In the book, though, are two pages of criticism of the AA model, and I read them eagerly (but, as much as I could, objectively).

I've been thinking much on some of the basic tenets, and come to the conclusion that the AA model is unnecessarily punitive and cult-like. It's Calvinistic, really, based more in Puritanism than in reality, and offers itself as the only solution that works. [I am advised by a respondent that it is actually Arminian, not Calvinist.] The problem is, it doesn't work very often. Yes, it works for those who make it work, and for those people, mazel tov. But it presumes much and accepts no deviation. I also don't like its tone: being in an AA meeting, for me, is a *trigger,* not a relief. Sitting around and hearing stories of use and redemption don't make me want to not drink, they make me want to drink so I don't have to listen to any more stories of use and redemption.

Some of the complaints in the text I have already made myself, though some I agree with were new to me with the reading. For instance, the insistence that newcomers must have come to this stage through desperation. True, AA is there if you are desperate...but why must you be in order to attend? I don't think that's an entirely valid complaint, though, from my own experience; as the preamble read at every meeting says, all you need to attend is the desire to stop drinking. That's really it. That's what it says, and that's true. But the real emphasis in meetings is of people who descended, and kept descending, until there was no other way out. If you admit to a problem with drinking but aren't desperate, chances are you will be told that you are in constant danger of the downward spiral into oblivion and must adopt the program in toto. It's a stark adaptation of Christianity, in which wretches who have no other place to turn finally give their lives up to God, and that makes AA religious in origin. That works for a great many people who lean towards Christianity to begin with, but for the atheist or the agnostic or the ambivalent, it can be oppressive and daunting. Telling addicts and alcoholics that the only way to health is through a quasi-religious "awakening" and surrendering to a Higher Power is indoctrinating. It also evokes the "all-or-nothing" personality trait of the addict, replacing the old addiction with the new. There can be, and are, other approaches to sobriety.

Which is another complaint. Just yesterday I read a quote that sobriety and abstinence are two different things. Sobriety, properly, is decision-making based on clear-headed reason; abstinence is the complete abandonment of a given substance. It's similar to the difference between chastity and celibacy. Some addicts--not many, I know, but SOME--are able to make the conscious, reasonable decision to imbibe and move on. (I don't believe this is true of cocaine, opiates, or their derivatives. They are simply too powerfully and chemically addictive. I don't think I've ever heard of someone who could go from addictive use of those drugs to casual use.) The important thing to address is, which approach is most appropriate for the particular addict. I would say that in most cases, as it is with me, that abstinence is the only safe path. I don't think I can ever have "just" a beer without triggering the landslide into oblivion again. For me, casual use of alcohol just doesn't work. But there are people who are alcohol-dependent but not addicted; they "need" a drink at the end of the day, or just before bed, or what have you, making them dependent on that ritual. That doesn't make them alcoholics, and even if the use is problematic in some way, that doesn't mean abstinence is the only answer. Learning different patterns of behavior and searching one's own self for answers are good approaches and may solve the problem without eternal meetings and self-flagellation.

And there is another complaint. AA takes the position (even though it is contradicted, in passing, in "The Big Book") that meetings are requisites for the rest of your life. You are never recovered, according to AA, always recovering. Now, for a lot of people, that's as true as the sun rising in the East. Some sober alcoholics need the meetings and the fellowship because they know the disease is lying in wait for them to stumble. I wouldn't dare to tell someone that *everyone* can recover and move on. But some people can, and AA doesn't accept that. For some people, continuing in AA may exacerbate the problem (as it does for me), imposing on them fairly rigid standards of behavior in a one-size-fits-all model of discipline. Not only does it impose the discipline, it imposes a fundamentalist philosophy on its members. Trust me on this one! In many meetings I've related how I don't always have to pray, I don't have to read the Daily Reflections, I don't actively "work the program," but that the meetings have helped because I get to talk to some people and unload, and that saves me. When I say things like that, you can hear the intake of breath and watch the eyerolls and head-shakes. They won't tell you that you don't belong; what they'll tell you, though, is that you don't "get it," and that you have to keep attending meetings until you DO. They don't accept that there are alternate routes to sobriety. It's indoctrination, really.

One of the personality traits that can lead to alcoholism (in conjunction with others, natch) is the need for outside approval. People who have low self-esteem, whose identity is dependent on the opinions of others, are ripe fruit for the alcoholic demon. But in AA, you're just as dependent on the outside approval as you were before you started drinking. You're not solving the problem, you're just transferring it. In that very narrow way, AA is much like the Scientologists or any other cult: they find the desperate, offer them a plan of action, insist on rigid discipline, don't allow for diversion, and impose upon the individual an entire system of thought and behavior that leads to approval. They require regular, frequent reinforcement through phone number lists, sponsors, Daily Reflections, "working the steps," and dependence on the Big Book. They don't cast you out for not believing, as cults don't, but they will not fully accept you until you conform...which is what cults do. The only difference is that AA lets you leave, whereas cults don't.

What's interesting is that some of the cornerstones of AA aren't falsifiable. The most powerful one is that without AA (or some treatment), the alcoholic (and the disease) will necessarily get worse and worse until they either hit "rock bottom" and either find AA or die. Research doesn't bear that out. AA's insistence on this is based on its members who have hit rock bottom and either become sober or died. You can see that the methodology there is dangerously flawed. They don't accept as role models those who have abandoned drink on their own, or who have found a different path to sobriety. But as we all know, not everyone who follows the AA program becomes a successfully recovering alcoholic, and not everyone who recovers does so under a 12-step program. Research shows that very few alcoholics actually end up in the death spiral that AA warns you about, though of course it does happen...just not predictably or reliably so.

There are, for me, some conceptual problems with some of the steps. Step 5 tells you that you have to admit to God and another human being the exact nature of their wrongs. This comes directly after the command to "make a fearless and searching moral inventory of ourselves," and together, steps 4 and 5 are powerful and restorative. As they say, you're only as sick as your secrets, and self-avowal (saying your secrets aloud so that you come to accept and comprehend the extent of your addiction) is the strongest step you can take toward recovery. I've told you many of my secrets, and by telling them I've been able to heal them. But Step 6 says that we "were entirely ready to have God remove all these defects of character," and Step 7 is that we "humbly asked Him to remove our shortcomings." I find this detestably crippling in that it sets the addict up for false hopes and self-reproachment. First, God (or your "Higher Power") is not going to remove your shortcomings. He, or you, may find paths to address them, to cope with them, to resolve them, and to carry on responsibly, but they're part of you. They're not going anywhere. No matter how good you become at becoming a better, more sober person, you're going to have a core that is the nuclear furnace of the abuse and trauma that led you to become an alcoholic in the first place. (With the caveat that it may be possible for some to reach that state...but it's not bloody likely.) Teaching the addict that God can "remove our shortcomings" while preaching that AA and recovery is forever is not only contradictory, it sets the addict up to relive one of the emotional states that led to the addiction. That is, the tendency to blame oneself for the failure of others.

I'll expound on that just a little, though I am sure my meaning is already obvious. Odds are, God is not going to remove your shortcomings. The reasons for that are debatable, metaphysically and organically, but you're not likely to go from self-loathing to happiness in this lifetime. If you do, mazel tov, God bless, good on ya, and all that, but it's an unrealistic, almost impossible, expectation, and when it fails--as it almost always will--you won't blame God. God is, after all, perfect and beyond reproach. Someone must be at fault, and if there are only two people involved (you and God), then that person must be you. That leads to the self-reproach that led to the drinking to begin with. To me, the sixth step is the make-or-break step: if God can't fix you, who will? Me? Might as well drink. That's reduction, but it's pretty accurate. It's a set-up to accept an article of faith that has very little chance of success. Like I said, I detest that step.

With the exception of the 3rd and 11th Steps--increasing our reliance on God--the rest of the steps are as valuable as gold. Yes, admit to others how you have wronged them, and ask for their forgiveness! (Unless doing so harms them or you or others.) Yes, take personal inventory! And especially the 12th step--reaching out to others. Nothing will help you, the individual, as much as helping others along the path you've successfully walked. It's generativity, it's the helper principle, it works. But there's one last complaint to be made.

AA is, at its heart, punitive and about powerlessness. It's not enough in AA to succeed: succeeding has to be painful and purgative, and that means no crutches (like Camprol, the anti-craving drug). The original goal was to obliterate the ego (that was Bill W's own belief) so that God can move in and heal. But the subtext of this is that when you succeed, you can't own it. It's God who did it for you. It doesn't give credit to the hard work the addict does to improve his or her life. Now, in treatment (hopefully, as it was for me), you will get a lot of support and reinforcement for the hard work of delving through your life and resolving the issues that made you an addict in the first place. It's tougher than just about anything you can do, and the addict needs to feel empowered, that he has made the success. But placing responsibility for your recovery on God takes it out of your hands. To me, that is more insidious than the unspoken idea that if you don't succeed, then God has abandoned you (or is ignoring you until you conform to AA's mindset). By giving the credit to the Higher Power, it's been taken away from the individual and left him or her weaker...which leads to the dependency on AA, thus reinforcing its cultishness.

Finishing up, I have to say that one thing I will teach the addicts I will eventually meet is that your guard always has to be up. The price of sobriety, not only freedom, is eternal vigilance. You have to be educated, you have to be aware, you have to always be watchful for the time your addiction tries to sneak up on you...and it will. It WILL. It's a hungry beast that lives inside you. But that beast can be tamed, and you can come to lead a normal life in which you aren't mandated to attend meetings that reinforce a sense of impotence, conformity, and dependence. AA is not about independence, not at all. For some people it provides much--fellowship, family, relief, salvation--but more people drop out of it than stay in it, and it can be improved upon so that even more people can overcome their addictions reliably and healthily.