Warm Horizon

Notes from Jim

I have worked extensively with hospitalized persons who are intent on being relieved of pain of various types. (Although possible, it is unlikely that those individuals have fabricated their complaints.)

But what I have consistently noticed in those patients—especially in those whose problem has existed for a significant time—is that they almost invariably will sacrifice day-long moderate relief of their pain for the opportunity to experience the “best” single degree of relief on one occasion during that day. That is, they will opt for the entire regimen of pain medication allowable as soon as they can have it. And while this policy gives them the greatest feeling (or perhaps high) possible within the constraints of the physician’s order, it leaves them with unnecessarily high levels of pain, sometimes for the balance of the day. (Remember, these are mostly people who have chronic conditions that staff members know are causing the pain.)

This practice is the strongest indicator I have found that those who use substances regularly have chosen to make life about feelings. And that their goal is to achieve the best feeling possible each day—an indication that I believe is emblematic that the false hope of a high is the ultimate goal.

Perhaps I have said all that is necessary about the lure of substance dependence. But I have a few more comments before dropping the subject.

Remember that substance dependence does not necessarily involve only the addictive drugs we generally associate with the problem. So let me further warn you that regular heavy use of food items such as citrus juices, decaffeinated soft drinks, butter/margarine, candy, ice cream, hot peppers, heavily salted products, presweetened cereals, and yellow cheeses can become extremely habitual and thus can constitute a substance abuse problem. As indicated, we often use the effects of such items to serve as the reassurance or nurturing we desire. However, regular consumption of those items not only can bring about health problems but also can serve to distract us from internal issues we must address.

Thus, it might be wisest to begin the effective use of affirmations (daily) that will serve to nurture and otherwise focus us on the (reassuring) truth of our being—practices that can be employed to diminish the urge to abuse substances.

Grief is quite similar to depression in its effect. In fact, I recall being told that grief would last about six months and that if its symptoms did not wane significantly by that time they would be seen as indicating depression. But my concern with that view is that I also have seen the average length of depressive episodes to be about six months. So I have never been sure about the difference between grief and depression, although with grievers the loss is much less often a mystery.

Grief is obviously thought to be more natural and certainly more common than depression. However, I see no reason to concern ourselves with distinguishing between these two phenomena. (In fact, for the purposes of this program, I think it makes sense to see grief as a degree of depression.) And I know that physicians treat them similarly pharmacologically. Furthermore, if you have suffered from depression, you are probably apt to have more difficulty with grief than those who have not—I believe.

The public generally accepts grief much more readily than it does depression. People who have not grieved significantly don’t tend to see those with grief as being lazy or just unmotivated, as they often do those with depression. So there is no stigma with grief, as there is with depression.

But, basically, most of the emotions, and to some degree the debilitating effects, of depression are found in grief reactions. Thus, anxiety and fear, sadness, anger, a sense of loss, and despair are usually present during grief periods. The famous work by Elizabeth Kublar-Ross, On Death and Dying (1969), is well known and delineates these and other emotions along with the ordering by which they usually appear. The book is a staple for caregivers, and I recommend it for anyone interested. A 1997 paperback production by Touchstone of Simon & Schuster, Inc./New York is available.

It is important to understand that grief occurs in response to almost any loss or significant change, not just after the loss of a loved one. Grief can emerge following a change of seasons, a change of location, or even a change of diet—although withdrawal could be a factor. In fact, I noticed job-related grief-like feelings of my own in the 1990s that I finally concluded were aroused in response to changes/cutbacks that had occurred in the inpatient psychiatric setting.

But if you are experiencing what you believe to be grief, it is as good a time as any to be involved in this program. The fact that most people naturally experience feelings of grief at appropriate times, I believe, is indicative of the fact that most people can also become depressed.