Thursday, February 6, 2014

Philip Seymour Hoffman: How COULD he?

I was scrolling mindlessly through my Facebook feed, the day the news broke, and I saw someone post "RIP Philip Seymour Hoffman. So sad."

My response was visceral and possessive:  WHAT? I thought.  MY Philip Seymour Hoffman?

I have no claim to him, of course. I never met him or even caught a glimpse of him in person.  It is a testimony to his strength as an actor that I felt such a connection with him.  His achingly beautiful performances, where he so often portrayed the dichotomies that lie within us all - sinner and saint, courageous and vulnerable - touched us all.

It is no surprise that he was such a talented character actor.  A hallmark of all addicts is that we're great chameleons.

His death effects me on another level, as someone who had recovery - good recovery - and then relapsed. It is hard to respond to the question how could he? because it is a question I ask myself, too.  How could I? With everything I know about addiction, with all the blessings in my life:  how could I? 

Let's start by talking about you for a moment.

Think back on resolutions you have made to yourself.  Perhaps to lose weight? Eat healthier?  Exercise three times a week?  All of the above?

You know, intellectually, that your life will improve if you stick to your plan. You come out of the gate going gangbusters.  It isn't hard to stick to your plan, because the benefits are immediate - hey! I have more energy! I'm sleeping better!  I can button these jeans!  My cholesterol went down! 

You are a disciplined, intelligent person, and you don't like to be bested by anything, so you stick with this plan.  For months.  You do this until the point where getting up in the morning and going to the gym is second nature. You reach for the carrot sticks instead of the cake without even thinking.   Friends compliment you on how good you look/feel.  The rewards for this healthier lifestyle make it easy to stick with it.

Over time, this healthier you is just, well, you.

One day you have an early morning meeting and you can't go to the gym. You haven't been scheduling early morning meetings, because it's your gym time, but hey, just this once won't matter. Things are nuts at work. The next day you decide you'll work out in the evenings because you got so much done at work early in the morning.  Except when you get home that night you're tired and don't go.  The next night there is a traffic jam and you get home too late to work out.

A few days, or maybe even weeks, later you skip your healthy home-brought salad and go out to lunch with co-workers.  While you're out at lunch, nibbling french fries, you think:  I should do this more often. It's important to socialize with work people. 

After a while, you're only bringing your healthy lunch once or twice a week, and you're only working out occasionally.  But you still feel good. Your clothes still fit.  You tell yourself you will amp up the workouts if your pants get tight.

One day you can't fit comfortably into your suit, so you head out and buy one - just one! - work outfit.  Just until you can take off the few extra pounds.

Weeks later you are mindlessly digging through your closet for your old two-sizes-bigger clothes.  It's just that you have been so busy.  You know what you need to do, and you've done it before, so you'll get back into shape when things calm down.  It's not like you're going to stay this weight.

Eventually you're not only back to your former weight, you're heavier.  How did this happen? Things were going so well!  You feel ashamed.  You feel like a failure. You feel so despondent.  Dieting doesn't work for me, you think.

Does any of this sound familiar?

What is so hard to see, in these situations, is that you didn't just end up heavy.  It all started the day you skipped your morning workout for what seemed like a perfectly good reason: work needed you.

It's death by a thousand paper cuts. It's a slow, almost invisible slide into old behaviors.

Recovering addicts need constant vigilance to stay sober. It's hard at first - everything (and I mean everything) feels different. Putting recovery before everything else is hard, counter-intuitive, because you are accustomed to letting the hectic pace of life to put the healthier, non-drinking you, last.

Eventually, though, with daily discipline, structure and support, being sober becomes second nature. You feel so good that you don't ever, ever want to go back to that dark, shameful, secretive place.

Someone who has worked hard to get fit doesn't want to go back to being heavy, either. But still it happens to almost all of us who try to lose weight. Very few of us do it once and keep fit for a lifetime.

With recovery it isn't a matter of what we want, either.  We all want to stay sober, but addiction is a brain disease, and what we want doesn't hold all the cards.

Put very simply - back when we (meaning addicts/alcoholics) first used alcohol or drugs, we triggered something in the primitive part of our brain - the part that governs survival instincts like shelter, reproduction, food, thirst.  Our addiction takes root in this primitive part of our brain, snuggled up next to the things we need to survive.  With time, as the addiction grows, our brain puts drinking first.  It moves up the ladder of needs - starting as an emotional addiction and ending as a physical one - and eventually it trumps everything. Active alcoholics will choose alcohol over food and hydration.

Their brain is literally telling them:  you need this to survive.

Additionally, the neocortex, the part of the brain responsible for rational thought, and the amygdala, which controls emotional processing, get hijacked.  The site, which targets teens, explains it simply:
"...drugs and alcohol also affect a part of your brain called the neocortex that keeps you from doing dangerous things. Ira Moses, Ph.D., who used to run a drug abuse program, calls the neocortex “the brain’s brakes—it controls most of the brain’s functions.” The neocortex helps us think through consequences of our behavior, consider risks, and stop us from doing things that might feel good in the short run, but harm us or the ones we love in the long run. This part of the brain basically gets turned off by drugs and alcohol."
Once activated by drugs or alcohol, in an addict's brain the neocortex hands the reins over to the lizard/primitive brain, which is thinking:  alcohol first. drugs first.  The symptoms of addiction are behavioral, because the rational part of the brain isn't functioning.  This is why people around active alcoholics are astounded by the insane behavior we do when we're drinking. Because it is, quite literally, insane.  Our neocortex is out of the picture.

So, back to the original question:  how COULD Philip Seymour Hoffman relapse?  With all he had going for him?  With all that sobriety?

The same way I did.

There is no cure for addiction, but it can be treated; it can go into remission.  Treatment involves a daily regimented program of recovery of rigorous honesty, communicating with fellow addicts/alcoholics in recovery, self-care and - for many of us in recovery - spirituality.  It involves a daily surrender to the fact that we are powerless over our disease and all its manifestations.

Here's what I mean by that:  my relapse didn't start when I drank. It started about a year and a half before when, coming out of cancer treatments, I had drifted away from active recovery.  I stopped engaging in the daily self-care regime that treated my alcoholism on a daily basis:  meetings, yoga, exercise, asking for help, prayer.

I substituted my recovery for what looked and felt like healthy behavior -particularly in the crazy pace of today's world - workaholism.

Just like the ill-fated dieter in the example above, it was a long slow slide towards a drink.  Without my knowledge or permission, my disease was ramping up, because I wasn't tending to it on a daily basis.

I don't remember actually drinking.  I was in an emotional blackout, I guess.  I was so far away from the healthy behaviors that kept my recovery alive that my disease took over, and I was without a single tool to resist it.

So where does personal responsibility factor in?  Especially as it pertains to relapse?

This is a dicey subject, so I offer here only my personal thoughts on the matter.

I view my alcoholism like I do my cancer:  a chronic, life-long and potentially fatal condition.  I didn't choose to have either one.

Neither one is my fault, but my recovery in both is my responsibility.

In my mind, my relapse is as if I found something troubling- perhaps a lump in my neck (where I had cancer before) - and I decided (consciously or unconsciously) that it was probably nothing and didn't see a doctor. Then, months later, I find out my cancer is back and it has spread.

The moment of responsibility lies with my knowledge that I am a cancer patient in remission and I can't afford not to have something checked out.

But, particularly when dealing with hard or scary things - it's human nature to dumb it down, file it away somewhere convenient or easy, or simply procrastinate.  Like our dieter.

With addiction, just like with cancer, we can't afford to file it away, though.  Once we have surrendered and know we are an alcoholic/addict, it is our responsibility to maintain that recovery.

BUT. Relapse happens. It happens with cancer. It happens with diets. It happens with addiction.  For all the reasons I described, alcoholics find themselves with a drink in their hand and no tools to resist.  Knowing alcohol is bad for you, that it could kill you in the end, doesn't factor in.  That bus left the station ages ago, when the first of the thousand paper cuts slid across your skin, seemingly without much impact.

When I am not active in a program of recovery, my addiction is untreated.

It is my responsibility to stay active in recovery.  I drifted away from it. I relapsed.

It is not a moral failing. It is my disease coming out of remission.  But, unlike cancer, I can choose to treat it on a daily basis and stay in recovery.  Cancer treatments cannot promise such a hopeful outcome. Hopefully I will be able to treat my addiction, daily, for the rest of my life.  I know this is confusing to people not in the world of addiction:  if you can choose it every day .. why don't you DO that every day?  I will politely refer back to the dieter.

Because we're also human.  And brains - all brains - are adept at side-stepping scary or unpleasant things.

So let's not wring our hands and ask why. Or how could he?  Philip Seymour Hoffman died because of his disease, not because he was weak, or willfully self-destructive or morally unfit. The argument "well, one doesn't just find oneself with a needle in one's arm" infuriates me. Because addicts do. Addicts who are not working a program of recovery find themselves with a needle in their arm and are just as baffled and saddened about it as those who love them. And once the drug is in their system, the sober person is just gone. And they can't get back without help.

And far too many addicts/alcoholics don't ask for help, because of the damn stigma.  Far too many addicts/alcoholics don't reach for a chance at recovery because they are too afraid of society's reaction to what they, too, perceive as a personal weakness or failing.

Lets band together to beat down the stigma of addiction that keeps alcoholics and addicts stuck in their fear of being judged.

I long for the day when addiction is viewed like cancer - without stigma and with the urgency of all potentially fatal conditions.

RIP, Philip.  May your tragic death in the spotlight help to bring more understanding to the disease of addiction.