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Tiny Little Crises.

25 July 2014

Jesus I’m tired of myself. I’m tired of wanting to be right. Tired of wanting people to agree with me. Tired of arguing and striving. I’m doing it completely wrong. All of it.

When I first got sober, there was an enormous relief that I felt in so many things. Relief that I didn’t have to be right for the whole world anymore. Relief that I didn’t have to care if other people were right or wrong. Relief that I didn’t have to lie and struggle and remember who I’d told which lie to. Relief that I could simply be clear and calm and restive in my mind and heart.

I’m wrenching myself into knots again. Struggling with people. People who know more than I do. It’s so easy for me to feel like I have some secret knowledge that other people don’t have. I don’t. I’m the same puffed-up know-it-all I was when I was twelve. And just like when I was twelve, I don’t actually know very much.

I’m turning forty in a minute. My life is around half over. I have a wonderful partner and a good career and I’m tying myself into knots worrying about things I have no influence on, and no real knowledge about. I’m still acting like a child, indignant and insistent and spoiled and unaware.

I know a few things. I know how to help someone who wants to recover from alcoholism recover from alcoholism. The way I know isn’t the only way. But it’s a way that worked for me and many others. I need to stop worrying about anything else, when it comes to recovery. I can help who I can help. And I don’t have much to say about anything else.

Of course, my lack of knowledge hasn’t stopped me from spouting off and being stupid. I hope I do less of it now than I used to, but I still do far too much.

A lot of people I care about are going through trials that are greatly burdensome. I can’t help any of them with it.

I am utterly and completely powerless over other people. Over my relationship with alcohol. Over the tribulations of my loved ones. I can choose only to engage or disengage. Fight and lose, or surrender and be free. There is no victory in struggling for me. I do not have access to the kind of life where battles are fought and won.

I am tired. I am tired of manufacturing these tiny little crises. I need to let go.

A Three Month Failure.

24 July 2014

Over at Complex Roots, I’m closing up shop after deciding I don’t have what it takes to make that place in my vision.

Medicine Will Never Cure Alcoholism.

23 July 2014

A couple of online conversations have me thinking. I’m about to put forth a fairly long “No True Scotsman” description of alcoholism. I am friends with a bunch of neuroscientists. Many of them study addictions. I am not going to pretend that I understand the first thing about neuroscience. I don’t even understand basic cell biology at the high school level, much less the cutting edge of brain science. My best attempt at a precis of their basic argument about the ability of science and medicine to cure alcoholism goes like this: “As we come to understand how substances affect and make changes to the brain, and understand the way that addicts’ brains behave differently from normal people’s brains, we will be able to make targeted interventions which will relieve symptoms and causes of addiction. These interventions may take a variety of forms, including therapy, pharmaceuticals, surgery, or something that hasn’t been developed yet. But understanding the brain will lead us to relieving and preventing the suffering from addictions.”

I want to stress again that this is my understanding of their argument, and could be flawed. It’s not a quote from any person, but a brief synthesis of many discussions in a variety of venues. One area which has been specifically described to me by a couple of my neuroscientist friends who study addiction is the area of relapse. Several neuroscientists have told me that they believe that “a pill to prevent relapse” is a reasonable possibility. Maybe not soon, but eventually. Essentially, they seem to believe that we could, with appropriate understanding, devise a pharmaceutical intervention which relieves addicts of all cravings, and thus prevent them from returning to use.

I am happy that people are making these efforts. I suspect that they will, in the long run, be useful for some people who struggle with addiction. And as I have repeated over and over here, I believe in the value of medicine for treatment of addictions, especially in the acute phase of detoxification and withdrawal. When I quit alcohol I was at extreme risk for seizure and death. I quit cold turkey, going from a bottle (or more) of 80 proof liquor a day to nothing in the period of 24 hours. I took Depakote, and Atavan. I didn’t have any seizures.

I stopped taking Atavan within 3 days of abstinence. I stopped taking Depakote a few months after that. I have taken and anti-depressant from time to time, but other than that, I take no medicines other than aspirin. But I would, if I needed to and was under the supervision of a physician. There are medicines, like Chantix, which purport to help quell cravings. It did not work for me when I took it for nicotine withdrawal. Apparently, it has worked for others for a variety of substances.

But the idea of a pill that prevents chronic relapse is ludicrous to me. But first, the issue of definitions.

Now. Not all problem drinkers are alcoholics. Not all alcoholics are the same, and what works for one may not work for another. Scientists and physicians tend to use particular and specific definitions for “abuse” and “dependency” which are, frankly, irrelevant to those of us in the trenches with “real” alcoholism. When I talk about alcoholism here, I am talking about a state far, far advanced compared with what meets the scientific thresholds for  “abuse” or “dependence”. Those definitions are so broad as to envelop huge numbers of drinkers who have no need for AA, or who are able to moderate or quit without outside assistance of any kind.

When I speak of alcoholism, I eschew the denotative definitions. In some ways, even having those definitions at all is counterproductive. We alcoholics, we can use any deviation from a medical definition we find to justify that we don’t have a problem. And any definition that does not allow us to wiggle out from under it will be too broad to be meaningful. The very existence of an attempt at a rigorous definition causes harm to alcoholics like me. And yet, without one, scientists and physicians cannot treat or study the disease.

Now, as I said before, medicines in the acute phases of withdrawal are perfectly appropriate. I had some awful cravings, and having those relieved would have been lovely. But a pill that could be taken long-term to prevent relapse in a chronic sense is absurd because it wouldn’t be treating anything. No one I’ve met or heard of with sobriety of a duration longer than a year says they continue to have cravings. No one I’ve met or heard of who has relapsed after long sobriety has said they did so because of cravings. Cravings exist in acute withdrawal, and then cease to exist. I haven’t had one since day 12.

People who relapse after long sobriety do so because, almost uniformly, they have stopped doing the things they need to do to maintain their sobriety. None of which have anything to do with alcohol, really. And if there were a pill that somehow – magic by today’s standards – prevented a person from taking another drink, they would still have to take that pill. We don’t relapse because we suddenly want alcohol. We relapse because we stop engaging with treatment. So any pill to prevent chronic relapse is almost by definition useless: it is treating something that doesn’t exist; and people who will assiduously take it don’t need it, because they already remain engaged with their sobriety.

The problem with addiction science is the same as its strength: it is focused on addiction. As such, medicine has done a wonderful job of treating the medical issues associated with cessation of substance abuse. Alcoholics used to die with alarming frequency while in acute withdrawal. Now, not so much. Thanks to science and medicine.

However, what addiction science and medicine cannot seem to accept is that treating my alcohol abuse and dependency was easily, far and away, by leaps and bounds, the least important part of my recovery. Alcohol is not my problem. I’m just addicted to it. That’s not really that big a deal. The big deal is that I am a person who likes to treat my discomfort with obliteration. Treating that required some enormous efforts, none of which were medical, or required medical intervention. And without which any attempt at treating my addiction to alcohol would have been futile, because I would not honestly engage with any treatment for my addiction to alcohol.

Barring some kind of childhood injection which fundamentally alters human responses to alcohol and/or misery, there will never be a cure for alcoholism based on science and medicine. Nor do we need one. Science and medicine have already done their heavy lifting, in my opinion. They have dramatically softened the course from active alcoholism to abstinence. But they continue to have nothing to say about sobriety. Alcoholics of the type that I am, which is a lot of us, cannot be maintained in sobriety  - that is, long-term, fruitful and happy abstinence – by science and medicine.

Those of us who do not want sobriety cannot be compelled to it. We can be compelled to abstinence, but those I know who have been down that road tell me it is worse that active alcoholism. There will be no triumph for the scientist who compels abstinence on unhappy alcoholics. That life is no better than drinking. And that path may actually cause great harm. Placing our sobriety in the hands of a physician gives us permission to fail: we can rationalize the failure to be someone else’s doing. Sobriety is emphatically not about will power. But we alcoholics often like to believe it is, so that we can blame our failures on frailty, or the failure of medicine to support our will. We will recruit anything at all to justify returning to alcohol.

And those of us who want and are willing to be sober have no need for science and medicine after the first initial detoxification. There is already a path to sobriety for us, and there is no way to make it easier by treating our addictions. Our addictions are not the problem. Our addictions are our perverse solutions to the disquiet in our selves. Treating that disquiet, daily and for the rest of our lives, is how we become sober, and happy, and free. It requires no medicine. No will power. Only willingness, and another alcoholic to talk to.

Early Recovery: What is Your Role?

22 July 2014

Yesterday I had a conversation with a new friend who knows someone newly in recovery. The alcoholic, sober six months, has asked my friend for a letter of recommendation. He needs this because he was terminated from his prior position for behaving badly while an active alcoholic. It is not entirely clear to me if his termination was in part explicitly due to drinking on the job (I think not), or if it was merely the result of the fruits of that tree (inappropriate behavior). Regardless, the dismissal happened, and alcoholism was in no small part a factor.

However, this alcoholic remains unwilling to allow future employers to be made aware of his condition, which my new friend feels might mitigate some of the negativity associated with his prior dismissal. Alcoholics in recovery are just like regular people, right? If the problem is addressed, then a new employer shouldn’t hold prior bad acts against an alcoholic, right? Or at least should consider the change in risk associated with recovery?

Well, maybe. That’s a question for another day. Today, I want to address what the roles of friends and family are when an alcoholic is in early recovery like this man is. First of all, six months is not a long time in recovery. Huge numbers of alcoholics flame out in the first year. Something like half of people who attempt abstinence fail in the first 30 days, and half of the remaining fail in the next 335. And that’s guessing generously. Far fewer than 25% of people who show up to AA one time are sober a year later.

Of course, far more people show up to AA once than have any intention of getting sober, and AA only works for people who are open, willing, and honest with themselves. But it is perfectly reasonable to be suspicious of six months of sobriety. Obviously, everyone’s experience is different, and the kind of program the person is working matters more than anything else, but at the population level, six months of sobriety does not necessarily instill confidence that a permanent change has taken place. But whether an alcoholic’s recovery is permanent or not is not for anyone to judge. We simply can’t know. Not even we alcoholics can know.

So, what is the answer to my friend’s question? Should the letter be written? And under what rules?

My answer to this is that each of us has the right to dictate our own involvement and preserve our autonomy. The alcoholic’s wish, that his condition not be reported to his new prospective employer, should be honored. If, that is, my friend chooses to write the letter at all. My friend has the right, completely and unambiguously, to say, “I would be willing to write the letter if I can be completely unfettered with regard to content. I am not willing to write a censored or expurgated letter. If you can accept that, then I will write the letter. If not, then I am not the person to write a letter for you.”

That is, we cannot control how anyone else behaves, and we can’t control how they feel or the (in our view) mistakes they make. We only get to decide what we can live with, and if we will participate in their designs or not. If my friend feels that the alcoholic is making a bad decision by not revealing the underlying cause of the behavior leading to his dismissal, then that’s as it is. People are free to make bad decisions. My friend can only decide how to engage, and guidelines under which a letter might be written.

Alcoholism has direct effects on people who don’t have it. In a way that is different from many other diseases. It wraps people up in codependencies that are toxic for everyone involved. And so friends and family of alcoholics often need their own recovery. They often need to understand how they’ve been seduced into enabling or reactivity. They may fear (even correctly!) that the alcoholic will die or suffer without their engagement.

Here is the truth: you have the right to let us suffer and die. You have the right to abandon us even in sobriety. You have the right to set boundaries and enforce them. In fact, I believe that doing these things helps us far more than enabling and engagement. Enabling us may help us stay clothed and housed and drunk. It may help us financially or medically. But it can also simply prolong a terrible death. Or buttress our own self-arranged misery. Even in sobriety, many of us choose the path of misery.

What is the role of the friends of alcoholics, when they enter early sobriety? Be supportive. Be compassionate. Be skeptical. And decide where your boundaries are. Stand by them. And if you are really close to an alcoholic, whether they are in recovery or not, consider a support group, like Alanon, for the friends and relatives of alcoholics. We visit misery on so many. Sometimes, some of us recover, and repair or attempt to repair the harms we’ve done. If you want to participate in that process, that’s wonderful. But you are not obliged to. You do not owe us anything.

Collecting Experiences

18 July 2014

Is the market truly choked with addiction memoirs? Can I cram one more salty snack into America’s slack-jawed gullet? I want to write a book. I want to write a book the same way I want to write a symphony. It’s not so much that I want to share something so much. It’s that I want, at the end of my life, to look back and be able to reflect on the experience of writing a book, and a symphony. Apparently, in the symphony’s case, I want it enough to write two-and-a-half movements. I wonder if I’d have the wherewithal to actually finish a book. Or if I’d end up with a half-finished block of paper.

When I write here, I sit down and write, generally with no agenda, and with little concern for quantity or quality. There’s no editing. There’s no investment. If what I write isn’t any good, well, it’s gone in a few days, down the memory hole. Sure, it’s still there to find for someone with some interest and intent, but for the most part, with the exception of a few posts of lingering interest, once something is off the front page, it’s gone forever.

And of course, books are the same way. It’s a rare exception that a book is of any interest longer than a few years, at the most. I have no illusions that I could end up writing a major work of lasting interest. Just like I have no hope of writing a great symphony that would be performed, well, ever. What I want is the experience. I’m a collector. I want to have had the experience of creating these things.

I wonder sometimes if I don’t look at my career the same way. I collect things. I collected degrees. I’ve now had the experience of publishing in reasonably well-respected academic journals. Of writing and being principal investigator of federal grants. Of conceiving science from idea to grant-writing to funding to research to result to publication. I’ve worked for famous institutions and been praised for my efforts there. I’m happy with that. Maybe soon it will be time for me to look for new experiences to collect, professionally.

I travel much the same way, collecting new countries. For the first time in a long time, my last (England), and next few trips will be to places I’ve been before. BB and I are going to return to Bermuda for a short vacation later this year. For our big trip next spring, we’re thinking of Europe. There aren’t many countries in Europe I haven’t been to. And I’m excited to go back, because it’s exciting to see things through new eyes, and because there is so much of so many countries that I haven’t seen, even if I have set foot to soil before.

So I want to write a book. I wonder if I will. I wonder what it would be about. There’s something so peculiar about trying to take a whole world of narrative and experience and inscribe it onto paper, where it can be neatly contained in strangely aperiodic inscriptions. Closed up and forgotten. A massive experience, translated to carefully arranged, dried-up pools of ink on a film of dead, pulverized cellulose.

But I don’t know how to write a book. And I don’t know how to sell one. Just like I don’t know much about symphonies. Chances are, my life’s published output will be a few dozen pages of journal articles. Which is great! I’m proud of those. But sometimes I think I’d like to write a book that people would read for the pleasure of reading, instead of to figure out how to improve their hospital.


17 July 2014

I have opinions on things. They’re often not particularly well-informed. I have gut feelings that I often run with. On a regular basis I find that they lead me to cul-de-sacs where I am trying to defend a position I no longer believe in. I usually speak before thinking. I usually think before listening. I put the process of developing my opinions backwards. The result is something unformed and poorly constructed.

I get excited about things. I move too quickly and ignore reservations and bad feelings. That’s how I ended up with a house with horrible plumbing problems. I didn’t feel right but I ploughed ahead because I was excited unaccountably. It’s happened many times in my life: I decide I want something, I go forward and invest in it, and end up with something I wouldn’t have gotten if I’d studied before acting. This has cost me money and time and effort repeatedly in my life.

I like to feel important. It’s a failing of mine. I want people to admire me and my work and my efforts, and not challenge me too strenuously. Whenever I make a step forward, I want to feel like it will get me more recognition and respect. When it doesn’t, I feel sullen and ignored. I’m always excited when I publish a new paper that I’ll get lots of citations and be vaulted to a place of prominence in my field. It hasn’t happened. When I started my expressly academic blog over at Scientopia I fantasized it would lead to immediate prominence as a science blogger. Of course that’s absurd – but fantasy doesn’t respond to realism.

I’m still me. I’m still just a mediocre engineer toiling away doing useful-but-uninspiring work. And that’s fine. I’m happy to be that guy. I’m good at being that guy. What I struggle with is knowing what’s appropriate ambition and what’s stupid fantasy of personal glory. I will do better without personal glory.

Personal glory is often toxic to alcoholics. As we see ourselves profiting from our own efforts, we start to believe we control our destinies. When we feel in charge, in control, invulnerable, we start to make decisions on our own. We alcoholics are not good at making decisions. We tend to decide to do deplorable destructive things to ourselves and others. When we try to operate in the world under our own power and process, we end up drunk, and dying.

I’m grateful that I have a framework for my life now. I’m glad I don’t have to keep relying on my own wretched insight and opinion. I’m glad I don’t have to be a warrior. I’m glad I don’t have to try to insist that my opinion is the only opinion. It’s exhausting to have to be right all the time. It’s exhausting to need to have others embrace my rightness. I spent so long fighting. I’m so grateful to be done.

I still advance too many opinions. The right thing for me to do would be to simply follow the advice in the book Alcoholics Anonymous: “We have ceased fighting anyone and anything.”, and “We have no opinion on outside issues.” It would be better for me, for my serenity and my development, to simply abandon the pretense that my ideas – about anything – are important enough to try to promulgate them. That is vanity, and I am vain.

I don’t have much of relevance to say about academia. I’m not a real academic. I don’t have much of relevance to say about the culture wars. I’ve never been marginalized. I really only know three things well enough to talk about them with any kind of impact: complex systems, health care delivery, and alcoholism. Beyond that, all I can do is bray.

Masculinity, Sensitivity, and Second Wave Privilege.

14 July 2014

I am frankly daunted even beginning to write about this topic. Sometimes I feel like it is audacity, these days, to suggest that masculinity has intrinsic value. Indeed, every time I write about masculinity my elder sister asks how anything I write is unique to maleness, and separate from simple adulthood. I don’t know that I have a better answer today than I ever have before. Certain aspects of my self, and of the male personages I admire as an adult man working his way through the world feel masculine to me, in a way that is apparently inexpressibly male. Maleness is different from femaleness in ways that I am unqualified to distinguish empirically, but perfectly capable of identifying in practice. I fall onto the capable rhetoric of Potter Stewart: I know it when I see it.

Oddly though, we collectively seem to have no difficulty identifying those negative characteristics of maleness we’d like to correct. Pointless aggression. Sexual malfeasances. Patriarchal power systems. Ruthlessness. The things that we abjure as toxic and rancid. I wish we knew as much about the male character that we would like to foster and support. I hear a great deal about what not to do as a man. I hear far less about how to embrace productive masculinity.

When I do hear about it, it is often presented as if it is a new concept: a new way to be a man, divorced from our vicious and rapacious history. I don’t believe that masculinity has ever been unrelentingly toxic. I think that there are and have been great examples of positive masculinity throughout history, and I believe good men are more common than bad ones. I also believe that while we have come far, in the west, toward better justice, we have much farther still to go. I believe that cultural changes are massively complex – the gears of a cultural machine grind slow but finely - and that they begin with individuals changing themselves.

And of course, nothing I write about men here should be taken to imply that women are or are not similar/different. I have less to write about how women are, because I’ve never been one. Because others know more and write better on the topic. And because the point of this essay is to try to explore masculinity in and of itself, rather than as a reaction, a reflection, or a complement to femininity (whatever that might mean in its many different incarnations).

I spent a long time feeling like a lost boy. I had no male role models. My father left long before my own maleness bloomed within me, and the men in near proximity to me while mine did were either predators or baffled in their own rights. I was raised by a single mother. I had two sisters and a much younger brother. I remember being passionately lonely for a man to teach me how to be a man. I went through a phase in junior high school during which, when I saw a sports hero or actor do something impressive or admirable, I would say, “Dude, that guy’s my dad.”

I feared my sexual urges enormously, so I repressed them. The structure and balance I needed, unprovided by a father, I found in the church. I became very religious, seeking some way of explaining a world I couldn’t confront without anger or confusion. I think we all have anger and confusion as we grow into our engagement with the world. With no effective father, I was left without answers for the young man emerging. I dreamed of joining the military, which I believed to be a place where men congregated to be men, with structure and discipline.

Instead, I retreated from the world. I collapsed emotionally, believing that men suffered in silence and stoic resolve. To be a man meant ploughing whatever trench must next be excavated to endure in the world another dread day. The harder the path, the greater the man who ground his way along it. I saw masculinity as exclusively a response to adversity. Toil in misery. And yet, I did not toil. I shrank into sedentism and alcohol and doughy, blank, insignificance.

It took women to set me on my path to being a man. First, it took a woman I desired recognizing that within me was something small and hurting. It took her willingness to see that, and to offer me something that she could give me, rather than the thing I wanted, which she could not. She gave me a phone number for a therapist. Another woman. Brilliant and penetrating. And for many thankless years, this woman endured my childish agonies while slowly guiding me into a place where I could embrace my own masculinity, in my own time. It took my sisters, relentlessly correcting my childishness and proto-masculine posturing.

And of course, it took my mother. I could fill books about my mother, and she frankly deserves a book or two. She used to say, “I have always been a better father than a mother.” I don’t really know what that means. I think she means it because her own father was an imperious magister, while her mother was a drunken and vicious harpy. She idolized her father, and the tales of my grandfather’s glories remain the puffed-up stuff of legend in my family. But my mother was ambitious and incredibly gifted. She captained the family, provider and nurturer (such as it was) both, and showed me what personal and professional success looked like. As well as showing me innumerable and specific things I wanted never to be.

I am privileged in many, many ways. Born white, and male, and healthy, and wealthy, I have not suffered much that wasn’t related to my mental illnesses. And I have recovered from those illnesses, I am sure, in no small part because I had resources and benefits that people with lower levels of privilege do not have. I recognize all that and I’m grateful for it. But I also have a kind of second-wave privilege. I was raised by an educated and successful woman. She was always in charge, and she set me onto a path of success in life. My sisters provided me with up-close examples of women navigating the same course. I have, as a result, never felt threatened by women with authority. That is its own privilege today. I have less railing with the future to do than many men who are not comfortable with a society that embraces equity.

I think that many men fear that as the world adopts a fairer structure, and embraces new paths and identities for women, that we will lose opportunity and authority and privilege. And we may, collectively. And that’s quite alright. There’s nothing about being male that means we must also be in charge. But as the world changes, we do not need to lose our internal essences. We do not need to abandon that which makes us feel like men.

In Alcoholics Anonymous, I have learned more about productive masculinity than ever before. Men helping men. Men being open and honest about struggles. Men showing what it means to trudge those difficult roads and dig those awful trenches. But not in isolation. Not alone. Men among men, shouldering loads together. Discovering that most of the burdens we bear we do so from choice. That we can band together to achieve what we cannot accomplish alone. That we can be sensitive to our needs and feelings and still admire each other’s strength and courage.

I drive forward in life. But I can now recognize that sometimes moving forward in the long game means relenting, stepping back, and finding a new way. I want to achieve things, personally, that bring me praise and reward. But garnering those while holding back anyone else invalidates the pleasure I get from it. I no longer fear my own masculine nature, and I don’t despise my ambition and my aggression. But I temper personal satisfaction in order to have others in my life willing to share it.

What I once thought was masculinity was a horrible mixture of selfishness, depression, self-loathing, tantrum, gluttony, and avarice. Today I understand it in a new way. Ambition, introspection, desire, courage, and resolve. These are positive things – no, not exclusive to men in any way – that I nevertheless experience, in myself and in other men, in a way that allows me to embrace my own masculinity in a way that attempts to enrich others, not degrade them. In a way that aspires to use the assets of manhood to improve my community, my relationships, and yes, my self.

How men, in aggregate, behave has to change. But there is nothing about masculinity, of itself, that needs be domineering or arrogant or rapacious. We can be men, and be good stewards.


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