You Don’t Have to Care.
There is growing compassion for those suffering from mental illness, and that’s a good thing. Addicts are recognized as sick, the depressed are recognized as suffering, those with other pernicious disorders are recognized as needing medical attention rather than scorn. All of this is good, and valuable, and likely to improve the lives not only of the mentally ill, but also of those who love them and care for them. I enthusiastically endorse addressing mental illness with compassion, medical evidence, and, in the case of addiction, 12 step programs.
That said, you don’t have to care. Mental illnesses take incredible tolls on the lives of those other than the sufferer. The two mental illnesses I’ve suffered from – and been diagnosed by trained professionals with – alcoholism and depression, are particularly egregious in the profound damage they do to people who are not alcoholics, and who are not depressed. I have less to say specifically about depression because my own depression has always been subordinate to my alcoholism, and treating my alcoholism will, for the most part, treat my depression as well. But alcoholism, it feeds off of the compassion of others.
Alcoholics are, by our nature, users and avoiders. We are assailed by difficult emotions (who isn’t?!) that we don’t know how to process, and generally have few tools to address. Alcohol is how we treat the condition that we find intolerable: feeling. We hate feeling. We love being drunk. Drinking quells the feelings. It has the added incentive of appealing intoxication. But it also prevents us from functioning in society. As things get worse, we cannot work, or manage our affairs. So we often latch on to people who will manage these things for us.
These people start as loving companions. Very rapidly they become crutches. Then simply tools that we use to keep drinking. We will attempt to inflame their compassion, their guilt, in order to keep using them. We’ll accuse them of being the source of our problems, so that they will stay and attempt to rectify this imaginary wrongdoing. We inveigle ourselves into their graces, we turn the good things about them, their empathy and their magnanimity, into grim obligations to care for us as we spiral into deeper addiction and depression.
You don’t have to care. Alcoholics are, by our natures, abusers. We abuse substances, and we abuse people. Anything that allows us to keep indulging in our addiction we will drain of every last ounce of strength and will. And then, when you are empty, we will rage against you and accuse you of failing us, of hating us, of abusing us. We do this in order to maintain access to what we need from you to keep drinking. This is our illness, that we will raze everything good in our lives to return to the succor of the bottle.
You don’t have to care. Yes, we are sick. Yes, it’s an illness. But it is an illness that has as one of its symptoms the ruthless consumption of other people. And you have the right to say: “I will not participate in your illness.” Because all your compassion for the drunk in your life does is help them stay sick. Withdrawing your aid may not help them get better. But emotional investment in an active alcoholic, and especially material investment in an active alcoholic, only helps them stay sick.
It is perfectly acceptable to walk away from a drunk. Your husband, your wife, your parent, your child. Your business partner, your best friend. Your priest. You don’t owe us the sacrifice of your sanity or your finances or your time or your trouble. Because we will use it all and then demand more. And we will lay the blame for our abuse squarely on your head.
Mental illness is so difficult to treat because all too frequently one of the symptoms of the disease is treatment avoidance. This is true with addiction, and in many cases with depression, and I presume also with many other afflictions. But just because this is a legitimate illness doesn’t mean that you have to participate in our self-destruction. You don’t have to care. And refusing to participate in our illness may, possibly, help us finally reach out for help to recover, rather than the help we’ve been demanding from you: help to stay sick.
Or it may not. We may find others to assist us in our disease. When your compassion is withdrawn, we may well simply move on to someone else. We throw people away like that.
But you don’t have to care. You are allowed to have all the full real life you deserve. You don’t have to waste your energy and vitality and hope and compassion on us. We are sick, yes. But we are abusers. And until we find recovery not only from our addiction but also from our tendency to use and discard those who we can convince to care for us, you owe us nothing. And once we have recovered from those things, we’ll demand nothing. Our demands are the voice of our disease. You have the right to ignore them guiltlessly.
PI Anxiety.
I’m in the process of hiring two student interns for my project here at MECMC. It’s a simulation study of one of our so-called luminary programs. One of the things that we do here more, and better, than any other hospital in the world. It’s really exciting to be a part of it. It’s humbling and gratifying and satisfying and terrifying all at the same time that they’re telling me, “Here is the finest program of its kind in the world. Make it better.” Well, gulp.
First, I have to hire some students. I’ll be calling three or four for interviews on Thursday. I have a number of VERY impressive resumes. But I’ve never hired anyone before. My previous funded grants were either small enough that they only paid my salary, or bought time from people already employed in my department, or were aimed at equipment and software. This is the first time I’m going out and finding people and asking them to come work for me for money. So I’m asking out there: how do you hire minions?
I need this to go well if I’m going to convince my office to let me pursue other and bigger grants. When I was a drunk, just graduating, I told people that I had no interest in academics or writing papers. And I didn’t. I wanted to be a consultant, in business for myself, and make lots of money. I rapidly discovered that it wasn’t that easy. Especially drinking the way I did. I was setting myself up for total disaster. And, arguably, I suffered that disaster, being unemployed for two years and then shipping off to alcohol rehab. Of course, it was the doorway to a new life.
A life in which I am, against all odds, a modestly successful academic. I have a couple of papers in a few basically decent journals. I’ve won a couple of moderately-sized grants. I wouldn’t make tenure anywhere. But my CV needn’t be printed on toilet paper, either.
And of course, I’m not a real academic. My academic title is “Adjunct Assistant Professor” at an institution I no longer have any real affiliation with, and do not expect to again (it expires next June 30). I’m hoping to get a new appointment at VFU or another of ECC’s large number of excellent schools somehow in the next year. We’ll see. It feels like an achievable but ambitious goal. One probably strongly associated with my ability to perform well on this grant, which was funded by VFU’s medical school and business school in a joint venture. I think there’s a reasonable chance I can offer to teach a course on simulation or operations research and get an adjunct position.
Why do I want it? I’m arrogant. I’m self-aggrandizing. I look around at my friends on twitter with great positions and impressive bibliographies and I feel ashamed of myself. I get a case of the “if-onlies”. If only I hadn’t been an alcoholic. I’d remember my math. I wouldn’t have wasted a decade of my life doing essentially nothing of value. I wouldn’t have abandoned my ambition for so long. If only I’d… been better. Smarter. If only I’d made better decisions.
But what then? Would I be any happier? I doubt it. I admit to shallowness. But I don’t think I’d be any happier in my personal life if I’d barged through academia the way it kind of looked like I would when I was a young graduate student. My life is fantastic today. I’m just perpetually unsatisfied that I don’t have what I look at in others and think I want.
From the outside, what other people have is always compelling. Prestige, Impact. But I can’t know how those people who I envy and admire feel unless they tell me. And those who do have told me the same stories everyone tells. Work is hard and stressful. Anxiety provoking. Having more or fancier publications, and more grant money may make your life a little easier, but it doesn’t make you happier in the aggregate. Life is life. It’s hard.
Trying to set aside my expectations for myself, my regrets about my wasted third decade, and my envy of others is a constant battle for me. I did some good work in my fourth decade, and I feel ready, as I look forward, to do something of value as I continue on. If I can figure out how to hire and train these students. If I can just keep from wasting their time.
Testing the Podcast Waters?
You may not know that I’ve already recorded a couple of simple podcasts. I will add to the offerings there as I speak at more AA meetings. But I’m also interested in doing a series of podcasts on alcoholism and addiction. I’m not entirely sure what it would entail yet, but I’m imagining recording a discussion with an addiction researcher, perhaps in a gchat format, in order to ask:
(1) What is the current state of addiction research?
(2) What does your research address?
(3) Why do you think there’s a gulf between research, treatment, and recovery?
(4) How can we translate addiction research to improved outcomes?
(5) How should we measure recovery?
I’d also like to talk to other addicts in recovery. What worked for you? How do you feel about efforts to build an evidence-base for addiction treatment? AA members often dismiss scientific efforts to approach addiction; why is this? And I’d like to talk to others whose lives are affected by addicts and alcoholics. How does addiction affect you?
So, if you’re a regular reader, please tell me, does this interest you? Would you listen to or watch a discussion of this kind? If you’re an addiction researcher, would you participate in a podcast like this? Would you consent to an on-the-record but casual and supportive interview about your science and the state of addiction research? If you’re in recovery, or if you are a family member or friend of someone with this disease (whether they’re in recovery or not), would you come on and talk about your experience, strength, and hope? Would you discuss what you think about systematic investigations of addiction?
I’m just taking the temperature here. Not sure anything will come of it. But I’d like to know what people think.
A Look Around.
One thing we do in AA is take regular stock of ourselves. Essentially, this is the work done for the tenth step, which states, “Continued to take personal inventory, and when we were wrong, promptly admitted it.” Now, I’m certainly wrong a lot. And my admission of such is often less than prompt. But today, at this moment, I feel like I’m in pretty good standing. The people I owe amends to have been offered them. The mistakes I’ve made have been acknowledged. There’s nothing sitting on my chest, inhibiting my free respiration. I have no doubt that this is a temporary condition. But it’s current, and that’s peaceful.
But the tenth step is bigger than simply making sure that we make amends for wrongs we commit in sobriety. Being an alcoholic means taking constant measure of our emotional and spiritual condition (whatever that means to each of us). Making corrections when we’re out of sorts. I feel like, even though I didn’t make note of it at the time, my recent pause in twittering was tenth-step work. I was feeling off kilter with how I was behaving. I needed to step back, reinforce some of my boundaries for myself, and then reengage when I was ready to act in a way that I found acceptable for myself.
The tenth step is about keeping track of who we are, where we are, and what we’re doing. Maintaining ourselves, deeply rooted in good earth, so that we can be at peace and of use to others. It’s about taking a look around. Being aware of what’s happening within and without. If I notice basic trends about where my mood is going, I can make sure I am centered, and I can take advantage of opportunities. It’s as much about capitalizing on good things as it is on forestalling bad things. Insofar as “good” and “bad” even make sense to an alcoholic in recovery. It’s all just stuff that happens. Obviously, I prefer some things to other things, but all in all, life happens and I face it as best I can regardless of the hand I’m dealt.
But these days, I gotta say, I’ve been dealt an pretty amazingly good hand. The job is going well. I had an informal evaluation last week, and I have a formal one next month. But all indications are that the structure above me is very pleased with my work. I have two papers submitted to big-name glamour journals right now. One is under review, and the other I’m trying to convince the editor to send it out for review (It came back “rejected unless you can convince me to send it out”. I did my best.). I feel reasonably confident that I’ve done good work with the one that’s out for review; this is the first paper I’ve written for MECMC. It would be great to get into a venerable journal right off the bat.
My relationship is going incredibly well. Despite the distance, I am feeling very connected. I don’t know what the future holds, obviously. But I’m trying to let go of expectations about the future and just enjoy this moment. The moment is good. I’m open to the future. But I will not try to control it.
I am falling in love with ECC. It’s a gorgeous city with incredible arts and food and institutions. I’m looking for a condo now, and I’ve discovered that there are several in decent locations that I can afford. I’ll be in a smaller space than I’ve been used to. Square footage in ECC is at a much higher premium than it was in St. Louis. But I’ll have my own place. Condo financing is astonishingly complex. Sometimes the homeowner’s association fee includes taxes and utilities, sometimes not, etc.. Figuring out what I can afford is very complicated.
But it’s exciting. Life is exciting. I am sober. And reasonably sane. And very, very happy. I will do whatever I can to enjoy this now, accept the life I have been granted. And when things change, and difficulties arise, I will try to face them with acceptance as well. Life happens. Life is happening. And here I am in the middle of it.
My Letters to US Airways.
Dear USAir,
I was scheduled to fly on flight [XXXX] from [XXX] to [XXX] on June 2, 2013.
My flight was cancelled due to the inability to get the aircraft to
[XXX] (and not the weather, according to your email.). As a
result, I was rescheduled some 5 hours earlier on [XXXX]. Which was
promptly cancelled. Then, I was rescheduled on [XXXX], which was delayed
about two hours. As a result, I was deprived of several hours I could
have spent in the arms of my lover, [girlfriend], whom I had traveled to
[XXX] to see. Hours which, because of your inability to provide
me with the travel arrangements I had purchased, are now lost to me
entirely. Hours spent in the dry, institutional, impersonal confines
of [an airport], and not in the vitalizing embrace of my darling
companion. Nothing can restore that time to me, it is vapor and
unrealized memory. However, the dignified thing for you to do would be
to provide me with a flight voucher so that I could see her in [XXX]
on an upcoming weekend. Allowing me to restore to rightness the sense,
if not the facts, of the past. Please follow your conscience. You know
the right path.
Sincerely,
Dr. 24Hours.
Dear Dr. 24Hours:
Thank you for writing to Customer Relations. I’m so sorry your
experience with US was disappointing.
Based on your email I know the cancellation and further delay of your
flight to [XXX] was disappointing. Our records show Flights
[XXXX] and [XXXX] were cancelled and Flight [XXXX] was delayed all due to
Air Traffic Control for safety reasons. Because the cancellations and
further delay were not within our control, no compensation is due.
Dr. 24Hours, we appreciate the time you took to contact us regarding this
matter. Above all, we appreciate your business and look forward to
serving you on a future US Airways flight.
Sincerely,
[redacted]
Representative, Customer Relations
US Airways Corporate Office
Dear [redacted],
While I doubt that you are incorrect on the law (though, your first
email to me regarding the cancellation of [XXXX] did not indicate
anything about weather or safety. I quote: “The aircraft is
unavailable because of a prior cancellation due to air traffic
congestion.”), and you may not – legally – owe me recompense, this is
a perplexing customer relations decision.
I travel between [XXX] and [XXX] several times a month, as
does my previously mentioned lover, the incomparable [girlfriend]. We have
many options for travel. Road, rail, and air all provide us with
convenient avenues to join together that which circumstance has
sundered. We will not be thwarted! The many flight options the US
Airways offers makes you an otherwise attractive option. Your rates
are competitive. But your service is unreliable. Is there anything
worse that believing you are to be reunited with the love from whom
you are cruelly separated, only to have those hopes dashed as ashes
from a cup by the sterile and uncaring brutality of an airline without
regard for the desires, the demands, of love?
I implore you, as a man with the same desire in his heart for his
lover as you must have felt in yours, make right your error. Be the
beacon on the hill. Rather than grasping fruitlessly at the two
hundred dollars I spent on the last passage that went wrong, think of
storing up the favor for all the bookings I’ll make in the future!
Then, when my mind turns, as it so often does, to the fevered dreams
of my lover’s embrace, where will I turn? Amtrak? With its six hour
trips? Rental cars? Or shall I aim my browser at the reservation page
for US Airways, with its nineteen flights per day?
You, [redacted], have the power to secure my loyalty. Reunite me
with my love! Be not dulled by the grey apathy of indifferent
corporate policy (A cruel word; a ruthless word.). Grant me a voucher.
And you will win my admiration, besides.
In undimmed hopefulness,
Dr. 24Hours
*****PHONE CALL***********
Dear Dr. 24Hours:
Thank you for taking the time to speak with me today.
I understand that a flight cancellation of any nature will affect your
impression of an airline. Because the decisions made by Air Traffic
Control are not, in any way, under the control of the airline, we do
not offer compensation.
When your flight is canceled by the ATC, safety is always the number
one priority. There are simply some situations such as weather or
conditions at the station, that are out of the airline’s control, that
cause flights to be held back from the original departure time.
All airlines must adhere to the instructions given by the airport’s
traffic tower. We realize the cancellation of your flight was a
frustrating situation; however, the flight was cancelled in
conjunction with airport conditions and information from the airport
tower.
Again, we apologize for the difficulties you encountered. We value
your business and are working hard to earn your continued patronage.
We hope you will give us the opportunity to do so.
Sincerely,
[redacted]
Representative, Customer Relations
US Airways Corporate Office
Dear [redacted],
I apologize that your call caught me by surprise, and I wasn’t in a
position to respond with the clarity of thought or presence of mind
I’ve come to expect of myself. For that, I am deeply sorry. I am
grateful to have received your call and explanation. I suppose that
you must reach out to many intemperate travelers, and I hope that your
experience speaking to me was among the least unpleasant.
I suppose the issue at hand in this experience, for me, is not that
I feel US Airways has done anything wrong. I’m convinced you’ve
conducted yourselves according to industry standards and within the
scope of the law and basic opprobrium. What perplexes me is that the
industry standard is so brutally indifferent to the carnival of
agonies fomented in the breast when travel – by whatever misfortune –
goes awry.
We, your customers (a word once pendulous with respect), have
invested our money and our time in your services. But more, we have
invested our hopes and aspirations, our goals and even lives with you.
In my own case, I entrust you with the delivery of own glass heart,
fragile and enraptured, into the beckoning embrace of my beloved
[girlfriend]. I do not transact with you out of vague necessity or caprice.
I do so for feverish dreams of liquid bliss, relying upon you to be
the chariot by which I am borne to the lofted spires of romance.
I concede, before you protest, that you cannot offer vouchers to
every traveler waylaid by weather and air traffic control. To do so
would surely rupture the already hard-straining membranes of your
purse. But surely, surely there is, printed somewhere among the cruel
lines of meticulous by-law, some dispensation by which you may
unclutch the skeletal hand of the miser from the throat of the bereft?
Once?
If there is not, then truly, you deserve my pity more than I do yours.
Very sincerely,
Dr. 24Hours
****************************************************************
I fear I will never see satisfaction.
Scientific Conceit Revisited.
One of my more popular posts has been on Scientific Conceit. Recently the issue has been popping up again on the twitter-place. A scientist was saddened to learn that her post-doc had taken a position outside of science, apparently at least in part so that she could go live in another city with her significant other. This was described as a “waste”. Not too long ago, when one of my friends tweeted about relaxing on the weekend, a drive-by scientist snarkily commented that it was surprising a scientist had any time off. Also making the rounds is a piece on Scientific American about getting tenure at Harvard while working reasonable hours and raising children, which to me reads more like bragging than a how-to.
There is a fundamental myopia in academia and science. The idea that the only success for a scientist, for an academic, is as a tenure-track professor at a major research university. And there is derision and contempt for those who make other choices. Frankly, the only place I’ve seen it rivaled for passive-aggressive condemnation of others’ choices is the so-called “Mommy Wars”. Nowhere else in life that I’ve found are people so eager to tell other people that they are failures, wastes, also-rans, and has-beens.
Now, I’ve never been on the tenure-track, so I don’t know what the supposed benefits are other than intangible prestige. But nearly everyone I know who is has significant dissatisfaction with broad swaths of the job description. whether teaching, grantsmanship, publishing, administration, or a combination, I don’t know anyone who comes across as simply satisfied with being on the tenure-track. I could be wrong. I hope that if I am, people will comment about their satisfaction level here.
But here’s what I know. I have been a professional scientist/engineer, responsible for grant-writing and publishing in an academic setting. I ended up doing precious little actual science. Most of my time was consumed writing more grants. And most of the people I know spend most of their time writing grants. It’s rewarding to win a grant. Hell, it’s thrilling and exciting and wonderful and being able to say that I have been a federally-funded principal investigator is something I’m proud of and conceited about. But all it really got me was the opportunity to write more grants.
I know that the difference between successful scientists and unsuccessful scientists, when comparing those who make the tenure-track or equivalent position, is down to simple luck. Everyone in a position to submit a grant application as PI is good. Those that are funded are those which happen to find sympathetic reviewers, or those in a position of privilege. We all have a tendency to think of our successes as deserved. But it’s been proven over and over again that we take internal credit for luck as if it were skill. I’m no better than someone I “beat out” for a grant. I’m just lucky. I’m lucky that I happened to study something currently fundable. I’m lucky that I got reviewers who understood or were intrigued by my topic.
I’m unlucky that I had an administration that was actively hostile toward research. With another round of submission, I firmly believe based on my last score that I would be funded. I was lucky that I got well reviewed and had a constructive review to respond to. But my administration decided they weren’t interested in supporting my department and so off I went. Where I’ve landed I’m far, far better positioned that I would be in any purely academic post. I get to do applied research and contribute to the literature while not subject to the vagaries of grant-review.
As for “wasting” talent? I get it. I do. Suppose the person were a brilliant concert pianist, and left music to go work in another field. I can see her teacher thinking she’d “wasted” her talent. But here’s the deal: we all get to choose how we pursue our own lives. And telling people that they’re wasting their talent, or failures for not going on to the tenure track, or because they weren’t lucky in grant review? That’s plain viciousness. It’s an attempt to raise one’s self by denigrating people arbitrarily choosen to be considered “less than”.
I’m going to go further: it is easier to be a productive scientist and make an important contribution outside of traditional academia. Universities have become so parasitic to grant money that federal budgets are thoroughly insufficient to support the volume of scientists we have capable of making good contributions. And universities are uninterested in footing part of the bill. As a result, fine scientists cannot participate, and those that are lucky enough to succeed spend the majority of their time writing applications rather than doing science.
In industry, a scientist can make important and direct contributions without being slave to grant funding. Academics often claim that industry scientists don’t get to work on their own ideas. But neither do academics. Everyone has to work on an idea that someone with money is interested in supporting. If you’re lucky enough that your ideas are in the funding agency’s wheelhouse, you’re lucky indeed. Otherwise, you have to change your focus. The only thing that academia offers that industry (often) doesn’t is publishing. We all claim that it’s all about the science. Bullshit. We want credit and fame and respect. Me too. Why do you think I insisted on being able to publish in my current position?
Academia is run by cannibals. At every level. Administrators feed on scientists. Established scientists feed on pipeline youngsters. It doesn’t have to be this way. But it won’t change until people demand that the culture changes, the funding changes, the pipeline changes. Until then, it will continue to be an extractive system, churning though people. Consuming and regurgitating some, turning others into the monsters they decry.
If you want to do great science, stay in academia through a post-doc and then get the hell out.
Job Creation.
I’ve decided to take a proactive approach to getting people like me hired at other hospitals. I’m doing this for several reasons. First, I think I do good work, and that my field is relevant and valuable to the industry of health care delivery. Second, if I ever decide to leave MECMC, I want there to be positions available for me to take. I have some published success at what I do. But being good at something that there’s no market for isn’t necessarily valuable.
So I’ve decided that I’m going to try to improve the market. I’m writing a paper for the Healthcare Quality literature on how to employ the kind of computer modeling I do, and incorporate people like me into the quality improvement department. A straightforward how-to paper: what is a healthcare delivery simulationist? Where should they fit in the hospital? What does project management look like? What is development and what is deployment of simulations?
I love science, and the academic aspects of my work. But I am, at my heart, an engineer. And I’ve never been gifted at academic rigor when it comes to the science side of my work. But I am good at building a model and figuring out how to make systems work better than they do. From an engineering point-of-view, a lot of the academic work in my field is done. We know how to build models and validate them. People often do it badly, but that’s not from lack of humanity’s understanding of the field, rather simply from that individual’s lack of education or diligence.
My goal is to provide a road-map for how to incorporate my kind of work, and a brief illustration of the value of such work. Ideally, the sorts of people who read the quality literature (often physicians with administrative responsibilities) will decide that their hospital can use a person like me to help them test improvements and develop simulations. The more institutions engaging such efforts, the more health care delivery is streamlined. And, in a perfect world, the more places I could theoretically work if I ever did want to move on (though, great jiggling friar-bellies do I love it here!).
I have no illusions that my one paper, if published, will single-handedly change the approach to quality improvement in any measurable way. But I think that, given that the technology I use is growing, and that there is a significant presence for it in a number of journals and conferences, a paper detailing how to make institutional use of such an asset, instead of just “here’s a technology with potential”, might influence a director or two to pull the trigger on hiring.
But of course, I’ll never know. In fact, except in rare circumstances, do we ever really get to know the impact of our work at all?
Doing the Research.
I’m guessing that today’s title means very different things to my readers who are academics vs. my readers who are alcoholics. I’m here to talk about the latter sort. Though it springs from a conversation I had with Drugmonkey and Dirk57, who are academics. And Drugmonkey researches addiction, and Dirk57 is also in recovery. So these lines are fairly blurred. It’s a crazy world we have online.
In AA, when we talk about “doing research”, we mean drinking. And of course, also, often doing drugs. There used to be a serious conflict in AA between the pure drinkers and the drug user/drinkers. In some places people will still “apologize” when telling their stories, and say: “I know this is AA, but drugs are a part of my story.” There was once, apparently, a big split between AA and NA, because some people who are addicted to drugs seem to be able to continue to drink normally. AA said they couldn’t be members. A desire to stop drinking is the only requirement. The drug addicts seeking recovery said, “Aren’t we all brothers in addiction?” A rift happened. There are still places where NA meetings include a statement, “We do not discuss other anonymous fellowships.”
I do feel strongly that people who can drink normally, and have no desire to stop drinking alcohol, should not be welcome at closed meetings. More than welcome at open ones. But closed meetings are for alcoholics. And if you can drink normally, and intend to continue doing so, you don’t belong there. I’ve written about my personal experience with this before. But none of this is what this post is about.
The conversation on twitter began when I was asked “how many times it takes for rehab to stick.” The question was tongue in cheek, and there’s no answer. Sometimes it happens right away. For others? Well, I’ve known people who went to rehab 16 times. Sometimes they eventually sober up. Sometimes they don’t. I commented that I suspect there’s a difference in outcomes between people sent to rehab, vs. people who seek it out of their own accord. This led to a discussion of what it means to be “ready” to recover.
Drugmonkey commented that AA seems to put a lot of stock in that. And we do. Though we certainly don’t claim to be able to discern who is and who isn’t ready. And it is really easy to go back after the fact and declare that a person must’ve been ready because this time it “took”. But the truth is, we simply don’t know what makes recovery solidify in one person and not in another. Anecdotally, and as it says in the Big Book, we rarely see people fail that thoroughly follow the path. That is, who get sponsors, go to meetings, and do the steps. Those people seem to have very high rates of recovery.
But most people don’t take those steps. Most people don’t continue to go to meetings. Most people don’t get sponsors. And most people don’t recover. So which is it? Is it that those who take the steps recover? Or is it that those who have some intrinsic capacity for recovery take the steps? If the latter, it would seem to me that we’d see these people everywhere. They’d recover in other ways, if they had some intrinsic means. I don’t know of many people who just give up alcoholic drinking with no program. But I do know of some. If the former, then is there some way of getting people to engage with the steps more thoroughly?
In AA, more people seem to take the attitude that what leads to recovery is honest and willing engagement with the program, and with God, or some higher power (usually God). Now, I’m of the camp that does not believe that God magically comes down and cures some alcoholics but not others. But I do believe that faith can be a powerful tool for recovery. But faith alone is not enough. Or we’d see the recovered in churches and synagogues and mosques, and they wouldn’t need AA or rehab. But we don’t. At least, not many.
When a person comes to AA and doesn’t do the steps, and doesn’t get a sponsor, and then goes back out to drink, we do often kind of shake our heads and say, “I guess they needed to do more research.” Meaning, they haven’t learned enough about their powerlessness over alcohol to do the work to recover. Many people come in to AA believing they’ll find a way to defeat their addiction. Either defeat it and return to normal drinking, or defeat it and be abstinent through victory over disease. It doesn’t work that way.
And sometimes, sponsors will use the “research” angle to try to motivate a recalcitrant sponsee. I’ve done that. I had a sponsee tell me that he couldn’t do the steps because he didn’t believe he had a real problem with alcohol; if his girlfriend came back to him, then he would be able to drink normally. I laughed. Out loud. I told him, “Really? Did you drink normally when you were with her? Or did you bail on her five nights a week to get drunk and smoke crack? Even after she told you she’d dump you if you did it again?”
That sponsee never wanted to do the work. He just wanted to fight with me about his problem and insist that alcohol wasn’t his issue. “I’m not even thinking about alcohol! I don’t miss it one bit! Why shouldn’t I go get a six pack?” Eventually, I told him to feel free. Some one who is miserable, refusing to do the work, embittered, and combative is not getting anything out of the program. I told him, “If you really want to drink, and you don’t think alcohol is your problem, then go drink. You’ll either be ok, or you’ll suffer worse consequences. I just hope you don’t kill anyone while you’re driving around drunk and high. But you’re probably going to end up dead or in jail.”
He needed to do more research. Nothing I could do would make him see that his problem was not his missing girlfriend. It was his devotion to his addiction. It was his disease, telling him that the only thing that mattered in his life was rationalizing the way to the next drink, the next hit. So, we don’t tell people to go out and do more research in order to get ready for recovery. But someone who is refusing to engage, and complaining that their life isn’t improving, and battling every step of the way? Sometimes we’ll throw up our hands. “I guess you need to do more research, if you’re not convinced you’ve got the disease.”
One other aphorism we have in AA is that “The only step you have to do perfectly is Step One.” Meaning, if you don’t believe that you are powerless over alcohol, and that your life has become unmanageable, you can’t recover. At least, not in the AA program. Because as long as we think that either we can drink normally, or that we can manage our lives while drinking abnormally, we will continue to drink. We stay trapped in the battle. A battle that ends, invariably, with defeat.
But there are different kinds of defeat. There is defeat that comes with a prison, or a grave. And there is the kind of defeat that I had: surrender, acceptance, and liberation.
What is my Business?
I wrote recently about not getting involved in matters that aren’t my business. Arguments online, political disagreements, etc. I mentioned the AA aphorism, “We have ceased fighting anyone and anything.” Many of us use it as a guideline for how to behave in the world. How to find peace and serenity in our lives. And for all the visible effort that AA puts in to abstinence from alcohol, the real purpose of the fellowship is the serenity of its members. Drinking is not our disease. Drinking is how we try to treat our disease.
I think this is why so many interventions, medical or otherwise, fail with alcoholics. As long as we focus on the alcohol, we’re doomed. Medicines that reduce cravings, attempts to learn to moderate, these things keep us in a battle. We cannot defeat alcohol by battling it. The key to recovery is not in winning a struggle. It is in abandoning it. Alcoholics are selves in constant conflict, predicament. We set ourselves into pitched battles on any number of subjects, and then we attempt to quell the disquiet in our minds with anesthetic liquors. It is by abandoning this dynamic that we can come to recovery.
But. AA is not a pacifist organization. AA was about 6 years old when World War II came about. I’ve read anecdotes and histories in which there was a great deal of concern as to how recovered alcoholics would acquit themselves at war. By all accounts, AA members performed in war the same as “normal” soldiers. And I have read nothing suggesting that combat experience led to relapse. So, when we say that we do not fight anyone or anything, clearly we don’t include opposing belligerents in wartime.
And AA members are not, individually, required to shrink from conflict or serve as doormats. The literature states explicitly that we do not need to grovel before anyone. When we make amends, we do so earnestly and honestly, and do not expect forgiveness. We pay what we owe, and not more. If a person does not accept our amends, or demands more than we are responsible for, we do not have to accept it. But we also don’t fight with them. A person who is determined to extract humiliation along with amends is not accepting an amends at all. We don’t have to participate in their game.
This is a long way around to wondering what it is that is my business. Because claiming “Sorry, that’s not my job,” is not a way of taking responsibility for my environment and my community. How can I decide what things are simply arguments I shouldn’t take part in, and what things are crucial issues, even if controversial, where I have a duty to stand for the right side? Saying something is not my business can too easily become a cop-out: “I’m sorry you’re drowning, but it’s not my business to toss you this life-preserver.”
My business is first and foremost my sobriety. I work first for that. Because anything I put in front of my sobriety I am going to lose. And then, my business is where the conviction of my heart will not allow me to stand passive while events that insult the personage or dignity of my friends and my fellows unfold.
This is why I make health care delivery my business. Not as an AA member (AA has no opinion on health care delivery), but because it is my livelihood, and I believe that providing sustainable means of access for all persons to health care is a crucial responsibility of societies. This is why I make marriage equality my business. I advocate for it, not as an AA member (AA has no opinion on marriage equality), but as a person in America who believes that all persons are entitled to access to the core institutions of civilization. And there are many other arenas of life that I make my business, because I believe I have the ability and capacity and obligation to participate productively.
And that matters. I need to be able to participate productively. Arguing with detractors about these things is not, in my view, productive. Hurling insults at people who disagree, or absorbing insults from them, does me no good. So, even on these topics, when faced with invective, I can decide that it’s not my business. Not because the topic is unimportant, but because it is not my business to engage with everyone who sees it differently.
Similarly, there are many important issues that have value that I am simply not moved by. Not enough to make them my business. And I know that many people become indignant when others don’t adopt their personal causes for their own. I do too. I can become myopic, and presume that because this is important to me, it must be important to everyone. But my decision not to engage in a politic is not a judgement on those for whom it is the most important issue.
So. What’s my business? What I choose it to be. I get to decide what’s important to me. I get to decide the level of my involvement. I am accountable for how I participate in politics and policy and social arenas and cultural shifts. I reserve the right to disengage from people with whom debate is not constructive. But it is not my business how anyone else chooses to behave. It’s not up to me to change anyone. I will only stand here and do what I believe is right. And I will apologize when I get it wrong.
I don’t claim to have answers. But I have more than just questions. I have the right to participate in discussion and debate. But I have a responsibility too. I have the responsibility to safeguard my serenity. To withdraw from invective. And so when discussion becomes argument, and argument becomes battle, I owe it to myself to step away. Because that way lies misery, for me. And I have come too far from misery to make new sorts for myself.
The Excitement of Productivity.
I have a lot going on professionally at the moment. I’ve recently completed my first major simulation for MECMC, and it’s really, really pretty if I do say so myself. I’ve already written a draft manuscript and gotten our Assoc. Director of Periop. to serve as senior author. And she’s taking it seriously. No courtesy authorship for her. She’s already dug into my first draft and torn it apart. I’ve integrated her comments and changes. I’ve also included a couple of co-authors from my department. They’re less enthusiastic about it, because they’re not academics and so they receive little benefit from publications. But they’ve contributed and it’s gratifying.
The result is that I think I have a really solid first paper, almost ready for submission. My co-authors want to submit to a high-impact specialty journal. All this is, I think, not shitty for having been here less than four months. I’ve been made a PI, negotiated the research minefields, finished a major simulation, written a manuscript, won a grant, gotten an IRB submission declared exempt, submitted another one for exemption. All of this while being really just alarmingly lazy. I could work so much harder than I do. When I’m focused, I get enormous amounts accomplished. But my focus is so hard to maintain.
Nevertheless, I feel like I’m doing very well. And I’m happy here, which is the most important thing. I feel like I’m contributing in important ways, that my coworkers and colleagues like me, and that the work is going to make a difference in the lives of real world patients. These are the things that make me a happy engineer.
Well, that and prestige. As everyone who has read my writing knows, I’m kind of shallow. I am easily seduced by institutional prestige, for example. MECMC has it dripping from the walls. I feel privileged every day to get up and come to work here. Not simply because they do great work in essentially every arena of medicine and research. But because I really like the response I get when I tell people where I work. I’ve always had a problem with being attracted to things that feed my ego.
I’m also attracted to glamour and prestige in academic success. Because of the kind of work that I do, I’ll almost certainly never have a paper in a truly prestigious medical journal. I’ll never submit to JAMA or NEJM or The Lancet. My work is just not on their radar. And even in the highly regarded specialty journals, I’ve only ever passed desk-review once. Followed by two months of hope and then rejection. I just recently submitted to a big-name journal with little hope of review, much less publication. But I can’t help dreaming about being accepted. It’s like dreaming of winning the lottery.
I know these are ugly things. I think they reveal a fundamental insecurity. I’m not a great scientist. I’m not a great engineer. I might have been good, once, if I hadn’t taken a decade-long detour into substance abuse. My concentration and short-term memory have been decimated. Even more than five years into sobriety, I’ve never regained the deep focus and creative insight I used to have. I’ll never be what I might once have been. I just have to hope that the shreds of my intellect and industry that I’ve retained are enough to make a meaningful contribution.
I am deeply insecure about my abilities, and I have good reason to be. But I am in a place where I somehow get to do the things I am trained to do. The things I enjoy, professionally. Where I have the reflected prestige of a world-class institution. These things make me want to rise to the implied challenge put forth. This is a great place. Great things are expected. They’ve given me a lever and a place to stand. It’s time to move the Earth.
Infactorium 