Category: Dreamland – Sam Quinones

A Different Take on Chronic Pain

A Different Take on Chronic Pain

Posted on by jabittan
In his book Dreamland Sam Quinones includes a quote by Dr. John Loeser, Professor Emeritus of Neurological Surgery at the University of Washington in Seattle. Quinones spoke with him to better understand chronic pain and how chronic pain can be approached without the use of opioids. Loeser has an approach to treating chronic pain that doesn’t rely purely on drugs and is more centered around the patient, their environment, and their social supports. Loeser describes his approach as a bio-psycho-social approach and Quinones provides the following quote:

 

“Chronic pain is more than something going wrong inside the person’s body. It always has social and psychological factors playing a role.”

 

What I think is interesting with this quote is how far it is from the experience that many of us have with doctors and medicine today. Much of our medical care comes in tiny ten minute packets, where we go back and forth with a doctor for a few minutes before they write us a prescription for something and send us on our way. The providers often don’t end up doing much to help us through our current issue, and we rely on a pill to suddenly make our lives better. The approach completely misses many other factors of health.

 

Where we live matters. Who we have in our lives matters. What our diet is like, what stress factors exist around us, how easily we can get outside or to a gym for physical activity matters. A ten minute conversation and a pill cannot address these issues and certainly cannot change them.

 

I’m not introducing this all to suggest that chronic pain isn’t real, or that it is all in a person’s head. I’m also not introducing it to suggest that people suffering from chronic pain simply are not trying hard enough, need to take more personal responsibility, or just need to move to fix their pain. Often these social determinants of health are beyond the control of any one person. Before criticizing another person, and if we want to help them, we must also consider their environment, and whether we ourselves are a factor that helps or hinders the health of another.  Our world is too connected to say that someone’s health is purely a matter of their own choices and behaviors, even if personal responsibility does have a role to play in managing health. Approaching health from this angle helps us understand that an opioid is never going to be sufficient in truly alleviating chronic pain. There have to be more efforts to understand the bio-psycho-social realities of the person’s life and the chronic pain they experience.
Limits in What We Do

Do We Need Some Type of Limit?

Posted on by jabittan
I’ve recently watched The Hobbit trilogy, and images of Tolkien’s dwarf kings consumed with greed and gold have stuck with me. For whatever reason, the image of King Thror spinning around in a state of dazed confusion among his treasure, and the image of Thorin becoming corrupted by the same gold bounty have replayed through my mind. Tolkien and the artistic creators of The Hobbit are using the dwarf kings to show the negatives of greed, of lust for power, and the danger in pursuing wealth over people and relationships. They also show what can go wrong in the mind when we have everything.

 

The Hobbit came back to mind as I looked over quotes I highlighted and notes I took in Dreamland by Sam Quinones. My last two posts were about our efforts to avoid pain, suffering, and negativity and about how we try to fill our lives with consumer products that promise to make us happy. Mixed in with those ideas, Quinones adds, “man’s decay has always begun as soon as he has it all, and is free of friction, pain, and the deprivation that temper his behavior.”

 

Thror and Thorin show us what Quinones means. When the kings were at the top, when there were no constraints in their power or wealth, they used other people for their own gain. Their minds turned to selfish impulses, and turned away from doing what was right for the good of their people. When they reached the top, they atrophied, with nothing to work toward but the preservation of their own grandeur.

 

A curious phenomenon that Quinones highlights throughout his book is how opioid addiction cuts across all socioeconomic status levels. The sons and daughters of esteemed judges and doctors just as well as men and women who have grown up in poverty all seem to be victims of opioid addiction. For some reason we expect addiction among the second group, but find it inconceivable that the first group might face the same challenges. In some ways, the quote above from Quinones answers part of why we see addiction among middle class families and among the children of talented professionals.

 

When we have no limits in what we do, when our lives are tailored, curated, but isolated, we begin to lack purpose. Our lives might look full from the outside, but be void on the inside. When we seem to have it all, the value of our lives can decay, and without friction under our feet to push us forward, we can’t move anywhere. Just as our excesses produce terrible externalities, our having it all, or at least thinking we can buy it all, produces a feeling of purposeless that can lead to drug use to blunt the meaninglessness of self-indulgence.

 

My recommendation is to remember Thorin and his grandfather. To remember that our selfish desires can become our own downfalls, and to turn instead toward community building and relationships with others. To strive for our own greatness will leave us on an empty throne, but to work with others for shared goals will help us develop real structures in our lives that last and have real value.
Excesses and Externalities

The Problem with our Excesses

Posted on by jabittan
My previous post was about our desires to live a life that never involves any pain or suffering. We try to build a life for ourselves and our loved ones where every moment is happy, and where we never have to engage in drudgery, never experience physical discomfort, and never face any obstacles. Today’s post looks at another related aspect of our lives and mindsets that Sam Quinones highlights in his book Dreamland as part of our current opioid crisis: excesses.

 

Quinones is critical of our capitalistic culture that creates a message of buying things to find happiness, fulfillment, and meaning. The marketing departments of everything from soap companies, life insurance companies, to take-out restaurants suggests that happiness is right around the corner, as long as we are willing and able to buy more of what they offer. It is owning something bigger, having more, and expanding our consumption that is branded as a good life. But as Quinones sees it, “Excess contaminated the best of America.”

 

I studied public policy and I spend a lot of time listening to podcasts with economists. A common idea in the world of public policy and the mind of economists is the idea of externalities, secondary consequences of policies and peoples actions. Some externalities are positive, such as people developing a sense of civic pride after participating in an election, but many externalities are negative, such as green house gasses polluting the planet as we drive to and from work. What Quinones describes with the quote above, is the reality that our drive for excesses produces negative externalities that damage our planet and ultimately ruin the lifestyle that we chase.

 

By always wanting more, wanting it faster, and wanting it more tailored to our specific desires to make us feel like royalty, we have put ourselves in a place that is unsustainable. Our single use plastic bags have trashed our cities and open spaces. Having our individual cars to drive to everyplace we want to go emits more pollution than a well developed public transportation infrastructure. Over-purchasing consumer goods produces more garbage that has to go someplace.

 

This post has simply highlighted the reality that we live with negative externalities, and that our consumer driven culture is creating externalities which poison the planet. Quinones throughout his book focuses on the idea that our culture’s excesses have fueled the opioid epidemic by turning us inward toward our own wants versus encouraging us to think of others and how we can work together as part of a community. I think he is correct, and I think the space to start in making a change is by getting people to truly reflect on their lives, their purchases, and what they pursue. As Ryan Holiday put it in Stillness is the Key, “Eventually one has to say the e-word, enough. or the world says it for you.”

 

The way out of our opioid crisis, and indeed the way out of so many of our problems today, is to say enough to our own selfish desires. We need to stop the negative externalities that we produce when we purely pursue our own selfish ends, and instead we need to embrace our communities and put others first, to create more positive externalities which can heal our communities and fill the empty holes that consumerism leaves inside of us.
Interconnected Inequalities

Interconnected Inequalities

Posted on by jabittan
Inequality isn’t something I have thought of at a truly deep level, but its consequences are becoming more apparent to me the more I learn about the world. I grew up believing that anything was possible for anyone, and that anyone could become president of the United States or successful in their own endeavors as long as they worked hard. While I still do believe that we can all become successful through hard work, and while I do think we should still encourage some form of this myth, I don’t fully believe the myth myself. I think that luck and structural factors of our lives play a huge role, in other words, inequalities matter.

 

In the myth that I grew up believing is that inequality was purely a result of one’s natural skills and how hard one worked. It was an end product, not an input. Many people choose to see the world this way, especially, in my experience, if they themselves are lucky, wealthy, and privileged. Inequality simply doesn’t matter in this worldview, and it is in some ways a good thing, reaffirming that the successful people are smart, hardworking, and deserve what they have.

 

I now think that our interconnected inequalities are much more serious that I had believed. Inequality is visible, and it is understood across the globe. It shapes how people think about themselves, about their futures, about the way other people value them, and about what they can and cannot be. A character introduced in Sam Quinones’ book Dreamland: The True Tale of America’s Opiate Epidemic speaks to this reality. A character by the name Enrique opens the book and Quinones writes, “Growing up in a poor Mexican village had attuned Enrique to the world’s unfairness. Those who worked hard and honestly got left behind. Only those with power and money could insist on decent treatment.”

 

From this mindset Enrique chose the only way out of his situation (being the son of a poor sugar cane farmer in Mexico) that he thought could get him money, prestige, and power. He chose to become a heroin dealer. His story is told in the book, and in the opening introduction we see Enrique feel guilty about his life choices, but confirm to himself that it was his only way out of destitute poverty as he watches a group of farm-hands/construction workers be deported in an airport.

 

It is global inequality that drove Enrique to drug trafficking. Through no fault of his own, Enrique was born into a family in a poor village, and the clearest path toward employment for him was pursuing his family’s sugarcane business. A career that meant hard work, near subsistence wages, and little respect. Sure, he could have found other options and become a rags to riches/slumdog millionaire story, but expecting everyone to do so ignores the reality of the message that inequality pushes in the face of those born into such adverse situations. Enrique learned that people didn’t treat him and his family with respect, but saw the respect shown to people in the town with more means.

 

Enrique eventually came to the United States to chase money and status back home in Mexico. The inequality he first saw in his home village never left him. He found inequality everywhere, and the interconnected inequalities between the United States and Mexico in many ways created his lifestyle and enabled his drug dealing.

 

I don’t have a solution to our interconnected inequalities, but I think we need to acknowledge them. I am sure that some level of inequality is inevitable, and likely even healthy, but I’m also convinced that the inequality we see between people and between nations is part of what drives much of our global conflict and grief. So much of the world’s inequality seems completely unnecessary, and in many ways should be addressed head-on, so that people at the bottom don’t believe that the only way to improve their lives is through illicit means, and so that people at the very top don’t use resources in such wanton ways to signal how wealthy and successful they are at the expense of others.
Our Efforts to Avoid Pain

Our Efforts to Avoid Pain

Posted on by jabittan
I had an amazing track coach at Reno High School. His name was Mark Smith (everyone called him Smitty) and like all great coaches, he knew what high school students needed in their workouts and in their heads in order to be successful both in sports and in life.

 

Some of the neighborhoods that Reno High School draws from are among the nicest and most expensive in all of Reno. Many students have very dedicated parents who will do anything to help their children succeed, be happy, and avoid pain and suffering. However, these parents often miss an important point, a point that Coach Smitty would always remind parents and athletes, “you can never eliminate suffering, and you can’t protect your child [or yourself] from all pain.”

 

Sam Quinones, author of Dreamland would certainly agree. In his book he writes, “In heroin addicts, I had seen the debasement that comes from the loss of free will and enslavement to what amounts to an idea: permanent pleasure, numbness, and the avoidance of pain.”

 

Our society, in TV shows and commercials, continually pushes a narrative that we should be happy and have lots of consumer goods in our lives. We seem to believe that every moment of our lives should be nothing but entertainment and enjoyment, and we pursue that, continuously trying to buy our happiness and avoid any possible pain or suffering. As Coach Smitty said, however, this is not possible, and as Quinones shows throughout Dreamland, this can lead to dangerous consequences. Part of the opioid problem in our country, Quinones argues, is that we place too high a value on never feeling pain and suffering, and we under-invest in the real things that would help us actually overcome and reasonably manage and respond to pain and suffering.

 

Our mental health, counseling, and therapy services are under-developed and costly. Our economic system doesn’t provide people the support they need in difficult times, and we don’t do a good job of helping get people into jobs that actually feel meaningful. We have built suburbs and isolated ourselves from community, and when we face hard times, we are afraid to admit it and don’t have many close people to turn to. We seek avoidance from these challenges with chemicals like alcohol, opioids, marijuana, or worse. We try to blunt the pain and reduce the suffering artificially, which doesn’t work, and doesn’t help us feel happy or fulfilled.

 

We have a myth that we can eliminate all the suffering in our lives and in the lives of our loved ones. However, the reality is that we must work to overcome that suffering together. As a team, we can support each other, train each other to be strong during adversity, and learn how to put in hard work and lean into the uncomfortable reality of the world to find a place where we can accept and appropriately respond to suffering and pain.

 

Coach Smitty passed away on October 12th, 2018. He was a truly great influence in my life and in the life of others. I hope everyone has a Coach Smitty in their lives, and please reach out to say hi and thanks if you do.