More on Isolation and Addiction

More on Isolation and Addiction

I previously wrote about pain medicine ideas that Sam Quinones presents in his book Dreamland. He is critical of the idea that we can take a pill to alleviate chronic pain without making substantial changes in our lives to address the root cause of our pain. Even if we can’t completely stop chronic pain by changing our habits, our environment, and our lifestyles, Quinones shares information which suggests that our experience of pain is connected to many parts of our lives, and that we can change how we think about and relate to pain, even if we cannot eliminate it completely. This is a holistic approach to pain and pain management that Quinones thinks is a crucial piece for understanding our nation’s current opioid epidemic.

 

Chronic pain and its mismanagement is a common route to opioid addiction. Quinones views opioid addictions similarly to how he views chronic pain. In his book he writes, “Chronic pain was probably best treated not by one pill but holistically. In the same way, the antidote to heroin wasn’t so much Naloxone; it was community.”

 

Naloxone is a drug that helps prevent opioid overdoses by binding to opioid receptors in the body to block the effect of opioids like heroin. This drug has helped save thousands of lives, but on its own it won’t stop addiction. Quinones argues that a big problem with addiction is the way in which we hide it from others, whether it is addiction to drugs, gambling, or something else, we don’t allow anyone to know about our addiction. Without talking about addiction, without acknowledging that it has had impacts on our families and lives, and without having meaningful connections with others, we languish in our isolation and addiction.

 

The argument that Quinones makes in his book is that we need more community. We need more things in our lives where we interact meaningfully with others. We need to find more ways to be in service to other people, to work together for meaningful causes, and to have greater social connections with the people around us. By developing meaningful relationships with others, we provide community for everyone, and that helps push back against the forces that drive toward isolation and drive many of us toward substance addiction. Community provides us the space to discuss our challenges, our addictions, and our discontents, and hopefully gives us the chance to build constructive spaces in which we can connect and find solutions to problems that we cannot find in isolation.
Technology & Pain

Questioning Our Confidence in Technological Solutions

Sam Quinones interviewed Alex Cahan, a pain medicine specialist in New York, for his book Dreamland. He is quoted in the book talking about the approach that most people have toward pain and alleviating their pain. Many people want an immediate solution that comes from technology and allows them to continue living their life as they always have.

 

Quinones writes, “Cahana saw stuff [Author Note: unproven medical treatments, more surgeries, more pills, etc…] as the problem. Our reverence for technology blinded us to more holistic solutions.” The holistic approach is not one of mystic arts or managing ones energy, but is an approach focused on how we live and what health habits we have. Smoking, minimal exercise, and living with stress that we can’t regulate are all parts of our life that can make the physical pain that we experience much worse, or can lead to worsening health and pain developing from other real medical conditions. An approach to pain medicine that doesn’t consider our actual lifestyle cannot help address the root of our pain.

 

Quinones continues with a quote from Cahana, “We got to the moon, invented the internet. We can do anything. It’s inconceivable to think there are problems that don’t have a technological solution. To go from I can do anything to I deserve everything is very quick.” 

 

Cahan’s argument is that our technological innovations and the stories we tell about our scientific progress blinds us from the reality of the human body. We are not machines, we are not our own technological innovations, even if we like to believe that we can all be Iron Man. The reality is that we have to think about how we live, about the things we do, and about what could be changed, adapted, or included in our lives to help us be more healthy and experience less pain. We don’t have to believe in a mystical energy around our bodies. We don’t have to turn to medical treatments that are not proven to be safe or effective. But we do have to think about what is important in our lives, what values we hold, and how we can make changes that help us align with  those values in a healthy and reasonable way. Once we have seen where we can make changes in our actual lives and what habits can help us improve our health and reduce our pain, it is up to us to live accordingly, not up to technology to instantly solve our problems.
A Different Take on Chronic Pain

A Different Take on Chronic Pain

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.
Our Efforts to Avoid Pain

Our Efforts to Avoid Pain

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.

The Scale of Our Pain

I usually have one of two feelings when I fly into a large city or walk through a large crowd of people. I either feel insignificant and tiny, recognizing that whatever I do will eventually fade into oblivion among a sea of billions of people. Or, I feel proud to be part of an incredible collection of brilliant and capable human beings, each experiencing the world from a unique point of view, each with our own desires and feelings, and all connected by our shared humanity. Regardless of which sensation comes to mind, both help me recognize that what is going on inside my head, the reality of the world that I have constructed for myself, is not the full scope of human experience and is nothing more than just a world inside of me. Whatever fears, doubts, plans, successes, and assumptions I have are not any more real than the same thoughts going through the millions of people that might be living in the big city that I am flying into.

 

Recently, an entry in Fernando Pessoa’s book, The Book of Disquiet, has given me the same type of feeling. In a section of Margaret Jull Costa’s translation, Pessoa writes about pain, and about how our pain can feel so infinite and overwhelming to us, yet at the same time be so small and insignificant within the scope of the universe. In 1933 he wrote, “To consider our greatest anguish an incident of no importance, not just in terms of the life of the universe, but in terms of our own souls, is the beginning of knowledge.” When we start to recognize that we are not the center of the universe and when we can acknowledge that the severity of our emotions and feelings do not make them more real or more important in the scope of the world, we can start to see more objectively and without a filter orienting everything around us.

 

“It isn’t true that life is painful or that it’s painful to think about life,” Pessoa writes, “What is true is that our pain is only as serious and important as we pretend it to be.” Anything in our lives can take on extreme meaning and value. At the same time, anything in our life can be tossed out without care. What we focus on, where we put our attention and energy, and what we decide to be important is what will become our reality. Pessoa recognized this through his extreme self reflection, and from this point he became aware of his own insignificance and how little his thoughts and desires truly mattered to the rest of the universe. Any pain that he felt is simply a pain that he felt at that moment. Any experience he had was fleeting, because he was not a permanent fixture in the universe and not something that overwhelmingly shaped the universe.

 

Seeing this in ourselves and becoming aware of who we are and where we exist in the world is important if we want to do the most good with the time that we have. If we choose to live completely within our own mind, then we risk living in a way where we put ourselves before all others. We will seek more and more and attempt to raise ourselves above others while decreasing the pain we feel. Alternatively, we can step outside ourselves and try to engage in the world in a way that will improve the interactions between us and everyone else. We can try to make the world a better place for other individuals to interact within, even if they are not interacting with us directly, and even if we don’t directly see a benefit to ourselves. The reason to live in this world is because it is a more accurate reflection of the reality we live within. Our brain will only ever perceive so much, and rather than making up stories about what it means, we can live in a world where we try to continually develop a more objective understanding of what we see and experience, so that we can do the most good.

 

Pessoa closes in writing, “Seeing myself frees me from myself. I almost smile, not because I understand myself, but because, having become other, I am no longer able to understand myself.”

Maintaining Your Character

“It can ruin your life only if it ruins your character.”

 

Ryan Holiday starts one of the chapters in his book Ego is the Enemy with the above quote from Marcus Aurelius. Holiday, in both Ego is the Enemy and his previous book The Obstacle is the Way, outlines principles of stoic philosophy and connects stoicism with the modern day. The only thing we can control, Holiday explains, is how we react to the events of the world around us. We are going to experience a lot of good and bad luck, and it is how we react to the events of our life that determine whether we will be successful.

 

No matter what goes on around us, Holiday argues that we can always think about how we are behaving and reacting and choose to act in the way that will be the most helpful for us. Whatever bad luck, failure, loss, or challenge rolls our way, we can decide how we will react to it and what impact it will have on who we are. We may lose the physical ability to do something, we may lose a spouse or family member, our property could be taken away from us, our career paths may be derailed, or our Facebook post might not get any likes. In each of these situations, we could react as though our life is over and as though there is no possible recovery. If we do, then we will create an almost self-fulfilling prophecy where the negative thoughts and opinions of our minds manifest in our lives. Stoic philosophy would encourage us to look at the loss around us and see that within the misery exists the opportunity to display strength in character and to maintain clear thoughts.

 

Most of us will never be tortured in our lives, but Holiday does give examples in his two books of prisoners of war who used stoic philosophy and maintained their character to stay united and survive the horrors of torture. There are people who are trafficked and exploited, and their pain and trauma is certainly real and help and guidance is certainly something they should seek out, but a touch of self-awareness can help everyone look at their current situation and think about how they can move forward in a positive way. For most of us, we can recognize that we will struggle and will feel as though things could never get worse, but we can also remember that people have faced far worse pain and recovered.

 

Ultimately, we can look at the negative pieces in our lives and the decisions we make each day and try to move in a direction which continually improves our character. The good things and the bad things in our life are only good or bad based on our opinions and decisions. Nothing can ruin our lives unless we decide that it has the power to ruin us. Choosing to maintain our character in any situation always gives us the option of being strong in the face of obstacles and turning those obstacles into learning opportunities for ourselves and the people around us.