Welcome to from Insults to Respect. Today we seek to answer the question, If we are experiencing sadness does that mean that we are bad? We’ll begin with a little parable to see what it might reveal. Then we’ll look at the real life example of Laura, a young woman who came to think there was something wrong with her because of her sadness.
The Parable of a Mother Disciplining Her Son
It’s a Sunday night. Eight-year-old Carl is playing a computer game. Suddenly, his mom cries out, “Time to head up to bed, tomorrow’s school.”
“Let me just finish my game, Mom!”
“Take another five minutes, and then it’s off to bed!”
Five minutes later, Carl, still engrossed in his game, hears his mother cry out again, “Time to head up to bed.”
“My game isn’t over yet Mom.”
“Put the game away now.”
“But Mom!”
“Don’t ‘but mom’ me, let’s go,” and she takes Carl firmly by his arm and begins to guide him to his bedroom. Carl’s eyes tear up, which infuriates his mother, and she cries out, don’t you start with this crap or I’ll give you a real reason to cry! You’re acting like an infant!!! Now you stop this instant and get to bed!!!”
Parable Discussion
First of all, I can empathize with this mother. Perhaps she had a very trying day. Perhaps she has learned how to handle the bedtime situation from her own growing up experience, observing how her parents handled this type of situation. Much of our own parenting skills are indeed learned this way, observing how our parents raised us. This mother’s intention was good; she wanted Carl to get enough sleep so he could be ready to do his best the next day at school. I certainly respect what she was trying to do.
That said, I find myself wondering if there might be some better way to respond when Carl begins to express his sadness, instead of threatening him and saying he is acting like an infant. Here’s one alternative approach that comes to mind.
When Carl begins to shed some tears, she might have said in a caring way,
“I see you are feeling sad. That’s understandable. You were enjoying the game so much, and you’re disappointed about having to stop. You know, when we feel sad, it’s to help us figure out how to better handle what we do in the future. I wonder how we can better handle the going to bed situation in the future. Any ideas, Carl?”
“No Mom. I just want to keep playing.”
“I think, Carl, that in the future playing these computer games right before going to bed might not be a good idea. They are designed to keep you wanting to play more and more, and it doesn’t come to an end. You reach one level and there is always another more challenging level to get to. What might be a better thing to do before bedtime?
“I could watch a show that ends at bedtime.”
“That sounds like a good thing to try, as long as it’s not a scary show that will get you all wound up right before bedtime. We could also go to the library and pick out some books that have pleasant short stories, and you can read one right before bed. Short stories come to an end in a reasonable period of time, and the reader feels a sense of completion when it’s over, without making you feel like you have to read the next chapter to see what happens next. That might work also. So, in the future, why don’t we try having you each night choose one of these ideas. I’ll let you decide each night which approach feels right to you.”
From this alternative scenario you might surmise that I think it would be better to frame our sad experiences as something useful for planning our future, rather than an experience that means we are bad or that there is something wrong with us. And, actually you would be right. But there is some nuance to my thinking about this issue that I wish to bring to your attention.
Some Nuanced Thinking When It Comes to Dealing with Our Sad Feelings
Suppose a guy named Fred tends to be sad more than the average person. This might be due to some natural born tendency to experience life in a more sensitive manner than most, or because of some rough stuff going on in his life, or some trauma in the past has been leading to recurring anguishing memories. For whatever reason, Fred regularly comes to work expressing his sadness from the look on his face as he goes around doing his job. Co-workers often stop what they are doing to ask what is wrong, and offer help by taking time to listen to Fred in a caring way. This would be nice in some ways, but let’s say it happens so often, coworkers begin to find that their work at the end of the day doesn’t always get done on time and they end up having to stay late. Some resentment begins to arise. Moreover, in this scenario, the boss begins to dislike what has been going on partly because of the time being taken from the tasks that have to get done with top-notch efficiency in a competitive business environment, and she was brought up by parents who taught that there is something wrong with people who are sad more than average. In the end, Fred loses his job.
Upset about this, Fred begins to share with his friends and family members how he is feeling, but his frequent expressions of sadness over an extended period soon begins to wear on them.
The point that I am trying to make is that experiencing sadness is not something that makes us bad, but how we express sadness can increase the chances that some will view us in a bad way.
Perhaps Fred would have been better off putting on a happy face at work despite his internal experience. Perhaps Fred, if he could afford it, would be better off hiring a professionally trained personal counselor to help him work through his sad experiences in a positive manner so that he doesn’t put too much on the shoulders of friends and family members. There are, in most communities, some counselors available, and at the top of any of my blog post there is a link titled “Counseling Services” that when clicked on provides descriptions and contact information for two excellent personal counselors that I personally can recommend who conveniently provide services through Skype, Zoom, or your phone.
However, counseling services do cost money, and if it is too expensive for someone’s budget, an alternative is to set up via such internet resources like meetup.com, a support group that meets regularly for the specific purpose of sharing challenging emotional experiences. Of course, the members will be unlikely to have the expertise of a trained personal counselor, but with trial and error it is often very possible to find the right mix of caring, empathic participants.
For these types of peer run support groups, it helps to set up some ground rules at the start of such meetings. Here are the rules that make sense to me.
We’re here to emotionally support one another.
Our internal emotions are to be met by group members with empathic caring and the encouraging of self-compassion.
When sad feelings are shared, it is worth considering how such feelings might help us to figure out how to better deal with the future.
When a member thinks that the way a fellow member is expressing his or her emotions is less than ideal, rather than to use any name calling, like, “You are being stupid for acting like that,” members are to gently frame their opinions as tentative suggestions. Here’s a useful phrase to consider using at such time, “I’m wondering if you were to (state whatever the suggestion might be) if that might be worth considering.”
The Example of Laura
Sometimes, instead of interpreting our sad feelings as “we are bad,” we come to think that something is wrong with our physical make-up. If this leads to considering taking steps in the future to improve our diet, get more exercise, or spend more time in nature, that can lead to healthy outcomes. However, there is potentially a dark side to blaming the body.
Rachel Aviv, New Yorker Staff writer
In an eye opening April 8, 2019 New Yorker article by Rachel Aviv titled, “The Challenge of Going Off Psychiatric Drugs,” we learn about Laura Delano, a remarkably talented woman. Although she did have a number of problems in her youth, as most of us do, she functioned well enough to get accepted to Harvard University. Then, at one point, she was at a party where she began sobbing so hard that her escort had to put her in a cab.
Shortly afterwards, she saw a psychiatrist who declared she had a mental disorder and prescribed an antidepressant. Laura was relieved to hear the doctor say that her distress stemmed from an illness. “It was like being told, It’s not your fault. You are not lazy. You are not irresponsible.”
So, at this point, Laura has become convinced that she is not being a bad person for how she was experiencing her emotion, it was her body that was being bad in the form of an illness. Was this really an improvement?
As her story continues,
“When on the drugs,” Laura said, “I never had a baseline sense of myself.”
She began taking twenty milligrams of Prozac, an antidepressant; when she still didn’t feel better, her dose was increased to forty milligrams, and then to sixty. With each raised dose, she felt thankful to have been heard. “It was a way for me to mark to the world: this is how much pain I am in,” she said….
At parties, she flirted intently, but by the time she and a partner were together in bed, she said, “I’d kind of get hit with this realization that I was physically disconnected. And then I’d feel taken advantage of, and I would kind of flip out and start crying, and the guy would be, like, ‘What the heck is going on?’” Most antidepressants dampen sexuality—up to seventy per cent of people who take the medications report this response….
During her junior year, her pharmacologist raised her Prozac prescription to eighty milligrams, the maximum recommended dose. The Prozac made her drowsy, so he prescribed two hundred milligrams of Provigil, a drug for narcolepsy that is often taken by soldiers and truck drivers to stay awake during overnight shifts. The Provigil gave her so much energy that, she said, “I was just a machine.”….
The Provigil made it hard for Laura to sleep, so her pharmacologist prescribed Ambien, which she took every night. In the course of a year, her doctors had created what’s known as “a prescription cascade”: the side effects of one medication are diagnosed as symptoms of another condition, leading to a succession of new prescriptions.
Despite taking all of these drugs she felt so distressed that she thought every day about dying. So a new psychiatrist put her on a new combination of pills. Again, despite these drugs she experienced what John Teasdale, a research psychologist at the University of Oxford, named “depression about depression.” She interpreted each moment of lethargy or disappointment as the start of a black mood that would never end. Psychiatric diagnoses can ensnare people in circular explanations: they are depressed because they are depressed.
As Laura’s story continued, during a brief period she decided to see another psychiatrist who was also a psychoanalyst. He questioned the way that she’d framed what she had been experiencing. He doubted her early diagnosis, writing that “many depressions are given a ‘medical’ name by a psychiatrist, ascribing the problem to ‘chemistry’ and neglecting the context and specificity of why someone is having those particular life problems at that particular time.” Laura decided that “he wasn’t legit.” She stopped going to her appointments.
Soon afterwards, despite all of the drugs that she was taking, she attempted to take her life. She did manage to survive, and afterwards,
She was started on a new combination of medications: lithium, to stabilize her moods, and Ativan, a benzodiazepine, in addition to the antipsychotic Seroquel, which she had already been taking. Later, a second antipsychotic, Abilify, was added—common practice, though there was limited research justifying the use of antipsychotics in combination. “It is tempting to add a second drug just for the sake of ‘doing something,’ ” a 2004 paper in Current Medicinal Chemistry warns.
In May, 2010, Laura wandered into a bookstore.
Robert Whitaker
On the table of new releases was “Anatomy of an Epidemic,” by Robert Whitaker. The book explained to her that as more and more Americans have taken to psychiatric drugs to deal with their emotions, the number of Americans disabled by mental illness has risen. Whitaker argues that psychiatric medications, taken over the course of a lifetime, may be turning some episodic emotional experiences into chronic disabilities. As Whitaker explains what people like Laura are going through, they have “been prescribed one drug, and then a second, and a third, and they are put on this other trajectory where their self-identity changes from being normal to abnormal—they are told that, basically, there is something wrong with their brain, and it isn’t temporary—and it changes their sense of resilience and the way they present themselves to others.”
It was at this point that Laura decided to see what would happen if she stopped taking the drugs, and found that the process was an excruciating experience because of the medication withdrawal reactions. It took her many extremely rough months before her goal was achieved.
Internal records of pharmaceutical manufacturers show that the companies have been aware of this withdrawal problem for many years, and many doctors mislead their patients suggesting to them that the prescribed drugs were either not addictive, or withdrawal symptoms are mild.
Now off the psychiatric drugs, Laura began a relationship with a guy named Rob Wipond. Both of them became emotional when discussing Laura’s sexuality. “I felt like a newborn,” Laura confided. “I hadn’t ever figured out what my body was meant to be.” Rob said, “She was open and awake. Everything was new to her. We were, like, ‘Well, gee, what is this sexuality thing—what shall we do?’ ”
Prior to coming off the psychiatric drugs, Laura had been unable to have stable relationships. “I honestly thought that, because I was mentally ill, the numbness was just part of me.” Now she wondered about the other effects of the many medications she had been taking. “On this very sensory, somatic level, I couldn’t bond with another human being,” she said. “It never felt real. It felt synthetic.”
Laura felt as if she were learning the contours of her adult self for the first time. When she felt dread or despair, she tried to accept the sensation without interpreting it as a sign that she was defective and would remain that way forever, until she committed suicide or took a new pill. It felt like a revelation, she said, to realize that “the objective in being alive isn’t the absence of pain.” She remembered identifying with a sad little bubble pictured in a popular advertisement for Zoloft—the bubble is moping around, crying and groaning, until it takes the medication and starts to bounce while birds sing—and became increasingly aware that her faith in the drugs’ potential had been misplaced. “I never felt helped by the drugs in the sense that I have meaning, I have purpose, I have relationships that matter to me,” she said.
Perhaps we can all learn something essential from Laura’s experience.
Final Thoughts
From today’s post, I hope that you will consider the value of giving up any belief that you may have that feeling sad means you are bad. If, when you experience sadness, you find yourself saying such words like, “I can’t believe I’m feeling sad again, what an idiot I am,” consider how it may be far more helpful to view your sadness as a useful tool for helping us to better plan our future. If you are a parent, consider the value of teaching your children this “sadness is a helpful tool” idea.
Also worth considering is that there are ways in which to express our emotions publicly that can either hurt our reputation or enhance it. Over a half million people have been using this blog as a no financial cost method to learn skills that can enhance their reputation whenever they find themselves in various emotionally arousing situations. I’m hoping you consider the value of joining them.
Finally, the pharmaceutical industry, along with its allied psychiatrists, have enormous resources to convince people that the best way to deal with sadness is to take pills. Laura’s story provides us a cautionary sign to all those who are tempted to go down that road.
Well, that’s my post for today. Here’s hoping you’ll soon join us again right here at From Insults to Respect.
My Best,
Jeff
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Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional and social intelligence. To begin at the very first post you can click HERE.
A while ago, as I began to think about what topic to write about for my next post, I received an email from Mindfreedom International (MI). It brought attention to a demonstration it was planning. As MI expressed it in part:
A mock funeral mourning those lost to psychiatry or who have had their spirits broken and struggle to survive is to be held as protesters deliver a public message to psychiatrists at the annual meeting of the American Psychiatric Association on Sunday, May 6, 2018. “First, Do No Harm” is the message that protesters hope will go viral and get people to think twice before getting involved with psychiatry.
Our coalition brings attention to the harm that psychiatry has caused for many people in the mental health system, psychiatric survivors, people of color, people with psychiatric histories, and people experiencing other forms of structural oppression. Uninformed or court-ordered psychiatric drugging; chemical and mechanical restraints, solitary confinement; forced and uninformed shock treatments….have caused irreversible damage to the minds, bodies, souls, and lives of people who voluntarily trusted their doctors or were brought to court to comply with their prescriptions over their objection….We will mourn the deaths and the ongoing forced treatment of our brothers and sisters.
Is there a way to move MI’s various conflicts with the psychiatric organization forward in a manner that leads to a more respectful relationship between the two?
My Views About Psychiatric Drugs
I became interested in the conflict about the use of psychiatric drugs very early in my career as a psychologist. I began to discuss the issues with psychiatrists as well as those who objected to this form of treatment. A broad outline of what I heard follows:
Advocates for the use of these drugs make the following claims: These drugs reduce emotional pain, correct abnormal brain patterns, and restore normal mental function. When used judiciously, they reduce hospitalization and may quickly alleviate symptoms of serious mental disorders such as depression and bipolar illness. Going off medication results in disruptive lives and devastating personal loss. Careers, relationships, financial troubles, and even life itself are all placed at grave risks without proper psychiatric medication management.
In contrast, critics of psychiatric drugs have made the following counter claims: The use of psychiatric drugs has unleashed the worst medically induced disaster in history. They have caused millions of people to become addicted to them, suffering debilitating, life threatening side effects. Rather than promoting mental health, these drugs are being used to promote social control and conformity. Reduction in hospitalization, moreover, occurred not because of the use of these drugs, but because of a deinstitutionalization policy that became known as “dumping.” Problems now being handled with psychiatric drugs can be more effectively, safely, and humanely handled with a variety of social support systems, counseling, mindfulness, healthy diet, and physical exercise techniques.
As I heard these conflicting claims, I initially thought that psychiatrists had principles of science on their side. With my graduate training in research methods and statistics, I thought that by doing a thorough job finding out the scientific research that backs up the psychiatric drug supporters I could explain in an easy to understand language why psychiatric drugs are necessary. With such an explanation, perhaps the conflict would be resolved.
My Ritalin Research Analysis
I began with researching Ritalin because I was working in Rochester, NY’s school system. This was from 1974 to 1979. It was a time when drugs were just beginning to be prescribed more and more to treat students who had teachers dissatisfied with their activity level or ability to pay attention. I had witnessed a time when schools managed to deal with such problems without the use of this drug and life went on reasonably well. With the rise in its use, some thought it was a wonderful advancement, while others were expressing great discomfort at this new trend.
So, off I went to a medical library to learn the scientific merits of this new approach. A brief summary of what I found follows.
Supporting the use of Ritalin were short-term randomized controlled studies lasting less than 12 weeks. Both inattentiveness-impulsivity and activity level were reduced, as assessed by parent and teacher rating scales, direct observations in natural settings, and various laboratory tests.
Not all of the findings were supportive. At the time I initially did my research, there was only one study that looked at the long-term results of Ritalin use. It compared children placed on methylphenidate, the generic version of Ritalin, with those who received no treatment. The children in the two groups were matched with respect to age, IQ, socioeconomic class and sex. After 3 to 5 years, no statistically significant differences were found between the two groups on the following outcome measures: emotion maladjustment, delinquency, Wechsler Intelligence Scale for Children, Bender gestalt visual-motor test, and academic performance.
In addition to this, I found many studies documenting a number of common adverse effects of treatment, such as headaches, insomnia, anorexia, stomach pain, irritability, and weight loss. Suppression of the normal rate of growth was just beginning to be reported. The sudden development of a tic disorder that sometimes did not go away when treatment stopped was viewed as a rare occurrence, but troubling nevertheless. Other serious rare adverse events had been observed including some involving heart functioning such as angina and cardiac arrhythmias. Perhaps most troubling of all was the recognition that the safety of long term use of Ritalin had not been established despite many students being treated for years.
To make sure that my analysis of the available scientific evidence was complete, I sent a Freedom of Information Request to the Food and Drug Administration for the documents that it used to approve the use of Ritalin with children as a treatment for attention and activity problems. I soon received a fairly large packet of information, and upon reviewing its contents I became convinced that I had not overlooked anything of scientific merit.
In the end, I discovered that although the approval process of the FDA had in its documents the available scientific evidence in making its decision to approve Ritalin, the reviewers’ decision nevertheless relied more on their personal values. It seemed to me, and it still does, that different people looking over the same scientific evidence could, depending on their values, come to completely different conclusions about whether or not the drug should be approved.
For me, personally, with the full awareness of the scientific evidence, I would have voted against approval of the drug. Relevant to me was that after thousands of dollars had been spent by the parents of the child or their insurance company, there was no lasting positive effects, while treated children were suffering side effects. The additional facts, especially the one that indicated long term safety had not been established, seemed to me to make non-approval the obvious choice. And yet, according to the value judgments of those who sat on the FDA approval board, they ended up supporting approval.
What I Found Afterwards
Since then, more research has come out regarding the drugs used to deal with ADHD. It further supports the conclusion that there are no long term benefits from using these types of drugs. Moreover, additional harm from their use has been identified.
After what I learned about the ADHD drug treatments, my efforts to find out about psychiatric drugs expanded.
Dr. Ross J. Baldessarini
As time went on, I took a psychopharmacology course taught by Harvard professor Dr. Ross J. Baldessarini; did additional research to get the latest updates, not only on Ritalin, but on other psychiatric drug treatments; and participated in six debates on this subject.
I’ve come to the conclusion that as with Ritalin, when highly intelligent people become familiar with the scientific evidence, they still draw completely different conclusions from one another about whether or not it is morally okay to use the approved drugs as a treatment. The decision is not solely made on scientific evidence. Moreover, I’ve seen evidence that there are far safer non-drug alternatives.
Since I did my original research on Ritalin, I also learned something crucial about the reliability of the relevant research findings. Initially, I assumed the scientific studies were carried out in a manner that I could have confidence in. Since then, I’ve begun to seriously question this.
Many experts have written about the reliability of the research. For example, Marcia Angell, M.D., is a former editor in chief of The New England Journal of Medicine, and now is a member of Harvard’s Medical School. In her insightful book, The Truth About the Drug Companies: How They Deceive Us and What to Do About It, she writes, “Is there some way companies can rig clinical trials to make their drugs look better than they are? Unfortunately, the answer is yes. Trials can be rigged in a dozen ways, and it happens all the time” (p. 95).
Conclusion
And so, even if we believe that the available research is accurate, it just so happens that an examination of it leads to very different moral conclusions by very intelligent people about the wisdom of using these drugs. The pharmaceutical industry’s influences on the body of research about the safety and effectiveness of these drugs make these types of conclusions ever more questionable.
For those interested in following the peer reviewed scientific research about the effectiveness and safety of these drugs, I highly recommend the Mad In America website. It describes the latest research in non-technical language while providing the links to all of the actual research articles so readers, if they so choose, can read them for themselves.
Members of MI have seen first hand people who have died and who have suffered terribly as a result of their involvement with the psychiatric profession. At the same time, psychiatrists also well know that there are many incidences of tragic outcomes due to their treatments, but they have come to believe that overall the benefits of their treatments far outweigh all of those tragedies. And the enormous financial benefits that come with being a psychiatrist are very likely to influence their views.
Civil rights activists worked for generations to make some progress in achieving their goals. Among the most successful of these advocates was Martin Luther King, Jr. When advocating for civil rights, he avoided throwing insults at those who resisted the changes he was after. Instead, he focussed on painting his dream in beautiful, hopeful phrases and demonstrating in nonviolent, but impossible to ignore, peaceful resistance.
In a country where many of our current politicians have taken to insulting anyone who disagrees with them, King’s approach may seem out of style. As for me, I personally think King’s approach is as timeless as stars twinkling in the heavens.
Welcome to From Insults to Respect. Today’s topic, addiction. When we see we have become addicted to something and find we are having difficulty breaking the habit, we may begin to lose some self respect. And sometimes our actions related to our addictions lead to others losing respect for us. So, it makes sense that we spend a little time giving this topic some thought.
Regular readers of this blog know that from time to time I like to enrich some ideas about a subject with some relevant thoughts that Bob Dylan has shared on his Theme Time Radio Hour show. His entertaining mixture of insightful observations with songs, humor, and poetry leaves us with a deeper sense of the topic at hand.
It just so happens that Bob has done three shows on themes related to today’s topic–“Smoking,” “Drinking,” and “Coffee.” Let’s begin with smoking.
Bob’s Show on the Theme of Smoking
Bob introduces his theme on smoking with the background music of “Smoke Gets in Your Eyes” and the following words:
Today’s show is all about smoking. We’re not here to encourage it or to glorify it. You’re smart enough to look up all the facts. What we’re going to do over the next hour, is to give a looking and a listen to what happens when the tobacco plant collides with popular culture. As Oscar Wilde once said, “A cigarette is the perfect type of a perfect pleasure; it is exquisite and it leaves one unsatisfied. What more can one want?” We’ll be examining tobacco in all of its forms, from plant, to ash, with stops at cigars, cigarette, snuff, and chewing tobacco. So sit back, smoke em if you got em, and enjoy the next 60 minutes as we blow a few musical smoke rings your way.
Then, Bob launches into a song by Tex Williams and His Western Caravan: Smoke! Smoke! Smoke! (That Cigarette):
Now I’m a fellow with a heart of gold
With the ways of a gentleman, I’ve been told
A kind of a fellow that wouldn’t even harm a flea
But if me and a certain character met
That guy that invented the cigarette
I’d murder that son of a gun in the first degree.
It ain’t that I don’t smoke myself
And I don’t reckon they’ll injure your health
I’ve smoked ’em all my life and I ain’t dead yet.
But nicotine slaves are all the same
At a pleasant party or a poker game
Everythin’s gotta stop
When they have that cigarette.
Smoke, smoke, smoke that cigarette
Puff, puff, puff and if you smoke yourself to death
Tell St. Peter at the Golden Gate that you hate to make him wait
But you just gotta have another cigarette.
I get a pretty clear sense from that song that the singer is not exactly thrilled with his smoking habit.
Several of the songs that Bob plays on this show expresses a longing for the next cigarette. He tries to explain this longing as follows:
One of the problems when you smoke is when you’re not smoking, you can have one of those nicotine fits. Here’s how nicotine fits work. Nicotine is physically addictive; it alters your brain functions. Every nerve in your brain’s nervous system has these very tiny neurotransmitters. Nicotine works on some of them, tricking your body that it needs more of these receptors. When you started smoking, your body started responding to the nicotine, and started growing these extra receptors. Over the years, your body has gotten used to these extra receptors, and needs the nicotine to feed them. When you stop smoking, your body thinks your body’s transmitters have been shut off. Your body seeks equilibrium. That’s what the craving for nicotine comes from. When you have a craving for nicotine, the only thing that will help you, is another cigarette.
Bob’s description of the addiction process is somewhat simplified, and he may be a bit off when he says that in responding to the nicotine the body starts growing these extra receptors. The theory I have heard discussed in the scientific literature (see HERE) suggests that nicotine tricks your body so that it actually reduces the number of your receptors.
Your body does so, according to this theory, because at first the nicotine leads to your receptors firing more frequently than usual. This leads to feeling more alert, which some of us experience as rather pleasant. But your body recognizes that if you were to keep firing those receptors at the pace that occurs when you first started smoking, certain functions in your body will end up exhausted. Thus, your body starts to reduce the number of these receptors. In the scientific literature, this process is called “down regulation” or “tolerance.”
For smokers, we see evidence of tolerance in studies that indicate fewer responses than do non-smokers to the same amount of nicotine (Perkins et al. 2001b). More specifically, we see a reduction on measures of subjective stimulation that may be viewed as pleasurable, such as arousal, vigor, and a subjective experience often referred to as “head rush” or “buzz.”
Once the down regulation process is complete, you end up with enough receptors to function fairly well as long as you are smoking. However, shortly after you pause from smoking even for a few minutes, you end up not having enough of these receptors to do what they were originally designed to do. It is this shortage of receptors that occurs when there is not enough nicotine in your system to keep your receptors firing at a rate that would typically occur if you were not addicted to the drug that leads to the uncomfortable, sluggish, stressful feelings that lead to a craving for the next cigarette. When you light up, you feel relief because now the reduced amount of receptors are sufficient to carry out your major life functions in a less distressed manner.
The relief that smokers feel each time they give themselves another dose of nicotine creates the powerful illusion that cigarettes help them to deal with stress. Thus, in a study published in the American Psychologist, researchers found the following:
Smokers often report that cigarettes help relieve feelings of stress. However, the stress levels of adult smokers are slightly higher than those of nonsmokers, adolescent smokers report increasing levels of stress as they develop regular patterns of smoking, and smoking cessation leads to reduced stress. Far from acting as an aid for mood control, nicotine dependency seems to exacerbate stress. This is confirmed in the daily mood patterns described by smokers, with normal moods during smoking and worsening moods between cigarettes. Thus, the apparent relaxant effect of smoking only reflects the reversal of the tension and irritability that develop during nicotine depletion. Dependent smokers need nicotine to remain feeling normal. The message that tobacco use does not alleviate stress but actually increases it needs to be far more widely known.
Theoretically, this same process is largely the reason why people become addicted to other substances, such as alcohol, caffeine, illegal drugs, and even the drugs that psychiatrists prescribe, such as the so called antianxiety drugs (anxiolytics), antidepressants, and ADHD stimulants such as Ritalin. They all have the potential of creating for addicted people the illusion that they are functioning better than they did before they started consuming the addictive drug.
Another major part of the addiction process is that the addictive substance often is used as part of a ceremony creating a very pleasant experience. As an example of this, Bob has us listen to the actor John Cusack explaining his smoking habit:
John Cusack
To me, cigars are a much better situation than cigarettes. Cigarettes are compulsive and cigars are kinda, languid, luminous conversation. Like you’re gonna sit for a couple of hours and talk to somebody. If you gotta smoke, I would say, at least have a long conversation with someone you like, rather than just compulsively sucking down a cigarette. That’s how I’m gonna lie to myself so I can keep smoking cigars.
Although the cigarette habit is not John’s cup of tea, many people have fond associations of sharing a cigarette with others, and drinkers have associations of some very good times hanging out with their buddies. Of course, others have very negative associations with an addictive substance, as one of Bob’s song selections suggests. Here are a few of the lyrics from “Dim Lights, Thick Smoke, and Loud, Loud Music” by Joe Maphis and Rose Lee:
Dim lights, thick smoke, and loud loud music
Is the only kind of life you’ll ever understand
Dim lights, thick smoke, and loud loud music
You’ll never make a wife to a home lovin’ man
A home and little children mean nothing to you
A house filled with love and a husband that’s true
You’d rather have a drink with the first guy you’ll meet
And the only home you know is the club down the street
Dim lights, thick smoke…
Dim lights, thick smoke…
Well, that should give you a little feel for Bob’s show that focussed on the smoking theme. Now, let’s turn our attention, with Bob’s help, to another addictive substance.
Bob’s Show on the Theme of Drinking
Bob begins this show with the following words:
“Sit down and enjoy yourself as we discuss the world of liquid libation, booze, sauce, hooch, white lightning, fire water, hard stuff, pick me up, gin and juice, moonshine, canned heat. We’re going to start off with George Zimmerman and the Thrills doing “Ain’t Got No Money to Pay for this Drink.”
With a great rollicking sax backing up the lead singer, a few of the lyrics go like this:
I ain’t got no money to pay for this drink, But boy I need it bad,
My wine headed baby’s taken everything I had.
Here we see a basic theme of addiction; something very upsetting happens to the addicted (my baby’s taken everything I had) and they have come to believe that they have to turn to the addictive substance to deal with the resulting emotional experience. Moreover they will seek the substance even when they no longer have the money to attain it.
After the song, Bob plays us a little audio clip of Ray Milland’s Academy Award winning portrayal of Mr. Birnam, an alcoholic in the movie, “The Lost Weekend.”
“Just give me a drink,” says Mr. Birnam with exquisite anguish.
The bartender, in a disbelieving voice: “Mr. Birnam, this is the morning!”
“That’s when you need it most, in the morning,” Mr. Birnam replies with disgust. “Haven’t you learned that yet! At night, it’s a drink, in the morning, it’s medicine!”
During Bob’s show on drinking, several of the songs show us the dark side of this activity from the perspective of family members. My personal favorite is, “Don’t Come Home A-Drinkin'” by Loretta Lynn. Here’s a few of the lyrics:
Well you thought I’d be waitin’ up when you came home last night You’d been out with all the boys and you ended up half tight But liquor and love they just don’t mix Leave the bottle or me behind And don’t come home a drinkin’ with lovin’ on your mind.
Like smoking cigarettes, drinking is often associated with particularly good times, and that’s part of the addiction process. Bob makes this point when he introduces us to American TV host and comedian, Jimmy Kimmel, who tells us why he enjoys beer so much:
Beer is, it’s not just a drink to me, it represents something, it reminds me of being in college and high school, and discovering getting drunk, and having a sixteen pack in the trunk of my friend, Tommy’s car, drinking it hot out of the can in a parking lot in Las Vegas. Something about beer equals good times to me.
Bob goes on from here to play a couple of songs that bring home this notion that for some, the association of drinking with good times, going out and meeting people, dancing, and partying is all just plain fun. But the vast majority of the songs he plays throughout this show mixes the fun stuff with some pretty sad stuff as well.
Bob’s Show on the Theme of Coffee
Here’s Bob introducing his show on coffee:
Welcome to Theme Time Radio Hour, full of caffeinated dreams, schemes, and themes. Pour yourself a hot, steaming cup of joe, cause we’re going to be talking about the amber liquid of life. No matter what you call it, it’s a drink made from a shrub of a tree. I’m talking about coffee. They call it a man’s gold, and like gold, it brings to every person a feeling of luxury and nobility.
There’s no question here that Bob likes his cup of java as he launches into the Ink Spots doing Java Jives, which is basically a love song to coffee.
I love java, sweet and hot Shoot me the pot and I’ll pour me a shot
Oh, slip me a slug from that wonderful mug And I’ll cut a rug till I’m snug in a jug
As sweet as a cup of coffee is, for some it’s even better with a cigarette, as Jerry Irby tells us in his song, One Cup of Coffee and a Cigarette:
Now when I get up in the morning
And I’m feeling mighty low
There’s just one thing that will pep me up
And I want you all to know.
Well it happens every morning
No matter where I’m at
I just gotta have a cup of coffee And a cigarette
Coffee, coffee, And a Cigarette Is a habit That you can’t forget…
As most of you know, coffee has, for some of us, some negatives. As examples, it can be moderately costly, it is associated with headaches and sleeping problems, and since it is usually consumed very hot, it may, according to some recent epidemiological data, be slightly related to throat cancer. But most people who drink coffee live to a ripe old age and believe the positive pleasures are well worth dealing with the negatives.
Final Thoughts
Well, there you have it, a little Bob Dylan meditation on the nature of addiction. As I listened to his shows, it came vividly clear to me that many people reach a point at which they decide that they want to get off the merry-go-round of their addiction. When this occurs, what is the best way to go about doing this?
I’ll soon be writing a follow-up post to address this question. I can sure use some help with this, so if any of you have some favorite ideas on this subject, please don’t hesitate to send them along either by making a comment in the comment section below, or on the various social media groups that I participate in.
Hoping to hear from you,
My Best,
Jeff
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Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional intelligence. To begin at the very first post you can click HERE.
It’s a Sunday night. Eight-year-old Carl is playing a computer game. Suddenly, his mom cries out, “Time to head up to bed, tomorrow’s school.”
“Don’t ‘but mom’ me, let’s go,” and she takes Carl firmly by his arm and begins to guide him to his bedroom. Carl’s eyes tear up, which infuriates his mother, and she cries out, don’t you start with this crap or I’ll give you a real reason to cry! You’re acting like an infant!!! Now you stop this instant and get to bed!!!”
“I see you are feeling sad. That’s understandable. You were enjoying the game so much, and you’re disappointed about having to stop. You know, when we feel sad, it’s to help us figure out how to better handle what we do in the future. I wonder how we can better handle the going to bed situation in the future. Any ideas, Carl?”
We could also go to the library and pick out some books that have pleasant short stories, and you can read one right before bed. Short stories come to an end in a reasonable period of time, and the reader feels a sense of completion when it’s over, without making you feel like you have to read the next chapter to see what happens next. That might work also. So, in the future, why don’t we try having you each night choose one of these ideas. I’ll let you decide each night which approach feels right to you.”
Suppose a guy named Fred tends to be sad more than the average person. This might be due to some natural born tendency to experience life in a more sensitive manner than most, or because of some rough stuff going on in his life, or some trauma in the past has been leading to recurring anguishing memories. For whatever reason, Fred regularly comes to work expressing his sadness from the look on his face as he goes around doing his job. Co-workers often stop what they are doing to ask what is wrong, and offer help by taking time to listen to Fred in a caring way. This would be nice in some ways, but let’s say it happens so often, coworkers begin to find that their work at the end of the day doesn’t always get done on time and they end up having to stay late. 
Some resentment begins to arise. Moreover, in this scenario, the boss begins to dislike what has been going on partly because of the time being taken from the tasks that have to get done with top-notch efficiency in a competitive business environment, and she was brought up by parents who taught that there is something wrong with people who are sad more than average. In the end, Fred loses his job.
Perhaps Fred, if he could afford it, would be better off hiring a professionally trained personal counselor to help him work through his sad experiences in a positive manner so that he doesn’t put too much on the shoulders of friends and family members. There are, in most communities, some counselors available, and at the top of any of my blog post there is a link titled “Counseling Services” that when clicked on provides descriptions and contact information for two excellent personal counselors that I personally can recommend who conveniently provide services through Skype, Zoom, or your phone.
However, counseling services do cost money, and if it is too expensive for someone’s budget, an alternative is to set up via such internet resources like meetup.com, a support group that meets regularly for the specific purpose of sharing challenging emotional experiences. Of course, the members will be unlikely to have the expertise of a trained personal counselor, but with trial and error it is often very possible to find the right mix of caring, empathic participants.
We’re here to emotionally support one another.
The Provigil made it hard for Laura to sleep, so her pharmacologist prescribed Ambien, which she took every night. In the course of a year, her doctors had created what’s known as “a prescription cascade”: the side effects of one medication are diagnosed as symptoms of another condition, leading to a succession of new prescriptions.
It was at this point that Laura decided to see what would happen if she stopped taking the drugs, and found that the process was an excruciating experience because of the medication withdrawal reactions. It took her many extremely rough months before her goal was achieved.
Prior to coming off the psychiatric drugs, Laura had been unable to have stable relationships. “I honestly thought that, because I was mentally ill, the numbness was just part of me.” Now she wondered about the other effects of the many medications she had been taking. “On this very sensory, somatic level, I couldn’t bond with another human being,” she said. “It never felt real. It felt synthetic.”
From today’s post, I hope that you will consider the value of giving up any belief that you may have that feeling sad means you are bad. If, when you experience sadness, you find yourself saying such words like, “I can’t believe I’m feeling sad again, what an idiot I am,” consider how it may be far more helpful to view your sadness as a useful tool for helping us to better plan our future. If you are a parent, consider the value of teaching your children this “sadness is a helpful tool” idea.
Welcome to From Insults to Respect.
A mock funeral mourning those lost to psychiatry or who have had their spirits broken and struggle to survive is to be held as protesters deliver a public message to psychiatrists at the annual meeting of the American Psychiatric Association on Sunday, May 6, 2018. “First, Do No Harm” is the message that protesters hope will go viral and get people to think twice before getting involved with psychiatry.
I became interested in the conflict about the use of psychiatric drugs very early in my career as a psychologist. I began to discuss the issues with psychiatrists as well as those who objected to this form of treatment. A broad outline of what I heard follows:
In contrast, critics of psychiatric drugs have made the following counter claims: The use of psychiatric drugs has unleashed the worst medically induced disaster in history. They have caused millions of people to become addicted to them, suffering debilitating, life threatening side effects. Rather than promoting mental health, these drugs are being used to promote social control and conformity. Reduction in hospitalization, moreover, occurred not because of the use of these drugs, but because of a deinstitutionalization policy that became known as “dumping.” Problems now being handled with psychiatric drugs can be more effectively, safely, and humanely handled with a variety of social support systems, counseling, mindfulness, healthy diet, and physical exercise techniques.
As I heard these conflicting claims, I initially thought that psychiatrists had principles of science on their side. With my graduate training in research methods and statistics, I thought that by doing a thorough job finding out the scientific research that backs up the psychiatric drug supporters I could explain in an easy to understand language why psychiatric drugs are necessary. With such an explanation, perhaps the conflict would be resolved.
I began with researching Ritalin because I was working in Rochester, NY’s school system. This was from 1974 to 1979. It was a time when drugs were just beginning to be prescribed more and more to treat students who had teachers dissatisfied with their activity level or ability to pay attention. I had witnessed a time when schools managed to deal with such problems without the use of this drug and life went on reasonably well. With the rise in its use, some thought it was a wonderful advancement, while others were expressing great discomfort at this new trend.
Not all of the findings were supportive. At the time I initially did my research, there was only one study that looked at the long-term results of Ritalin use. It compared children placed on methylphenidate, the generic version of Ritalin, with those who received no treatment. The children in the two groups were matched with respect to age, IQ, socioeconomic class and sex. After 3 to 5 years, no statistically significant differences were found between the two groups on the following outcome measures: emotion maladjustment, delinquency, Wechsler Intelligence Scale for Children, Bender gestalt visual-motor test, and academic performance.
Perhaps most troubling of all was the recognition that the safety of long term use of Ritalin had not been established despite many students being treated for years.
In the end, I discovered that although the approval process of the FDA had in its documents the available scientific evidence in making its decision to approve Ritalin, the reviewers’ decision nevertheless relied more on their personal values. It seemed to me, and it still does, that different people looking over the same scientific evidence could, depending on their values, come to completely different conclusions about whether or not the drug should be approved.
For example, Marcia Angell, M.D., is a former editor in chief of The New England Journal of Medicine, and now is a member of Harvard’s Medical School. In her insightful book, The Truth About the Drug Companies: How They Deceive Us and What to Do About It, she writes, “Is there some way companies can rig clinical trials to make their drugs look better than they are? Unfortunately, the answer is yes. Trials can be rigged in a dozen ways, and it happens all the time” (p. 95).
Civil rights activists worked for generations to make some progress in achieving their goals. Among the most successful of these advocates was Martin Luther King, Jr. When advocating for civil rights, he avoided throwing insults at those who resisted the changes he was after. Instead, he focussed on painting his dream in beautiful, hopeful phrases and demonstrating in nonviolent, but impossible to ignore, peaceful resistance.
Welcome to From Insults to Respect. Today’s topic, addiction. When we see we have become addicted to something and find we are having difficulty breaking the habit, we may begin to lose some self respect. And sometimes our actions related to our addictions lead to others losing respect for us. So, it makes sense that we spend a little time giving this topic some thought.
Regular readers of this blog know that from time to time I like to enrich some ideas about a subject with some relevant thoughts that Bob Dylan has shared on his 
Today’s show is all about smoking. We’re not here to encourage it or to glorify it. You’re smart enough to look up all the facts. What we’re going to do over the next hour, is to give a looking and a listen to what happens when the tobacco plant collides with popular culture. As Oscar Wilde once said, “A cigarette is the perfect type of a perfect pleasure; it is exquisite and it leaves one unsatisfied. What more can one want?” We’ll be examining tobacco in all of its forms, from plant, to ash, with stops at cigars, cigarette, snuff, and chewing tobacco. So sit back, smoke em if you got em, and enjoy the next 60 minutes as we blow a few musical smoke rings your way.
Now I’m a fellow with a heart of gold
One of the problems when you smoke is when you’re not smoking, you can have one of those nicotine fits. Here’s how nicotine fits work. Nicotine is physically addictive; it alters your brain functions. Every nerve in your brain’s nervous system has these very tiny neurotransmitters. Nicotine works on some of them, tricking your body that it needs more of these receptors. When you started smoking, your body started responding to the nicotine, and started growing these extra receptors. Over the years, your body has gotten used to these extra receptors, and needs the nicotine to feed them. When you stop smoking, your body thinks your body’s transmitters have been shut off. Your body seeks equilibrium. That’s what the craving for nicotine comes from. When you have a craving for nicotine, the only thing that will help you, is another cigarette. 
Your body does so, according to this theory, because at first the nicotine leads to your receptors firing more frequently than usual. This leads to feeling more alert, which some of us experience as rather pleasant. But your body recognizes that if you were to keep firing those receptors at the pace that occurs when you first started smoking, certain functions in your body will end up exhausted. Thus, your body starts to reduce the number of these receptors. In the scientific literature, this process is called “down regulation” or “tolerance.”
However, shortly after you pause from smoking even for a few minutes, you end up not having enough of these receptors to do what they were originally designed to do. It is this shortage of receptors that occurs when there is not enough nicotine in your system to keep your receptors firing at a rate that would typically occur if you were not addicted to the drug that leads to the uncomfortable, sluggish, stressful feelings that lead to a craving for the next cigarette. When you light up, you feel relief because now the reduced amount of receptors are sufficient to carry out your major life functions in a less distressed manner.
Theoretically, this same process is largely the reason why people become addicted to other substances, such as alcohol, caffeine, illegal drugs, and even the drugs that psychiatrists prescribe, such as the so called antianxiety drugs (anxiolytics), antidepressants, and ADHD stimulants such as Ritalin. They all have the potential of creating for addicted people the illusion that they are functioning better than they did before they started consuming the addictive drug.
Dim lights, thick smoke, and loud loud music
We’re going to start off with George Zimmerman and the Thrills doing “Ain’t Got No Money to Pay for this Drink.”
“Just give me a drink,” says Mr. Birnam with exquisite anguish.
Well you thought I’d be waitin’ up when you came home last night
Beer is, it’s not just a drink to me, it represents something, it reminds me of being in college and high school, and discovering getting drunk, and having a sixteen pack in the trunk of my friend, Tommy’s car, drinking it hot out of the can in a parking lot in Las Vegas. Something about beer equals good times to me. 
I love java, sweet and hot
Now when I get up in the morning
Well, there you have it, a little Bob Dylan meditation on the nature of addiction. As I listened to his shows, it came vividly clear to me that many people reach a point at which they decide that they want to get off the merry-go-round of their addiction. When this occurs, what is the best way to go about doing this?