Loving the Label

Loving the Label

One of the first “sermons” I ever gave was for student High Holiday services in 1993.  I spoke about a camper I had worked with more than once, a kid who had always been marked as a “bad kid,” but in whom I had found a sweet demeanor and a fascinating personality.  He was really coming around – until he stole money out of another kid’s wallet.  “No more tears,” I pleaded with him in the sermon.

I don’t know what made him decide, at that moment when he was finally shedding his troubled image, to lift five dollars from one of his bunkmates.  But I know I see this kind of thing happening often in my work – and the stakes are a lot higher than getting sent home early from camp.

Twice recently, I’ve heard from people I care for who have months or even years of sobriety to their name, but the image, the label just won’t go away.  Either they are still surrounded by the people and situations that facilitated their substance dependency in the first place, or they continue to be stigmatized in the present for behavior in the past. 

The stigma can be far-reaching; they not only are not taken at their word when they have pain, but occasionally even ER visits for serious, non-painful medical conditions like vomiting and dehydration, or pneumonia, don’t get the careful, rapid attention they deserve.  Listen long enough and you will hear stories of brain abscesses, gangrenous gallbladders, and cancers missed because teams of my colleagues could not see past the addiction.

Faced with this kind of stigma, these folks told me, they eventually caved in.  With all the positive impulses in them to stay sober, they got sick of being pigeonholed, or of being stuck in relationships where their partner was not staying sober, or of still cleaning up the consequences of prior mistakes.  “Screw it,” they said, “if I’m living like I’m still on drugs, and everyone’s treating me like I’m still on drugs, I may as well go back to using.  What difference does it make?”

It’s an old sentiment – like Biblically old.  Rebecca, after years of being infertile, finally gets pregnant – but even then, things are horribly wrong.  She feels her twins struggling, literally “running around” in her womb, and cries out to God, “If so, why am I alive?”  Why do I have to have all this internal conflict?  Why, every time it seems like I’m going to finally succeed at something, does the opposite impulse have to reach out, grab the heels of success, and pull it back?

We all have those impulses in us – the positive ones and the negative ones alike.  Rebecca responds to hers by favoring the impulse she thinks is best, Jacob, and trying to suppress and cut out the one she doesn’t like, Esau.  That suppressed child, once cheated by the favored one out of his blessing and deprived of his birthright in a moment of weakness, turns from merely rough around the edges to downright murderous.

Which is kind of what happens, not just to people facing addiction, but to all of us.  We struggle with our conflicting impulses – a voracious appetite, laziness that keeps us from exercising, or hypersexuality on the one hand, while opposite them we have our poor body image that cries out to look different, the urge to be able to keep up with our energetic kids, or our desire to settle into a healthy relationship.

The “bad” impulses need attention, too.  After he is deprived of his blessing, Esau cries out to Isaac, “Bless me, too!”  They need someone to listen to them, figure out where they are coming from, give them legitimacy.  Jewish tradition holds that the yetzer hara, the evil impulse, is necessary for human existence because it is what fuels much of our creativity, our desire for success, and our self-esteem.  It needs to be co-opted, not eliminated.

We need to change our approach to “bad habits” and negative impulses.  This afternoon I heard an addiction medicine doctor and a layperson in sometimes recovery talk about the way doctors stereotype, pigeonhole, and stigmatize drug users, instead of speaking frankly about the drug use, understanding the motivation, and addressing the real problem – including the fact that people who misuse or abuse pain medications still have real pain and failing to treat it may push them into using street drugs and overdosing instead of into abstinence.  Like Isaac and Esau, the doctor may not provide the exact “blessing” the user is looking for, but at least by listening and providing a different blessing – a real one, one that helps instead of a dismissal – some healing can take place.  Methadone instead of oxycodone, help with housing, a better therapist, or a work excuse – something that feels like real caring.

At the same conference, another speaker told the story of the first morphine addicts – people treated for tubercular coughs with morphine injected by their doctors.  When the doctors realized that they had caused this new, devastating disease, they didn’t blame the patient – they blamed themselves, and carefully nursed the patients back to health by continuing to inject morphine diluted little-by-little until it was just pure water.

We need an approach like that today, some way of engaging with both the good and bad impulses as part of the same person.  We need to finally break through on a way to treat chronic and acute pain without feeding the life-threatening disease of addiction and without telling people they “need to learn to suffer.”  We need a way to stop making folks say of their addictions, “If I can’t beat ‘em, I may as well join ‘em.”  Why should I live with these two struggling impulses inside of me?  Because they’re both part of who you are.  The last time we see Jacob and Esau together they are embracing.  Let’s embrace both parts of you instead of cutting you out of the story.

Dr. Jonathan Weinkle

Dr. Jonathan Weinkle is an experienced primary care physician seeking to fix our broken healthcare system by returning the focus to the relationship between human beings. His new book, Healing People, Not Patients, gathers together ancient wisdom, medical science, and the experiences of one doctor to draw a portrait of a partnership—a medical covenant—not just between doctor and patient, but also including receptionist, nurse, transporter, and radiology technician.

Healers Who Listen would love to listen to what you have to say, too.

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