Saturday, May 06, 2006

The Haunted

Still trying to put the borderline post into English. In the interim, the haunted.

I saw a woman yesterday who is one of our more successful clients. No heroin for ten years - hasn't known any users for five. She has been clean for not only the last six years (the Years of Famine) but also the four years before that (the Years of Plenty - when people talk about it it sounds like that bit from the Book of Daniel*), before the heroin supply in Australia all dried up, back when you could get stuff that "kids of today wouldn't believe". She is one of our truly stable clients - mother, grandmother, works at the school tuckshop, somebody's confidant and advisor and best friend.

Anyway, for the last five or so years she's been on stream C. She picks up her buprenorphine Mondays, Wednesdays and Fridays, before work, and has takeaways the other days. I looked at her dose.

"Point eight milligrams" I said. "So you're one of our big time users."

She laughed. Twelve years ago it was heroin six times a day, six years ago it was a hundred and fifty milligrams of methadone. Now it's two of the smallest tablets of the mildest under her tongue, an almost homeopathic dose.

"Ever feel like reducing off?" I ask. "Forget about us entirely?"

She shook her head, suddenly utterly serious. "Never" she said. "If it works, don't fix it."

Anyway, we chatted about kids and the hassle they were, and I wrote her script, and she went out and the next guy didn't turn up.

And this got me thinking.

I think some of these people are haunted.

What do I mean by haunted? One meaning is the most obvious. I see clients every day who are fleeing from themselves, people haunted by what they were. She was certainly one. I got the feeling with this woman, and she was a lovely woman, that she could see in every reflective surface, every window pane and mirror, every spoon, the gaunt and ragged junkie she used to be.

One part of helping people like her, I feel, is getting her to accept some of the credit for what she has done. It's surprising (until you think about it) how few of my clients give themselves credit for what they have done. For a lot of them the consultations are all about what a shit parent they've been, how smack has ruined everything, how they've fucked everything up. You have to almost grab them - metaphorically speaking - and say "Jesus Christ woman, you beat smack! You've done one of the hardest things someone can do! Whether you did it for your kids or yourself or whatever, you beat heroin! I want you to get up tomorrow morning and stand naked in front of the mirror and scream fifty times "I am a frickin legend!"

Perhaps not. But you want to send her home with more than she came in with, with more than just the sensation of a temporary rest before resuming her eternal flight.

But I think for some of these people there is another way of being haunted. I'm not sure I can explain this well. I think that instead of the traditional haunting, being haunted something there that should not be, some of the people I see have the reverse.

I think as much as by any spectral presence, you can be haunted by an absence.

I think there are people who sit in the chair across from me who have some kind of absence, a chasm where we have a bridge, a hole within the heart.

When I started doing theology, years ago, the confession and absolution was one of the most powerful parts of the liturgy, and it is something that even now retains the power to move me, long after I found myself unable to mouth the Creed.

From the way I saw it (and I am aware that this departs somewhat from the orthodox understanding) the pastor did not and could not forgive sins. But he could and did tell us that we were forgiven. Implicit in how I saw an eternal God then was the idea that then we must have always been forgiven, that we were always forgiven, that the thing that stopped us and held us back was not how good or bad we were, but how long and how hard we struggled against the forgiveness. As for "good" and "evil", good or bad behaviour, it was forgiveness that made us good, rather than goodness that earnt us forgiveness.

That's clumsy and couched in language that many of my readers will find repellant, but that's where some of my clients seem to have a problem. They cannot forgive themselves. They cannot be whole, the have something lacking, something missing. As real an absence as a deletion on a chromosome, or a leaflet on the heart valve that did not form, a bone that never grew, they lack something necessary for a full and real life.

And they can't get better until they get it. And some of them never will.

Anyhow, that was the feeling I got with our successful grandmother. She wasn't ready to give up the buprenorphine, maybe never would be. Even though on a biochemical level it was doing close to nothing for her, on an emotional level she still needed it. It was a surety, a lifeline, some kind of way that she could avoid taking the next step.

Because while she's on the bup she can see herself as a bad person who's getting treatment. If she wasn't on the bup she'd have choose: to be either a bad person who wasn't getting treatment - and she knew she was better than that - or, more terrifyingly, a good person. And she wasn't ready for that.

Anyhow. In the end, medicine is about what works. If her meds work for her, no problems. It certainly makes a nice change seeing her in between the man drinking five litres of wine a day (every day: each week he goes shopping and loads seven five litre casks of wine into his trolley: Monday, Tuesday, Wednesday...) and the woman injecting amphetamines into the veins beneath her tongue.

Anyway, off for Sara's birthday - oysters and fine friends, one of whom has been "let out" for this very occasion, as long as she goes back and has more ECT tomorrow.

Thanks for listening,
John

*Not the Daniel who is getting married, to whom loud huzzahs must be directed. Damn good night/celebratory announcement/weird cocktail thing last night.

PS: Geoffrey Chaucer has a blog - and it's damn fine.

Also, it's been a big week in football over here, full of controvery, treachery and intrigue, and as we speak we are playing the arch enemy, the West Coast Eagles. Depending on the result, I may or may not be held responsible for the content of the next post.

John

5 Comments:

Blogger Prom said...

I don't agree that it is a choice for her between bad with treatment and good on her own. I think that the buprenorphine is the equivalent of her 12 step program higher power.

Staying off is a struggle - a struggle to be good if you will. Giving it all over to the bup (or God) removes the struggle. It isn't a question of forgiveness at all. I doubt that most of these people think of themselves as "bad" people even when using. It is the struggle not to fall into the arms of your most precious lover, to not succumb, not because it is bad of you to do so but because it consumes you if you do.

Staying afloat in your own identity is hard work for many people - hey, maybe a lead in for borderline there!

8:21 PM  
Blogger Benedict 16th said...

You can open your eyes now
the dockers WON!!!!!!

8:34 PM  
Blogger Foilwoman said...

So the other team really was a plucked stuffed roast chicken? Go you. Oh, and the Chaucer blog is a hoot and a half. Thanks.

10:57 PM  
Anonymous Camilla said...

CARN THE MIGHTY DOCKERS!!! :D :D :D And right big kick in the backside for the idiot who broke Sandilands' jaw.

Excellent post, this one. My take is that maybe the woman's buprenorphine is like a walking stick - she's continuing to use it because she's not completely sure she can walk without it, and maybe is a little bit scared to try in case she falls over again. I wouldn't know though. I've never been there. And yeah, I agree with you - having beaten something like heroin should be an occasion for joyous celebration.

4:07 AM  
Blogger Bronze John said...

Hail all, back from the Desperate Alcoholics Clinic and... well, desperate to talk to people who aren't alcoholics.

Prom - you may be right (at least about some of my patients - they're a complex bunch). Had't thought about the giving it over to teh bup thing, and she certainly sees it as a higher power. Having said that, I am pretty sure that at least to me a fair proportion of the clients present as "people who think they are bad". There's a vast amount of self-loathing there, and the depressing thing is how often the "feel like crap because I'm a junkie, inject some more stuff because I feel like crap" cycle sucks everything away form them.

Cam - thanks for the compliment. The other thing I just thought is that letting the bup dissolve under her tongue isn't the whole of what she does. She makes the thrice-weekly
pilgrimage to the pharmacist, she sees me four times a year... it may be that there is something she finds gratifying in the process as a whole, above and beyond the chemical side of it. Maybe (and I'd hope this was true), she's even using it as a bit of a prop to her self-esteem, reminding herself in some way how far she's come.

That'd be nice.

Now, can't remember if I mentioned the football next post or not...

John

8:35 PM  

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