Every therapist remembers their first client suicide, and when it happened to me, I cried that entire night.
I can only describe such cries as guttural and primal- they shouted to the universe begging for a rationale, pleading for some understanding to a question that seemed impossible to answer.
The woman was young, and her life had been undoubtedly difficult. She did not have to die, but it was clear that she did not believe she could live, either.
I want to say that every therapist working in addiction also remembers their first drug-related death. This client was even younger; he was charismatic and humorous, and his body was found in a rundown motel room days after overdosing on heroin. The last time I saw him, he was smiling and seemingly grateful, proudly sharing his goals for a future in recovery, positioning himself for the best chances of success and joy. His death was mentally shattering, just as hers had been, and I reacted with just as many tears.
His death, unlike hers, maintains an aura of ambiguity, and the nature of it keeps his intentions painfully unknown. Had it been entirely accidental? Did he know what was going to happen? Did he care?
Drugs and alcohol kill. We know this. We read the dizzying statistics and tragic obituaries. By their mid-twenties, many of my clients have attended more funerals for friends than weddings. In the throes of addiction, life loses its vulnerability; death loses its shock value.
I’m totally desensitized to it, I often hear, in response to this chilling epidemic, It just happens so often. It’s kind of like waiting to see who’s next.
Unfazed by death, the number of their own overdoses and touches with mortality becomes just another figure, as nonchalant and matter-of-fact as social security or date of birth.
So, when we dig to the crux of it, what is really going on here? Is drug addiction a death wish, just a passive or active suicide of varying speeds, ranging between a bullet train plunging into death to a slow and lethal decline, as quiet as the dead of the night?
To explore these aching questions, we must picture the overarching dilemma of addiction.
We must picture a primal mode of desperation- essentially living as a slave to an external substance and inadvertently living as a prisoner of self. And, with that in mind, we must picture facing this dynamic while simultaneously grappling society’s anger, condemnation, and ridicule for it even happening at all.
We must picture how this drug takes over everything that matters, over family and values, over common sense and sanity. We must picture how it ensues a cyclical whirlpool of shame, remorse, anxiety, and depression. With those spinning layers in mind, we must also picture how truly terrible and convoluted this lifestyle is- how it wrecks a human’s physical, mental, spiritual, and financial spirit, often until just a shell of that person remains.
I don’t know about you, but when I picture this, when I sit down with it every therapy hour of every workday, I picture the epitome of purgatory, a thin fog of existence teetering between the depths of life and death itself.
But, why would anyone put themselves in such a hopeless situation? How could anyone lose such control and integrity?
The answers exist beyond the edges of addiction stigma and into the convoluted phenomena of human behavior and motivation.
We have the faces of society, the people that blend into the background, the victims who never intended for this kind of torturous punishment.
We have the young and fragile girl who suffered chronic molestation as a young child. We have her innocently drinking alcohol with friends and quickly discovering that it can help numbing horrific memories.
We have the teenage boy who lived in and out of foster homes as his own parents struggled with addiction. We have him experiencing a perceived sense of acceptance and familial connection through the local gang- and the subsequent drug use- who has taken him under their wing.
We have the innocuous suburban mother who comes down with a debilitating pain condition. We have her trying to balance her household and young children, taking a few extra painkillers because it makes the daily living a bit more tolerable.
We have these people, and we have their stories. We have a desperation so raw and so severe that playing Russian Roulette with life or death is justifiably worth the risk.
Can addiction really be considered a death wish? Or is it more of a just get me out of this misery wish? Is it a bit of both?
Invariably, we see a complex equilibrium; these highs and lows provide as much pleasure as they do pain; as much perceived life as they do potential death. We can react and judge, we can condemn, and we can assume that death can scare people right out of using. Sober up, as if it’s an item on a to-do list between dishes and brushing teeth. Sober up, as if it guarantees an elixir to happiness and purpose.
But imagine how hard it is to convince someone that life can be worthwhile when it has only been a labyrinth of pain and horror. Imagine how asinine it seems to trust in hope when everything has been a rotating series of hopelessness.
In the darkest trenches of addiction, drug use is the predominant coping skill for any and all emotions. People in this place, in this purgatory of sorts, are not actively living or dying. Instead, they exist in a fuzzy state of indifference. Indifferent to life, indifferent to death, essentially indifferent to anything but the fierce compulsion to avoid pain. It is a lonely and confusing place, but any place, with enough time, can become comfortable and familiar.
For better or worse, if you are reading this, you know someone in this purgatory, and maybe you’re the one stuck in there yourself. Maybe it all feels pointless and futile and a journey of one step forward and a thousands steps back.
But, what about those who do emerge from the indifference? The ones who remove themselves from the slavery and agony from addiction?
They exist, and they’re everywhere. Maybe you know some of them. Maybe it’s the client who had been struggling for over a decade, who everyone gave up on, who visited me a few days ago and proudly gushed about how her life has never been better. Maybe it’s the client who once shot heroin into his neck and slept in cars, but now successfully works in treatment and helps other addicts discover their own hope and healing.
Maybe it’s just the person who decided that she was going to choose life, in whatever form that meant, and just see where it took her.
Maybe it’s not about finding a cure or happily-ever-after or even a complete sense of relief and comfort.
Maybe it’s simply finding the slightest glimmer of hope that life has the potential to be cherished.