we are working on a film about the relationship between stress and pain. The film focuses on Dr. John Sarno. Jonathan Ames, who referenced Dr. Sarno’s book “Healing Back Pain, on his show HBO “Bored to Death” is in the film. On Saturday I picked up his book “The Alcoholic“. Last night after Phillip Seymour Hoffman had passed away I read it. I was insipred to write this.

Addiction is unrecognized sadness, pain, anger, anxiety, depression, etc. It is the attempt to quell the hungry ghost that eats at us, goading us to fill an ineffable void. If one resorts to a dialectical way of looking at things then addictive behavior might be classified as selfish. However, this is only true in the same sense that removing one’s hand from water that has slowly heated up to near the boiling point, is selfish. This isn’t bleeding heart liberalism, its just reality. Tough love is tough, and it doesn’t save people. Empathy and acceptance has a much better shot, but a society built on empathy and acceptance gets messy. It’s much simpler to get angry with people who make messes then it is to get down on one’s knees, tell them it’s all right, and help them clean it up.

I did not know Phillip Seymour Hoffman, but like him, I have stuck a needle in my arm. It’s silly to deny that heroin feels good. However, it wasn’t the good feeling that defined that moment. It was the absence of the bad feeling that did. I don’t, or more accurately, I didn’t, until this moment, see myself as an extremely anxious person. However, even as I write this, I am coming to realize how powerfully I have been affected by unconscious anxiety for much of my life. There are so many different ways to define, frame, or name these feelings. I’ve been focused on the idea of “unconsciously repressed emotions”. I can see that when those emotions get repressed, they can express themselves as “anxiety” or in my case, largely “unconscious anxiety”. For me this unconscious anxiety can express itself as negative thought processes, tight shoulders, migraines, back-leg-foot problems, gut problems, and in many other ways that I am not aware of.

When I look back, I can see that in that moment, when the drugs hit my system, the silent storm abated and I was calm. There were other good feelings going on, but more than anything the drugs stopped that awful feeling of anxiety. With that anxiety went the guilt as well as shame. Opioids are like alcohol on steroids when it comes to getting rid of those bad feelings, the ones that tear us apart in ways we didn’t even realize. Then we wake up the next morning and remember what it feels like to have all the anxiety, shame, and guilt again, and then some. So, many people repeat the process.

I have always been terrified of feeling like I needed anything. If I start to feel like I need coffee to function I stop drinking it for a while. As such, while I did take some drugs in my early 20’s, I did not fall into them, as many of my friends did. At the time, the East Village, where I lived, was awash in drugs. The stigma of their use was scoured away by the waves of branded baggies that littered the streets. Some friends died, some cleaned up, others went to very dark places before they came back. These were the smart ones, the ones that went to the good colleges, made the great art, and like the rest of us they suffered, in many cases in ways that they did not even understand. Suffering doesn’t require knowledge of ones pain.

When I learned that drugs were the cause of Hoffman’s death, and that the actor had three small children, I felt a pang of anger. Then I felt sadness and empathy. As with all great stories, things are not what they seem. With some people anxiety exists clearly on the surface in ways that are visible to everyone. They move quickly, can’t make decisions, or they appear nervous and sweaty. They are visibly “anxious”. For others, these behaviors are at times visible, but the real iceberg lies beneath. I can recall when I first became conscious of being anxious. I was in college and I kept trying to figure out exactly what it was that was bothering me because I was stressed out all the time. I imagined that if I could just pinpoint the thing; the class, the test, a crush, something I’d said, whether or not I’d done something stupid when I was drunk, I could put it to rest. The process of inventorying my thoughts calmed me down, but it didn’t solve the problem. On some level, college was simply overwhelming, but I was also bowled over by a growing sense of unassigned anxiety. I felt stressed and I couldn’t figure out the reason.

Ashok Gupta, who is based in England, and treats people with chronic fatigue, describes the process of developing unconscious anxiety. He says to imagine that you aren’t paying attention and you step off the curb and almost get hit by a bus. The flight or fight response kicks in and throws you back onto the sidewalk. In this moment the amygdala, which controls the fight or flight response, checks in with the frontal cortex, the current attention part of the brain, and asks, “are buses scary?” If the frontal cortex answers, “Hell Yes!!” then the amygdala knows to flood the system with stress hormones to prepare for action anytime you see a bus. If the cortex responds with “No, just pay attention!!” then buses don’t inspire an unconscious stress reaction in the future. The same is true of school assignments. When the first assignments and tests start rolling in we are often consciously aware of how they stress us out. We think about them and worry consciously. We are aware that they make our hearts beat faster and our hands sweat. After a while, we may have become consciously calmer about school, but our bodies still flood the system with stress response hormones whenever we get an assignment. We may be conscious of the feelings of stress but not even know their source.

When this pattern repeats, as if there is a computer script working in the background, the amount of data being processed becomes enormous, and at some point the system starts to break down. It starts to send error messages in the form of headaches, back problems, irritable bowel syndrome, or panic attacks. Sometimes we listen to these signals, but for the most part we build new patches, add new servers, and try to power through. Sometimes we power through by “blowing off steam” with alcohol, drugs, or other behaviors designed to avoid feeling our emotions.

I know that I try to power through, often pushing myself beyond my physical and emotional capacity, until my body crashes with sickness, or pain, or both. Over the past few months though, I have been making strides, mostly through meditation, in calming myself, and becoming more aware of this process. Hemmingway once wrote about going bankrupt “Gradually and then suddenly”. The same is true in reverse. Over many months of practice I have made gradual improvements, and then last week, suddenly I was much calmer. I come by the anxiety naturally, and nurturely. My mother is, and was, a whirlwind of activity, and anxiety. This is not a game of blame, but instead of understanding. The more I can forgive my mother, the more I forgive myself. The more we forgive ourselves, the more we can forgive, and understand those around us who suffer. Understanding is medicine. Understanding takes away stigma, which brings honesty, which allows healing to take place.

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