"On Healing" December 2003

Posted on Mon, Dec. 15, 2003
To be vulnerable is to see kindness - for a change
By Dan Gottlieb

This week will be the 24th anniversary of my life as a quadriplegic. Of course, this disability carries a great deal of adversity. But it also has taught me some valuable lessons, one as recently as last month.

I drive an adapted van. Because I have difficulty with body control, I drive slower than most people - especially on windy days. Or if I am having problems with spasms or blood pressure, I will drive even slower, in the right-hand lane, well below the speed limit. And when I do, many people speed up to my car, blow their horns, drive by, stare at me angrily, and show me how long their fingers can get. I don't understand why some people are so proud of the length of their fingers, but there are many things I don't understand.

Nevertheless, when this happens to me, those angry drivers add stress to what already is a stressful experience of driving.

So last month as I was completing a lecture on a terribly windy day in Fort Washington, I was beginning to feel unwell. I was feeling increasing spasms in my legs and back and became anxious as I anticipated a difficult ride back to my office in Bala Cynwyd. Making matters worse, I knew I had to travel the Blue Route and the Schuylkill Expressway by myself and was feeling unsafe. I also knew that with the wind and my spasms, I would have to drive extremely slowly and would probably be hearing a lot of horns and seeing a lot of those long fingers.

I left my lecture and drove slowly on the back roads, and as someone approached, I pulled over and let them pass. But as I approached the Blue Route, I became more frightened.

And then I did something I had never done before.

For the first time in 24 years of driving, I decided to put on my flashers. I drove the Blue Route and Schuylkill at 35 m.p.h. Guess what happened? Nothing! No horns and no fingers. But why?

When I put on my flashers, I was saying to other drivers: "I have a problem here - I am vulnerable and doing the best I can." And everyone understood. There were several people who wanted to pass and couldn't because of traffic in the passing lane. They just waited, knowing the driver in front of them was in some way weak.

There is something about vulnerability that elicits compassion.

It is in our hard wiring. I see it every day when people help me by holding doors, pouring cream in my coffee, or with putting on my coat. Sometimes I feel sad because from my wheelchair perspective, I see the best in people. But those who appear strong and invulnerable typically are not exposed to the kindness I see daily.

All of us need care and compassion. Everyone needs people to be more patient with them. I know that our lives would be easier if we were exposed to the kind of patience and understanding I experienced that day on the Blue Route.

So what do we do when we feel vulnerable? Typically, when we feel weak, we pretend we are strong and when we feel scared we pretend we are not. So what does that behavior elicit in people? Not compassion.

That instinctive reaction to defend ourselves and pretend we are strong when we are not probably comes from our primitive brains. When we were on all fours, if we made our vulnerability public, we probably would have become somebody's lunch. So it is instinct to pretend we are not vulnerable when we are. As a matter of fact, sometimes when we are vulnerable we get more reactive and more aggressive. Most acts of violence are a misguided attempt to manage one's vulnerability.

Sure, it is animal instinct to protect ourselves and act strong when we feel vulnerable. But our job as humans is to rise above these animal instincts. The world might be a safer place if everyone who felt vulnerable wore flashers that said: "I have a problem and I'm doing the best I can. Please be patient." And if when we saw someone moving slowly - on the road or in life - instead of showing them our fingers, we could visualize their blinkers and show them compassion.

I was recently told that the Hebrew word for wind is the same as for spirit. Who would have thought that on a windy day with my flashers on, I would have seen so much of the beauty of the human spirit?

Posted on Mon, Dec. 01, 2003
Letters about the anxious alcoholic
By Dan Gottlieb

In an October column, I responded to a letter from a woman concerned about her brother, who apparently suffered a severe anxiety disorder. He lived alone and frequently missed work for fear of being around people. To cope with the anxiety, he began drinking excessively. As a result of the alcohol abuse, he developed a variety of other problems, including multiple hospitalizations.

I spoke with John Grayson, a psychologist in Bala Cynwyd who specializes in anxiety disorders. He recommended that this man be detoxified from alcohol before being treated for anxiety. I also recommended that the sister attend Al-Anon meetings, which are designed to help friends and loved ones of alcoholics.

Several readers have also offered their insights. Here are two of those letters:

Dr. Gottlieb:

I am a psychiatrist who specializes in "dual diagnostic" conditions. I agree with John Grayson that hospitalization and detoxification is the place to start, but I would go further and state that a full inpatient rehabilitation treatment is essential for this patient to succeed and get well. The only way that his denial and other defense mechanisms can be addressed is through the extensive treatment still available at a quality treatment program that also offers co-management of his anxiety disorder(s). The overwhelming likelihood is that anything less than a minimum of a 28-day inpatient program will fail for this patient with the history described in your column. The concerned family should be advised that an intervention is an excellent idea, but the initial goal should be to get this patient into a rehab program for several weeks. It is a dated concept to state that one condition should be treated before the other; rather they need to be treated concurrently and in an integrated manner.

Michael W. Shore, M.D.

Cherry Hill

Dr. Shore is correct when he suggests a lengthier inpatient stay in a quality treatment program. But in the world of restrictive managed-care carriers, it can be quite difficult to get approval for a lengthy inpatient program. In addition, there have been dramatic cutbacks in staff and services at most of these programs, leaving fewer quality programs with longer waiting lists. And to pay out of pocket is extraordinarily expensive. It's too bad, because we have the skills to provide quality care for both substance abuse and mental illness, which could improve the lives of countless thousands. But between government cutbacks and managed-care organizations, most of which would prefer medication to hospitalization, these advances in science don't readily get to the people who most need them. But there are other options, as this reader suggests:

Dear Dr. Gottlieb,

I can attest to the truth and accuracy in the answer to that woman's letter. After suffering lifelong anxiety/panic disorder and depression, no amount of therapy was any help until I stopped drinking and drugging. People (friends, family, therapists) told me I wouldn't get any better until I stopped my attempts to "self-medicate," but I was very stubborn and wouldn't listen until my dual addictions led to a near-fatal suicide attempt. I am only clean and sober for one year and four months, but what a change! I have hooked up with a fantastic therapist, and once I accepted the first of the 12 steps (powerless over alcohol) and began to practice the principles of both AA and NA, wonderful things began to occur. I am actually in a position now to help others who suffer from the same sort of debilitating conditions from which I suffered. I have a wonderful support group, and when I feel strange or uncomfortable I know I can call someone and talk about it and maybe begin to understand what's happening instead of trying to alleviate my discomfort by "using." I lost everything I worked very hard for and am quite poor right now but I have what I need: wonderful people surrounding me. I had the privilege of speaking before a group of addicted teens at a recovery center in Quakertown last month, and when I told the story of my suicide attempt and resulting coma (eight days on life support) a 17-year-old boy made the comment that "maybe God had to put you in a coma before you would wake up." Such wisdom from so young a person.

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