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Treatment Resistance: The Biggest Heartbreak

At work in the pharmacy yesterday, the pharmacist and I were discussing substance misuse and its tragic detriments on people affected by it. “It’s not a life you’d choose,” she said. And rightfully so.

This is always my stance on the subject. And not just in the context of substance misuse but any lifestyle choice that causes so much harm.

“At the center of every addiction, as at the center of every cyclone, is a vacuum, a still point of emptiness that generates circles of frantic movement at its periphery.” – Peter Trachtenburg

I think all of us are familiar with this emptiness. The silent tug in us to pick up our phone, reach for a snack, pick our nails. But I think the “emptiness” is actually overwhelm disguised as emptiness. An overwhelming rise in emotion threatening to overflow at any moment.

This happened to me yesterday at work when I was feeling unbelievably low and depleted in energy. I could feel it rising in me, suffocating me to the point where I knew when I finally sat down for my break I would binge.

And I’m alright. I probably won’t do it again for a while. I just had a shit day.

My point is that all of us can empathise with addiction on one level or another, whether your compulsions are major or minor – we all have the capacity for addiction within us. And I think we all have the capacity for mental illness, too.

So how do we grapple with the tragedy of watching people resist treatment to either of these things?

I work in a pharmacy in a low-income area and I see a lot of people plagued with addiction – many of whom are on the methadone programme which is an opioid-replacement service for those addicted to heroin and other morphine-derivatives looking to give it up. Some people come in to the pharmacy for methadone and also access the needle exchange service – I’ll let you put two and two together.

Some people come into the pharmacy to get their methadone and bring their children. This was something I’d never seen before and it touched a nerve in me. I saw a woman come in with her son to get her supervised methadone, leaving him sitting alone in the waiting area. He looked lonely and sad. He was probably embarrassed. There’s lots of moments like these in the pharmacy when tears would prick my eyes if I didn’t remind myself I was at work.

As a child of a heroin-user myself, I was always so positive about the methadone programme. I thought it was a fantastic idea. I loved its potential to minimise the harm and the lies so strongly linked to heroin addiction. I loved its potential to repair broken families. But I’d never seen a kid in that situation before and I didn’t know how to feel.

I always thought the main intention with the methadone programme was to give people the tools to combat addiction but when I see the same people come into the pharmacy day after day, month after month, on the same dose, I realise that it’s just another kind of addiction. And it’s heartbreaking.

It’s difficult seeing the kids of addicts right in front of you like that. It’s difficult not to feel angry. It’s difficult to practice compassion for people in the throes of addiction when in some cases their kids are barely getting a chance at a decent start.

What’s easier is categorising people into good and bad. Calling addicts “junkies” and writing them off as leeches of the system instead of looking deep inside yourself for the dark places we all share. One locum pharmacist I worked with once said my pharmacy would be alright if it wasn’t for the junkies.

“Do your harsh judgements make you happy?” – Byron Katie

I think in judging others and viewing them as separate from ourselves we sow the seeds of our own suffering. It doesn’t make us happy. It might give us the illusion of control and understanding about what’s happening but really it creates more conflict and friction within us. Because to completely denounce another is to reject a part of ourselves.

Speaking of categorising things into good and bad, I did some research about compartmentalization the other day.

“Compartmentalization is the mental process of keeping things separate in order to avoid unpleasant feelings.” Avalon Malibu

These unpleasant feelings could be the realisation that what we’re reacting to is also in us. This can be difficult to navigate because our subconscious is telling us that we’re experiencing an aversion to ourselves or our behaviour. It’s much easier to express this externally and project it onto others than to confront the conflict within us.

My Dad has always been a big one for compartmentalization. All of us do it to a greater or lesser extent. None of us have perfectly aligned belief systems but my Dad always seemed to express great distress at having to consider a different viewpoint. It seemed like it was giving him a headache.

Compartmentalization is an evident symptom of dissociative identity disorder (DID), a personality disorder I suspect my Dad suffers from. The short-term amnesia, the depression and headaches, the different states he seemed to inhabit like Jekyll and Hyde, the way I always heard him talking quietly to himself – as if he was having private conversations.

He seemed to forget whole conversations between us and then get angry and flatly deny them when I brought them up. The amount of distress these exchanges gave him.

The overwhelming majority of people with DID have suffered childhood trauma – the first three main caregivers in my Dad’s life were taken away from him in the first few years of childhood, including his mother at just two weeks.

I would love nothing more than for my Dad to access help for his struggles with addiction and mental illness but I’m almost certain this will never happen. Despite all the pain our relationship caused me growing up, the greatest heartbreak of all is knowing that he will always resist treatment and never get better. But I know that those are the cards with which he has been dealt. “It’s not a life you’d choose.”

Thanks for reading.

– SMUT. ❤ xxxx



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