MARCIA DAY CHILDRESS: Good afternoon.
I'd like to welcome you to today's Medical Center
Hour, a program entitled When Addiction Strikes A Family--
Writing For Recovery.
I'm Marcia Day Childress from the Center
for Biomedical Ethics and Humanities
here in the School of Medicine, and we're
happy to bring you these weekly Medical Center Hour programs.
Amid our nation's current opioid epidemic,
discourse around addicts and addiction
tends to be negative, pessimistic, quite hopeless,
reinforcing negative stereotypes.
And negativity about addiction prevails, too,
throughout health care, often making
it more challenging for clinicians and organizations
to respond with appropriate care, services, and resources.
No question, the toll of addiction is staggering.
But while statistical and fiscal analysis
of the current epidemic can also overwhelm and fuel
further negativity, might we gain a different view
of addiction by accessing the particular experience of it
as it affects individuals, especially their families?
To know better what is at stake and how to foster recovery,
this Medical Center Hour turns to distinguished poet Kate
Daniels and Owen Lewis for their responses
to addiction when it has struck close to heart and home.
How can writing access and elucidate
the lived experience of addiction inside the family
circle, addiction complicated by kinship, loyalties,
and obligations and fraught with powerful emotion, with love?
In particular, Kate Daniels and Owen Lewis
will help us grasp how writing can aid
and recovery for everyone involved.
We've set this program just ahead of Valentine's Day,
because this is about love and compassion
and care, the hard work of the heart in dealing with addiction
in those we love.
Kate Daniels is the Edwin Mims Endowed Professor in English
at Vanderbilt University.
In addition to writing and teaching poetry,
she works increasingly at the intersection of poetry,
health care, and healing.
This semester, we're delighted that Kate is in Charlottesville
and a visiting scholar at UVA in residence
in our Center for Biomedical Ethics and Humanities.
Owen Lewis, who will offer a response
to Kate's presentation, is a poet and child psychiatrist
in New York City.
A clinical professor of psychiatry
at Columbia University, he teaches in Columbia's narrative
medicine program.
Both Kate and Owen have published widely,
and some of their books of poetry
are available here from the UVA bookstore
just outside the upstairs door.
We're grateful to the Department of Psychiatry
and Neurobehavioral Sciences and the Creative Writing Program
in the Department of English for being
our partners on this program.
I will quickly say that neither speaker disclosed
any conflict of interest related to health care goods
and services.
So please welcome Kate Daniels, to be followed by Owen Lewis.
Welcome.
[APPLAUSE]
KATE DANIELS: Thank you very much for coming.
I'm really particularly pleased to be here,
as I spent 10 very formative years of my life right
here at this university, from age 18 until 32.
I even worked for a year as a nurse's aide in the hospital.
So it's quite an extraordinary opportunity.
And a very nostalgic one, also, to be able to come back at what
is nearly the very end of my teaching career as a visiting
scholar in the Center for Biomedical Ethics
and the Humanities.
And I want to particularly thank Marcia Childress,
the current director, and Danny Becker, the former director,
for the invitation to be here and for making that possible.
I'm going to talk for a few minutes.
Then, I'm going to read a few poems.
And then my friend and fellow poet
Owen Lewis is going to respond.
And just let me know if you can't hear me.
I think this will be OK.
Is it OK?
I'll begin by saying that I am used to bringing poetry
into health care settings and situations,
and I have spent a good deal of my career
in academia working in health care arts.
Over the years, I've served as poet in residence
at Duke Medical Center and at Vanderbilt Medical Center.
I've taught writing for more than a decade now
at a psychoanalytic training institute in Washington, DC.
And I've presented in various types of health care settings,
inpatient and outpatient alike, addressing
patients, their families, and care providers.
At Vanderbilt, I'm part of the medicine, health, and society
faculty, and I offer courses that
combine creative writing, literature,
and medicine, the medical humanities and narrative
medicine.
One of the things that I've discovered along the way--
oh, wait.
I'll never figure out how to do a PowerPoint.
One of the things that I've discovered along the way
is that many of the quiet, intensely focused, mindful
habits of poetry reading and writing
are applicable, or can be, in health care settings.
So though it may seem odd to some people,
I have found that there is a convergence between some
of the mental qualities that poetry both cultivates and is
dependent upon and some of the qualities that allow us to be
supportively present with someone who is ill
and whose narrative of illness we are committed to witnessing,
whether that is as a care provider
or as a poet in residence.
And I would say that some of those qualities
include the following--
an openness to whatever form transformation
might take; a robust ability to endure one's
own aloneness, as well as the weight of someone else's
aloneness; the stoicism to sit calmly
with failure and uncertainty, something
that I think the poet John Keats might have called
negative capability; the patience to return repeatedly
to the same texts or situations in order to re-imagine
and revise; and, finally, the capacity to absorb an outcome,
even if unwelcome or negative.
As I'm used to bringing poetry into health care settings,
I'm also used to having the exigencies of my life
enter my poetry, flowing easily from everyday reality
into the realm of art.
As an autobiographically inclined, highly narrative
poet, I have thought of my aesthetic preference
and my poetic practice as a kind of magpies nest--
able to make use of whatever my life might
plow up as raw material and turn it, somehow, into story.
Thus, over the years, certain aspects of health and health
care have entered my poetry and become an organic feeling
part of it--
pregnancy and childbirth, the death
of a young nephew by drowning, suicide, my mother's lung
cancer, my son's asthma, a home accident that nearly
cost my daughter her index finger, and actually,
more than a few times, my work here as a nurse's aide at UVA
medical center.
But in 2012, my assumptions about my ability
to poetically encompass the challenging
situations with which my life presented me were blown to bits
when I discovered that one of my grown children,
away at college in another state,
had become addicted to both alcohol and opioids
and was using heroin and was in dire condition.
I will take a moment here for a public service announcement,
because I can't do this without that.
You all are surely aware that we are, in fact,
in the midst of a true public health crisis with regard
to the opioid epidemic.
More than 130 people die every day from overdose.
Some of the startling statistics are
that in 2017, more than 72,000 people
died from drug overdoses, and about 2/3 of those,
more than 47,000, were opioid related.
It's estimated that for every successful fatal overdose,
at least 30 nonfatal overdose episodes take place.
So we are talking about something
that brings in millions of people
when you consider everyone who is affected by this.
Along with addiction, officially known
as substance use disorder since 1994,
comes something that 12-step support groups routinely
call the family illness.
This is a term that refers to the systemic, wave-like effect
of addiction on all those who are in relation to a person
with substance use disorder.
And this is the subject of the poems
I'm going to read you in a few minutes.
What is meant by this term "family illness"?
Typically, family and friends of people with substance use
disorder find their lives hijacked
by the chaos and crisis mentality that
characterize addiction.
As addicts organize their lives around alcohol and drugs,
friends and family often find themselves involuntarily
organizing their lives around that
of the addict and the increasing dysfunction
that addiction tends, over time, to engender.
And though they are not substance dependent themselves,
family and friends of addicts may find themselves,
nevertheless, engaging in some of the forms of behaviors
that we have come to associate with addiction.
And these are some of those-- compulsive thinking and acting,
but about and/or on behalf of the addict;
the inability to refrain from undesirable behaviors;
over-focus on the addict or enabling behaviors;
self-neglect; shame; living in crisis mode
with an impaired sense of time, something
that may be analogous to craving, the cravings that
characterize withdrawal from a substance.
So it was that the opioid epidemic, previously
familiar to me only from media representations,
entered the narrative of my life.
I remember exactly how I felt sitting
in the office of my child's psychotherapist in a family
counseling session when I learned
what the situation was--
as if the world was falling away beneath
me and I was tumbling down after, but never landing.
A completely totalizing terror and sense of unreality
took hold of me and kept hold of me for almost a year.
I was trapped inside what I eventually
came to think of as a double narrative.
Closest to my heart, I was mired in a deeply painful
and profoundly threatening personal narrative--
the annihilating fear that my beloved child might die.
But that narrative itself was enclosed
within something larger--
an external, society-wide story which
circumscribed not only the personal loss
I might suffer, but also weighed me down
with negative stereotypes of addicts and addiction,
a widely accepted narrative that stigmatizes people
with substance use disorder and shames them and their families
and often prevents people from seeking help.
You know this larger demonizing storyline,
the one that tells us that addicts are not like us,
and we are not like them.
They are weak-willed and hedonistic and devoid
of human caring.
They are morally flawed people who rob their own families,
ignore their responsibilities, and fail
to care for their offspring.
If they were really serious about getting sober,
as the 1980s public health campaign so glibly phrased it,
they would just say no to alcohol and drugs.
Even now, in 2019, when we know that addiction
is far more complicated than this finger-waving, moralizing
tale of personal weakness and character flaw,
it is hard to resist the shaming shadow
that addiction's negative narrative casts
when our own lives or those of our loved ones
become part of the story of substance use disorder.
Counter-narratives that suggest the possibility
of a different outcome can help resist the lure
of this prevailing narrative.
The first counter-narrative that entered my mind
came almost a year into this experience from a friend who
was a judge in New England.
Like most judges, she is even-tempered, rational minded,
and of a judicious temperament.
She had known my child since birth.
We were on the telephone, both of us crying uninhibitedly.
Then, she said this, "You need to hear me.
The opioid epidemic is very, very bad in New England,
and I see a lot of it in court.
But you need to know some people do get better.
Some people get through it, and they recover."
When I heard those words, my entire approach
to the situation that my family and I had been drawn into
was re-framed.
The moment felt like that moment when
everything changes in the writing of a poem and the words
take a turn you did not or could not anticipate and fill you
with surprise and even a kind of awe, inspired
by the power of imagination.
For the very first time in almost a year,
it occurred to me that there might be another possible
ending to the story my family and I were living inside.
In that moment, I was able to remember that writing
was my oldest friend.
It had always helped me understand my life,
and that putting words down on paper
had never failed to sort my thoughts
and had always been able to show me
things I knew without knowing I knew them.
It has come to be my belief, my conviction
even, that the mental qualities that writing both
requires and develops--
intense focus, mindfulness, perseverance,
extraordinary patience, and the ability
to deploy intention and abandon simultaneously--
can have efficacious effects for people
striving to reclaim their lives from the chaos of the family
illness.
Certainly, this was the case for me.
So what I want to do now is read you some of the poems
that I wrote during this experience.
I have to make a couple of caveats first.
First is that only about 1 in 10 people in the United States
who needs drug treatment ever gets it.
Our family was extremely fortunate.
Over the course of two years, my child
had two psychiatric hospital admissions, three
residential treatment stays, was accepted
into a highly selective suboxone program at Vanderbilt Medical,
lived for a while in a post-treatment halfway house,
and, finally, was part of a long-term recovery
community for the last six months of the process.
All of these cost money, lots and lots of money.
Our access to good health care, decent health insurance,
adequate financial resources, our level of education
that facilitated our comprehension
of the complexities of addiction,
as well as our location at a research university
with an excellent medical center that included an addiction
psychiatry department, all these were
instrumental in what has turned out, thus far,
to be a good outcome.
My child is, in fact, in recovery, recently celebrating
five years of sobriety.
I tell this story and read these poems
with the permission of everyone in my family,
including, first and foremost, that of my child
whose situation prompted the writing of them.
And then, secondly, I want to say briefly
that I was taken right away by a good friend--
I mean right away, within 24 hours
of finding out this news--
to Al-Anon.
And Al-Anon was instrumental in my ability to--
Al-Anon is a 12-step support group for families and friends
of people who have substance use disorder.
Al-Anon worked for me.
But in talking about it or reading/seeing representations
of it in some of these poems I'm going to read you,
I want to be clear that nobody thinks I'm advocating
Al-Anon or anything else.
As far as I'm concerned, whatever it takes to get sober,
that's what it takes to get sober.
And there's a lot of different approaches
and programs and treatments available.
Plenty of different variations on 12-step groups, which
is essentially group therapy, but also programs
that are cognitive behavior therapy based.
There's a lot of excitement right now around something
called MAT, Medication-Assisted Treatment.
There are religious faith-based programs,
various types of psychotherapy.
So I just want to make sure that's a disclaimer.
I'm not advocating anything.
This worked for me, but it doesn't work for everyone.
OK, so I've written a lot of poems out of this experience.
And I'm going to begin with one in which I think I was--
one of the hardest parts of the entire situation
was accepting that this was the situation.
That, in fact, my identity as a late 50's
English professor, poet, with three grown children,
moving along in the middle class had
all of a sudden turned into mother of a heroin addict.
That was extremely difficult for me.
There were times when I locked myself in my bathroom
and stood in front of the mirror and just look myself in the eye
and said, you are the mother of a heroin addict.
Because until I could accept the reality that I was living,
I didn't feel that I was going to be
able to make any progress in reclaiming
my life from the chaos that had engulfed it.
So this is called "In the Mist of the Heroin Epidemic."
Oh, let's see.
Was I going to--
I think I was going to put this one up so you could follow it
if you want to.
When I heard the news that Cynthia's daughter had
died all alone, slumped over on the ground
beside a dumpster behind the convenience store where she'd
made her final buy, I logged off and walked outside
to look at the water before I could think too much.
It's become a habit now, losing myself
in the soothing image of moving water, before the headlines
and the stats start blaring out the way they do,
performing themselves inside my mind that has always
imagined too vividly, too much.
You think too much, my parents always said.
But thinking about this or not thinking
won't reverse the events that have captured Cynthia
or bring back the daughter who's been carried away
in the opening chapter of a terrible plot.
Addicts destroy themselves.
That's just where we start.
And why they might have wanted to or if it was an accident
is beside the point.
The aftermath is what's at stake--
the human flotsam captured in addiction's filthy wake.
Ordinary citizens like Cynthia, with her stone
face and her dead blue eyes, single mother of one child,
deceased.
She works at the bakery down the block from me.
I pay her for a cappuccino and a buttered roll every morning
on my way to work.
Afterwards, I linger on the wooden pier
and drown my eyes in the river's watery embrace and lick butter
from my fingers and fill my head with the strong smell
of hot coffee Cynthia poured for me--
small actions that distract.
They minimize, but can't efface any of the suffering.
This is called "Molecules."
Certain phrases or items, even, in this case, a place,
took on terrible sort of totemic significance for me
during this process.
And it felt necessary to try to write them out of myself
in poems some way.
The totemic location in this is the store
in Nashville called Cash 4 Gold on 8th Avenue South, which
is known for being a place where drug addicts go
and hawk things that they've often
stolen from their families.
I'm sorry?
No, no slide.
AUDIENCE: OK, I'm sorry.
KATE DANIELS: It's all right.
"Molecules."
Oh, and I have a friend, Mark Jarman, who says,
it should be atoms, Kate, not molecules.
And I'm aware there's a lot of STEM-minded people in the room,
so tell me afterwards if it's really supposed to be
atoms instead of molecules.
"Molecules."
Whether it's true or not that all our molecules replace
themselves each seven years, his body seems halfway new
again one year into sobriety.
I keep my distance now, but recall
his painful 10-pound freight, the torpor
of late-term pregnancy.
All those final weeks, I rested, famished,
calling for food I could spin into blood and bones
so he could thrive.
Even then, his cravings ruled us both.
Mindlessly, he craved to grow, taking
what he needed from my willing body,
as, two decades later, he would steal what he needed
from my dresser drawers--
bankbook, string of pearls, his grandmother's tiny chip
of diamond-studded wedding ring.
The latter must have brought him almost nothing
at the Cash 4 Gold store, where all the junkies hang out.
Addiction is hard on every member of a family.
I have come to believe that it may be particularly
fraught for mothers, partly because of the fact
that mothers not only love their children
but have created the bodies of these people
in their own bodies.
And so the defilement, the physical destructiveness
of addiction is a particularly hard aspect of that,
of the whole situation, I think, for all family members.
But possibly, in a particular way, for women who have given
birth to their own children.
This is called "Birth Story--
The Addict's Mother."
And I love reading it in a room that has some docs in it,
because it has some image associations to the delivery
room for a C-section, where the mother is awake.
"Birth Story-- The Addict's Mother."
She wasn't watching when they cut him out--
C-section, you know-- green drape
obscuring the mound of ripened belly they extracted him from.
He spilled out squalling, already starving.
Still stitching her up, they fastened him to her breast
so he could feed.
There, he rooted for the milk, so lustful in his sucking
that weeping roses grew from the edges of her nipples.
For weeks, they festered there, blooming bloody trails
anew each and every time he made a meal of her.
I know what you're thinking, but he was her child.
She had to let him do that to her.
That was one of those poems where you start out
writing it thinking it's about one thing,
and it turns out to be about something else entirely.
As I said, I wrote a lot of poems in this sequence,
and quite a number of them addressed the, to me,
somewhat mysterious structure of 12-step programs, particularly
the Al-Anon group that I go to.
I go to a group of all women that's been around since 1978.
It has, in the jargon of 12-step recovery, a lot of experience,
strength, and hope.
There's a lot of wisdom in the room.
And so I'm going to read this one poem that is about that.
It's called "Support Group."
Of all the poems I wrote, it is the least poetic.
It's very jagged.
I don't even know if it's a poem,
but it's in a book of poems, so I guess it's passing that way.
I have to have a trigger warning.
It has the F-word in it, but you all can probably take it.
If you've never been to a 12-step meeting,
or you haven't seen a convincing representation of it,
you may or may not know that a--
these meetings are, for me, like a cross
between a Quaker meeting and an old-time psychoanalytic
session.
They're extremely controlled, but there's also
a lot of silence and compassion and acceptance in the room.
In the group that I go to, you have three minutes of testimony
that makes up the bulk of the meeting.
And you can't respond to what any anyone else says.
So it's a very interesting dynamic in the room.
You speak for three minutes.
You be quiet.
Without responding to what you say, someone else starts up.
You may or may not know that the first step of the 12 steps,
considered the most fundamental and the most important,
is we admitted we were powerless over alcohol and drugs.
That's referred to in here, too.
"Support Group."
Oh, and one more thing-- the time.
It's very funny.
12-step meetings are timed in all different kinds
of ways-- timers, cell phones, hand-waving signs.
"Support Group."
For a long time, each day was a bad day.
Truthfully, for years, each day was a bad day.
The nights were worse, but she could slide the deadbolt
on the bedroom door and swallow an Ambien or two
to summon sleep.
Thank God she never dreamed about it.
The meetings helped, but it was hard to go,
because the first thing you did was
admit you were fucked and had no power.
But it was worse to stay home, sitting
on the fear like a solitary hen hatching poisoned eggs.
There were a lot of rules and tissues in the room.
The rules were followed.
The tissues were dispensed to those who wept.
Many wept.
In the rooms, there was infinite suffering.
It had three minutes each to describe itself.
A little timer went off or someone waved a cardboard clock
face in the air.
One suffering stopped talking.
Then, the next suffering started up.
A lot of suffering in the world.
That's the first clear thought most people have
when they come here.
I'm having a hard time seeing this clock up here.
For people who decide that inpatient drug treatment is
the best option, or have access to it, the first stage of that
is always a detox.
And so this poem comes out of that experience.
One of the interesting parts of this whole thing for me
was the ways in which the experiences that my child was
having going through treatment caused me
and other members of my family to be
self-reflective about our own habits.
And that, I think, is what this poem is about.
"Detox."
So she wouldn't judge, she practiced empathy,
sitting for months in full Lotus,
palms open, thumb and forefinger touching to make a circle.
She could empty her thoughts inside
until emptiness was all that filled her.
To complete the ritual, she purified her body,
deleting the nightly glass of Spanish red
she savored while preparing dinner.
Her medications, all prescribed, were next--
the benzodiazepine she seldom took, trazodone
to help her sleep, the antidepressant she
swallowed every day.
It surprised her how long they took to leave her body,
how reluctantly they exited.
They bothered her for weeks, waking her at night,
throbbing through the lengthy spans of muscles,
the quadriceps and gastrocnemius complaining
as her system forced them out.
It was harder than she'd thought, giving up
her little pleasures, taking the shine off things
she'd gotten used to polishing up at the end of the day
to anesthetize their prick.
Still, it wasn't all that difficult to shed those habits.
And she barely noticed any difference, until she saw him
in the detox unit behind the glass, lined up on a bench
with other addicts, with many drunks.
They looked like convicts, sitting side by side,
with their laceless sneakers and their beltless pants,
locked in and shackled to beeping monitors and IV drips.
She was clean herself by then, so nothing softened the blow
or diluted the force of awful feelings
that slammed up inside her chest when she saw that sight.
She had to take it raw, because she couldn't rush home anymore,
as she would have done before, to calm herself with a soothing
dose of Zoloft and Merlot.
I have to say, it's an incredible pleasure
to be able to read a poem with the word gastrocnemius in it
and believe that some people in the audience
are going to know exactly what muscle that is.
An inevitable part of this almost entirely
harrowing process is, of course, relapse.
Relapse is almost always inevitable.
On average, it takes people who ultimately achieve
long-term abstinence or sobriety about seven years from when
they first decide to make a serious attempt at getting
sober.
So relapse is almost always part of this process,
and that's what this poem is called, "Relapse."
If you're familiar with inpatient drug treatment
programs, you'll know that they almost always include
some version of what's called a family program, where
family members are invited to come in and get educated and go
through various types of group therapy situations
with each other and with their addicted family members.
"Relapse."
Several of the young men from the treatment center
are already dead.
They spanned the demographic spectrum,
so no conclusions can be made about why
they did or didn't make it.
They just went back to using.
I remember their mothers from the family program,
where we gathered for a week to educate ourselves
about addiction as disease and to learn to not enable
and to practice letting go.
We held hands and role-played and chanted healing mantras
and shared "experience," strength, and hope.
But in the restroom, we dropped our masks and wailed full blast
and held each other and collapsed on the floor,
showing cell phone images of our boys,
suited up for Little League and tumbling with their puppies.
Like every other addict's mother,
I have cried myself out, wrung dry
and ground down by the grief and fear that fuel my weeping.
The single lesson I have learned is this--
a person can only feel so much.
Eventually, affect overflows and loses shape
as it escapes from its container.
If the thing inside is hot, it scalds or scorches
every part of us it touches, and if it's cold, it freezes.
"Metaphorless," which is to say, without metaphor.
"Metaphorless."
The dryness, dead center, of deep pain.
The bone-on-bone grinding that goes on for months
preceding the surgery.
That's the way the parent whose child is using heroin again
feels in the middle of the night, unable to sleep,
standing at the bedroom window looking out,
just barely conscious of what the moon looks
like drained gray.
The moon is a popular literary image--
solipsistic misery, misplaced love, whatever.
Tonight, it's nothing but a source of milky light swinging
high up in the sky, shining weakly on the bleakness inside
and the bleakness outside that has
no other meaning but the cold, uncrackable rock of itself.
Addiction can destroy families.
It can also bring families closer together
in certain ways.
It can make heroes of certain family members.
My daughter-in-law was a hero in our family.
She's a tiny, very beautiful, very fierce young woman
who showed extraordinary strengths I didn't
know she have in this crisis.
This is a very autobiographical poem
that refers to the attempt to extricate
my child from the college town where they were living.
And we could not get our child to respond to us,
so my daughter-in-law said, I'll take care of it.
"The Daughter-In-Law."
She called them the night before to let
him know she'd be there early in the morning.
Of course, he called her an interfering whore
and hung up on her and got high.
She was there anyway by 8:15, and when he wouldn't open up,
the Swiss army knife she always carries
on her belt sliced right through the window screen.
I keep seeing her crawling in to wake him up
and how she would have entered feet
first, and the colorful tats on her calves and ankles
I'd always hated until then.
Turns out, she also took a gun, though no one ever told me
if she unholstered it to make her point
or exactly what she said or what it
took to extract him from the filthy blankets on his bed.
Or how she forced him in the car and child-locked him
in and drove to the airport and walked beside him to the gate
and stayed until the plane had lifted off.
She doesn't talk about her feelings
very much, so who knows how much it cost her.
What I know is this--
because of her, he made the flight I'd booked.
It landed in another state, where
his father picked him up and drove him
straight to treatment.
I want to read two more poems, but OK.
So if you're lucky, if you have the gift of grace,
if you have enough money, if you have access to good health
care, and if your family is supportive,
it is true that you may go into recovery and save your life.
But a essential aspect of that is that life is never
going to be the same.
You're not going back to anything.
You're going forward into something brand new.
"Recovery."
Nothing's the same anymore, now that the drinking is stopped
and the drugs have been flushed from the system,
now that no one who lives here is snorting or shooting
up or coming home deranged with craving
or littering the bathroom with tiny bits of balled-up tin
foil blackened by flame.
Despite the brand-new quiet that forms a fragile skin,
tranquility eludes.
Something uneasy still moves beneath the surface
of daily life.
Tentative, nervous, I strive for rhythms
that will make it right.
In grade school, skipping rope, we girls
rocked our bodies in staccato time with the turning ropes,
trying to isolate the perfect moment we could jump inside
without rupturing the pattern.
It's like that now, I think.
That's what I tell myself, anyway, to keep my mind off
how powerless I am and how I can't control what he's doing
or where he is or who he's with or if he's back to using.
Every time my mind jumps away from me like that,
I do the next right thing--
I bring it back.
Ditto when I fail again.
Ditto after that and after that, ad infinitum.
And then I'll close with this poem.
It's written in tercets.
One of the central concepts of any 12-step program
is something called detachment, the ability
to remove yourself emotionally from the object
of your concerns in order to pursue
recovery and health for yourself and your loved ones.
"Detachment."
The things you love are still beautiful in the new dark
they live in now.
Is that it?
AUDIENCE: Yup.
KATE DANIELS: The things you love
are still beautiful in the new dark they live in now.
They're in their own stories, part
of a larger plot you are too small to see the sense of.
You can go on being unchanged yourself,
still wrecking your hands and throwing out
your back trying to force open the window that's
been stuck for ages.
Or you can give it up and sit still in the center of the room
and just breathe and feel the grinding
without trying to change it.
Thank you for listening.
[APPLAUSE]
OWEN LEWIS: OK.
Wonderful.
I want to thank Marcia and Danny for bringing me here.
And I also want to say this has special meaning, being here.
My father, son of immigrants from Brooklyn, sometime
in the '30s, found his way to UVA and graduated, I think,
1937.
And I know he would be unbelievably pleased to know
that I was here speaking.
Kate, what magnificent poetry and what
daring poetry, and how important to document your experiences.
There's so many poems I could speak about,
and the one I wanted to focus--
I thought you were going to read and didn't, but I'm going to--
KATE DANIELS: It was too garrulous.
I had to cut something.
OWEN LEWIS: OK.
So you're going to hear a little bit more from Kate.
This is from a poem called "At The Meeting,
They Say Detached With Love."
I could not make it fit the rage-filled narrative
I lived inside that starred a drug-addicted son who
jacked his mother's car and traded it for dope.
I settled for detachment minus hatred.
Regardless, love's cellmate, hate,
germinated and grew until the bilious pit in my stomach when
his name blinked into view on the iPhone screen
had eaten me in two.
For longer than you might imagine,
I lived like that, the two halves of me
detached, one from the other, heart from mind,
my body from his.
Now, I want to look at what's happening in that section.
The narrative is calling for detachment
and very much following the advice of the program.
She writes, "I settled for detachment minus hatred."
Really?
Well, you know, poetry means to invoke, not instruct.
And immediately, she goes on to talk about hatred,
love's cellmate, grows.
The two halves detach--
heart from mind.
So I want to reserve judgment for a moment
whether this is detachment or, in fact, something else.
I want to read you the opening poem from my book Best Man.
It's a different sort of recovery narrative--
my brother didn't make it--
but there is always the recovery of the family.
And the book consists of 23 poems for his 23 years.
And the set begins with this poem "So."
I am still mad at you.
Every week, another call from a pharmacy, a burnt-out Bronx
neighborhood or Brooklyn.
Percocet, Dexedrine shopping lists, benzos.
That last visit, you took my prescription pad, sold it.
I refused your calls from Florida, from the ICU.
Frantic, your girlfriend overdosed.
Our grandmother told me you were OK.
She cooked you a pair of fried eggs.
I've never known how to think about your end, so often,
I just don't.
So I want to ask you, what do we make thinking,
"I just don't know what to think about your death,
so I just didn't."
What is that?
Now, this being written, mind you,
30-plus years after the fact.
I want to say this is not just denial.
This is not just not remembering.
I think this is a statement of dissociation.
In Kate's poem, is it detachment?
I'd like to suggest something more is at work.
The anger at a brother who steals a prescription
pad, a son who steals a car, more emotion than the system
can handle.
And these facts are just the tip of the iceberg.
They're not isolated.
Kate and her son, my brother and I, what happens, I think,
when the emotional system is overwhelmed,
it just splits off what it can't cope with.
And this, I would say, is the process of trauma.
And in fact, if we think about one of the hallmarks of PTSD,
it's really a kind of numbness.
In one of your poems, you said, "What's hot scalds, what's cold
freezes."
And I would say a lot gets frozen.
So if we are speaking of dissociation,
we are speaking about trauma.
I want to further make this point.
Kate very generously wrote a blurb for my book Best Man.
And in it, she said, "A bold and gritty elegy."
And then she went on to say, "The book
is also a poetic treatise on the aspects of addiction
and the systemic effects of one member's
illness on an entire family."
And when I read that, I have to tell you,
it was like I was hit in the stomach.
The book was written.
I had seen my brother in and out of treatment programs and yet
never, until I read Kate's blurb, had the word--
I associated the word addict with my brother.
So again, what is that?
I think that this is not your garden variety detachment.
This is real dissociation.
Now, I have eight minutes allotted to me,
so I have to make some bold statements here and move
quickly from bold statements.
So the first bold statement is this,
that in the family of every addict and in the addict
him or herself is trauma.
And I don't mean from an epidemiological point of view,
because we know that there are high rates of trauma
in individuals who go on to develop addiction.
I mean the trauma that is caused by the addiction itself
to the individual and to his or her family.
And then, I want to ask the question--
OK, that's maybe a half bold statement,
to say there's trauma in every family system.
But what about the clinicians?
What are we feeling when we're listening to these narratives?
I have to say that, for myself, lots of psychotherapy
didn't get at, for me, what the writing did for me.
When we read narratives, both of addiction and recovery,
particularly when we're reading in small groups,
we can step outside of ourselves.
When we are listening on the spot, whether as physicians,
nurses, social workers, we have to listen to get information.
We have to listen to provide some empathy.
We are listening and, at the same time,
planning what we are going to do next.
And in the mix of all that, can we actually
sit and take in what our own feelings are in relation?
I think not.
And in fact, that is the process of being
in a healing profession.
We have to learn to detach.
And if not, I think--
and I think the detachment is on a straight line
to dissociation.
So what I learned in thinking about narratives of addiction,
I realized, could apply to all the helping professions.
And here, I want to make a very bold statement, which
is to be a doctor or a nurse, to be attending
to humans in their most pained moments,
is in itself traumatizing.
And I think because of the nature of being in the trenches
with human suffering, we all come to some dissociation.
You know, I think of my students,
and they start out so full of aspiration and idealism
and hope.
And one of the things that they most fear
is being turned into their attendings, who they sometimes
see as grumpy, irritable, not empathic.
And so I would say because of this dissociation,
we put aside feelings.
And in the normal process, we cannot bring those feelings
back.
We can't access them unless we step outside
of the clinical process.
So those feelings, we can't--
don't find us.
They find us.
And when they do find us, they really
interrupt the normal flow of empathy in caregiving.
So here's my next bold statement.
Do the healing professions need poetry?
You bet they do, in a very, very big way.
And it's not that I think poetry, per se,
is going to be curative.
It's the reading and dwelling on poetry,
particularly in small groups, where
we can learn from others what we are missing
in the reading of a poem and, therefore, confront us
with something that we've put aside.
So I think if you accept the statement
that the practice of caregiving is, in and of itself,
traumatizing, I hope you'll consider the solution
that poetry offers.
I want to close with a wonderful poem
by Franz Wright called "The Drunk."
I don't understand any more than you do.
I only know he stays here like some huge wounded animal.
Open the door and he will gaze at you, linger.
Close the door, and he will break it down.
And the magic, I think, of this poem is, one,
I think this is a metaphor for alcoholism, per se,
how overpowering it is.
But I think that, at the same time,
this is the story of a child being traumatized
by an alcoholic father.
So is there trauma in all of this?
I think so.
But to quote Franz Wright, "I don't understand any more
than you do" Thank you.
[APPLAUSE]
MARCIA DAY CHILDRESS: I'd like to thank both of you
for amazing presentations.
Very moving, very open, and, I think,
provocative for all of us who've heard what you have to say
and are working on it.
We have just a few minutes for some questions and comments.
We have a couple of microphones.
You may direct your question or comment
to either Owen or Kate or both.
I'll ask you, please identify yourself
when you ask a question or make a comment.
So it's awfully soon after such intense things to think about,
but we'll see what people have to say.
Yes?
AUDIENCE: Hi.
I'm John Ashley.
I'm retired now, but I used to be here.
So the value of these kind of writing and poetry to you,
as caregivers, or in the case of family members, is obvious.
Do you encourage, and if so how do you encourage,
the addict themselves to engage in writing
and in reflecting on what those feelings are that they record?
KATE DANIELS: Well, I can only tell you
that writing therapies of various types
are increasingly being considered
a kind of soft component of various treatment approaches.
And there's a lot of research that some of you
all may know about.
It started in the 1980s with a guy
at University of Texas named James Pennebaker called
expressive writing, about the ways
in which writing can be helpful in slowing down
compulsive thinking.
And that is part of what's being used sometimes
in treatment centers.
I do Writing For Recovery workshops
with people whose lives have been affected by other people's
addictions, which is similar but not exactly the same.
AUDIENCE: I had a comment.
I'm Danny Becker, one of those grumpy attendings.
James Pennebaker was at UVA, also, before he went to Texas.
KATE DANIELS: That's right, before he went to Texas.
That's right.
Well, I didn't want to bring that up.
MARCIA DAY CHILDRESS: Go ahead.
AUDIENCE: I'm Katie Snyder, from the transplant office,
and we've had personal addiction in the family.
And I'm just wondering, as a parent,
I can see how it's therapeutic to do
the Al-Anon and the writing.
Do you find it as helpful for the siblings of the addict?
You mentioned that you had, I believe, three children?
And how are the other in-laws and your other children doing?
KATE DANIELS: Yeah, well, so in our case--
and I have three children.
One of them was affected.
My husband chose not to go the Al-Anon route,
though he did participate in the family programs
at various treatment centers.
One of my other children participated
in family programs, but did not go to Al-Anon.
My youngest child absolutely refused,
was in college at the time herself,
and said this extraordinary thing to me--
I'm not going to let his problems destroy
my time in college.
I thought, good psychological boundaries there.
I mean, that was not a position that anybody else was
really capable in our family of holding, but she did.
So yeah, Alateen is a version, you know,
a form of Al-Anon for younger people.
I encourage everybody, but it doesn't work for everybody.
OWEN LEWIS: I would say it would have been helpful for me,
but as I said, there was such denial.
Even at the same time we were taking my brother
to treatment programs, somehow we didn't connect the dots.
But I think it would have been very helpful to me.
AUDIENCE: I'm Janice Park.
I'm a fourth year medical student.
Thank you both so much for coming.
I had a kind of more technical question.
I noticed in, Ms. Daniel's, your poems
that you kind of switched between first person
and third person in a number of them.
Was there kind of like a conscious choice
in the beginning of writing those,
or was there a reason that some of them
were kind of from an outside eye rather than first person?
KATE DANIELS: Originally, they were all first person,
but I couldn't bear that ultimately.
Some of them were just too hot to use the first person.
So it was a form of-- it was like a lightning rod, in a way,
to back away from it.
I'm pretty comfortable in the first person.
I'm a very autobiographical writer,
but this was too incendiary, I guess, some of the time.
MARCIA DAY CHILDRESS: I think sometimes the third person
helps to universalize it, as well.
Other people can find a place in the poem in that way, too.
AUDIENCE: Speaking, again, as an attending,
I wanted to commend Janet.
That's a good pick-up that you noticed that.
MARCIA DAY CHILDRESS: Yeah, acute listening.
I'm afraid that we're at the end of our hour,
but I would encourage those of you
with additional questions and comments
to come down front and talk with Kate and Owen.
Also, remember there are books outside,
and we'll also want Kate and Owen to move up there to sign
books, if they will, please.
We welcome you to come back next week, the 20th of February.
We have Pulitzer Prize winning author David Oshinsky here
with us in a program that is also a history of the health
sciences.
Lecture entitled Bellevue--
Three Centuries of Medicine and Mayhem
at America's Most Storied Hospital.
This is a talk based on Oshinsky's recent book
about Bellevue Hospital.
So we look forward to seeing you then.
Again, please thank Kate Daniels and Owen Lewis
for a splendid presentation.
[APPLAUSE]