Monday, November 23, 2015

Diagnosis: Hypersobriety. Or, What's So Bad About Self-Medicating?

I love to drink. I drink more is recommended by the medico-establishment powers that be, but I think in 2015 that's not the shocking thing. The shocking thing is that I don't really worry about it too much.

There are several reasons I'm not in a moral panic about my own drinking. For one thing, I used to have a wide range of bad habits and I've managed to quit almost all of them. Even Diet Coke, which I love and regard as the pinnacle of human taste perfection, I haven't had in about five years. Really, you can't expect a person to give up everything.

For another thing, I suffer zero noticeable bad effects from my drinking. I never have a hangover or feel bad, and pace the omnipresent freak-out over "relationship problems," my loved ones agree: drinking makes me, if anything, kinder, happier, warmer, more patient, and more fun.

Also, and as I've written about before, I feel like drinking makes me more me. A better version of me. I don't know if you remember that book Listening to Prozac, from the early 90s? The author, Peter Kramer, argued that some patients on anti-depressants experience a sense of being more themselves. The widespread fear that psycho-pharmaceuticals always make you less you is wrong, just a prejudice, based on some implicit mistaken metaphysics of personal identity.

Listening to Prozac quotes one patient as saying that being on Prozac makes them feel "Unencumbered, more vitally alive, less pessimistic" -- and when I read that I was like, "Yes!" That's how drinking makes me feel. Without drinking, I tend toward sadness and low life-force. When I stop for a while, I run into trouble: my mind gets filled up with stuff, clogged with emotion, the mental equivalent of a hoarder's living room. Drinking, I'm fresh and alive.

Pursuing the medical model analogy, I was thinking about what it is about me that makes this the appropriate treatment, and I noticed that I often have the feeling that two drinks makes me feel normal, well, brought to some imaginary baseline. Feelings of sadness and dread are kept at bay. I was struggling to interpret the underlying feeling. What is this? Anxiety? Depression? Melancholia?

And then it hit me: if drinking is the solution, maybe my problem is just sobriety. I have an excess of it. Hypersobriety. Though there are probably many, this condition has one obvious and natural treatment option: namely, drinking.

The diagnosis actually fits my personality in other ways as well. I'm organized, I don't really procrastinate, and I read books for fun. Plus, I often feel excessively clear-eyed about the world, a characteristic of sobriety that is known to lead to trouble: as we know, self-deceiving, overly optimistic people do well with life while seeing things as they are leads to sadness and depression.

For me, part of being excessively clear-eyed is a deficit in the repression direction. I seem to have trouble blocking out those kinds of facts that, when you're aware of them, get quickly overwhelming. We are all going to die in the not so far away future. And we're either going to die young, or get old. This is going to happen not just to you but to your kids and all the people you love.

The only healthy response to these facts is to frequently repress awareness of them. But if you suffer from hypersobriety -- well, you need a little boost in the repression direction.

I feel like there's a lot of resistance to the use of alcohol and other fun substances to make people feel better. Some of this is based on the very real fact that for a lot of people, using fun substances doesn't work so well in the long run, leading to addiction and other problems. But what about the rest of us? If it's working reasonably well, what's the big deal?

I think a lot of the resistance comes from the idea that self-medicating might come with health risks or side-effects, and this leads to free-rider type indignation, like "OMG, you are doing this thing to make yourself feel better, but that might lead, in some vague and long-term way, to some way in which the rest of us have to pay more to help you down the line. Even though lots of treatments come with other health effects down the line, we'd hate to think that somehow your self-medication might be enjoyable, so that you're somehow having a good time."

But I think this form of indignation is a little overblown and ridiculous. Lots of medical treatments come with downsides and side effects, many of them serious. Just yesterday in the New York Times Ezekiel Emanuel wrote about how astonishingly often more medical care can lead to much worse outcomes. Having the best, most senior cardiac doctors led to more deaths. Stopping medications in elderly patients made them better off.

Again, I'm not denying that in some circumstances self-medication doesn't work. But I don't think the relative frequency of failure justifies the negativity. I guess what I'm saying is, next time you see someone eating a lot of cake or chewing nicotine gum or drinking a lot of Diet Coke or Pinot Grigio or whatever, don't think you have to immediately moralize about it. Maybe overall, it's just the thing they need.


Daniel said...


Janet Vickers said...

I feel better now I have read this. My self-medicating comes in the form of a cocktail - 75% caffeine, 10% red wine and 15% dreaming up better worlds. I think the latter of these is most irritating to my family and friends.

Gottabounceyo said...

Great post Cuz! Couldn't agree more.