SZ-Magazine: Which patients did you have to deal with in addiction psychiatry?
With heavily addicted, usually heroin or cocaine addicts. Most of us in the clinic and dispensary were methadone substituted. Many have been trapped in addiction for decades. Often only the smallest steps of improvement were seen.
The case of your life was not a heroin addict, but an alcohol addict. What was it about?
A man, let's call him Tom, was in his fifties and had been drinking since he was 18 – fierce and steady, but he "worked": he had a well-paying job as an ITl for whom he worked all over the world, leading a jet-set life. When his mother died, she fell from top to bottom within a few months. He no longer goes to work, losing his apartment, neglecting, on the verge of drinking to death.
What happened when he came to addiction psychiatry?
Alcohol withdrawal is one of the few denials that can truly become life-threatening. Alcohol has an inhibitory effect that the body becomes accustomed to. If this suddenly disappears, it can lead to alcohol withdrawal, seizures and circulatory disorders, which can be fatal. Therefore, withdrawal must be well monitored. In therapy, we first replace the alcohol with other inhibitory substances to alleviate withdrawal symptoms. Because these drugs also make you addicted in the long run, you should get them out again soon. After ten days, Tom was deprived of alcohol, then we tried to get him to psychotherapy. He refused, was finally released, transferred to the Army Room Rescuing – and, since he lacked the structure and alcohol there, collapsed again. Only when he came to us a second time, a few months later, was he ready for psychotherapy, also because he recognized me.
What kind of a man is that?
I was first impressed by his life story, he grew up in different countries in Africa because his parents lived there for work. At the time of the Civil War, Tom had a terrible atrocity as a child: He saw corpses on the streets. One time, a bomb exploded right in the car next to it. Once abducted by the rebels, he survived that too. Yet, and I find it so extraordinary, he always described his childhood as happy – his eyes, when talking about nature experiences in the African steppe, gleamed from his work as a young man. Adults ranked in national parks, lions and giraffes. He made no connection between bad experiences as a child and his addiction.
What made Tam's case the case of your life?
I started outpatient psychotherapy with him, two hours a week for an hour. Along the way, he visited further therapeutic offerings, discovering, for example, his love for origami – which was touching because Tom was a bear man. Very strong, arms as big as shovels. And now, all of a sudden, he created these little animals … For my life, I became that, because I could see him start to look clearly at his life: He was sober for the first time in over 30 years. He revealed to us how alcohol bypassed him, how to build relationships, live his longing for nature in relation to his parents, whom he loved dearly. He could now also give way to grief for his mother, now that he was no longer deaf. And despite the sadness, there was so much confidence and a desire to tackle the things he had lacked for years.
Do regrets and shame overwhelm that addiction has ruined everything?
Yes and often there are many things in pieces. We made a timeline and Tom went looking for clues, calling up old buddies and asking them how drinking started and how he changed after that and that childhood experience. I encouraged him to write down his childhood experiences and he started the book. Rarely have I seen such patient satisfaction clearing the trash of my life. At the time, I could not often say: my job, the patient healed, the case closed. With Tom, I could see that everything could be okay.
How is Thomas today?
During our outpatient therapy, he found a place to live and started working again, and because of his workload, he rarely came to meetings. At some point our contact broke off. After a while I worried I wanted to know how he was doing. I accidentally learned that he had a tragic accident, that he did not return again. It was probably a hard fall that he did not survive. His death deeply affected me and another doctor. We were comforted by just one thought: that during his life he had managed to be happy again.