“Cracked: Putting Broken Lives Together Again” by Dr. Drew Pinsky

I’ve always been a fan of Dr. Drew as a radio personality but didn’t know much about his everyday personal and professional life. It feels like he he left nothing out in this book. His busy professional life is covered in great detail (he runs a private practice as a general care physician, a drug treatment facility, and at night answers calls on the long-running radio show Loveline), but he also opens up about his own fears and neuroses.

However, the book is mostly about drug addiction and treatment. No matter what anyone says about drug addiction (is it a disease? a failure of impulse control? Poor parenting?) what is readily apparent from this book is that opiate withdrawal is brutal. If nothing else, read this book to scare yourself about and find out about prescription drug use, which is killing about 44 Americans per day.

Further Links:
The Dr. Drew Podcast—specifically my favorite ones pertaining to addiction/treatment:
David Sheff (wrote a couple books and this article recounting his son’s drug problems)
Chris Kennedy Lawford (ex-addict who’s interviewed hundreds of treatment experts for a book)
Bob Forrest (huuuuge ex-junkie and now a rehab counselor)
What the professionals are saying: The Publisher’s Weekly review
Vicodin addiction is linked to profound hearing loss and TV medical dramas give misleading medical information (which should be no surprise!)
Buy on Amazon: Cracked: Life on the Edge in a Rehab Clinic

Vocabulary and Stuff of Interest:
somatically—of the body; bodily; physical. ‘…somatically preoccupied heroin addicts.’
labile—liable to change; easily altered. Easily broken down or displaced.
turgor—a sign used by health care workers to assess fluid loss or dehydration.

Quotes and Anecdotes: Dr. Drew on the Emptiness of Entertainment and In Drug Rehab With Dr. Drew.

She is a very pretty girl. I think Truman Capote once said something like, Beauty makes its own rules. I might add from experience that beauty also suffers its own tragedies.

“As far as I’m concerned, the people who create the culture tend to be sick and have no idea what’s real or healthy.”

A vision bubbles through my head: the unmistakable voice of Robert Evans, the legendary Hollywood producer. Not long ago I listened to the audio edition of his celebrated autobiography, The Kid Stays in The Picture, and my reaction was a constant Oh my God. Evans was talented, to be sure. But a whole generation was influenced by him and his kind.

Seeing her laugh reminds me why I am obsessed about my work, why I am on the radio five nights a week when I could be at home with my wife, why I speak at colleges, and why I’m so committed to making a difference in the quality of people’s lives. I am not interested in telling people what to do. But I want to make them think about what’s healthy and what’s not, and perhaps encourage them to make better choices.

I very quickly saw more than I ever imagined, and came to realize that doctors are basically biological repairmen, especially in inner-city hospitals on violence-ridden Saturday nights. On my first night at County General, I treated a guy with a penis the size of a football. It turned out he’d been shot in the ass, and the bullet had exited through his penis.

To me, mental health isn’t always about feeling good. Nor is it always about avoiding depression. Nor about being happy. As I define it, mental health is about accepting reality on reality’s terms.

Richard is exceptional. He seemed to accept the infirmities of aging as a part of life. This sets him apart from most Americans. In this country, we don’t care for the aged and diseased. We keep them hidden away in hospitals and institutions, never to dirty our hands with their care, while we inundate ourselves with images of youth and unrealistic messages about optimum health. As a result, most of us are shocked when we age. We expect eternal youth and health. And because we have no sense of our biology, we are bewildered when a medical problem emerges. I’m always amused when a seventy- or eighty-year-old patient with a new medical problem reacts in disbelief. “How could this be? I’ve never been sick before.” The next question is usually, “What did I do to cause this?” Usually, it’s just the biological process of aging. And I try to get them to understand that aging beats the alternative.

As a doctor, I don’t believe in sustaining life in a strictly clinical sense. There has to be quality, not just form.

This is the key point in everything I do and believe. My elderly patients constantly reaffirm it. Through them, I have developed a sense about what matters in life. When people have a finite amount of time left, they focus on what’s most important, and 99.9 percent of the time it is the same thing—other people. People are not solo acts. Saying “everyone is interconnected” isn’t just a cliche. At the end of our lives, it’s all about the connections we have made with other people. Filling our memories, they give our lives substance and meaning.

I see quite a few patients who are totally despicable. But part of my job is to find something worthwhile about every patient, and even when dealing with the most despicable I have to try to understand the feelings behind the behavior. Generally, the worst-behaved patients are the ones in the most pain. They tend to be people who can’t tolerate overwhelming feelings, and when they experience dread, shame, rage, and envy, they project them onto other people.

If I am standing in front of them, they project them onto me. They perceive me as the source and container of their horrible feelings. If you aren’t aware of the exchange taking place, they will make you feel horrible. They are great at it. That is their goal. There are others who are capable of being awful, but they have much better skills when it comes to manipulating people, and they make you feel great. Alexi loves these patients. But they’re only interested in themselves and their own needs.

After twenty years of treating addicts, I’ve learned not to expect anything. Every time I have felt as if I have someone figured out, they surprise me. It never fails, for better or for worse. I have become so used to being lied to by my patients. We have a saying: “If their lips are moving, they’re lying.” We just lost a young nurse who seemed to be doing well in treatment—or so I thought. It turned out she was continuing to chip heroin. Her peers found her dead at home when she didn’t show up for her meetings. This disease can be cunning as well as baffling.

As a culture, we’re woefully disconnected from the biological reality of our lives. We are born, and then, at some point we can’t predict, we die. Like Dr. Finley always reminds me, “There’s never a perfect time to be born, to die, or to have a child.” We are biological organisms that operate for a finite amount of time. Those are the facts of the human condition, and we don’t have any control over them. The one thing we can do is exert some control over what we do with our lives between birth and death.

“Barry’s a great kid. He’s a B-plus student at the University of Colorado.”

What does one thing have to do with another>? Nothing. I get scared thinking of how many parents i speak to who only know their children by their SAT scores.

I never thought much about death growing up, and when I was exposed to it in medical school it was very clinical. Without any kind of personal investment, I couldn’t think about it beyond the way I felt about death myself, which has evolved over time. My attitude is matter-of-fact, pragmatic: It’s better to be alive than dead, and while you’re alive, you should try your best to make the experience rich and meaningful. At the end, you want to be flooded with good memories, with thanks for the people you love and the time you’ve shared with them. Just as no one ever died wishing the’d spent more time at the office, no one ever died saying, I wish I’d spent more time by myself.

Occasionally I’m asked what, if anything, I know about death beyond the clinical. I usually say there’s a lot to learn about death from people who are dying, but in the end they really teach us the value of living, and that’s where I place my attention.

Human beings feel best when they’re spending time face to face, particularly in times of adversity or when they’re feeling threatened. If nothing else, we learned that from September 11th. We define ourselves by the way we relate to other people. We get deep, lasting, and meaningful satisfaction from giving selflessly to, and being present with, others. We develop trust. We feel better about ourselves and our world. This is what we’ve forgotten: Our decisions should be made on the basis of what’s most healthy, not what will satisfy me the quickest. Live with integrity and a clear sense of right and wrong. Consider consequences. Listen to the inner voice of your instinct as carefully as a doctor checks your heartbeat. This is what i wish we all knew to do.

Dr. Finley leans forward. “Whatever his whim is in the moment—that’s his higher power,” he says.

For a split second, I imagine what it must be like to be Matty, and I flash on a scene I’d recently witnessed at the airport. A four-year-old boy began crying in the terminal as his mother walked to the ticket counter. He was clearly frightened by the crowd. Immediately, his father, a twenty-three-year-old version of Matty, yanked him close, put his face nose-to-nose against the child’s, and in a menacing voice said, “Shut up!”

The little boy cried even harder as his father walked away with him, and I cringed along with him. The boy was crying in the first place because he was feeling anxious and powerless, and instead of getting what he needed from an adult, he got rage, abuse, and separation from his mother—exactly what he feared in the first place.

That’s how it happens. Soon there’d be a wall build around his unbearable pain and powerlessness. Soon we’d have another Matty.

The twelve steps of AA are simply empirical structures that have proved useful for getting addicts to engage slowly in a therapeutic process. Fundamentally, they are a structured journey into a healthy, intimate relationship. There are numerous theories about why addicts are able to connect with one another in this process. Most believe they connect around a common experience of pain and powerlessness without the fear of exploitation. Their pain is so raw and tender that getting them to start the process requires them to be convinced that their pain will be understood. They’re all people with extreme trust issues, and the only people they’ve ever trusted are other addicts. They understand each other. (Interestingly, doctors have discovered that survivors of torture have similar reactions to treatment. They don’t open up unless they’re around others who’ve been through similar horrors, as though the pain of being misunderstood would be too great of a risk.)

“When opiate addicts try to stop, their brains drive them to seek other thrills. Shoplifting is a common manifestation.”

Later, I’m still thinking about that encounter. You never know for sure, but I believe Amber and I had one of those significant moments when a patient takes a completely honest look at their past, present, and future, and decides—maybe without knowing or articulating it—to reconnect with humanity after years of being cut off. If her recovery happens, she’ll need years to get entrenched and feel the full effect. It was one brief moment in which she allowed herself to accept connectedness. and experience herself as reflected by another person.

It wouldn’t be the first time I’ve seen a young person with heart damage from cocaine. Coke restricts the blood supply to the heart, dissolving the cordlike fibers that tack down the valves. If the cords break, the valves flap.

What’s life, after all, but a series of problems? And your life is defined by how you handle them.

There it is. Dad would beat her for her own good. Not only did she feel she’d deserved to be hit, she was cool with it. No biggie. She had just described what human beings do when they have been victimized. First they deal with the overwhelming threat by immediately believing it’s something they’ve caused. I’m wicked and I deserve this. At least that’s not as threatening as the reality of their safety being threatened by someone they rely upon for nuturance.

“Those cigarettes need to go, too,” I say.

She dismisses me with a simple wave of her fragile hand. For a moment, I can picture her fifty years earlier, a spry young woman at a cocktail party holding a martini glass and a cigarette. The early 1950s. A whole generation of young women like her defined themselves by their freedom to smoke and drink. The next generation would partake of drugs and sex. If a show like Sex and the City is any indication, the current generation is defined by a desperate inability to maintain a genuine relationship. I’m reminded of the old Virginia Slims cigarette slogan: You’ve come a long way, baby. But is this progress?

Mental health is defined by one’s ability to be fully present and integrated in reality. Of course, that reality may not always be happy. There might be negative experiences. In fact, there will be negative experiences, days that are downright crappy, moments or even years so painful you’ll ask why such shit is happening to you. But if you are mentally healthy, you will be able to tolerate such experiences, regulate your emotions. And in the end you will be nourished by something more real than merely “feeling good.”

A genuine self can only develop in relation to someone else. In the past, people turned to loved ones, neighbors, or religion to heal their problems. That doesn’t happen anymore. Nowadays the culture is all about arousal and quick fixes. But they don’t work.

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