So You think You Are Done Grieving?

Sometimes I may read something that appears unrelated to grief and my brain will start putting some thoughts together. This happened last month when I was reading an article about a playwriter named Tarell Alvin McRaney. It was titled “Connoisseur of Grief” (NY Times Sunday Magazine, January 20,2019).The author of the article, Carvell Wallace, describes a rehearsal of a new play, “Choir Boy”. McRaney, as the playwriter, was in attendance sitting quietly in the back of the theater.
At one point, the director and actors were at a stuck point trying to solve a problem with a scene. McRaney approached the stage and began talking about his experience with losing his mother at the age of 22. He shared the following:

“Mcraney described how grief lives in a person’s body, how it settles there. He explained it’s half-life, the unreliable nature of its decay. He talked about the phenomenon, when grieving a loved one, in which you begin to have memories of times after their death that you think they must have been present for. He talked about how things like that make you grieve their absence all over again, and how that grief catches you unawares when you least expect it.”

I hadn’t read anything like that in print with the exception of specific grief related literature. I had to stop and digest this because it was powerful how McRaney described the unpredictability of the grief experience. I have heard clients describe this phenomena and experienced this with my own losses. I often think that when we are triggered by stimuli like movies, songs, seeing someone who resembles a deceased loved one, it feels like being punched in the stomach.

The effect on the actors was immediate. One of them asked to try something different. Everyone agreed that it solved the puzzle of making the scene work. Although McRaney spoke of something seemingly unelated, It moved the process along. It reminds me of how the narrative of our grief can have unintended consequences that can be amazingly healing. In another article I read in The New Yorker (February 4, 2019), the importance of meaning making of our grief experience and the importance of telling our stories is evident.

The article is a review by critic James Wood of a book by the Mexican writer, Valeria Luiselli titled “Tell Me How It Ends”. She is quoted as saying, “In the meantime, while the story continues, the only thing to do is tell it over again as it develops, bifurcates, knots around itself. And it must be told, because before anything can be understood, it has to be narrated many times, in many words and from many different angles, by many different minds”. Specifically, she is writing about the crisis at our borders and the separation of children from their parents, a tragic and meanspirited loss of security, identity and hope.

So, in closing, these articles spoke to me in a profound way. It reinforces ideas about the grieving experience that I have entertained for several years. I have also been influenced by writers in the bereavement field who have articulated these thoughts in more eloquent ways. I’m grateful that I have been given the opportunity to work with clients whose lives have been touched by tragedy.

Dry Drunk Syndrome

Dry Drunk Syndrome: How does it happen and what can we do about it.
When I had a few years of recovery, my family and I went on a Caribbean cruise. On one of those days, I decided to catch some sun on one of the decks. The majority of the people were drinking but I was not triggered as I heard the servers announce special drinks deals like: “Bahama Mama”. Wondering if anyone around me was sober, I noticed a man, nearby, who was drinking Ginger Ale. Somehow we started to converse. He stated that he had twelve years of sobriety from alcohol and drugs, but did not participate in 12-step recovery. He had attended meetings when he first got sober but had not done so for many years. It was not his “thing”. The longer we talked the more uneasy I became. Sadly, this gentleman was filled with resentment and bile. He was quite miserable. It happened to have been his birthday and he was not a happy guy.
I had heard about “dry drunk” at meetings and I was now face to face with a prime example. It made a powerful impression on me. Why get sober to be that unhappy? In preparing for this article, I started thinking about defining the phenomena of dry drunk. The word “dry” refers to abstinence from substance use, a person that has stopped using. “Drunk” implies behaviors and attitudes that occur when intoxicated. Therefore, “dry drunk” can be described as intoxication without alcohol or abstinence without recovery. Many recovering people are aware of an old expression, “What do you get if you sober up a horse thief? A sober horse thief”. You could add, “You still have to teach him how to stop stealing horses!”

This is an exaggeration but it helps us to understand that when people become sober, there is a need to make internal changes to avoid a relapse or to become like the man on the cruise. The syndrome, or group of symptoms, can be identified in two types of people. Some addicts and alcoholics have achieved abstinence but with limited emotional and behavioral changes. They tend to stay fixed in early recovery. Another group is the people who were once active in their recovery and making progress, but have returned to rejecting help, self-pity, defensiveness, impulsivity, and resentment. We often see people, in this group, becoming compulsive in process addictions such as gambling, spending, internet, and sex. I remember knowing a man who had two years clean and sober. He was working out intensely and was looking very buff. Eventually, he started using IV steroids and this lead to a return to his drug of choice, IV heroin. Fortunately, he was able to make it back into recovery.

In early recovery we experience what has been described as Post Acute Withdrawal Syndrome (PAWS). I experienced the symptoms as difficulty sleeping restfully, short term memory loss, coordination problems, impaired focus and concentration, and mood swings. I had difficulty comprehending what I read. My forgetfulness was so bad that my wife told our counselor that I had Alzheimer’s disease. I had two minor accidents in the first month of sobriety that had freaked me out after twenty years of driving under the influence without an accident. My moods varied throughout the day between irritability and immense sadness. I later learned that my central nervous system was healing and that the symptoms would lessen over time. This can become dangerous for early recovering people as the flood of feelings can be overwhelming. Unless this phenomenon is understood and treated, a person can fall into the category of dry drunk.
There are obvious and subtle traits that emerge in a person experiencing a dry drunk. The Big Book (Alcoholics Anonymous, 2001), on page 52, describes what can be referred to as untreated alcoholism. I believe these “bedevilments” can also refer to abstinent alcoholics and addicts who have stopped working a program of recovery.

“We were having trouble with personal relationships, we couldn’t control our emotional natures, we were prey to misery and depression, we couldn’t make a living, we had a feeling of uselessness, we were full of fear, we were unhappy, we couldn’t seem to be of real help to other people.”

Recently, I was having a conversation with my sponsor about dry drunk. We were describing examples of behaviors that fit under this description. There are people who will work steps one and twelve and never address the other ten steps. They stay clean and sober and may perform service such as speaking at meetings and helping the newcomer. When you listen to them, it sounds like they are models of recovery. Yet, in other ways they may betray the lack of internal changes that appear in people who have become spiritually evolved and truly happy.
One prime example is “thirteen stepping”. Many of us are familiar with this behavior. A newcomer starts attending meetings. She or he may be approached by someone who has several years of sobriety. Under the guise of being helpful, they offer support. What starts out as innocent meetings over coffee sometimes become romantic relationships. After the initial courtship, the relationship may end. Often, the newcomer may relapse when feeling confused and heartbroken. This is a scenario that is unpleasant. There is an incongruity within people who articulate spiritual principles and behave otherwise. I wish I could say that this is a rare occurrence but I have observed this, repeatedly, over my years of recovery.
There are several observable traits that can be classified as dry drunk syndrome. Grandiosity can be manifested in behaving as if we are unique and the rules don’t apply to us. We may believe in our self importance and superiority. We may revert to self centeredness which can also manifest itself as self-pity.

Sometimes we may become judgmental, making harsh criticisms of others and engaging in cognitive distortions such as black and white thinking. This can manifest in making comparisons either favorably to ourselves or self condemning. One of my warning signs has been when I’m at a meeting and I hear the same story I’ve heard many times before. I find myself becoming impatient as I mentally criticize the person who is sharing. I believe I can label this as a form of intolerance.

Another red flag is complacency. I believe that when we are in dry drunk behavior it can often lead to relapse. I know I am heading in the wrong direction when I start “blowing off” activities that are part of my positive self care. A warning sign is deciding not to go to meetings or other treatment activities, declining social interactions with friends or family, procrastination and wishful thinking or fantasizing ruminations. Thoughts of wanting to be happy without taking action or a sense of increasing inertia can be predictors of relapse. Indecision or paralysis can become more dominant in our thinking. I believe that it is difficult to stay in one place when in recovery. Either we are moving forward or backwards. It is said that we are always either moving away from a drink or towards it. We need to continue to be introspective and self aware. I have revised a statement from the “Big Book”, “I know only a little”. I believe we have to take ourselves to higher levels of awareness and improvement. A structure that is not renovated and repaired will experience entropy, or a return to chaos. I have never been comfortable with the concept of maintenance. If I want to be happy, joyous and free, I need to learn more, do more and connect more both with others, myself and my higher power.

Unless there is an intervention by ourselves or others who care, we start to experience discomfort on a mental, physical, cognitive and spiritual level. Some of us experience increasing mood swings, variability between irritability, anxiety, and sadness. We may start to think more pessimistically about the future. Our ability to balance past, present and future becomes unstable and we focus more on fear, remorse, and resentment. We start to regret the past and we wax nostalgic for the “good old days”. Sometimes, these thoughts take the form of euphoric recall. I have a built in forgetter in my brain. Without self inventory, I might start longing for the “summer of love” back in 1967 rather than remembering the pain of the Fall of 1987. Once again daydreaming and escapism start to insert themselves into my thinking.

Physically, I may start to neglect exercise, nutrition and rest. My immune system becomes less effective and I am prone to somatic complaints. Focus and concentration decrease. I become less effective in my work, making mistakes as I bemoan the way the powers that be screw things up and are insensitive to my needs.

Spiritually, I start to pull away from conscious contact and connections. I stop routines of prayer and meditation. I narrow my world view and question the existence of a power greater than myself. Cynicism gains a foothold and thoughts of being helpful to others get pushed out by my egocentrism. Ultimately, the warning signs of relapse escalate until the thought of returning to destructive behavior is enticing. Thoughts of being in recovery are slowly replaced with thoughts like, “This is too hard. Why me? And, “you would use if you had my problems.” I start to have thoughts of wanting to use or act out. Mental cravings become prevalent. I rationalize that “one won’t hurt”, “no one has to know, I’ll start over tomorrow, and I deserve this”. As I go through this process, my ability to intervene on my own behalf becomes less likely. I start to plan my relapse.

Throughout this process, I am more vulnerable to high risk factors and situations. Negative feelings like resentment and shame rear their ugly heads. Positive feelings like reward and celebrating my successes may rationalize the use of substances or other behaviors. Physical discomfort or illness can make us more susceptible to thoughts of relieving distress in old ways. We experience problems with sleeping and look to unhealthy ways to fix the problems. We become secretive about pain medications and may begin to abuse them. We begin keeping secrets.

We start to test our control by placing ourselves in risky situations. We become like the jaywalker, putting ourselves in danger. We become more vulnerable to social pressure when around people who do not know we are in recovery. We want to belong and feel shame about being different. We reminisce about the ways we used to have fun using social lubricants to enjoy music, films, dancing, and sex. Our ability to cope with conflict becomes inappropriate. We start manifesting inappropriate responses in coping with conflict. We become quick to anger and argue in an extreme manner. We bring up irrelevancies when dealing with the here and now. We return to the use of bad language. We externalize blame and alienate our partners or significant others.

As I write this I realize how bleak this sounds. The consequences seem dire. Are we all subject to dry drunk syndrome? What can we do if we detect that we are pulling away from what we have worked so hard to achieve. Certainly corrective measures are necessary. I think that at any time we can be vulnerable to dry drunk behavior. If we stay in recovery long enough we are going to experience life on life’s terms. Loved ones become ill and die. Relationships can become troubled. We experience career setbacks. We find ourselves in the unenviable position of having to cope with loved ones who succumb to addiction. We may be troubled and unsure about the future.

I have to increase my attendance at meetings. Sometimes, I need to hear new voices and regain enthusiasm as I get a fresh perspective. I have found that meetings that are literature based are helpful. Also, hearing others talk about their experience with the steps can help me to regain focus.
I didn’t get sober by myself and I need others to confront me, in a loving way, when I stray from the path. If we have avoided working with a sponsor, it’s time to get one. If we have created distance from our current sponsor, we need to get reacquainted. Perhaps we have a sponsor that is unavailable or inaccessible. The sponsor may be caught in the same malaise that we are struggling with. It may be an opportunity to work with someone else. I want a sponsor and people in my support system, to confront me when I am engaging in self sabotage. But I want this to happen in a loving spirit. Many of us have experienced abuse and require more patience and understanding. When I was in early recovery, I attended a spiritual retreat for recovering men in New Jersey. The leader for the weekend was a priest who happened to be in recovery himself. I will never forget Father Jack saying, “If your sponsor never makes you feel uncomfortable, you better get a new sponsor”.

I have always worked with sponsors. I enjoy the relationship and value the guidance and support. Several years ago I was traveling to the east coast for business. My most frequent stop was to New York City. I would fly in on a Sunday and return the following Saturday. I have an older daughter who lives in New Jersey and works in Manhattan. My routine was to call her to see if she was available for lunch or coffee. One week, I called after I arrived. Monday she didn’t get back to me. Tuesday and Wednesday were the same. I was now irritated and hurt that she didn’t return my call. My plan was to call her again and give her a piece of my mind. I had my guilt trip script worked out.

Somehow I thought that maybe I should call my sponsor first. When I did so he said, “Why don’t you reconsider. If you tell her what you are prepared to say, you might create some bad feelings. Why don’t you try something like this instead?” “Hi, sweetheart. I called and didn’t hear from you. Is everything all right? Is there anything I can do to help you?” He also reminded me that she was pregnant at the time and had a toddler at home. She had a job that required working on deadlines. I followed his suggestion. She called back saying, “Dad, I’m really sorry. The baby has a cold and I’m all jammed up”. I was so grateful that I called him first.

Along with meetings, we can get involved in service such as taking meetings to correctional institutions and treatment centers, reaching out to others, chairing meetings and other activities. Sponsorship has always been personally helpful. There have been times when I was preoccupied with my own problems and a sponsee called asking for support. When I focus on how I can help him, I forget about me for the moment. Participating in the fellowship aspect of recovery can help us to feel a part of what’s going on.

Many of us have co-occurring issues such as Post Acute Traumatic Disorder (PTSD), depression, Bipolar Disorder, anxiety and issues relating to our family of origin. Some of us have grown up in dysfunctional homes that have left lasting scars. At three years of sobriety I joined a therapy group. It was helpful in addressing anger issues related to my childhood experiences. There are some problems that cannot be treated at 12-step meetings. We may need professional help. Sometimes psychiatric care is necessary. Staying sober with untreated Bipolar Disorder can be difficult. Sometimes, the workplace can help by providing Employee Assistance Programs (EAP) on a confidential basis.

Spirituality is a valuable coping tool regardless of belief systems. Many people have confused spirituality with religion. It doesn’t have to include belief in a personal deity. There are many ways to explore our personal definitions of what is spiritual. Certainly, participation in religious practices has often helped. Yoga and meditation have proven helpful in helping us to get centered. Exercise and proper nutrition are also helpful.

In closing, it’s important to remember that dry drunk syndrome does not mean that we have to relapse. It can be corrected. In fact, when we have the awareness that we need to make changes and have the willingness to do so, we can experience our recoveries in ways that can be even more fulfilling. We can, then, experience life to the fullest.

Dan Stone LCSW, LISAC, CT October 27, 2013

Grief Can Transform Us

In a recent New yorker magazine (March 11, 2013) written by Alec Wilkinson, the noted jazz pianist, Jason Moran, described his experience with the death of his mother. I found this part of the article interesting and relevant to many of us who have lost loved ones.

“Moran grew his beard in 2005, when his mother died of cancer. He says it is a veil he wears in mourning. When she died, he lost interest in his appearance. ‘I didn’t know what to do anymore,”he said. ‘I felt like the music doesn’t care what the musician looks like, and now I had pain”. He spent the last night she was conscious at her bedside. ‘I was very ambivalent about watching the process,’ he went on. ‘Spending that last night with her evoked almost a kind of terror. I don’t recommend it. It’s too much too watch. With someone you love, you keep that part at the end with you almost as much as you keep how you grew up and remember them. I have to make my mind remeber her as healthy, or I can’t move’.

The article continues with Moran discussing how his mother woulod take notes when she attended his piano lessons, encouraging him to work on his tone and fingering. He later wrote a composition titled “Cradle Song” to memorialize her.

I appreciate Moran’s remarks about remembering the time before the death. Early in the mourning process, It’s easy to focus on the tragedy of the final months, weeks, days and moments. Many of us havre recurring images that are painful and in some situations, traumatic. When my mother was dying, she lived one week after having a stroke. My sister and I were at her bedside daily. During the last moments of her life, I was able to speak to her in a tender manner, encouraging her to let go and be at peace. She was not conscious; however, I was comforted at being there to support her. Over a period of time, I was able to see her for the total person she was. I have often remembered some of the special times we had together. Sometimes, I remember some unpleasant events, but I am able to recall her in a way that encompassess her humanity and totality.

When my father died, I did not have the blessing of being at his side. I have often regretted that but it was a long time ago. My life and my understanding of grief have changed significantly since then. I can identify with Moran’s composition that is dedicated to his mother. With the guidance of a wise friend, I found a way to honor my Dad. I was encouraged to think of a positive quality of his and replicate it in my own life. After some thought, I remembered that on many ocassions when he would leave our home, my mother would ask him where he was going. He usually replied saying he was paying a condolence call to one of his friends, neighbors and fellow congregants, to provide support. I decided to support those in my world who were suffering with loss. Eventually after becoming a therapist, I was drawn to grief counseling and therapy. Since 1997 I have decveloped a focus on bereavement that includes complicated and traumatic grief. I often think of my father and I believe that if he knew, he would approve.

Today, in my work with the bereacved, I respect the diversity of grievinhg styles be they religious, cultural or personally developed.I believe that the telling of the story of our losses and our relationship with the deceased is important. I find it interesting how our meaning of the grieving experience changes over time. With many of my clents, I have observed the process of what has been called posttraumatic growth. This has been apparent in the way people discover a new purpose and often find a more spiritual approach to their existence.

Several years ago, I read about a study that was done with eight mothers of children who had died as a result of birth defects. These children died from six months of age to as old as 37 years old. The mothers were in a bereavement group. About two years from the commencement of the the group, they were administered questionaires that would assess where they were in the grieving process Seven of the eight women reported that they had no regrets. They felt that they wouldn’t want to give up the experience of having the child in their lives. They reported that they were no longer “sweating the small stuff”. In fact, the experience had infused their lives with a new meaning.These women had grown spiritually and were interested in being of service to others.

I find this analogous to the experience of recovery. Many of us who have been addicted to substances have suffered various consequences and losses. In working a program of recovery, we find that life takes on new meaning and that we become people who are able to be of service to others. Like the seven mothers, we experience a change in our world view as we change our perception of the meaning of life.

Disenfranchised Grief

Ken Doka (1989) described the phenomena of disenfranchised grief. While a person is experiencing a loss, the grief is not openly acknowledged, socially validated or publically observed. It brings to mind some of the work I have done with adolescent females who have not had the support they needed. This has sometimes resulted in a complicated greiving which is manifested in the increase or commencement of substance use, depressive episodes and behavioral manifestations such as self harm. I recall working with an adolescent who witnessed the murder of her best friend at a drug deal that went bad. In this case the grief of the friend was not acknowledged and went unnoticed. In fact, stigma was attached to the friend because of her association with drugs.

In some cases the adolescent, themselves, may contribute to their own disenfranchisement as a result of repressing the grief reactions and then turning to drugs for medication. One young adult lost her father at 15. She spent the next three years putting all her energy into school and extracurricular activities. By her own report she ceased thinking about her father alltogether. Three years late, she was dropped off at college by her mother. Within a week, she withdrew after having a depressive episode. Shortly after returning home, she began using heroin.

In situations like these, the grief has been prolonged, traumatic and complicated. It requires treatment in which the clientt is provided with a safe environment and a therapeutic alliance is created with the therapist. Clients need to tell the story of the loss. There is power in the narration. Written exercises, unsent letters, guided imagery and symbolic dialoguing with the deceased have been useful in my work with grievers. Assessing for co-morbid issues like depression. PTSD and substance use are a necessity. My goal is not to end the grieving process because that is unrealistic. Rather, I like to assist the client in accomodating to the loss and developing a holistic view of the deceased that is not centered on the tragedy alone. In future blogs, I will comment on other aspects of grief and loss as well as other topics.