A dance with the devil

I don’t know a single zebra who hasn’t at some point been told something like “I hate it when you take your painkillers”, by someone that they love and value. Best friend, partner, family member; The kind of person whose opinion matters, and where you might want to do anything to make them think better of you.

“I hate it when you take your painkillers”

Let me count the ways that that sentence is fucked up.

“I hate it when you take your painkillers” translates pretty neatly to “I prefer it when you’re in pain”. Regardless of if they’re trying to say “I prefer it when you’re in pain to when you’re socially inappropriate” or “I prefer it when you’re in pain to when you’re sleepy” or “I prefer it when you’re in pain to when you need someone else to drive and cook for you.” it, at its heart, is “I prefer it when you’re in pain.”

The most insidious justification of it that I’ve heard has always involved children, or pets (Disclaimer; I don’t have children, but I do have a dog) and it’s generally put as “But you can’t look after Isertana/Fido when you’re on painkillers!” It’s then followed up with “You’re irresponsible” or “You’re a bad Mum/Dad/dog owner for taking drugs in front of your child/pet”. And at this point, people tend to look smug – It’s a big social win, after all. Who wants a drug user, no, better than that; Who wants an opiate addict in a position where they’re responsible for the welfare of another living creature?

The picture paints itself; Mum laid on the sofa, surrounded by empty pill packets and half-demolished takeaway cartons, whilst toddler Isertana sits in their underwear, eating stale bread and margarine. Bloke staring at the television, numb, whilst Fido pisses on the carpet for the nineteenth time, thin and flea-ridden. Hogarth would weep with joy.

But let’s look at this in a much more realistic way. Here’s our two people, minus their pain relief;

Mum sits on the sofa, wracked with pain. Little Isertana watches her curling up and screaming over and over again, and wonders why she can’t help her poor Mum. Mum, for her part, is trying everything that she can to stop the pain – Yoga, acupuncture, better food. All of those cost money, and take time. Isertana’s clarinet lessons have to go first – They’re expensive and they clash with Mum’s reiki. Dinner becomes a massive trial, as the whole family switches to macro-probiotic-super-green-organic-gluten-free, and Izzie wonders why she’s being punished with horrible food. In addition to this, Mum snaps and shouts at her over the tiniest things, because she’s in so much pain.

Dog-owner Bloke lies in bed all day, unable to take his dog for a walk. He can’t even get downstairs to put food in the bowl, since every time he tries his knees explode with pain. He gets more short-tempered and stops talking to Dog, other than to tell it to get down off the furniture and to shout at it until it stops crying for food and attention. Dog pisses on the floor anyway, as Bloke can’t get to the door to let it out.

Now, let’s give them back their painkillers;

Mum sits on the sofa whilst Isertana plays, and they chat and play games. Sometimes, Izzie goes and brings her Mum a cup of orange juice, because she likes to help, and her Mum thanks her for it. When Mum is in pain, she takes her medicine, and goes a bit sleepy and easily distracted, but she still likes to sit with Isertana and they watch cartoons together. Sometimes they work together and cook cakes and make big meals, even if mostly they just eat instant, but once a week they order in a Chinese takeaway and it’s a real treat. Both are happier.

Bloke takes his painkillers, and at least makes it downstairs to feed Dog and let him out into the garden. He’s also in a better mood due to not being in pain, so although his dog doesn’t get as many walks as it could, it gets plenty of affection. Since he’s not distracted by the pain, he books a dog walker for a few days a week to make sure that Dog gets exercise. Both are happier.

So, why do people keep saying “I hate it when you take your painkillers”?

My theory is because they can’t imagine the alternative. They assume that (zebra)-(pain relief)=(functional person). Rather than (zebra)-(pain relief)=(person in incredible pain).

They see their partner and think that without the morphine their partner would be more lively, more focused, more of a “responsible adult”. They don’t realise that, usually, without the morphine, their partner would be just as lethargic and scatterbrained, only instead of being just lethargic and scatterbrained, they’d be lethargic and scatterbrained and suffering tremendously.

This is a difficult notion to get into people’s skulls, for a couple of reasons;

1) Society tends to parse “Very stoned” as being a desirable state to be in. Thus, partners will often assume that you just want to be stoned rather than sober.

– This one is difficult. There’s no denying that the feeling of being on morphine can be pleasant; In the right circumstances it’s soothing and restful, it comes with a tremendous sense of peace and affection to those around you, and ‘codeine skin’ (that feeling of having incredibly sensitive, velvety, tingly skin all over) is distractingly lovely.

Note, however, that I say “In the right circumstances”. As an alternative to being in horrific pain it is nearly always desirable. At the end of a long day, when all you have to do is lie around with good company and gently drift off to sleep whilst having inane conversations, it’s pleasant.

In the wrong circumstances (like at work, or on the bus, or at the shops), it’s horrible. That sense of tremendous emotional connectedness translates into painful, terrifying vulnerability. The peace and relaxation becomes exhaustion and grogginess and confusion. The all-over tingling becomes itching and irritation with every buckle, zip and strap.

I’ve said before that it’s like being drunk – Imagine if every morning you were forced to neck half a bottle of vodka, and then sent out into the world. You’d quickly stop feeling as if being drunk was in any way a desireable thing.

2) Society at-large is very suspicious of opiate use, and we have no cultural way of drawing the distinction between “drug dependent” and “drug addict”.

– In the absence of pain, I wouldn’t take opiates. I don’t think I’ve ever taken them other than to either dull pain that I was feeling, or in anticipation of pain that was about to happen. This, of course, means that I take between 20 and 120mg a day, every day.

To the layman, someone who takes 120mg of laudanum a day is an addict. We don’t really have a word for “Person with chronic pain who requires regular pain relief”. It’s similar, almost, to the attitude that some people take to antidepressants – That anyone who is taking them is somehow weak, or an addict, or otherwise morally dubious. It’s still bollocks. Nobody (or not many people) take that kind of attitude to people on long-term statins, or insulin, or antiretrovirals.

Thus, to many people, watching their best friend or their partner turn into the morphine queen feels like watching their partner turn into a drug addict, society’s second most hated bogeyman (after paedophiles). And thus they want their partner to stop taking the evil bad drugs.

3) Many people see looking after yourself, and putting your own needs first, regardless of what they are, as selfish.

– They are generally hypocritical in this. I have found that most people who say “I hate it when you take painkillers” hate it because they want you to be able to do something for them, whether that thing is look after another person, clean the house, go to work, perform sexually, or listen more carefully to whatever they’re saying. My only counter to this is to point out that, in the absence of the painkillers, you’re not going to be better, you’re just going to be in more pain.

And finally

4) People who don’t suffer from long-term pain don’t viscerally know what it’s like.

– When they say “Oh, don’t take your painkillers”, they imagine that it’s like having a headache, or a twisted ankle, or a gravel burn. They imagine that it’s like the kind of pain where, if you just leave it for a minute, it’ll go away. They possibly imagine that it’s like having pulled a muscle or cricked your neck – that it’s bad, but that you can work around it.

It’s not. When you’ve been in pain all the time, you’re already at “I’m working around it” levels of function. The pain that means that you neeed to take more pain relief on top of that is called “breakthrough pain” and it is exactly what it sounds like – It’s a pain that’s so bad that it shatters through any pain relief that you’re already on like a bull ripping through a paper bag. Suddenly, there is all the pain, and you’re feeling it all at once, and it can be anything from “Completely ruins your concentration” to “Curled up, screaming, begging for death”.

I volunteer a solution – Anyone who says “I hate it when you take your painkillers” has to promise to swear off pain relief entirely. And then has to wear shoes full of broken glass for a year. And then they might get the idea.

Short of actually hurting your partner/friend then refusing to give them pain relief, though, how do you get them to understand?

Well, it probably all depends on the person. Someone who dislikes it when you take painkillers because they’re frightened that you’ll become an addict will need a very different tactic to someone who dislikes it when you take painkillers because they find it embarrassing when you’re confused in public.

The common steps I’ve found are basically as follows;

1) Remind them that your painkiller use isn’t about them. It’s your experience, your pain, your choice of which is the lesser of two evils. If they push, find out what it is about your painkiller use bothers them, and gently remind them that without them, you won’t be “better”, you won’t be more attentive or more responsible, you’ll just be in pain.

2) Remind them of the clinical guidelines for the use of whatever painkiller you’re on. If you can demonstrate that what you’re taking is safe, that might help.

3) Point them at the Rat Park experiments. I know I bang on about them far too much but they’re just that important.

4) Involve them in some kind of ritual around your painkiller use sometimes. Not every time, obviously, but a compromise like “When I’ve taken my morphine and can’t have a real conversation, we can settle in with popcorn and watch those trashy old films you like”. Demonstrating over and over the difference betwen a morphine night (Relaxed, quiet, low-energy) and a pain-but-no-relief night (Crying, tension, possibility of a hospital visit, conversation always centred on pain) is a good way to get someone that you’re close to to be firmly on the side of morphine.

5) Reassure them that you want to be “you” as much as they want you to be you. I don’t know why so many people can’t see how upsetting and painful it is to be forced into a stupor against your will at unpredictable times. Especially when the alternative is blinding pain. There’s no win there.

I don’t know, there’s probably more, but that’s the stuff that comes to mind. Empathy is the key thing, really. And, well, good luck all of you.

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