“I’ll Quit Tomorrow!”

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It is mind boggling how alcoholism impacts people from all cultures, races, socioeconomic class, gender, religion, profession, and academic background. Interestingly, all alcoholics are ultimately alike. The disease itself swallows up differences and creates a universal alcoholic profile. The personality changes that go with alcoholism are predictable and virtually inevitable.  Alcohol can precipitate the onset of a disease with a predictable, inexorable course. It can ultimately destroy the physical, emotional, spiritual, and mental life of the sufferer. Alcoholism is typified by a progressive mental “mismanagement” and an increasing emotional distress that can reach suicidal proportions.

Hidden costs of alcoholism are not small. Alcohol-related expenses cost federal, state and local governments $223.5 billion. Of that amount, tax payers are footing the bill for $92.4 billion.

Drinking Was Fun, Once Upon a Time

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Early drinking is a mood-swinger, typically in a positive direction. It gives the drinker a warm, good feeling, that may lead to giddiness. When the effects wear off, the drinker feels normal. It does not take long to learn how to set the amount and select the mood. As the typical social drinker gets deeper into the booze, getting drunk begins to have a very different effect. Heavy drinking creates a sort of undertow that drags the drinker back beyond normal and into pain. This might be the point where euphoria is reached at a big cost—if it’s achieved at all. Now the booze is consumed in order to feel no pain. In other words, to get back to some degree of normal. This is the beginning of harmful alcohol dependence.

In addition to dependency, this phase also involves a rising emotional cost. We we see a significant and progressive deterioration of the personality of the alcoholic, and (eventually) a visible physical deterioration. Ultimately, the alcoholic’s whole emotional environment is torn to pieces and destroyed. Of course, most active alcoholics are in complete denial of the impending bottom.

There is now a progressive emotional cost for every single drink. The carefree days are gone, but the alcoholic is dimly aware of this fact at best. The rising cost is willingly paid. This is proof that dependency has become truly harmful. Of course, the drinker fails to comprehend the increasingly clear signs of destruction by alcohol. Frankly, at this point the alcoholic is learning to depend more and more on rationalization. Intellect begins to blindly defend against reason—indeed, against intervention. Eventually, the alcoholic will be completely out of touch with emotions. Internal dialog will become the soundtrack of an increasingly impenetrable defense system.

Denial is Not Just a River in Egypt

The tragedy is that rationalization actually works! This form of defense—which I employed constantly during my active addiction—continues to operate as the disease progresses. The alcoholic’s behavior will become increasingly bizarre, and the innate and unconscious ability to rationalize will be practiced to the point of perfection. The drinker finds it increasingly difficult to accept blame. Time passes, and the alcoholic condition worsens. Over a period of months and years the alcoholic’s self-image continues to wane. Ego strength ebbs. Feelings of self-worth sink low, and excessive drinking continues, producing painful and bizarre behavior. Eventually, emotional distress becomes a chronic condition. The drinker feels distress unconsciously even when not drinking.

Unfortunately, rationalization works. The tragedy is that this form of defense will continue to operate as the illness progresses.

Now, “mood swings” or personality changes are evidenced while drinking. The kind person becomes angry or hostile; the happy person becomes sad or morose; the gentle person becomes violent. Alcohol causes one’s guard to drop, and chronic unconscious negative feelings are laid bare. The drinker becomes truly self-destructive. All this drinking and emotional distress may lead to a vague but poignant feeling, I just might have a drinking problem. There is a general malaise so strong felt that desperate measures to escape are actually attempted. Geographical cure, a new job, divorce.

The Pathology of Alcohol Dependence

The final stages of alcoholism are close at hand. Continued excessive drinking and accompanying behavior bring on chronic suicidal feelings. I remember thinking many times, I should just go jump in the Susquehanna River! If the course of the disease is not interrupted, the end of all this is suicide—either slowly by continued drinking or in a direct manner. This is because as emotional distress mounts, and deterioration of the personality accelerates, these negative feelings are not clearly discernible. Quite the opposite is true: They are more effectively hidden.

A pathological use of alcohol can be measured by how the individual answers the following questions:

  • Have you ever drank early or first thing in the morning?
  • Have you ever drank alone?
  • Have you ever drank an entire fifth of alcohol in a day?
  • Have you ever felt remorse after drinking?
  • Is there a growing anticipation of the welcome effects of alcohol?
  • Has the anticipation moved into the realm of preoccupation?
  • Do you hide your booze in unusual places?
  • Are you unable to be honest about how much alcohol you consume?
  • Do you suffer blackouts or experience an inability to remember chunks of time?
  • Are you having difficulty with personal relationships, work, or the law due to drinking?

Counselors gather a history of the behavior patterns by questioning those who spend meaningful or extended time around the alcoholic. Here, the basic goal is to discover whether there has been a changing lifestyle secondary to the use of alcohol, which would indicate a growing dependence.

Drug and alcohol counselors often explore this changing lifestyle by asking probing questions. Has there been a growing tolerance to alcohol? Does it take more booze for the drinker to get the desired effect? Does the alcoholic start drinking in the kitchen before bringing drinks for guests into the living room? (I often drank secretly before drinking in front of guests or family.) To what lengths is the alcoholic willing to go to get the amount of alcohol needed? The degree of ingenuity used to get more booze becomes the scale for determining how far dependency has progressed. All instances of harmful dependency that show up in alcoholic behavior patterns indicate a maladaptation of the lifestyle to (a) growing anticipation of the welcome effects of drinking, (b) an increasingly rigid expected time of use, and (c) a progressive cunning in obtaining larger amounts of alcohol.

Rational defenses and projection take hold. Why is it that the alcoholic cannot see what is happening? Simple. They have lost the ability to see it at all. The reason alcoholics are unable to perceive what is happening to them is actually understandable. As the condition develops, self-image continues to deteriorate. Ego strength grows increasingly weaker. For many reasons, they are progressively unable to keep track of their own behavior and begin to lose contact with their emotions. Their defense systems continue to grow, so that they can survive in the face of their mounting problems. The greater the pain, the higher and more rigid the defenses become—and this whole process is unconscious. Alcoholics do not comprehend what is happening. Quite literally, they are victims of their own stinkin’ thinkin’.

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As the emotional turmoil grows in chemically-dependent people, rational defense activity turns into real mental mismanagement. The drinker erects a wall around him or her. The end result is that the alcoholic is cut off from increasingly negative feelings about themselves. They are unaware of the presence of such destructive emotions.

Not only is the drinker unaware of the powerful, highly developed defense systems, they are also unaware of the intense feelings of self-hate buried inside them. Moreover, the problem is being compounded by the fact that these defenses have now created a mass of free-floating anxiety, guilt, shame and remorse, which becomes chronic. In other words, the alcoholic no longer drinks from a “normal” point, experiencing an upswing in mood to feeling great or euphoric; rather, they must start from where they feel depressed or pained and drink to feel normal again.

Drink Takes a Man

Alcoholics drink because they drink. A Chinese proverb says, “First the man takes a drink, then the drink takes a drink, then the drink takes the man.” The drinking pattern becomes thoroughly unpredictable or compulsive. The alcoholic quits, then resumes, and does not know why he or she is drinking again. And whenever they do start again, the resumption is at the level of chronic emotional deterioration. Conditions worsen with each new episode, trapping the drinker in a deadly downward spiral.

Depression and low self-esteem become so great, the alcoholic begins to employ projection—a defense mechanism in which unwanted feelings are displaced onto another person, where they then appear as a threat from the external world rather than from within. The alcoholic does not know this is happening. The more hateful alcoholics see themselves, the more they will come to find themselves surrounded by hateful people. Depending on the personality of the drinker, such projection can present itself in ways ranging from gentle complaining to outright aggression. It is obvious the easier targets are those people typically spending time with the alcoholic, including the most meaningful. Although alcoholics tend to hate themselves, their projection works so well that they actually believe they are attacking hateful people.

People who live and exist around the active alcoholic have predictable experiences that are also psychologically damaging. As they meet failure after failure, their feelings of fear, shame, frustration, inadequacy, guilt, resentment, self-pity and anger mount. So also do their defense mechanisms. They too use rationalization as a defense against these feelings. The chemically-dependent—and those around them—all have impaired judgment; they differ only in the degree of impairment.

People who are chemically-dependent on alcohol have such a highly-developed defense system that they become seriously self-deluded. The rigid defenses that have risen spontaneously around their negative feelings about themselves, and therefore around their behaviors that caused these feelings, would be quite enough, were they the only deluding factors, to draw these people progressively and thoroughly out of touch with reality. Not only do these defense mechanisms become more rigid, but such individuals develop a growing rigidity in their very lifestyle. They are less able to adapt to unexpected change. They eventually reach a point where even schedules are burdensome. This is primarily because, paradoxically, they are less likely to plan ahead. Or, when they do plan something, they tend to feel trapped as the moment closes in.

To Make Matters Worse

Chemically-dependent people have two factors progressively working together to draw them out of touch with reality: Their defense mechanisms and distortions of memory. Consider euphoric recall, which is the tendency for an alcoholic to remember their drinking escapades euphorically or happily—in only the best light—with gross distortion of the truth. They believe they remember everything in vivid and accurate detail, thinking that all was “just fine.” Of course, this will only serve to bury the drinker’s antisocial or destructive behavior. There is a destructive distortion of perception itself. There is a lack of ability to see and appreciate reality. No recognition or acceptance that they are on a downward spiral, fast approaching rock bottom.

Rock Bottom Became the Foundation

Either of these defense mechanisms seriously impair judgment. The time inevitably comes when it is plain that alcoholics cannot see they are sick. Yet they are acutely ill with a condition that will ultimately lead to death and destruction, and which will seriously impair their constitution emotionally, mentally, and spiritually during the final months of year of their active addiction. Accordingly, treatment for acute alcoholism cannot concern itself merely with putting the drink down. It also has to do with restoration of adequate ego strength to enable the alcoholic once again to cope with life.

The Best Approach

Therapy for acute alcoholics must address the whole person. The alcoholic suffers emotionally, mentally, physically, and spiritually. Treatment often involves physicians, psychiatrists, sociologists, psychologists, pathologists, and clergy. If the whole person is not treated simultaneously, relapse is simply… inevitable. If, for example, the emotional disorder alone is addressed, the alcoholic may believe he or she feels “so good” now that they can handle the drink. When treatment is short-sighted or limited, friends and family of the alcoholic may be heard commenting, “He was easier to live with when he was drinking!” This is akin to being a dry drunk. As this “dry” condition worsens, mental gains erode away and the alcoholic inevitably reverts to drinking to feel normal.

A description of despair by Søren Kierkegaard found in his book The Sickness Unto Death. Human despair is found at three distinct levels. First is the despair that expresses itself in sentences such as, “Oh what a miserable wretch I am! Oh, how unbearable it is to be me!” Second is the despair  that expresses itself by crying out, “Oh, if only I were not what I am. If only I could be like that person!” This is deeper despair because it considers self to be so worthless as to want to abandon it completely. But the third, deepest, despair of all is despair that does not believe one is a self at all. In other words, “I used to be… but not I am not.”

Physical complications, mental mismanagement, and emotional disorder are accompanied by a similarly progressive spiritual deterioration. Guilt, shame, and remorse exact their inevitable and immobilizing toll as time goes on. Feelings of self-worth begin to decline. As meaningful relationships wither on the vine, the growing estrangements lead to spiritual collapse. At the end, these feelings produce suicidal moods, ideation, and, unfortunately, suicidal attempt and/or death. If asked, “Can’t you see you’re drinking yourself to death?” the alcoholic replies, “So what? Who cares?”

Concluding Remarks

When asked how alcoholism is treated, people commonly think of either the 12-step program of Alcoholics Anonymous (AA) or inpatient drug and alcohol rehabilitation. There are, however, a variety of treatment modalities currently available. Today’s treatment for alcoholism naturally rests upon decades of research. AA was founded by Bill Wilson (“Bill W.”) and Bob Smith (“Dr. Bob”) in Akron, Ohio in 1935. AA’s program of spiritual and character development is based on the premise that turning one’s life and will over to a “personally meaningful higher power” is the key to recovery. It is, in fact, referred to as the key of willingness. Another central idea is that sobriety or recovery depends on the admission of powerlessness with respect to alcohol or other substances.

Treatment for alcoholism has made significant advances in the last 20 years. Researchers are constantly seeking novel approaches for improving the effectiveness, accessibility, quality, and cost-effectiveness of treatment. Alcoholism is a treatable disease. Regardless of how someone is diagnosed as alcohol-dependent, or how they came to realize they have a drinking problem, the first step to treatment is a sincere desire to get help. Overcoming an alcohol problem is an ongoing process that sadly might involve relapse. Granted, relapse is not a “requirement” for recovery—you don’t have to change your sobriety anniversary!—but it is merely a setback and not an indication that you will fail in your attempt to get sober.

 

A Fundamental Orientation of the Heart

Perhaps one of the hardest things we face is taking stock of whether our actions match what we claim to believe. Our worldview – that is, how we see the world and our place in it, or, if you prefer, our “philosophy of life” – should be obvious from our behavior. A worldview is not just a set of basic concepts but a fundamental orientation of the heart.

Since the events of 9/11, the term worldview is often used as a very general label for how people view the cultures with which their culture clashes. This is very important to note, as a worldview is a set of presuppositions (assumptions which may be true, partially true, or entirely false) which we hold (consciously or unconsciously, consistently or inconsistently) about the basic makeup of our world. A worldview is sometimes considered to be the fundamental perspective from which we address every issue of life.

From a Human Perspective

Imagine someone who thinks life has no true purpose. For that person, events are random. “I live, then I die.” A meaningless existence requires nothing from anyone. There is no need to check our bearings along the way to see of we’re “on track.” There is no need to justify our choices, values, or goals. There is a quiet desperation that drives humanity to think about the question, “Does life have meaning?” Even non-religious people understand that man has a burning desire to make sense of his life. Humanist Deane Starr writes, “Humans find their most complete fulfillment, whether real or imaginary, in some sort of intimacy with the Ultimate.” Our greatest and most difficult achievement is to find meaning in life. It is well known that many people lose their will to live because such meaning evades them.

What happens when someone fails to find a reason for living? Often they experience a spectrum of emotional and behavioral aberrations. Jay Asher published a book in 2007 titled Thirteen Reasons Why. Netflix has produced a mini-series based on Asher’s book, which has caused quite an uproar across the country. The story begins when Clay Jensen returns home from school to find a strange package with his name on it lying on his porch. Inside he discovers several cassette tapes recorded by Hannah Baker—his classmate and crush—who committed suicide two weeks earlier. Hannah’s voice tells him that there are thirteen reasons why she decided to end her life. Clay is one of them. If he listens, he’ll find out why.

Suicide is the third leading cause of death in the age group of 10 to 24 years. It is a critical problem in America. Educators and mental health professionals have mixed feelings about Thirteen Reasons Why. Dr. Nicole Quinlan, a pediatric psychologist at Geisinger Medical Center in Danville, PA, objects to the show’s graphic, gratuitous portrayal of Hanna Baker’s suicide. I watched the mini-series, and I was shocked and upset by the final scene. I didn’t expect to see Hanna Baker drag a razor blade up both of her arms while sitting in a bathtub of warm water. It was, indeed, horrific.

Hanna Baker is a fictional character, but her plight is far from pretend. She was hounded by classmates, bullied online, and was labeled a “slut” after a football jock posted a random shot of her dress flying up when she came down a sliding board during her date with him. He intimated in his online post that Hanna was “easy.” Hanna’s problems worsened when she was raped by another member of the football team. On each side of the cassette tapes, she exposed one person (one “reason”) why she decided to end her life. Her thirteen excuses. Teenage angst is a very real and difficult emotion. Hanna, as are many teens, was trying to find meaning in what she felt was an already meaningless existence. Her worldview was that life was without purpose. The fault of the story depicted in Thirteen Reasons Why is its lack of providing meaning, hope, or the option of seeking treatment.

From a Biblical Perspective

Developing a biblical worldview involves both a mindset and a willset. First, how does the Bible explain and interpret my life and the world around me? Once this question is answered and accepted, the next aspect of a biblical worldview presents the challenge of putting this view into practice. A worldview is the framework of our most basic beliefs that shapes our view of and for the world, and is the basis for our decisions and actions. Worldview leads to values, which lead to actions. Beliefs clearly shape our behavior.

Man’s attempts to explain his existence are just that: man’s attempts. Within the world, man’s experience and perceptions of the infinite universe are limited and inadequate. We need help from the “outside.” This is what a biblical worldview is. Help from the outside. More fundamental than any worldview that can be delineated by ideas and propositions is the religious or faith orientation of the heart. There are only two basic commitments, leading to two basic conditions of life: “man converted to God,” and “man averted from God.” The commitment one makes is decisive for all life and thoughts. From a Christian perspective,  worldview is not so much a matter of theoretical thought expressed in propositions, but is a deeply rooted commitment of the heart. Theory and practice are a product of the will, not the intellect; of the heart, not the head.

How Would My Life be Different if I Lived Out my Convictions?

I have spent most of my life manipulating others. For reasons best understood by reading my testimony, https://theaccidentalpoet.net/about/, I felt the need to hide, run away, or escape. I had a difficult time telling the truth, and, because of a victim mentality, I was able to rationalize my behavior. I became a born-again Christian at age 13, but never fully developed a relationship with, nor the mind of, Christ. When I began escaping through drugs and alcohol, I set off down a road that ultimately took me until August of last year to get off of and head in the right direction.

How could I act in such a callous and selfish manner if I was a Christian? I now understand the reason. One of my sponsors in Alcoholics Anonymous kept saying, “I hope you get God out of your head and into your heart.” Each time I heard that, I became defensive. Who are you to tell me I don’t have God in my heart? My former pastor said the same thing when he commented, “You don’t seem to have a heart for God.” What? I continued becoming defensive.  Several things happened over the past year that finally got through to me

First, I returned to the church of my youth where I accepted Christ. Within a few months, our church got a new pastor from New Jersey. Pastor Mike is exactly what I needed. He has a wealth of experience counseling Christians struggling with addiction. In our several one-on-one meetings, he has been able to help me restructure how I see my addiction and the many excuses I was holding on to as justification. He has also helped me take a different approach to my chronic back pain. He made an amazing statement: “Have you ever considered that your chronic pain gives you the opportunity to share in the sufferings of Christ?” Whoa!

Last August I made the ridiculous decision to “help myself” to some of my mother’s oxycodone. Unfortunately, this was not the first (or second, or third) time I’ve done so. The result was serious damage to my relationship with her and the rest of my family. Interestingly, this is something I feared would happen if I did not stop using drugs. Especially using mom’s medication! I remain estranged from the family, and can only continue on my road to recovery, turning my relationship with the family over to Christ. I know I am delivered from the bondage of addiction. I have to live that freedom all over again each day. One day at a time.

Luke 6:45 is a Scripture I meditate on daily. It is very convincing, and seems to confirm what my former pastor and a former sponsor said regarding my lack of having God in my heart. The verse states, “A good man out of the good treasure of his heart bringeth forth that which is good; and an evil man out of the evil treasure of his heart bringeth forth that which is evil: for of the abundance of the heart his mouth speaketh.” Proverbs 23:7 says, “As a man thinketh in his heart, so is he.” God is concerned about the hidden man of the heart, which is our inner life. Our inner life is what we think about. And like the Scriptures above indicate, how we live and who we are.

A Change of Behavior Requires a Change of Heart

It says in Jeremiah 17:9, “The heart is deceitful above all things, and desperately wicked: who can know it?” Why do we sin, do bad things, and make mistakes? Because of our heart, which the Bible says is desperately wicked. Why do so many people struggle with drugs and pornography, returning again and again to these sins and vices even though they know their lives are being ruined by them? Because our heart often leads us astray. We cannot live perfect lives, and we cannot save ourselves from the punishment that we deserve. Moreover, it is impossible to deny the flesh, resist temptation, and stop living a self-centered and sinful life without a true change of heart.

Can this explain my constant relapsing over nearly forty years? Can it account for my selfishness? The disrespect and dishonor I’ve shown toward my parents and siblings? Does it help explain how I can “believe” and “speak” about Christ and recovery while secretly using drugs? Worldview, as I mentioned at the beginning of this post, is how we think about the world and our place in it. This basic belief establishes our values, which directly control our actions.

O Lord, how heartily sorry I am for failing to establish the proper Christian worldview, and to hide your Word in my heart that I might not sin against Thee.

It is only through my embracing a true Christian perspective and asking Christ to take away my heart of stone and give me a heart of flesh that I can hope to act from a position of love and respect.

Opioid Use Disorders and Suicide

The following is a guest blog taken verbatim from the monthly blog post of Dr. Nora Volkow, director, National Institute of Drug Abuse published April 20, 2017.

“At a Congressional briefing on April 6, the President of the American Psychiatric Association, Dr. Maria Oquendo, presented startling data about the opioid overdose epidemic and the role suicide is playing in many of these deaths. I invited her to write a blog on this important topic. More research needs to be done on this hidden aspect of the crisis, including whether there may be a link between pain and suicide.” – Nora

In 2015, over 33,000 Americans died from opioids—either prescription drugs or heroin or, in many cases, more powerful synthetic opioids like Fentanyl. Hidden behind the terrible epidemic of opioid overdose deaths looms the fact that many of these deaths are far from accidental. They are suicides. Let me share with you some chilling data from three recent studies that have investigated the issue.

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In a study of nearly 5 million veterans recently published in Addiction, scientists reported that presence of a diagnosis of any substance use disorder and specifically diagnoses of opioid use disorders (OUD) led to increased risk of suicide for both males and females.  The risk for suicide death was over 2-fold for men with OUD.  For women, it was more than 8-fold.  Interestingly, when the researchers controlled the statistical analyses for other factors, including co-morbid psychiatric diagnoses, greater suicide risk for females with opioid use disorder remained quite elevated, still more than two times greater than that for unaffected women.  For men, it was 30 percent greater.  The researchers also calculated that the suicide rate among those with OUD was 86.9/100,000.  Compare that with already alarming rate of 14/100,000 in the general US population.

You may be tempted to think that these shocking findings about the effects of OUD on suicide risk are true for this very special population.  But that turns out not to be the case. 

Another US study, published last month in the Journal of Psychiatric Research, focused on 41,053 participants from the 2014 National Survey of Drug Use and Health.  This survey uses a sample specifically designed to be representative of the entire US population.  After controlling for overall health and psychiatric conditions, the researchers found that prescription opioid misuse was associated with anywhere between a 40 and 60 percent increased risk for suicidal ideation (thoughts of suicide).  Those reporting at least weekly opioid misuse were at much greater risk for suicide planning and attempts than those who used less often.  They were about 75 percent more likely to make plans for a suicide, and made suicide attempts at a rate 200 percent greater than those unaffected.

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Using a different strategy, a review of the literature in the journal Drug and Alcohol Dependence estimated standardized mortality ratios for suicide.  This is a way of comparing the risk of death in individuals with a given condition compared to individuals from the general population.  The researchers found that for people with OUD, the standardized mortality ratio was 1,351 and for injection drug use it was 1,373.  This means that compared to the general population, OUD and injection drug use are both associated with a more than 13-fold increased risk for suicide death. These are stunning numbers and should be a strong call to action.

Persons who suffer from OUD are highly stigmatized. They often talk about their experience that others view them as “not deserving” treatment or “not deserving” to be rescued if they overdose because they are perceived as a scourge on society.  The devastating impact of this brain disorder needs to be addressed.  People who could be productive members of society and contribute to their families, their communities, and the general economy deserve treatment and attention.

As a country, we desperately need to overcome stigmatizing attitudes and confront the problem. We need to understand what causes some individuals to become addicted when exposed to opioids and thus study the biological basis of the disease of opioid addiction. We desperately need to know what the best treatments are for a given individual, and for that too, we need research to identify biomarkers for treatment response. Given the fact that effective medications exist but are drastically underutilized, we need to overcome institutional and attitudinal barriers to these treatments and deliver them to the 24 million people who could benefit. It can prevent not only the suffering of addiction and the danger of unintentional overdose but also help prevent the tragic outcome of opioid-related suicide.

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Ronnie’s Leap

Dedicated to the memory of my friend, Ronnie Benner, who killed himself by jumping off  the Shikellamy State Park lookout.

I keep playing it over and over
In my mind; he leaps again and again.
He climbs over the fence
And steps to the edge of all his yesterdays,
The breeze making his hair dance.
He has become unable to remember pleasure,
Thinking only of pain;
He is smothered in a blanket heavy with malaise;
No one to talk to,
No chance for release.
He takes one last step,
Then he’s gone.