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People often ask me, “how can you put up with all this misery that you hear?” And I agree, it’s not easy. But one of the things that helps you is to really understand that people do the best they can, that somebody who’s enraged in response to a minor thing is not becoming enraged because they just are unpleasant, difficult, people who don’t try. No, they try. And so people try to survive. Every person tries to have the best possible life they can have, and sometimes it goes really wrong. But, for example, when you’re a little kid and you don’t feel like anybody’s there to help you when you become distressed, you may learn that banging your head against the wall, or stabbing yourself, or burning yourself, or starving yourself may make you feel better. And so we discover that people do all kinds of things that seem pretty weird sometimes on the surface to protect themselves.
There was a moment in the history of our field: Vince Felitti, who was the internist who did the Adverse Childhood Experiences study, had a very important experience that he shared with all of us. He had a weight loss program and that’s all he did. He was very proud of his weight loss program. And then one day, a woman came to his office who had lost something like 150 pounds or something in the course of the weight loss program, and she came back three months later and had regained almost all of her weight. And he said, “I didn’t know people could gain so much weight in such a short period. What’s happened to you?” And she says, “You know, Dr. Felitti, your weight loss program was terrific. I became svelte, and people’s reaction to me completely changed. So after my last visit to you where you complimented me about how well I was doing, I went back to my office, and one of my coworkers said, ‘Boy, you look really hot, would like to go on a date tonight?’ And the moment he said that, I started to eat and haven’t stopped eating, because what I realized is overweight is overlooked. And the way I dealt with my childhood sexual abuse is to make myself grossly obese so nobody would have an interest in me in a sexual way.”
So it was one of these openings when you get to see that some of the behaviors that we may condemn or be upset about actually are behaviors that start off as trying to take care of yourself. That actually is also true for drug abuse. People say, “It’s a biological illness, blah, blah.” It’s not so simple. But if I say to you right now, “Oh, I have a little needle with some heroin in it. It makes you feel really good. Would you like to try it?” You’d say, “You’re crazy. I’m not going to take heroin.” But if you are in despair and you don’t know if you’re going to make it through the night, and I say, “I have a little drug here that can help you make it through the night,” you are like, “Please, please give it to me.” That’s where drug addiction comes from. That’s also to a large extent where our opioid epidemic comes from. It’s also the stuff being made available to people. But, you know, among my colleagues who have privileged lives, they don’t become drug addicts because they have good lives. And so they don’t need to cure something in terms of how upset they are. But since time immemorial, people have taken drugs in order to deal with unbearable sensations. The military has a huge alcohol problem. I don’t know how it is right now, but there was a huge drug problem during the Vietnam War because people take these drugs in order not to feel their pain. And so if you really want to take care of drug abuse, we really have to look at social situations and circumstances that make people feel desperate and hopeless.