The psychological symptoms and how to help sufferers to deal with them are:
- Depression
- Panic
- Fear
- Derealisation
- Depersonalisation
- Phobia
- Anger
- Cognitive Loss
- Intrusive Thoughts
Depression
A common and consistent symptom of withdrawal and recovery is depression. People suffer from feelings of hopelessness, and their moods are flat. Moods also swing from optimism to pessimism very quickly in the manner of a bipolar disorder. As a result sufferers experience such feelings as:
- I’ll have permanent brain damage
- I’ll never feel normal again
- nobody understands or believes what I am going through
- I am alone and isolated
- nothing interests me
These low moods sometimes produce crying jags, which the sufferer just cannot help, but in common with any emotional outburst can have a therapeutic effect.
Helping. At this point the carer’s concern will be at its most stretched, and constant reassurance most needed. Sometimes persuading sufferers that the mood problems they face are also faced by many other people and they will eventually disappear will help, but many sufferers will find it difficult to believe when they are distressed, and so all that the carer can do is hold on and wait until things improve.
Panic
Panic appears as unreasonable fear, adrenaline rushes, overbreathing and palpitations. People feel as if they are choking, unable to breathe or even dying. Obsessions occur. One that happened to my wife was the feeling that she was perpetually late for everything which had the result that we were getting up at a ridiculously early hour every day. Sufferers are very sensitive to unexpected sounds, people or events, and they can have intense crying spells for no apparent reason.
Helping. The classic treatment for panic attacks (apart from benzodiazepines of course) is diaphragmatic breathing, which is intended to overcome the hyperventilation which usually accompanies panic. One simple way to do this, which is useful wherever the panic occurs, is to breath in through the nose to a count of 2 and breath out through pursed lips to a count of 4. The idea is that it both gets the breathing under control and distracts from the attack to some extent.
Fear
Like panic fear can be both incapacitating and feel very real. It takes many forms such as:
- being unable to cope with leaving the house
- being unable to cope with visitors, even family
- fear of driving
- morbid fear of heights
- fear of impending doom
These fears can seem to the carer to be quite unreasonable, and often have no obvious cause. We have taken the approach that facing a fear and overcoming it, which could well work under normal circumstances, would be quite inappropriate and too stressful, so avoidance is a better strategy.
Derealisation
Derealisation (together with depersonalization) is a perceptual distortion of the outside world often with no apparent stimulus, most famously induced in the 1960s by psychedelic drugs. People withdrawing can suffer from these distortions or hallucinations which take many forms from objects such as chairs moving about to one’s body falling through a bed. Normal objects assume imagined forms, and people feel as is they are seeing the world through a cloud or mist. They describe their brains as being immersed in fog. Sometimes the experiences are quite terrifying or threatening much like nightmares except that the people are not actually asleep. Derealisation is often accompanied by sweating and panic. Sufferers ask such questions as:
- where am I?
- why is there a goat in the corner of the room?
- what’s wrong with the TV picture?
One effect of this distortion is sensory overload, for example being unable to cope with the visual and aural pressure of watching television. The brain seems to switch off. More complicated is the feeling of slipping between reality and unreality. So for instance “I know this room and recognise it, but it still doesn’t look right”.
Helping. As so often happens, the carer is left with few ways of dealing with this problem. Talking about a hallucination, aiming to reduce its impact and restore it to its proper proportion often works. Telling a sufferer that it’s all in the mind doesn’t.
Depersonalisation
People suffering from depersonalisation feel detached from themselves. They feel as if they are watching themselves act, without having any control over the process. Their world is dream-like; they feel distant, cut off, and in a surreal state. People talk about being an alien in their own body. It can be a very disturbing experience. Sufferers from this ask questions such as:
- who am I?
- who are you?
- who are all these other people in the room? – when there aren’t any
My wife felt as if another person was living inside her, a sort of ogre attempting to prevent healing all the time. We nicknamed this creature “Benzo” in the hope that giving this thing a personality would help us deal with it.
Helping. This is a problem which seems to lend itself to just talking about the confusion, and slowly readjusting the confusion.
Phobias
The most common phobias are associated with the need to feel safe. Examples are agoraphobia, the fear of open spaces, and social phobia, the fear of having to communicate with people. For this reason people tend to stay in their own homes which feel safer. Outside becomes a threat, and includes the fear of having panic attacks in unfamiliar places. Being hypersensitive to the smallest stimulus just makes things worse.
Helping. The difficulty for carers when faced with, say, the sufferer being frightened by a potential visit, even from a close friend, is whether to cancel or encourage it. It is often a matter of fine judgement based on your assessment of the potential benefit of the visit.
Emotions
As so often happens during withdrawal, emotions can swing from one extreme to another without any obvious reason. It is one of the most difficult things for a carer to deal with, and requires considerable patience and understanding. On the one hand sufferers become angry, argumentative or just irritable. The uncontrollable crying mentioned earlier often forms part of this. They may feel the need to lash out. On the other hand their emotions can be blunted, almost anaesthetized. They feel flat, neither positive nor negative, and detached from their normal feelings. People blame themselves for their behaviour, when it is quite clear that the drugs are actually to blame.
Helping. Trying to deal with the sufferer’s moods is sometimes defeating. The sufferer can’t explain, can’t find the words, and the carer just has to guess. You will get it wrong, so be prepared to get a wet shoulder.
Cognitive Loss
Being unable to remember facts events or names, particularly in the short-term, is one of the most frustrating things that can happen to anyone. Unfortunately, it often happens to sufferers. Combined with poor concentration it makes conversation very difficult, especially when the conversation changes rapidly from one topic to another.
In general cognitive function is impaired. This takes many forms, such as the inability to learn new things, to retain or digest ideas or to make sense of something they have just read about.
Helping. A carer can do much to buffer the sufferer by filling in the gaps. Loss of memory can affect anyone, and it is often possible to make a joke of it. When the sufferer is losing the thread of a conversation, the carer can carefully re-iterate the missing pieces without stopping the conversation stone dead.
Intrusive Thoughts
To compound cognitive loss, people find themselves stuck in a particular line of thought which gets in the way of normal thinking, on a par with a tune which repeats itself over and over again and is impossible to shift. Such unwanted thoughts are often unpleasant and obsessive. Traumatic memories surface, people feel suspicious about others’ actions or motives, and worst of all, they feel that the only way out of the distress caused by withdrawal is to commit suicide. Unless a person has a previous history of contemplating or attempting suicide it is unlikely that a sufferer would actually try, but the thought is still powerful and real. Less severe but nonetheless intrusive is the conviction that an imaginary someone is trying to do the sufferer down, criticising and deriding their illness and attempts to get better.
Helping. These thoughts will decrease as the person recovers, so reassurance from the carer I called for. Improved sleep patterns are thought to help reduce these thoughts. It is also reassuring to realise that these thoughts, though unpleasant, are a sign of recovery.
