not without doing some violence to that instinctive sense of propriety
which prompts men to shrink from giving publicity to their weaknesses
and from the vanity of seeming to imply that their individual
experience of life is of special value to others. Leaving undecided
the question whether under any circumstances a departure from the
general rule of good sense and good taste in such matters is
justifiable, I have, nevertheless, done what I could to give to
opium-eaters a truthful statement of the consequences that may ensue
from their abandonment of the habit. The path toward perfect recovery
is certainly a weary one to travel; but in all these long years, with
nervous sensibilities unnaturally active, in much pain of body,
through innumerable sleepless nights, with hope deferred and the
expectation of complete restoration indefinitely prolonged, I have
never lost faith in the final triumph of a patient and persistent
resolution. Many men seem to know little of the wonderful power which
simple endurance has, in determining every conflict between good and
evil. The triumph which is achieved in a single day is a triumph
hardly worth the having; but when all impatience, unreasonableness,
weaknesses and vanities have been burned out of our natures by the
heat of suffering; when the resolution never falters to endure
patiently whatever may come in the endeavor to measure one's own case
justly, and exactly as it is; and when time has been allowed to exert
its legitimate influence in calming whatever has been disturbed and
correcting whatever has been prejudiced, a conscious strength is
developed far beyond what is natural to men possessed only of ordinary
powers of endurance. It is chiefly through patient waiting that the
confirmed victim of opium can look for relief. All who have made
heroic efforts to this end, and yet have failed in their attempt, have
done so through the absence of adequate confidence in the efficacy of
time to bring them relief. The _one_ lesson, however, which the
reforming opium-eater must learn is, never to relinquish any gain,
however slight, which he may make upon his bad habit. Patience will
bring him relief at last, and though he may and will find his progress
continually thwarted and himself often tempted to give over the
contest in despair, he may be sure that year by year he is steadily
advancing to the perfect recovery of all that he has lost.
The opium-eater will not regard as amiss some few suggestions as to
the mode in which his habit may most easily be abandoned. The best
advice that can be given--the _only_ advice that will ever be
given by an opium-eater--is, never to begin the habit. The objection
at once occurs, both to the medical man and to the patient suffering
from extreme nervous disorder, What remedy then shall be given in
those numerous cases in which the protracted use of opium, laudanum,
or morphine is found necessary? The obvious answer is, that no medical
man ever intends to give this drug in such quantities or for so long a
time as to establish in the patient a confirmed habit. The frequent,
if not the usual history of confirmed opium-eaters is this: A
physician prescribes opium as an anodyne, and the patient finds from
its use the relief which was anticipated. Very frequently he finds not
merely that his pain has been relieved, but that with this relief has
been associated a feeling of positive, perhaps of extreme enjoyment. A
recurrence of the same pain infallibly suggests a recurrence to the
same remedy. The advice of the medical man is not invoked, because the
patient knows that morphine or laudanum was the simple remedy that
proved so efficacious before, and this he can procure as well without
as with the direction of his physician. He becomes his own doctor,
prescribes the same remedy the medical man has prescribed, and charges
nothing for his advice. The resort to this pleasant medication after
no long time becomes habitual, and the patient finds that the remedy,
whose use he had supposed was sanctioned by his physician, has become
his tyrant. If patients exhibited the same reluctance to the
administration of opium that they do to drugs that are nauseous, if
the collateral effects of the former were no more pleasurable than
lobelia or castor oil, nothing more could be said against
self-medication in one case than the other. Opium-eaters are made
such, not by the physician's prescription of opium to patients in
whose cases its use is indispensable, but by their not giving together
with such prescriptions emphatic and earnest caution that the remedy
is not to be taken except when specially ordered, in consequence of
the hazard that a habit may be formed which it will be difficult to
break. Patients to whom it is regularly administered are not at first
generally aware how easily this habit is acquired, nor with what
difficulty it is relinquished, especially by persons of nervous
temperament and enfeebled health. The number of cases, I suspect, is
small in which the use of opium has become a necessity, where the
direction of a physician may not be pleaded as justifying its original
employment.
The object I have in view is not, however, so much to make suggestions
to medical men as it is to awaken in the victims of opium the feeling
that they can master the tyrant by such acts of resolution, patience,
and self-control as most men are fully capable of exhibiting. Certain
conditions, however, seem to be the almost indispensable preliminaries
to success in relinquishing opium by those who have been _long_
habituated to its use. The first and most important of these is a firm
conviction on the part of the patient that the task can be
accomplished. Without this he can do nothing. The narratives given in
this volume show its entire practicability. In addition to this, it
should be remembered that these experiments were most of them made in
the absence of any sufficient guidance, from the experience of others,
as to the method and alleviations with which the task can be
accomplished. A second condition necessary to success, is sufficient
physical health, with sufficient firmness of character to undergo, as
a matter of course, the inevitable suffering of the body, and to
resist the equally inevitable temptation to the mind to give up the
strife under some paroxysm of impatience, or in some moment of dark
despondency. With a very moderate share of vigor of constitution, and
with a will, capable under other circumstances of strenuous and
sustained exertion, there is no occasion to anticipate a failure
here. Even in cases of impaired health, and with a diminished capacity
for resolute endeavor, success is, I believe, attainable, provided
sufficient time be taken for the trial.
A further condition lies in the attempt being made under the most
favorable circumstances in respect to absolute leisure from business
of every kind. That nothing can be accomplished by persons whose time
is not at their own command, by a graduated effort protracted through
many months, I do not say, for I do not believe it; but any speedy
relinquishment of opium--that is, within a month or two--seems to me
to be wholly impossible, except to those who are so situated that they
can give up their whole time and attention to the effort.
This effort should be made with the advice and under the eye of an
intelligent physician. So far as I have had opportunity to know, the
profession generally is not well informed on the subject. In my own
case I certainly found no one who seemed familiar with the phenomena
pertaining to the relinquishment of opium, or whose suggestions
indicated even in cases where the physician has had no experience
whatever in this class of disorders, he can, if a well-educated man,
bring his medical knowledge and medical reasoning to bear upon the
various states, both of body and mind, which the varying sufferings of
the patient may make known to him. Were there, indeed, no professional
helps to be secured by such consultation, it is still of infinite
service to the patient to know some one to whom he can frequently
impart the history of his struggle and the progress he is making. Such
confidence may do much to encourage the patient, and no one is so
proper a person in whom to repose this confidence as an intelligent
physician.
The amount of time which should be devoted to the experiment must
depend very greatly upon these considerations--the constitution of
the patient, the length of time which has elapsed since the habit was
formed, and the quantity habitually taken. When the habit is of recent
date, and the daily dose has not been large--say not more than ten or
twelve grains--if the patient has average health, his emancipation
from the evil may be attained in a comparatively short period, though
not without many sharp pangs and many wakeful nights which will call
for the exercise of all his resolution.
The question will naturally suggest itself to others, as it has often
done to myself, whether a less sudden relinquishment of opium would
not be preferable as being attended with less present and less
subsequent suffering. Numerous cases have come under my notice where a
very gradual reduction was attempted, but which resulted in
failure. Only two exceptions are known to me: in one of these the
patient, himself a physician, effected his release by a graduated
reduction extending through five months. The other is the case of
Dr. S., a physician of eminence in Connecticut many years ago. This
gentleman had made so free use of opium to counteract a tendency to
consumption that the habit became established. After several years,
and at the suggestion of his wife, he made a resolution to abandon it,
engaging to take no opium except as it passed through her hands, but
with the understanding that the process of relinquishment was to be
slow and gradual. His allowance at this time was understood to be from
twenty to thirty grains of crude opium daily. At the end of two years
the habit was abandoned, with no very serious suffering during the
time, and so far as his daughter was informed, with no subsequent
inconvenience to himself. He lived many years after his disuse of
opium, in the active discharge of the duties of his profession, and
died at last in the ninetieth year of his age. The hazard of this
course, however, consists in the possibility, not to say with some
temperaments the probability, that somewhere in the course of so very
gradual a descent the same influences which led originally to the use
of opium may recur, with no counteracting influence derived from the
excitement of the mind produced by the earnestness of the
struggle. With some constitutions I have no doubt that a process even
so slow as that of Dr. S.'s might be successful, but I suspect, with
most men, that some mood of excited feeling, and some conscious sense
of conflict, will be found necessary, in order to bring them up
resolutely to the work of self-emancipation. On the other hand, I am
satisfied that my own descent was too rapid. Had the experiment of
between five and six weeks been protracted to twice that time, much of
the immediate suffering, and probably more of that which soon
followed, might have been prevented. As in the constitution of every
person there is a limit beyond which further indulgence in any
pernicious habit results in chronic derangement, so also there seems
to be a limit in the discontinuance of accustomed indulgence, going
beyond which is sure to result in some increased physical disorder. In
the cure of _delirium tremens_, the first step of the physician
is to stimulate. With more moderate drinkers abrupt cessation from the
use of stimulants is the only sure remedy. In the first instance the
nervous system is too violently agitated to dispense entirely with the
accustomed habit; in the second, the nerves are presumed to be able to
bear the temporary strain imposed upon them by the condition of the
stomach and other organs. But with opium the case is otherwise.
Insanity, I think, would be the general result of an attempt
immediately to relinquish the habit by those who have long indulged
it. The most the opium-eater can do is to diminish his allowance as
rapidly as is safe. For the same reason that no sensible physician
would direct the confinement of a patient and the absolute disuse of
opium with the certainty that mania would result, so it would be
equally ill advised to recommend a diminution so rapid as necessarily
to call out the most serious disorder and derangement of all the
bodily functions, especially if these could be made more endurable by
being spread over a longer period. In one respect the opium-eater has
greatly the advantage over those addicted to other bad habits. Those
who have used distilled or fermented drinks, tobacco, and sometimes
coffee and tea in excess, experience for a time a strong and definite
craving for the wonted indulgence. This is never the case with the
opium-eater; he has no specific desire whatever for the drug. The only
difficulty he has to encounter is the agony of pain--for no other word
adequately expresses the suffering he endures--conjoined with a
general desire for relief. Yet in the very _acme_ of his punishment
he will be sensible of no craving for opium at all like the craving
of the drunkard for spirits. As De Quincey justly represents
it, the feeling is more that of a person under actual torture, aching
for relief, though with no care from what source that relief comes. So
far from there being any particular desire for opium, there ensues
very speedily, I suspect, after the attempt to abandon it is begun,
and long before the necessity for its use has ceased, and even while
the suffering from its partial disuse is most unendurable, a feeling
in reference to the drug itself not far removed from disgust. The only
occasion that I have had of late years to make use of opium or any of
its preparations, was within a twelvemonth after it had been laid
aside. A morbid feeling had long troubled me with the suggestion that
should a necessity ever arise for the medical use of opium, I might be
precipitated back into the habit. I was not sorry, therefore, when the
necessity for its use occurred, that I might test the correctness of
my apprehension. To my surprise, not only was no desire for a second
trial of its virtues awakened, but the very effort to swallow the pill
was accompanied with a feeling akin to loathing.
The final decision of the question, How long a time should be allowed
for the final relinquishment of the drug? must, I imagine, be left to
a wider experience than has yet been recorded. The general strength of
the constitution, the force of the will, the degree of nervous
sensibility, together with the external circumstances of one's life,
have all much to do with its proper explication.
The general directions I should be disposed to suggest for the
observance of the confirmed opium-eater would be something as follows:
1. To diminish the daily allowance as rapidly as possible to
one-half. A fortnight's time should effect this without serious
suffering, or any thing more than the slight irritation and some other
inconveniences that will be found quite endurable to one who is in
earnest in his purpose.
2. For the first week, if the previous habit has been to take the
daily dose in a single portion, or even in two portions, morning and
night, it will be found advisable to divide the diminished quantity
into four parts. Thus, if eighty grains has been the customary
quantity taken, four pills of fifteen grains each, taken at regular
intervals, say one at eight and one at twelve o'clock in the morning,
and one at four and one at eight in the evening, will be found nearly
equal in their effect to the eighty grains taken at once in the
morning. A further diminution of two grains a day, or of half a grain
in each of these four daily portions, will within the week reduce the
quantity taken to fifty grains, and this without much difficulty, and
with positive gain in respect to elasticity of spirits, arising, in
part, from the newly-awakened hope of ultimate success. A second week
should suffice for a reduction to forty grains. It will probably be
better to divide the slightly diminished daily allowance into five
portions, to be taken at intervals of two hours from rising in the
morning till the daily quantity is consumed. With such a graduated
scale of descent, it will be found at the end of two weeks that
one-half of the original quantity of opium has been abandoned, and
that, with so little pain of body, and so much gain to the general
health and spirits, that the completion of the task will seem to the
patient ridiculously easy. He will soon learn, however, that he has
not found out all the truth.
In the third week a further gain of ten grains can the more easily be
made by still further dividing the daily portion into an increased
number of parts, say ten. The feeling of restlessness and irritability
by this time will have become somewhat annoying, and the actual
struggle will be seen to have commenced. It will doubtless require at
this point some persistence of character to bear up against the
increased impatience, both of body and spirit, which marks this stage
of the descent. The feelings will endeavor to palm off upon the
judgment a variety of reasons why, for a time, a larger quantity
should be taken; but this is merely the effect of the diminished
amount of the stimulant. Sleep will probably be found to be of short
continuance as well as a good deal broken. Reading has ceased to
interest, and a fidgety, fault-finding temper not unlikely has begun
to exhibit itself. At this point, I am satisfied, most opium-eaters
who have endeavored in vain to renounce the habit, have broken down.
Their resolution has failed them not because they were unable to stand
much greater punishment than had yet been inflicted, but because they
yielded to the impression that some other time would prove more
opportune for the final experiment. Under this delusion they have
foolishly thrown away the benefit of their past self-control, with the
certainty that should the trial be again made, they would once more be
assailed by a similar temptation. But if this stage of the process has
been safely passed, the next--that of reducing the daily quantity from
thirty grains to twenty-five, still dividing the day's allowance into
ten portions--would probably have added little aggravation to the
uncomfortable feeling which already existed, but not without some
conscious addition, on the other hand, to their enjoyment from the
partially successful result of the experiment. Thus in four weeks a
very substantial gain, by the reduction of the needed quantity from
eighty grains to twenty-five, would have been attained.
If the patient should find it necessary to stop at this point for a
week, a fortnight, or even longer, no great harm would necessarily
result; it would only postpone by so much his ultimate triumph. He
should never forget, however, that the one indispensable condition of
success is this: _Never under any circumstances to give up what has
been once gained_. If in any manner the patient has been able to
get through the day with the use of only twenty-five grains, it is
certain that he can get through the next, and the next, and the
subsequent day with the same amount, with the further certainty that
the habit of being content with this minimum quantity will soon begin
to be established, and that speedily a further advance may be made in
the direction of an entire disuse. Whenever the patient finds his
condition to be somewhat more endurable, whether the time be longer or
shorter, he should make a still further reduction, say to one-quarter
of his original dose. If this abatement of quantity be spread over the
entire week the aggravation of his discomfort will not be great, while
the elation of his spirits over what he has already accomplished will
go far in enabling him to bear the degree of pain which necessarily
pertains to the stage of the experiment which he has now reached. The
caution, however, must be borne continually in mind that under no
circumstances and on no pretext must the patient entertain the idea
that any part of that which he has gained can he surrendered. Better
for him to be years in the accomplishment of his deliverance than to
recede a step from any advantage he may have secured. If he persists,
he will in a few days, or at the longest in a few weeks, find his
condition as to bodily pain endurable if nothing more. There may not,
probably will not be any very appreciable gain from day to day. The
excited sufferer, judging from his feelings alone, may think that he
has made no progress whatever; but if after the lapse of a week he
will contrast his command of temper, or his ability to fix his
attention upon a subject, as evinced at the beginning and end of this
period, he can hardly fail to see that there has been a real if not a
very marked advance in his status. Such a person has no right to
expect, after years of uninterrupted indulgence, that the most
obstinate of all habits can be relinquished with ease, or that he can
escape the penalty which is wisely and kindly attached to all
departures from the natural or supernatural laws which govern the
world. It should be enough for him to know that there is no habit of
mind or of body which may not be overcome, and that the process of
overcoming, in its infinite variety of forms, is that out of which
almost all that is good in character or conduct grows, and that the
amount of this good is usually measured by the struggle which has been
found necessary to ensure success.
Considerations of this nature, however, are of too general a character
to be of much service to one enduring the misery of the reforming
opium-eater. He has now arrived at a point where he is obliged to ask
himself when and how the contest is to end. He has succeeded in
abandoning three-quarters of the opium to which he has so long been
accustomed. A few weeks have enabled him to accomplish this much. He
endures, indeed, great discomfort by day and by night; but hope has
been re-awakened; his mind has recovered greater activity than it has
known for years; and, on the whole, he feels that he has been greatly
the gainer from the contest.
Let me repeat, that the main thing for the patient at this point of
his trial is not to forego the advantage he has already attained--"not
to go back." If he can only hold his own he has so far triumphed, and
it is only a question of time when the triumph shall be made
complete. _When_ this shall be effected _he_ must decide.
The rapidity of his further progress must be determined by what
he himself is conscious he has the strength, physical and moral,
to endure. With some natures any very sudden descent is impossible;
with others, whatever is done must be done continuously and rapidly or
is not done at all. The one temperament can not stand up against the
assaults of a fierce attack, the other loses courage except when the
fight is at the hottest. For the former ample time must be given or he
surrenders; the latter will succumb if any interval is allowed for
repose. It is, therefore, difficult to suggest from this point
downward any rule which shall apply equally to temperaments
essentially unlike. I think, however, that the suggestion to divide
the daily allowance, whether the descent be a slow or a rapid one,
into numerous small parts to be taken at equal intervals of time, will
be found to facilitate the success of the attempt in the case of
both. The chief value of such subdivision probably consists in its
throwing the aggregate influence of the day's opium nearer the hour of
bed-time, when it is most needed, than to an earlier hour, when its
soporific power is less felt. In addition to this, the importance to
the excited and irritated patient of being able to look forward during
the long-protracted hours to frequent, even if slight, alleviations of
his pain, should not be left out of the account. In general it may be
said that whenever the patient feels that he can safely, that is,
without danger of failing in his resolution, adventure upon a further
diminution of the quantity, an additional amount, smaller or greater
according to circumstances, should be deducted till the point is
reached where the suffering becomes unendurable; then after a delay of
few or many days, as may be needed to make him somewhat habituated to
the diminished allowance, a still further reduction should be made,
and so on for such time as the peculiarities of different
constitutions and circumstances may make necessary, till the quantity
daily required has become so small, say a grain or two, that by still
more minute subdivisions, and by dropping one of them daily, the final
victory is achieved.