One thing I have noticed these past few weeks that was especially apparent today is how tenuous our ties to reality and to our lives as we know them can be; how easy it is to lose control. I’ve met a lot of people whose lives have been ruined by substance use, and for all their differences, a lot of the stories are somewhat similar. Alcohol, weed, cocaine, opiates, etc., it all starts as a coping mechanism — a way to relieve whatever kind of mental or spiritual pain they are experiencing (whether they are cognizant of it or not). Control gives way to the illusion of control and to dependence, tolerance, expansion, things that can be harmful to a person. I’ve seen alcohol give way to loss of custody, weed give way to psychosis (hallucinations, delusions, derealization), benzos give way to homelessness, and various other permutations.
On a regular basis in psychiatry you are talking to people during perhaps some of the most vulnerable moments of their lives, which is a scary thing, but also something I find beautiful about psychiatry.