DRUNK WITH LOVE


by Lida Prypchan

When a normal individual (normal being the term for average, not a value judgment) gets drunk, he displays a statistically average form of behavior, called normal or simple inebriety.  This is characterized by a change in mood (which becomes expansive or, less frequently, depressed), behavior, attention, and in motor function.  It has three phases.  The first shows a pattern of hypomania: the individual is euphoric, abnormally talkative, care free, mentally agile, and intellectually hyper productive, but this is accompanied by a decrease in self control, as well as in attention and vigilance, which, together with the release of his inhibitions causes him to speak tactlessly.  In a second stage there is incoherence of speech, the faculty for self-criticism decreases or disappears completely, motor coordination is impaired (difficulty in articulation, unsteady gait and clumsy gesticulation), swings in mood increase: he is easily offended, flies into rages, sings, and displays general sensory hypoesthesia.  In the third phase the subject collapses, vomits, his breathing becomes labored, his breath smells of acetone, his reflexes diminish, his body feels anesthetized and he may become incontinent.  After sleeping for several hours he wakes up quite normal, unless ingestion was excessive, in which case he passes from a coma to complete collapse – or a better life.  Preceding these phases is the pre-clinical phase, where alcoholemia reaches 0.80 gr/l.  In this phase the individual does not display symptoms, but if tested psychometrically, alteration in sensory function and decrease in sensory motor activity can be observed.

The difference between simple and complicated inebriety is in the intensity of the latter, namely a quantitative difference, since complicated inebriety presents the symptoms of simple inebriety but in a more exaggerated form.

Biochemically, the pre-clinical state is considered to occur between 0.5 to 1 gr/l of alcohol; inebriety at 1 gr/l; between 1 and 1.5 gr/l signs of intoxication are evident; between 1.5 and 2 gr/l there is a state of intoxication; above 2 gr/l intoxication is deep, the lethal dose between 4 and 5 gr/l.

Pathological intoxication, as differentiated from the simple and complicated forms, is displayed in individuals whose constitution is so predisposed, suffice to say that it is typical among neuropaths, hysterics, schizophrenics, epileptics and psychopaths.  It can also, however, be caused by abuse of alcohol (in chronic alcoholism), by cranioencephalitic traumatism, severe cerebral illness, syphilis etc.  There are six main characteristics of pathological intoxication:  1) the insignificant amount of alcohol which is necessary to unleash it; 2) the almost immediate surrender of oneself to the  consumption of alcohol;  3) its duration, either very short or very long (up to 24 hours); 4) extreme violence, which is why homicidal assaults, pyromania, rapes, exhibitionism and pederasty are frequent; 5) almost entire lace of recollection afterwards of what has happened) tendency for relapses.

Pathological intoxication can be classified into three types: excitomotory, hallucinatory, and delirious.  In the excitomotor type, the individual is possessed for several hours by an uncontainable fury, he brushes everything aside, strikes out in any direction, gesticulates threateningly, and displays great anguish on his face with bulging eyes and fixed stare.

In the hallucinatory form, the subject lives his visual or auditory hallucinations, confusing them with reality, as is the case in delusions of flagrant infidelity, of massacres, threatening gangs, with the possibility of impulsive homicidal reactions.  The third form is the delirious form.  Here confabulation preponderates, with four main themes: self-accusation, megalomania, jealousy and persecution. In delirious self-accusation, the drunkard goes to the police station to denounce himself for a crime which is currently in the headlines. In these cases it is necessary to guard the individual from suicidal impulses. In megalomania the drunk presents himself at the presidential mansion, demanding entry because he is the President.  When the theme of his delirium is jealousy, the victim can see and hear his wife’s lovers.  In these cases the person to be protected is the wife, since he may kill her (and since all this can happen so quickly, it would be advisable for the wife to have a scooter around the house too).  When the delirium is persecutory, the individual seeks protection desperately from the police, since he feels threatened by a gang of crooks that wants to trash him, and he may in his panic have defensive and aggressive reactions.

This article is not entitled “Drunk with Love” by chance, since as I was writing it I found similarities between the stages of falling in love and the phases of drunkenness.  In a love affair the conscience recedes into the background, resembling a pattern of hypomania: the individual is euphoric, abnormally talkative, carefree, mentally agile (unless revealing severe mental retardation), intellectually hyper-productive (works and thinks better), but at the same time self-control is reduced (saying inappropriate things like “if I ever stop loving you I will give you an income for life”), attention and vigilance diminish (he doesn’t notice that his future mother-in-law is intolerable and will make life impossible for him).  In a second stage after marriage, two things can happen: either compatibility or mutual tolerance prevail in the relationship or, what happens in the majority of cases, incompatibility.  If the latter occurs, one observes verbal incoherence, decreased or zero facility for self-criticism in both persons, impaired motor coordination (stammering, prolonged silences, staggering gait upon arriving home at dawn and clumsy gesticulation during explanations), and increased swings in mood (morning irritability and evening irascibility) interspersed with periods of reconciliation which again suggest a pattern of hypomania.


MALE AND FEMALE ALCOHOLISM

by Lida Prypchan

When a woman gets drunk, she tends to hide herself away, to be ashamed of herself.  A man on the other hand, for social reasons, boasts about it.  The alcoholic female drinks alone, the male tends more to meet up with friends and only to become captive to the addiction when it reaches its more advanced stage.  Women more often recognize their sickness, while men deny it, even as they fall down drunk with a drink in their hand.  The disasters caused by alcoholism in the family acquire a much more serious aspect when it is the mother who drinks, because the maternal figure in the family unit is more important than the paternal figure, in fact indispensable.

Certainly much more is expected of a woman on both family and social planes.  More is expected because she can give more, due to her ability to mature and bear great responsibility.  Although it is claimed that the male sex is the stronger, the facts show that men are weaker in character and have more difficulty in maturing and bearing moral responsibilities (the ones which have nothing to do with generating income or following courses of study).  That is why everything is made easy for him and why he is forgiven for his philandering (sexual promiscuity), drunkenness and lack of attachment to the family (he is always at work, on a trip, playing dominoes or with his lover).  So little is demanded of a man on the family level; he is considered a successful father just because he brings money home, even though he never talks to his children – who are like aliens to him.

A woman is a woman, and for that simple reason her errors, either as mother, wife, daughter, or employee, are not forgiven.  With today’s lamentable change in women, who are imitating the errors they so criticized in men, more alcohol is being consumed by them daily, which translates into an increase in the figures for female alcoholism.  

I will now present the case histories of two alcoholics: a man and a woman.  Each was given a blank sheet of paper with the following questions: How long have you been drinking?  With whom do you drink?  Why do you drink?  What have been the consequences of your addiction?

Here are their replies:
Case No.1 – 59 year old woman, foreigner, widow, housewife, 4 children.

“I could not say precisely why I drink.  It was mainly to go along with my husband.  Over the past nine years, because of his death, drinking has become a habit.  For the past five years I have been drinking more than normal: from addiction, lack of sleep too – when I drink before going to bed it’s easy to get to sleep.  My marriage was better than most.  I have been particularly prone to depression since my husband died.  Inevitably, my past is always present – I survived the war and lost all my family in it.  Alcohol makes me forget all these thoughts.  I have mixed tranquilizers and other drugs with alcohol and they bring about an incredible sensation of peace, although the next day I am sure to say I will never drink again.  But it is inevitable…after a while I have to start drinking.  When my children became aware of my addiction, they removed every drop of alcohol from my home.  It was worse because I even drank “eau de cologne”.  I can see the consequences clearly now: to be precise, the inability to do without alcohol, mental collapse and the feeling of being a slave to it… when I have it, I can’t stop drinking it…what else can I say?”

Case No. 2 – 44 year old man, died a few months ago of a hemorrhage due to rupture of esophageal varices, Venezuelan, divorced after 8 months of marriage.  Occupation:  businessman (bar owner).

“I began to drink when I was young, in a group.  I come from a large family where they drink a lot.  Two of my brothers are alcoholics and so was my father.  I come from a part of the country where the only pastimes other than chasing women are drinking aguardiente and betting on the cocks.  Anyway, this problem I have now began when I bought a bar where I was working.  There are regular customers who invite you or almost force you to drink with them. I had a good marriage relationship.  It was because of the death of a brother I was close to that I began to drink more frequently: at least, I got dead drunk three or four times a week and my wife, instead of being sympathetic, treated me badly and wouldn’t cook for me and worse, she refused to have sex with me – which made me so mad that I would hit her.  Then we had money problems and she wanted a divorce, which I gave her right away, but when I got drunk, which was every day then, I went to her house and yelled at her because it annoyed me that while I had to work, she lived off what I earned and when I began to have problems, instead of being by my side she threw me out.  All women are the same: they use you as long as they can… then they make out that they are martyrs.  You can see the results of this:  I am forty-four years old and look like seventy,  I’ve lost a lot of weight  because when I was drinking I lost my appetite, and when I get up I vomit a lot and have meager, foul-smelling bowel movements.  My marriage didn’t fail because of alcohol, but because my wife was a mean, dull creature, incapable of understanding me.

THERE ARE ALCOHOLICS AND THEN THERE ARE ALCOHOLICS

by Lida Prypchan

“All we know of happiness is the word itself.  Our oldest companion is new wine.  Caress with your eyes and clasp in your fingers the only good thing that never fails: the living amphora of the blood of the grapevine.”                 (Omar Khayyam, Rubaiyat)

Unquestionably there are alcoholics and then there are alcoholics; they are rich and perfumed, poor and slovenly, ill-humored and aggressive, sweet and affectionate, weeping or silent, brilliant or dull, shrewd or perverse, refined or tasteless.  Those were not the parameters, however, which Fouquet and Jellinek selected to define their classifications of the main types of alcoholism.  The classification I am presenting here is an adaptation of the one established by Jellinek in which he elaborated upon certain aspects of Fouquet’s classification.

A.    The drinker with a dependence on alcohol: This is the individual with a psychological dependence, who finds relief from some emotional tension or some physical discomfort, or who simply claims to have courage to face “soberly” the burdens of everyday life.  He ingests large quantities of alcohol but does not lose control and is able to abstain.  Withdrawal symptoms are rare, unless consumption is interrupted abruptly, such as being hospitalized for injury or sickness (frequently cirrhosis of the liver or polyneuritis).

B.    The alcoholic who drinks wine:  This individual is able to control the quantity of drink which he imbibes at a certain moment and seldom needs to drink to the point of severe intoxication, but he is unable to abstain for one single day.  If he does, he experiences strong cravings and almost immediately displays withdrawal symptoms, which within a few days lead to delirium tremens.  He thus displays both physical and psychological dependence.  Few of these types consider themselves alcoholics, but the truth is that they are in a constant state of slight intoxication.  It is for this reason that this is a public health problem in wine-consuming countries such as France and Italy.

C.    The compulsive drinker: This is the individual who, once he has taken the first swig, drinks until his stock of money or alcohol runs dry, or until loss of consciousness or an accident ends the session.  This loss of control is accompanied by increasing tolerance, psychological then physical dependence, violent cravings, and withdrawal symptoms in the event of deprivation.  It is frequently observed in Canada, the United States, Australia and Nordic countries.




D.    The symptomatic alcoholic: In this, individual alcoholism is secondary to some psychiatric disorder, such as neurosis (phobias, in particular), psychosis (depression or schizophrenia), or some organic lesion (such as the initial changes accompanying a brain tumor).  It is particularly common in males who in time develop a physical dependence and addiction.

E.    The occasional drinker: This is the person who alternates brief periods in which he drinks pathological quantities, with long periods during which he is able to drink reasonably or to abstain altogether.  The weekend drunk belongs to this group.  This is the predominant form of alcoholism in Venezuela: those timeworn machos that, if they don’t go out for a spin and end up smashing into a wall, spend from Friday to Sunday boasting about their conquests.

F.    The dipsomaniac:    This one only drinks during brief crises (for hours or days) without anything else mattering to him; he generally hides away and ingests anything he can find in his path, drinking even eau de cologne, perfume or ethylated spirits, reaching a severe state of alcoholic intoxication which produces a comatose condition from which he emerges repentant and rejecting alcohol.  He abstains for long periods but as the years pass he develops an alcoholic neurosis.  Dipsomania is more common among women.

G.    The chronic alcoholic: This is the final fate of excessive drinkers, whatever form their alcoholism takes.  The chronic alcoholic displays psychological and physical changes, the latter being due not only to the unfortunate effect of alcohol on the various organs and systems, but also to inadequate nutritional habits and hydroelectrolitic disturbances.  This individual suffers constant diarrhea and nausea which aggravate his malnutrition even more.  This condition is frequently complicated by polyneuritis or cirrhosis of the liver followed shortly after by liver failure.  At this stage he feels drunk even after drinking small quantities, because his tolerance has decreased.  His economic situation deteriorates because he is incapable of work; he is rejected by his family and society and ends up in hospital for some physical complication or psychiatric disturbance such as delirium tremens, alcoholic hallucinosis, epilepsy or paranoid psychosis.

So, as a toast to the future of alcoholism in Venezuela, shall we serve another drink?

ALCOHOLIC HALLUCINOSIS


by Lida Prypchan

Very rare in its pure form, alcoholic hallucinosis, also known as hallucinatory paranoia and chronic alcoholic delirium, characteristically exhibits auditory hallucinations which generate delusions of persecution, while retaining clarity of the senses without impairment.  It differs from delirium tremens in the predominance of auditory and tactile hallucinations and clarity of consciousness; in that the prolonged abuse of alcohol as displayed among younger drinkers is not inevitable; in that it is not characteristic of those who drink spirits, hence its frequency among women, and in the lack of serious organic changes.  Some authors concur that delirium tremens and alcoholic hallucinosis are pathogenically identical.  Kraepelin concedes that the onset of delirium tremens is caused by sudden inundation of the brain by alcoholic metatoxins, whereas if there are fewer of them, they attack only the auditory centers, causing sounds of voices and slight obnubilation, a pathogenic explanation for the intensity of the delirium and the mildness of the hallucinosis.  The observations of Wolfer, Sberger and Bleuler tend to attach great importance to the schizophrenic tendency of the constitution, which is set in motion by the metabolic changes produced by alcohol.  This hypothesis has been supported in the cases of hallucinosis where the final development is clearly schizophrenic.  In hallucinosis the somatic and neurological symptoms of chronic alcoholism are imperceptible or not particularly pronounced, whereas sleep is always insufficient and never peaceful.

The main psychic symptoms are the auditory hallucinations, or voices, of one or more invisible people who talk about the subject in the third person, referring to his habits and practices and uttering true or false accusations.  In very advanced cases the subject participates in the dialogue himself.  Some of the voices speak in his favor and others against him, although in the beginning they are not too clear, more a sort of murmur.  Frequently tactile hallucinations follow next, such as being pinched or nipped.  Then come visual hallucinations in which the individual sees a person in the darkness or behind the door.  When hallucinations of coenesthesia, smell and taste occur, schizophrenia must be considered.  The hallucinations are accompanied by delusions, concerning guilt over alcoholic abuse and real or imaginary errors.

The voices present delusions of persecution, plans for escape, always senseless and passing uncriticized by the victim.  The tremendous anxiety caused by harassment from these presumed persecutors induces the victims to commit acts of self-abuse.

Clarity of their senses is preserved almost intact, although hallucinatory experiences mingle with actual perceptions.  Orientation is perfect and behavior correct, to the point of not attracting the attention of colleagues at work.  Concentration and attention appear normal, and they can carry on a lucid conversation, although from time to time they withdraw from it to attend to their voices.  Memory remains intact, proof of which is that they often relate minute details of their hallucinatory experiences and the events in their lives without tending to lie.  The predominant emotion ruling their behavior is anxiety.  Duration of alcoholic hallucinosis is somewhat longer than that of delirium tremens, between a week and three months, abstinence being indispensable for a cure.

Lastly I will dedicate a short space in commenting on a movie which impressed me both with the theme and the harshness of its portrayal.  I am referring to “Ironweed”, with Jack Nicholson and Meryl Streep, who won an Oscar for best actress instead of Cher, since Ms. Streep managed a rather difficult role which not just any actress could have done.  It is about the life of a couple of alcoholic vagrants who are reduced to poverty by their addiction.  She is a singer, successful in radio, whose downfall is caused by the temporary relief and euphoria produced by alcohol.  She ends up as a vagrant who, so as not to die of cold or be devoured by the hungry denizens of the streets, takes refuge in a man’s car, the price of this sojourn being to have sex with him.  He was apparently married with children and in one of his drunken bouts returns home and accidentally causes the death of his youngest daughter and on other occasions gets involved in some disturbance or strike, causing the accidental deaths of still more people.  What is certain is that because of his alcoholic excesses he has visual hallucinations which consist in seeing all these people whom he has harmed and who ask him questions, watch and deride him.  One guesses, we are not actually shown, that both of the couple end up committing suicide.

AMONG ALCOHOLICS AND PSYCHOPATHS

by Lida Prypchan

“Since you do not know what tomorrow will bring, try to be happy today.  Take a pitcher of wine, sit in the moonlight and drink it, reflecting that maybe tomorrow will be better.”  (Omar Khayyam, Rubaiyat)

There are two dominant psychological types of alcoholic.  There is the sensitive type, who feels inferior and insufficient and has difficulty with interpersonal contact, who is timid and although in great need of affection and friendship, lacks the ability to obtain them.  People like this find that alcohol gives them self-confidence – makes them euphoric, but leaves them depressed – because as long as they are floating in alcohol their troubles vanish, but when they come to the dregs they return to reality.  The other type is the antithesis of the former, but becomes just as much of an alcoholic though by different means and for other reasons.  The extrovert is genial and talkative, very sociable, likeable and active, always euphoric and eventually experiencing a certain decline in inhibitions and self-criticism.  He begins by becoming a habitual excessive drinker convinced that “it doesn’t hurt me” because of his particular blindness towards his own weakness of character.  Given his low tolerance for unpleasant experiences and for failures (which are frequent because of his inability to make long-term plans and his propensity for “living in the present moment”), he usually first becomes a habitual drinker, then an alcoholic.  Although these two types appear opposites, they share characteristics such as immaturity, insecurity, dependency and intolerance of frustration.

Their environment, physical predisposition, and heredity (the predisposition to establish a habit easily is inherited) interact in the problem.  The increase in female alcoholism is alarming.  It is more varied and bears more of a social stigma, frequently originating in some neurosis or depression.

The common trait of all personalities which are predisposed to alcoholism is a lack of harmony and balance between the instinctive emotional and volitional psychic strata.  This is also a trait of psychopaths, for a number of them are alcoholics.  The alcoholic conduct of psychopaths is often related to socio-cultural factors.  In under-developed countries inebriation is infrequent, except in the case of periodical celebrations of an orgiastic nature, reminiscent of the Bacchanalia celebrated in Greece in honor of the god Bacchus.

The consequences of alcoholism are very serious: repercussions at home and at work which can lead to family break-up and real social dislocation; a considerable higher mortality rate due to visceral complications, depressions, suicides and accidents, psychic complications and crime (blows and injuries, child abuse, rapes, homicides).

What is evident is that both alcoholism and psychopathy are moral problems, social fossils.  Both display a desperate search for pleasure and an inability to allow life to proceed with its natural rhythms and changes.