What substance use and Instaglamour might have in common

“I’m so sorry,” she apologized profusely, catching her breath between sobs, “I’m trying my best.”

She called the hospital in a panic. Her neighbor had stolen her buprenorphine, a medication needed to prevent cravings and withdrawal for people who suffer from opioid addiction. The last time she went through withdrawal was three years prior, when she was using heroin and almost died from overdose. She got herself into treatment, and was abstinent from illicit drugs ever since. Now out of medication, she was in a physical turmoil of withdrawal symptoms — nausea, sweating, muscle aches, restlessness — in addition to the psychologic torment of betrayal, guilt, and the shame of reliving her prior IV drug use. “I feel so bad,” she said, expressing more regret than complaint, “I just never wanted to remember what this feels like.”

On any other day, my immediate thoughts would have been about other patients. I would have thought about the stories I’ve heard, the numerous recounts of living through trauma.

According to the National Council for Behavioral Health, 70% of adults in the U.S. have experienced a traumatic experience in their lives.

The Center for Disease Control and Prevention reports that 1 in 3 women and 1 in 4 men experience sexual violence in their lifetimes. At least 1 in 7 children experience abuse or neglect, 1 in 4 are raised with an alcoholic relative, and 1 in 8 witness their mother being abused.

Given topics of intimacy, sex and sexual health, fertility, and pain, it is only natural that patients begin to unpack their traumas in the Ob/Gyn office. Here I find myself, listening to women as they try to make decisions for bodies they were convinced are not theirs. Their bodies had been vessels — getting bruised, carrying pregnancies, providing comfort, providing answers, always providing, never asking. And here they find themselves in a clinic exam room, cold, taking to a doctor, answering questions, feeling like they may as well be in a court room, but half-naked, and completely alone.

On any other day, I would have thought about other patients. Today, I thought about Paris Hilton.

I admit that I’m late to the hype, but I recently watched This is Paris on Paris Hilton’s YouTube channel. The documentary about her life has had mixed reviews, and I can understand why. Superficially, there is a large amount of time dedicated to portraying her glamourous life, which seems disproportionate for a documentary aiming to tell a story of trauma. What I found compelling was that, despite the number of reels of her getting her makeup done, despite the exhibition of fame and fandom ad nauseum, her story was truly authentic. It is told from the perspective of someone who has only known the life of a Hilton heiress, and in absence of self-worth she clung to what gave her a sense of appreciation — Instagram. “I don’t even care about any of these things,” she said, pointing to her elaborately housed shoe collection, “This isn’t who I am.”

The mind can repress, but the body never forgets.

In the documentary, she discusses what she refers to as her “real life,” with recurring nightmares of getting abducted in her sleep, abused, and forced into solitary confinement. She only faced those memories when the lights and cameras were off, and she was forced to be alone. The mind can repress, but the body never forgets.

[Traumatic experiences] leave traces on our minds and emotions, on our capacity for joy and intimacy, and even on our biology and immune systems.

— From The Body Keeps the Score by Dr. Bessel Van Der Kolk

As we encounter challenges in our lives, we are constantly reminded of the times we have failed, the times we have been powerless, hurt, or afraid. Without any healthy way of expressing these experiences into reality, we store them in our minds, our muscles and our instincts. Trauma is weaved into our identities and we become patchworks of insecurity, anger, resentment, and apology.

What the documentary confirmed for me is that trauma is everywhere.

While women, transgender, queer, and people of color are disproportionately affected by adverse childhood experiences and trauma in adulthood, people of all socio-demographics are indeed affected. Violence in so many forms is prevalent in our society, and even those without personal experiences of trauma can understand what it is to be violated or feel shame.

Simultaneously, I’ve discovered that survival is also everywhere. In telling our stories, we emerge as more than victims. We emerge as whole people with hurt, regret, and anger, but also with courage, hope and determination. Telling the story is the first step toward healing, understanding the events that happen in our lives may happen to us, but not because of us.

I told the patient that she was, in fact, trying her best, and let her talk until she became tired of apologizing. I imagined the black-and-white memories playing in her head, the melodramas of ‘junkie,’ ‘bad mother,’ ‘worthless,’ and ‘alone’ that she described in so many words. It is rare to be at our best when we feel our self-worth crumbling.

“I’ll do whatever it takes to make it,” she finally said, “I’ve gone through the worst of it already.” There she was, reclaiming her story, allowing to emerge her narrative of survival.

Author Note

Physician, Writer, Humankind Enthusiast

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