Mental Health and the Brain: Working Group

I would have to agree with the person who posted, "That's not necessarily true", in reply to your comment about your health not being good because you smoke.

Certainly your health is compromised if you smoke. We know a lot about smoking now: It contributes to cancers, heart disease, stroke, cardiovascular disorders...a long list of health problems. It even increases anxiety & agitation. Even though we might reach for a cigarette when we're feeling stressed & feel like it "calms us down", that's only because you're fulfilling a craving based on addiction.

There is no doubt your health would be vastly improved if you quit smoking - but there's also no doubt that it's a very difficult thing to do. I can say this from experience: I was a heavy smoker for 27 years (at least 2 packs a day). When I was younger I had a job where I could smoke, and as I got older I went to university as a "mature student", which meant that I spent many hours at my computer with books all around me trying to squeeze out a decent 5 page paper. I used to have a cigarette or 2 in the ashtray & one between my fingers which I had a habit of resting against the side of my head. Sometimes the ash would fall of intact...I hadn't smoked any of - only lit it and sat there thinking.

My point is that although nicotine is as addictive as heroin (I could refer you to many articles or research studies that back this up, but at this point it's so well known a fact I feel I can just let it speak for itself). And just like anyone who has been addicted to heroin can tell you, there's the main "pay-off" when the drug is "mainlined" from a vein (or all the little blood vessels & capillaries in our lungs) directly to the brain & hits the 'pleasure centre" there (and there IS one) - but there's also the sequence of meticulously & methodically preparing for the "hit" which can include everything from going to the club or place you usually "hook up", then going home & preparing your "works". In the classic 1st album by New York's 70's band "The Velvet Underground", Lou Reed sings of "Waiting for the Man" (his drug connection), and then devotes an entire song to the preparation of & administration of his drug in a song entitled simply, "Heroin" ("It's my life & it's my wife" is a line that indicates his "life" is pretty empty & mentally he excludes everything long term & complex - like marriage & all the many facets of life - to commit only to his drug. That's sad. Amazingly, Reed is still alive although he admits he was a slave to drugs & then later alcohol. He is now clean of everything & still making music, so we can say he was one out of many who made it.)

I don't mean to glorify the use of either of these drugs (nicotine IS a drug -it's just a legal one and, unfortunately, I believe even if it were made illegal, people would still find a way to get it). But just as those in AA teach that one has to admit one is "powerless" when it comes to the substance, I believe we have to look at the many situations & "triggers" that are associated with the use of the drug - in this case, nicotine, which I wish all people would come to understand is a powerful addiction which supports the truth: The inability to quit smoking on one's own is NOT an indication of character weakness. Don't let anyone convince you it is. Don't let those who just "threw them away" & quit cold turkey make you feel inadequate for not being able to do the same. They're the exception. Don't let anyone make you feel like "a loser" if you made an attempt, told people you were quitting, and then relapsed & ended up not being able to. It doesn't mean you'll NEVER be able to. It just means you couldn't THAT time. Statistically it takes the average person SEVEN attempts to quit smoking for good. In a way that can be roughly translated to say that for every person who quit "cold turkey", THIRTEEN people failed on their first attempt.

You are ADDICTED to a VERY powerful DRUG which means the parts of your brain involved in that addictive process are PRIMED to receive a hit of nicotine delivered through a puff on a cigarette. It doesn't mean you'll NEVER be able to silence that area - people quit using heroin & cocaine, or crack & crystal meth, or alcohol all the time. The problem in my view is that society sees all those as "legitimate" addictions, but smoking as a "character weakness." If you've been dealing with a mental illness too, some times you can sure feel down on yourself. I know - it's part of my story. We have finally got a model of addiction that views & treats it as a mental illness. But if there's a gap in our treatment facilities or ways of helping those of us who deal with such a challenge, it's that smoking somehow seems to be excluded from most psychiatrists' main concerns, or even from those who have very specific programs to help people conquer other addictions. Alcohol is a legal drug, just as nicotine is, but I've been to AA meetings with friends & have noticed that as soon as there's a break, you'll find a fairly large group of people outside with a coffee in one hand & a cigarette in another. Now please understand I'm not criticizing AA - I've seen it help many people. I'm just saying I found it a little bit ironic! There are groups for almost any addiction but so far, to my knowledge (I may be wrong) none for smoking. Some hospitals or health centers are beginning to hold workshops or group meetings to encourage & help those who want to quit smoking. I look forward to seeing more of these. WE can even influence policy if enough of us contact our local health center - or the mental health center where we go for help with that aspect of our life - and ASK for a group like this. ANYTHING that adds to the number of places or things we can draw on for support with this is worth fighting for, because we're trying to fight a powerful addiction with little to no structured systems or sources of help.

Why do I say I agree with the statement,"That's not necessarily true", after indicating how devastating the effects of smoking are to the body? Well, as I've indicated, I was a very heavy smoker for a long period of time. I finally won my personal battle with tobacco just over a year ago, with only one relapse since then following an extremely stressful event in my life - and even that was only a few cigarettes at which point I threw out the pack.

I'm not going to talk about quitting right now because I'm trying to explain why I agree with the reply to your statement - but I will eventually because you put it down as the main reason you consider yourself to be not healthy. This makes me think that you would eventually or perhaps IDEALLY want to be a non-smoker since it's what you know it's an obstacle to health, but maybe you think you just can't give up cigarettes, or you're worried about it but are having trouble quitting or have tried but think you just can't. I'd like to tell you that I felt this way & failed many times, but have been smoke free for almost 2 years now.

But then WHY would I agree that smoking ALONE is not the ONLY indicator of your physical or mental health? Because there are many things we can do or not do that affect our health and smoking is just one of them. Don't get me wrong - we all know it's bad for us - but even if you're not ready to quit smoking there are things you can do to improve your health or if you already do them, to keep your body & mind healthy in other ways that are very important. Diet, exercise, socializing, having good relationships, seeing a doctor for any other problems we may have, whether physical or mental..

I will be 44 in a couple of months. When I was in my late 20's & early 30's I was getting excellent marks in classes at a major university, I would take advantage of the university's "health centre" which was one of the most well-equipped gyms I've ever seen. Students were too busy trying to fit in their own workout or swim to be comparing themselves to others -which turned me off in some other gyms.

Now don't look at my routine & compare it to what you can do if you're a beginner, because I worked up to this over years of training - I didn't start doing this out of the blue one day. But at the time this was my routine: At least 3 or 4 times a week. I spent 1 hour on cardio (step-machines & stationary bikes) and 1 hour on "strength training" (there were many "Nautilus' machines that helped one focus on particular areas of the body such as biceps, tripeps, "lats", etc..). I'll be very honest with you - the workout made me feel great & reduces my stress levels tremendously, but my favorite part of it was the cigarette I'd light after showering, getting dressed, & leaving the gym!! NOT a very healthy ending to a lot of time invested in being "healthy".

I was also very careful about the nutritional value of what I was eating at the time. My mind was clear & my depression was greatly abated. It was one of the "healthiest" times in my life. I was even in what seemed like a great relationship - I was engaged! (Didn't marry him because he cheated on me, but that's another story!)

My point is that in many ways it was the "healthiest" I have ever felt. When I quit smoking, I gradually stopped exercising as my life changed. I haven't worked out for years now - and it's one of those things that makes me think, "I'm not healthy", even though I quit smoking! I'm not as careful about what I eat. My stress levels are very high. My dental health is seriously compromised due to long term use of prescription medication that dried my mouth out (a very unhealthy state but one you can ask you dentist about if you feel it's a problem for any reason because I didn't realize there were many things that could have prevented things from getting this bad). This combined with the negative effects on my oral health from smoking for so long & now I'm seeing my dentist far more than I'd like to!

In short, my lifestyle may not seem as "healthy" as it used to - and to be honest, I don't FEEL very healthy much of the time because of other trials that have come along. BUT I need to KEEP ON REMINDING MYSELF that I have been smoke free (pretty much) for almost 2 YEARS! I even calculated how much money I saved from not smoking - another benefit! Because that is a MAJOR accomplishment. And if I can encourage myself by focusing on what I'm doing that IS healthy I can help empower myself to gradually bring back those other routines that helped detoxify my body when I WAS smoking. I mean, I know I did damage to my body - I can't change that - but I also know that the healthy habits I had also make a difference in my long-term health. AND - I'm NOT doing the damage to my body that I WAS any more. Which is a big deal & one I tend to forget or minimize when I think of my accomplishments.

IF you don't feel ready to quit smoking, try adding some other healthier routines to your life. Because taking care of ourselves is something many of us are bad at. I know I am. And the more you do to take care of yourself - even if it's just making sure you take 1/2 hour a day to do something you enjoy, phoning a friend, or taking a walk - the more you can build on those "little" things the more those little things add up and end up making a "big" difference. And they help your confidence - so it may help you in areas you want to change but feel powerless to like smoking.

There was a time when I couldn't even imagine myself as a non-smoker. I saw smoking as part of my "personality", and I just wouldn't be the same person if I quit.....What I really was sabotaged by was my "attitude". I've always seen myself as someone who was a bit of a "rebel", a little "nonconformist", "too cool" to lose the smokes. I mean, smoking at a big university (and these days, anywhere) generally puts you in the "minority" - and I didn't see that minority as people who were not loving themselves enough to take care of themselves. I saw us as the last remnants of a great tradition of those who rebelled against "the establishment": Beat Poets; Rock Stars; the James Deans, the Marlon Brandos, the Bogarts (although I'm a woman - so I can also say the Lauren Bacalls & Marlena Dietrichs). Remember those cigarette ads that targeted women who wanted to feel like they were part of a movement to free women from restrictions they had suffered for a long time? "You've Come a Long Way, Baby!", was their slogan. I mean - how dumb would I look riding my motorcycle & not lighting up when I got off?

I used the excuse that those of us who struggled with mental illness had higher rates of smoking because we were "self-medicating" - not realizing that this way of thinking was actually propagated by tobacco companies (see:" Longitudinal rates of smoking in a schizophrenia sample Tobacco Control (2008) 17(4): 271-275http://tobaccocontrol.bmj.com/cgi/content/full/
17/4/271"). By that measure one could also say crack-cocaine,
heroin,methamphetamine & other lethal & dangerous drugs are "self-medication".

When I was a teenager had promised myself I'd quit when I turned 30 - an age which seemed old to me at the time. When 30 came & I was feeling great & following healthy routines in so many other areas of my life, including my social life, I thought, "I'll quite when I'm 40 or when I get pregnant - either one." But I never got pregnant & 40 rolled around at a time when I had just been delivered two of the most difficult personal blows of my life: A very serious financial betrayal by my family, and the death of my husband at only 38, during a nap we took together.
I spent about a year mostly in bed, smoking & watching TV - in shock, in severe depression, too confused to even cry.

How did I manage to quit? I'd say the main thing that helped ME - because we're all so different - was there was someone I really respected who I felt REALLY CARED, which meant he cared about my smoking. This was not a potential lover or boyfriend - he was my psychologist who knew my husband well & had seen the deception we had been subjected to. He is married & I've never considered him any more than a friend - but to have a REAL FRIEND in your corner is one thing that I found unbelievably helpful - whether they're a psychologist or not!

He knew the "health" angle wasn't going to work well because if one has smoked for a long time - well, we know it's bad for you, bad for your health - but we continue to do it anyways. Having such strong competing ideas in our minds is what psychology terms "cognitive dissonance". Wikipedia gives this definition of the term: "Cognitive dissonance is a discomfort caused by holding conflicting cognitions (e.g., ideas, beliefs, values, emotional reactions) simultaneously." It even gives smoking as its first example. We know smoking is bad for us but we're addicted to a very powerful drug that we don't want to give up- so we make up reasons (or excuses) that tilt the bias away from the "bad for our health" idea & tilt it towards, "but...." - anything that helps us silence the competing idea so we can keep smoking. "But my friend's grandmother smoked 2 packs a day & lived to be 98!" is one we hear often. Maybe it's true, maybe it's not, but if it is you can bet it's the exception to the rule. "But my best friend (or even harder - my boyfriend/girlfriend) smokes too & they seem fine." Eventually our ways of silencing - or at least "muffling" - the voice that tells us we're harming ourselves become so effective we don't really need to "think" of anything at all because we've sort of "calloused" the voice that competes with our desire to keep smoking. Like working with tools that rub against your skin, or in the kitchen, grabbing hot pans - people who do such things for a living end up with callouses so it doesn't hurt anymore. We can do that to just about any idea in our minds if we have strong enough motivation - and severe addiction is pretty strong motivation! I'm European & some of my older relatives would say, "I know it helps calm your nerves, but maybe you should cut down". They still had this older, prevailing attitude that it somehow "helped us deal with stress".

It actually doesn't - physically it's agitates the body because it's a stimulant. Maybe you've had the experience of feeling "smoked out" -like you're hands are shaking a bit & you have a buzzing head...a little TOO stimulated! But smoking is a habit that we use to cope with things - so it's comforting in many ways. Anything comforting helps us deal with stress, even potentially harmful things: a drink, a pill, a donut, maybe a compulsive tendency to harm ourselves. But other things help us deal with stress too: The voice of a friend, a hug from someone who cares about you, buying a new lipstick or magazine, a hot bubble bath with candles - or for men (and many women too) going out to shoot some hoops with the guys, giving yourself permission to play hooky from all that work piled up so you can watch a good movie or the game, a long drive on a fairly empty road, working on a personal project in the garage or house, whether it's mechanical or something more like knitting. Learning a new skill is often very helpful, and in many areas there are smoker's "hotlines" which you call when you have a craving or when you've had a "slip" & smoked.

It took me 11 attempts to quit smoking. That meant 10 times I felt like I failed. But my psychologist/friend was so persistent: "How's the smoking coming?" was always his first question. And if I'd been doing well he'd give me a lot of praise & tell me about how hard it was when he quit smoking in his early 20's. To "keep at it". When I slipped up he'd say, "That's too bad. But it doesn't mean you're starting all over again, you know. It means you had 3 months without smoking - which is amazing! And then you had 2 cigarettes. That's THREE MONTHS with only 2 SMOKES! Next time it could be 5 or 6 - or more!" It helped me look at it differently - and I felt like someone I respected was really pulling for me!

Like most literature & experts will tell you, we can only stop smoking (or doing anything that isn't good for us) when we make a FIRM DECISION to do so in our minds. I went to my doctor & found 2 little booklets: One was titled: "Quitting smoking for those who don't want to quit" & the other was, "Quitting smoking for those who want to quit." Well I picked them both up, but you can bet the first one I looked at was, "..for those who DON'T WANT to quit." It was really helpful, and when it came time that I thought I was one of those who "DID WANT to quit" I felt ready & sure of my decision.

I used nicotine substitutes: Patches & occasionally some nicotine gum for really strong cravings. Of course I did so under my doctor's supervision, because nicotine is so deadly it can kill in high enough doses, & those products should be used responsibly. I know there are some drugs marketed for quitting & some people find them very helpful, but they also carry a lot of potential side-effects or risks which you should discuss with your doctor or psychiatrist.

If you're ready to quit, telling people is a great way to help yourself stay honest. Next time you're out having a beer with some friends & they're smoking, they might be a little more considerate if they know you're trying to quit, or you might be able to say, "No thanks - you know I'm quitting!" Just like anything, we need to tell people what works to encourage us. Whenever I was doing really well & getting no support or praise from my mother, I'd mention it to her: "Hey mom...I haven't smoked in a month & you haven't said a thing about it!", to which she kept answering, "Oh - but I'm SO proud of you! I think it all the time!"..."Thanks mom, that's so helpful, because I'm so good at reading your mind!" I'd joke back. And she finally got the message.

And remember, there are certain activities we associate with smoking. For me, it was lighting up as soon as I woke up, even before I got out of bed. Or if I woke up in the middle of the night & was having trouble falling asleep again, sitting on the edge of the bed, ruminating on some problem & smoking would go on for a long time. Nicotine increases our blood pressure, hits our brains pretty much as soon as we take a long drag & makes us EDGIER if anything - at least physically (because it's a stimulant). So biologically it's not helping anyone relax except insofar as we associate smoking with making us feel better psychologically.

I don't know if I"ve helped with the first statement, or if I"ve lived up to my goal of supporting the person who said "that's not necessarily true." I tried. But my experience is mine, and we're all very different. We think differently, we act differently, we live differently.

One thing we have in common if we're on this site is we struggle in ways not everyone does. We can see this as meaning we're weak - but that's really NOT what it means. I think it means we're STRONGER than some people who never had to deal with or cope with the issues & health problems we do. Just like not being able to quit smoking isn't a weakness because it's an addiction to a powerful drug, which is a mental illness- and one we don't usually realize we're beginning when we take that first cigarette - neither is depression or bipolar disorder or issues with anxiety or compulsions, etc. I don't like the TV shows that seem to take people with serious health issues or mental illnesses & exploit them, as if they're freaks in a side show. That's my opinion. I've heard that other people say it's comforting for them to see other people who struggle with the same issues they do, or who have the same addictions. So even though it's something I can try to see both sides of & understand how it might help some people, I still feel strongly about my opinion. That's what makes us different & how boring would life be if we were all the same?

Good luck to you & thanks for sparking me to write something. I haven't written in a very long time & now I feel self-conscious about it. But I can hope it was helpful to whoever reads this, since it was helpful for me to share my experience & knowledge. I think the best resource we often have is each other. I'd also like to say I didn't mention spiritual sources of strength which are often very powerful motivators. This is because not everyone has the same beliefs & I didn't want to feel like I was imposing any particular ideas on those who might read this. But if this is an important part of your life - for some, the MOST important - then by all means, use it.

Anything that can fill us with the confidence we need, encourage us to know we'll never be perfect but we can keep trying to be the best we can at this time in our lives, & help us to see ourselves as worthy of treating ourselves - our minds & bodies - well: To be good to ourselves, to focus on our strengths and not think we're defined by just ONE thing that we struggle with - well "whatever gets you through" in such a way should be something we all think of as OK, in my opinion.

Think differently?
Let me know - and let me know why!