Part 4

4. Acute shooting pains, confined to no one part of the body.

5. An unnatural sensitiveness to cold.

6. Frequent cold perspiration in parts of the body.

7. A tendency to impatience and irritability of temper, with paroxysms of excitement wholly foreign to the natural disposition.

8. Deficiency and irregularity of sleep.

9. Occasional prostration of strength.

10. Inaptitude for steady exertion.

I mention without hesitancy these consequences of the abandonment of opium, from the belief that any person really in earnest in his desire to relinquish the habit will be more likely to persevere by knowing at the start exactly what obstacles he may meet in his progress toward perfect recovery, than by having it gradually revealed to him, and that at times when his body and mind are both enfeebled by what he has passed through. With a single exception, the dismost serious one I have been obliged to encounter. Whether it is one of the specific effects of the disuse of opium, or only one of the many general results of a disordered constitution, I do not know.

I can only say in my own case, that after the lapse of years, this particular difficulty is not wholly overcome. This electric condition, so to call it, still continues a serious annoyance. But when it occurs, the pain is of less duration, and gradually, but very slowly, is of diminished frequency. Violent exercise will sometimes relieve it; a long walk has often the same effect. The use of stimulants brings alleviation for a time, but there seems to be no permanent remedy except in the perfect restoration of the system by time from this effect of the wear and tear of opium upon the nerves. Irregularity in the action of the liver, while singularly marked in the earlier stages of the experiment, and continuing for years to make its agency manifestly felt, is in a considerable degree checked and controlled by a judicious use of calomel.

The condition of the digestive organs is less impaired than I should have supposed possible, judging from the experience of others. A moderate degree of attention to the quality of what is eaten, with proper care to avoid what is not easily digested, with the exercise of habitual self-control in respect to quantity, suffices to prevent, for the most part, all unendurable feelings of discomfort in this part of the system. Whether the habitually febrile condition of the mouth, and the swollen state of the tongue, is referable to a disturbed action of the stomach or of the liver I can not say. It is certain that none of the effects of opium-eating are more marked or more obstinately tenacious in their hold upon the system than these. I barely advert to the frequent impossibility of retaining some kinds of food upon the stomach, which has been one unpleasant part of my experience, because I doubt whether this return of a difficulty which began in childhood has any necessary connection with the use of opium. For many years before I knew any thing of the drug I had been a daily sufferer from this cause. Indeed the use of opium seemed to control this tendency, and it was only when the remedy was abandoned that the old annoyance returned. For a few months the stomach rejected every kind of food; but in less than a year, and subsequently to the present time, this has been of only occasional ocurrence.

I am also at a loss how far to connect the disuse of opium with the lancinating pains which have troubled me since the time to which I refer. These pains began long before I had recourse to opium, they did not cease their frequent attacks while opium was used, nor have they failed to make their potency felt since opium was abandoned. While it is not improbable that the neuralgic difficulties of my childhood might have remained to the present time, even if I had never made use of opium, I think that the experience of all who have undergone the trial shows that similar pains are invariably attendant upon the disuse of opium. How long their presence might be protracted with persons not antecedently troubled in this way, is a question I can not answer. I infer from what little has been recorded, and from what I have learned in other ways, that the reforming opium-eater must make up his mind to a protracted encounter with this great enemy to his peace. That the struggle of others with this difficulty will be prolonged as mine has been I do not believe, unless they have been subjected for a lifetime to pains connected with disorder in the nervous system.

The unnatural sensitiveness to cold to which I have alluded is rather a discomfort than any thing else. It merely makes a higher temperature necessary for enjoyment, but in no other respect can it be regarded as deserving special mention. With the thermometer standing at 80° to 85° the sensation of agreeable warmth is perfect; with the mercury at 70° or even higher, there is a good deal of the feeling that the bones are inadequately protected by the flesh, that the clothing is too limited in quantity, and in winter that the coal-dealer is hardly doing you justice.

The cold perspiration down the spine, which was so marked a sensation during the worst of the trial, has not yet wholly left the system, but is greatly limited in the extent of surface it affects and in the frequency of its return.

The tendency to impatience and irritability of temper to which I have adverted is by far the most humiliating of the effects resulting from the abandonment of opium. Men differ very widely both in their liability to these excesses of temper as well as in their power to control them; but under the aggravations which necessarily attend an entire change of habit, this natural tendency, whether it be small or great, to hastiness of mind is greatly increased. So long as the disturbing causes remain, whether these be the state of the liver or the stomach, or a want of sufficient sleep, or the excited condition of the nervous system, the patient will find himself called upon for the exercise of all his self-control to keep in check his exaggerated sensibility to the daily annoyances of life.

Intimately connected with the preceding is the frequent recurrence of sleepless nights, which seem invariably to attend upon the abandonment of the habit. Possibly some part of this state of agitated wakefulness may pertain to the natural temperament of the patient, but this tendency is greatly aggravated by the condition of the nerves, so thoroughly shattered by the violent struggle to oblige the system to dispense with the soothing influence of the drug upon which it has so long relied. Whatever method others may have found to counteract this infirmity, I have been able as yet to find no remedy for it. Especially are those nights made long and weary which precede any long continuance of wet weather. A moist condition of the atmosphere still serves the double purpose of setting in play the nervous sensibilities, and, as a concomitant or a consequence, of greatly disturbing, if not destroying sleep.

In connection with this matter something should be said on the subject of dreaming, to which De Quincey has given so marked a prominence in his "Confessions" and "Suspiris de Profundis." In my own case, neither when beginning the use of opium, nor while making use of it in the largest quantities and after the habit had long been established, nor while engaged in the painful process of relinquishing it, nor at any time subsequently, have I had any experience worth narrating of the influence of the drug over the dreaming faculty. On the contrary, I doubt whether many men of mature age know so little of this peculiar state of mind as myself. The conditions in this respect, imposed by my own peculiarities of constitution, have been either no sleep sufficiently sound as to interfere with the consciousness of what was passing, or mere restlessness, or sleep so profound as to leave behind it no trace of the mind's activity. While it is therefore certain that this exaggeration of the dreaming faculty is not necessarily connected with the use of opium, but is rather to be referred to some peculiarity of temperament or organization in De Quincey himself, I find myself in turn at a loss to know how far to regard other phenomena to which I have previously alluded as the natural and necessary consequences of opium, or how far they may be owing to peculiarities of constitution in myself. Opium-eaters have said but little on the subject. The medical profession, so far as I have conversed with them, and I have consulted with some of the most eminent, are not generally well informed on any thing beyond the specific effects of the drug as witnessed in ordinary medication. In the absence of sufficient authority, it may be safer to say that the remoter consequences of the disuse of opium consist in a general disorder and derangement of the nervous system, exhibiting itself in such particular symptoms as are most accordant with the temperament, constitutional weaknesses, and personal idiosyncrasies of the patient. That some considerable suffering must be regarded as unavoidable seems to be placed beyond question from the nature of the trial to which the body has been subjected, as well as from what little has been said on the subject by those who have relinquished the habit.

I close this brief reference to the remoter consequences of the habits of the opium-eater by calling the attention of the reader to the physical weakness with consequent inaptitude for continuous exertion which forms a part of my own experience. Unable as I am to refer it to any immediate cause, frequent and sudden prostration of strength occurs, accompanied by slight dizziness, impaired sight, and a sense of overwhelming weakness, though never going to the extent of absolute faintness. Its recurrence seems to be governed by no rule. It sometimes comes with great frequency, and sometimes weeks will elapse without a return. Neither the state of the weather, nor any particular condition of the body, appears to call it out. It sometimes is relieved by a glass of water, by the entrance of a stranger, by the very slightest excitement, and it sometimes resists the strongest stimulants and every other attempt to combat it. I can record nothing else respecting this visitant except that its presence is always accompanied with a singular sensation in the stomach, and that the entire nervous system is affected by its attack.

The inaptitude for steady exertion is not merely the consequence of this occasional feeling of exhaustion, but is for a time the inevitable result of the accumulated pain and weakness to which his system, not yet restored to health, is still subject. This impatience of continued application to work, which is common to all opium-eaters, and which does not cease with the abandonment of the habit, seems to result in the first case from some specific relation between the drug and the meditative faculties, promoting a state of habitual reverie and day-dreaming, utterly indisposing the opium-user for any occupation which will disturb the calm current of his thoughts, and in the other, proceeding from the direct disorder of the nervous organization itself. Strange as it may seem, the very thought of exertion will often waken in the reforming opium-eater acute nervous pains, which cease only as the purpose is abandoned. In other cases, where there is no special nervous suffering at the time, work is easy and pleasant even beyond what is natural.

One effect of opium upon the mind deserves to be mentioned; its influence upon the faculty of memory. The logical memory, De Quincey says, seems in no way to be weakened by its use, but rather the contrary. His own devotion to the abstract principles of political economy; the character of Coleridge's literary labors between the years 1804-16, when his use of opium was most inordinate; together with the cast of mind of many other well-known opium-eaters, confirms this suggestion of De Quincey. His further statement that the memory of dates, isolated events, and particular facts, is greatly weakened by opium, is confirmed by my own experience. However physiologists may explain this fact, a knowledge of it may not be without its use to those who desire to be made thoroughly acquainted with all the consequences of the opium habit.

If to these discomforts be added a prevailing tendency to a febrile condition of body, together with permanent disorder in portions of the secretory system, the catalogue of annoyances with which the long-reformed opium-eater may have to contend is completed. This statement is not made to exaggerate the suffering consequent upon the disuse of opium, but is made on the ground that a full apprehension of what the patient may be called upon to go through will best enable him to make up his mind to one resolute, unflinching effort for the redemption of himself from his bad habits.

So far as the body is concerned, there is much in my experience which induces me to give a general assent to the opinion expressed by a medical man of great reputation whom I repeatedly consulted in reference to the discouraging slowness of my own restoration to perfect health. "I can not see," he said, "that your constitution has been permanently injured; but you were a great many years getting into this state, and I think it will take nearly as many to get you out of it."

It may not be amiss to add that those opium-eaters whose circumstances exempt them from harassing cares, who meet only with kindness and sympathy from friends, and who have resources for enjoyment within themselves, have in respect to these subsequent inconveniences greatly the advantage of those whose position and circumstances are less fortunate.

These free and almost confidential personal statements have been made, 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.