Part 5

The question will naturally suggest itself to others, as it has often done to myself, whether a less sudden relinquishment of opium would not be preferable as being attended with less present and less subsequent suffering. Numerous cases have come under my notice where a very gradual reduction was attempted, but which resulted in failure. Only two exceptions are known to me: in one of these the patient, himself a physician, effected his release by a graduated reduction extending through five months. The other is the case of Dr. S., a physician of eminence in Connecticut many years ago. This gentleman had made so free use of opium to counteract a tendency to consumption that the habit became established. After several years, and at the suggestion of his wife, he made a resolution to abandon it, engaging to take no opium except as it passed through her hands, but with the understanding that the process of relinquishment was to be slow and gradual. His allowance at this time was understood to be from twenty to thirty grains of crude opium daily. At the end of two years the habit was abandoned, with no very serious suffering during the time, and so far as his daughter was informed, with no subsequent inconvenience to himself. He lived many years after his disuse of opium, in the active discharge of the duties of his profession, and died at last in the ninetieth year of his age. The hazard of this course, however, consists in the possibility, not to say with some temperaments the probability, that somewhere in the course of so very gradual a descent the same influences which led originally to the use of opium may recur, with no counteracting influence derived from the excitement of the mind produced by the earnestness of the struggle. With some constitutions I have no doubt that a process even so slow as that of Dr. S.'s might be successful, but I suspect, with most men, that some mood of excited feeling, and some conscious sense of conflict, will be found necessary, in order to bring them up resolutely to the work of self-emancipation. On the other hand, I am satisfied that my own descent was too rapid. Had the experiment of between five and six weeks been protracted to twice that time, much of the immediate suffering, and probably more of that which soon followed, might have been prevented. As in the constitution of every person there is a limit beyond which further indulgence in any pernicious habit results in chronic derangement, so also there seems to be a limit in the discontinuance of accustomed indulgence, going beyond which is sure to result in some increased physical disorder. In the cure of delirium tremens, the first step of the physician is to stimulate. With more moderate drinkers abrupt cessation from the use of stimulants is the only sure remedy. In the first instance the nervous system is too violently agitated to dispense entirely with the accustomed habit; in the second, the nerves are presumed to be able to bear the temporary strain imposed upon them by the condition of the stomach and other organs. But with opium the case is otherwise. Insanity, I think, would be the general result of an attempt immediately to relinquish the habit by those who have long indulged it. The most the opium-eater can do is to diminish his allowance as rapidly as is safe. For the same reason that no sensible physician would direct the confinement of a patient and the absolute disuse of opium with the certainty that mania would result, so it would be equally ill advised to recommend a diminution so rapid as necessarily to call out the most serious disorder and derangement of all the bodily functions, especially if these could be made more endurable by being spread over a longer period. In one respect the opium-eater has greatly the advantage over those addicted to other bad habits. Those who have used distilled or fermented drinks, tobacco, and sometimes coffee and tea in excess, experience for a time a strong and definite craving for the wonted indulgence. This is never the case with the opium-eater; he has no specific desire whatever for the drug. The only difficulty he has to encounter is the agony of pain--for no other word adequately expresses the suffering he endures--conjoined with a general desire for relief. Yet in the very acme of his punishment he will be sensible of no craving for opium at all like the craving of the drunkard for spirits. As De Quincey justly represents it, the feeling is more that of a person under actual torture, aching for relief, though with no care from what source that relief comes. So far from there being any particular desire for opium, there ensues very speedily, I suspect, after the attempt to abandon it is begun, and long before the necessity for its use has ceased, and even while the suffering from its partial disuse is most unendurable, a feeling in reference to the drug itself not far removed from disgust. The only occasion that I have had of late years to make use of opium or any of its preparations, was within a twelvemonth after it had been laid aside. A morbid feeling had long troubled me with the suggestion that should a necessity ever arise for the medical use of opium, I might be precipitated back into the habit. I was not sorry, therefore, when the necessity for its use occurred, that I might test the correctness of my apprehension. To my surprise, not only was no desire for a second trial of its virtues awakened, but the very effort to swallow the pill was accompanied with a feeling akin to loathing.

The final decision of the question, How long a time should be allowed for the final relinquishment of the drug? must, I imagine, be left to a wider experience than has yet been recorded. The general strength of the constitution, the force of the will, the degree of nervous sensibility, together with the external circumstances of one's life, have all much to do with its proper explication.

The general directions I should be disposed to suggest for the observance of the confirmed opium-eater would be something as follows:

1. To diminish the daily allowance as rapidly as possible to one-half. A fortnight's time should effect this without serious suffering, or any thing more than the slight irritation and some other inconveniences that will be found quite endurable to one who is in earnest in his purpose.

2. For the first week, if the previous habit has been to take the daily dose in a single portion, or even in two portions, morning and night, it will be found advisable to divide the diminished quantity into four parts. Thus, if eighty grains has been the customary quantity taken, four pills of fifteen grains each, taken at regular intervals, say one at eight and one at twelve o'clock in the morning, and one at four and one at eight in the evening, will be found nearly equal in their effect to the eighty grains taken at once in the morning. A further diminution of two grains a day, or of half a grain in each of these four daily portions, will within the week reduce the quantity taken to fifty grains, and this without much difficulty, and with positive gain in respect to elasticity of spirits, arising, in part, from the newly-awakened hope of ultimate success. A second week should suffice for a reduction to forty grains. It will probably be better to divide the slightly diminished daily allowance into five portions, to be taken at intervals of two hours from rising in the morning till the daily quantity is consumed. With such a graduated scale of descent, it will be found at the end of two weeks that one-half of the original quantity of opium has been abandoned, and that, with so little pain of body, and so much gain to the general health and spirits, that the completion of the task will seem to the patient ridiculously easy. He will soon learn, however, that he has not found out all the truth.

In the third week a further gain of ten grains can the more easily be made by still further dividing the daily portion into an increased number of parts, say ten. The feeling of restlessness and irritability by this time will have become somewhat annoying, and the actual struggle will be seen to have commenced. It will doubtless require at this point some persistence of character to bear up against the increased impatience, both of body and spirit, which marks this stage of the descent. The feelings will endeavor to palm off upon the judgment a variety of reasons why, for a time, a larger quantity should be taken; but this is merely the effect of the diminished amount of the stimulant. Sleep will probably be found to be of short continuance as well as a good deal broken. Reading has ceased to interest, and a fidgety, fault-finding temper not unlikely has begun to exhibit itself. At this point, I am satisfied, most opium-eaters who have endeavored in vain to renounce the habit, have broken down. Their resolution has failed them not because they were unable to stand much greater punishment than had yet been inflicted, but because they yielded to the impression that some other time would prove more opportune for the final experiment. Under this delusion they have foolishly thrown away the benefit of their past self-control, with the certainty that should the trial be again made, they would once more be assailed by a similar temptation. But if this stage of the process has been safely passed, the next--that of reducing the daily quantity from thirty grains to twenty-five, still dividing the day's allowance into ten portions--would probably have added little aggravation to the uncomfortable feeling which already existed, but not without some conscious addition, on the other hand, to their enjoyment from the partially successful result of the experiment. Thus in four weeks a very substantial gain, by the reduction of the needed quantity from eighty grains to twenty-five, would have been attained.

If the patient should find it necessary to stop at this point for a week, a fortnight, or even longer, no great harm would necessarily result; it would only postpone by so much his ultimate triumph. He should never forget, however, that the one indispensable condition of success is this: Never under any circumstances to give up what has been once gained. If in any manner the patient has been able to get through the day with the use of only twenty-five grains, it is certain that he can get through the next, and the next, and the subsequent day with the same amount, with the further certainty that the habit of being content with this minimum quantity will soon begin to be established, and that speedily a further advance may be made in the direction of an entire disuse. Whenever the patient finds his condition to be somewhat more endurable, whether the time be longer or shorter, he should make a still further reduction, say to one-quarter of his original dose. If this abatement of quantity be spread over the entire week the aggravation of his discomfort will not be great, while the elation of his spirits over what he has already accomplished will go far in enabling him to bear the degree of pain which necessarily pertains to the stage of the experiment which he has now reached. The caution, however, must be borne continually in mind that under no circumstances and on no pretext must the patient entertain the idea that any part of that which he has gained can he surrendered. Better for him to be years in the accomplishment of his deliverance than to recede a step from any advantage he may have secured. If he persists, he will in a few days, or at the longest in a few weeks, find his condition as to bodily pain endurable if nothing more. There may not, probably will not be any very appreciable gain from day to day. The excited sufferer, judging from his feelings alone, may think that he has made no progress whatever; but if after the lapse of a week he will contrast his command of temper, or his ability to fix his attention upon a subject, as evinced at the beginning and end of this period, he can hardly fail to see that there has been a real if not a very marked advance in his status. Such a person has no right to expect, after years of uninterrupted indulgence, that the most obstinate of all habits can be relinquished with ease, or that he can escape the penalty which is wisely and kindly attached to all departures from the natural or supernatural laws which govern the world. It should be enough for him to know that there is no habit of mind or of body which may not be overcome, and that the process of overcoming, in its infinite variety of forms, is that out of which almost all that is good in character or conduct grows, and that the amount of this good is usually measured by the struggle which has been found necessary to ensure success.

Considerations of this nature, however, are of too general a character to be of much service to one enduring the misery of the reforming opium-eater. He has now arrived at a point where he is obliged to ask himself when and how the contest is to end. He has succeeded in abandoning three-quarters of the opium to which he has so long been accustomed. A few weeks have enabled him to accomplish this much. He endures, indeed, great discomfort by day and by night; but hope has been re-awakened; his mind has recovered greater activity than it has known for years; and, on the whole, he feels that he has been greatly the gainer from the contest.

Let me repeat, that the main thing for the patient at this point of his trial is not to forego the advantage he has already attained--"not to go back." If he can only hold his own he has so far triumphed, and it is only a question of time when the triumph shall be made complete. When this shall be effected he must decide. The rapidity of his further progress must be determined by what he himself is conscious he has the strength, physical and moral, to endure. With some natures any very sudden descent is impossible; with others, whatever is done must be done continuously and rapidly or is not done at all. The one temperament can not stand up against the assaults of a fierce attack, the other loses courage except when the fight is at the hottest. For the former ample time must be given or he surrenders; the latter will succumb if any interval is allowed for repose. It is, therefore, difficult to suggest from this point downward any rule which shall apply equally to temperaments essentially unlike. I think, however, that the suggestion to divide the daily allowance, whether the descent be a slow or a rapid one, into numerous small parts to be taken at equal intervals of time, will be found to facilitate the success of the attempt in the case of both. The chief value of such subdivision probably consists in its throwing the aggregate influence of the day's opium nearer the hour of bed-time, when it is most needed, than to an earlier hour, when its soporific power is less felt. In addition to this, the importance to the excited and irritated patient of being able to look forward during the long-protracted hours to frequent, even if slight, alleviations of his pain, should not be left out of the account. In general it may be said that whenever the patient feels that he can safely, that is, without danger of failing in his resolution, adventure upon a further diminution of the quantity, an additional amount, smaller or greater according to circumstances, should be deducted till the point is reached where the suffering becomes unendurable; then after a delay of few or many days, as may be needed to make him somewhat habituated to the diminished allowance, a still further reduction should be made, and so on for such time as the peculiarities of different constitutions and circumstances may make necessary, till the quantity daily required has become so small, say a grain or two, that by still more minute subdivisions, and by dropping one of them daily, the final victory is achieved.

I have not ventured to say in how short a time confirmed habits of opium-eating may be abandoned. In my own case it was thirty-nine days, but with my present experience I should greatly prefer to extend the time to at least sixty days; and this chiefly with reference to the violent effects upon the constitution produced by the suddenness of the change of habit. Some constitutions may possibly require less time and some probably, more. While I regard the abandonment of the first three-quarters of the accustomed allowance as being a much easier task than the last quarter, and one which can be accomplished with comparative impunity in a brief period, I would allow at least twice the time for the experiment of dispensing with the last quarter; unless, indeed, I should be apprehensive that my resolution might break down through the absence of the excitement which is unquestionably afforded by the feeling that you are engaged in a deadly but doubtful conflict. So far, also, as can be inferred from cases subsequently narrated in this volume, the probability of success would seem to be enhanced by devoting a longer time to the trial. It can not, however, be too often repeated, that however slow or however rapid the pace may be, the rule to be rigidly observed is this: Never to increase the minimum dose that has once been attained. This is the only rule of safety, and by adhering to it, persons in infirm health, or with weakened powers of resolution, will ultimately succeed in their efforts.

I subjoin my own record of the quantity of opium daily consumed, for the possible encouragement of such opium-eaters as may be disposed to make trial of their own resources in the endurance of bodily and mental distress.

Saturday, Nov. 25....80 grains, = 2000 drops of laudanum. Sunday, " 26....60 " 1500 " " Monday, " 27....50 " 1250 " " Tuesday, " 28....40 " 1000 " " Wednesday, " 29....30 " 750 " " Thursday, " 30....25 " 625 " " Friday, Dec. 1....20 " 500 " " --- ----- Average of 1st week....44 " 1089 " "

Saturday, Dec. 2.....19 grains, = 475 drops of laudanum. Sunday, " 3.....18 " 450 " " Monday, " 4.....17 " 425 " " Tuesday, " 5.....16 " 400 " " Wednesday, " 6.....15 " 375 " " Thursday, " 7.....15 " 375 " " Friday, " 8.....15 " 375 " " ---- ---- Average of 2d week.....16.43" 411 " "

Saturday, Dec. 9.....14 grains, = 350 drops of laudanum. Sunday, " 10.....13 " 325 " " Monday, " 11.....13 " 325 " " Tuesday, " 12.....12 " 300 " " Wednesday, " 13.....12 " 300 " " Thursday, " 14.....11 " 275 " " Friday, " 15.....10 " 250 " " ---- ---- Average of 3d week.....12.14" 304 " "

Saturday, Dec.16..... 9 grains, = 225 drops of laudanum. Sunday, " 17..... 8 " 200 " " Monday, " 18..... 8 " 200 " " Tuesday, " 19..... 7 " 175 " " Wednesday, " 20..... 6 " 150 " " Thursday, " 21..... 5 " 125 " " Friday, " 22..... 4 " 100 " " ---- ---- Average of 4th week.....6.71" 168 " "

Saturday, Dec.23..... 3 grains, = 75 drops of laudanum. Sunday, " 24..... 3 " 75 " " Monday, " 25..... 2 " 50 " " Tuesday, " 26..... 2 " 50 " " Wednesday, " 27..... 2 " 50 " " Thursday, " 28..... 2 " 50 " " Friday, " 29..... 1 " 25 " " ---- ---- Average of 5th week.....2.14" 54 " "

Saturday, Dec.30..... 1 grain, = 25 drops of laudanum. Sunday, " 31..... 1 " 25 " " Monday, Jan. 1..... 1 " 25 " " Tuesday, " 2.....1/2 " 12 " " Wednesday, " 3.....1/4 " 6 " " ---- ---- Average of 6th week....0.75 " 18 " "

The fourth and fifth weeks I found to be immeasurably the most difficult to manage. By the sixth week the system had become somewhat accustomed to the denial of the long-used stimulant. At any rate, though no abatement of the previous wretchedness was apparent, it certainly seemed less difficult to endure it. It is at this stage of the process that I regard the advice and encouragement of a physician as most important. He may not indeed be able to do much in direct alleviation of the pain incident to the abandonment of opium, for I suspect that little reliance can be placed upon the medicines ordinarily recommended. The system has become accustomed to the stimulant to an exorbitant degree; the suffering is consequent upon the effort to accustom the system to get on without it. Other kinds of stimulants, like spirits or wine, will afford a slight relief for a few days, especially if taken in sufficiently large quantities to induce sleep. It is the sedative qualities of the opium that are chiefly missed, for as to excitement the patient has quite as much of it as he can bear. For this reason malt liquors are preferable to distilled spirits--they stupefy more than they excite. But to malt liquors this serious objection exists, they tend powerfully to aggravate all disorders of the liver. This tendency the reforming opium-eater can not afford to overlook, for no one effect of the experiment is more distressing than the marvellous and unhealthy activity given to this organ by the process through which he is passing. The testimony of all opium-eaters on this point is uniform. For months and even years this organ in those who have relinquished the drug remains disordered. When in its worst state, the use of something bitter, the more bitter the better, is exceedingly grateful. The difficulty lies in finding any thing that has a properly bitter taste. Aloes, nux vomica, colocynth, quassia, have a flavor that is much more sweet than bitter. These serious annoyances from the condition of the liver, as well as those arising from the state of the stomach and some of the other organs, may be somewhat mitigated by the skill of an intelligent medical man, who, even if he happens to know little about the habit of opium-eating, should know much as to the proper regimen to be observed in cases where these organs are disordered.

In respect to food it seems impossible to lay down any general rule. De Quincey advises beefsteak, not too much cooked, and stale bread as the chief diet, and doubtless this was the best diet for him. Yet it is not the less true that "what is one man's meat is another man's poison," and food that is absolutely harmless to one may disorder the entire digestion of another. Roast pork, mince pies, and cheese do not, I believe, rank high with the Faculty for ease of digestion, yet I have found them comparatively innoxious, while poultry, milk, oysters, fish, some kinds of vegetables, and even dry toast have caused me serious inconvenience. The appetite of the recovering opium-eater will probably be voracious and not at all discriminating during the earlier stages of his experiment, and will continue unimpaired even when the stomach begins to be fastidious as to what it will receive. Probably no safer rule can be given than to limit the quantity eaten as far as practicable, and to use only such food as in each particular case is found to be most easy of digestion.

Too much prominence can not be given to bodily exercise as intimately connected with the recovery of the patient. Without this it seems to me doubtful whether a person could withstand the extreme irritation of his nervous system. In his worst state he can not sit still; he must be moving. The complication of springs in the famous Kilmansegge leg, is nothing compared with the necesity for motion which is developed in the limbs of the recovering opium-eater. Whatever his health, whatever his spirits, whatever the weather, walk he must. Ten miles before breakfast will be found a moderate allowance for many months after the habit has been subdued. A patient who could afford to give up three months of his time after the opium had been entirely discarded, to the perfect recovery of his health, could probably turn it to no better account than by stretching out on a pedestrian excursion of a thousand miles and back. This would be at the rate of nearly twenty-six miles a day, allowing Sunday as a day of rest. This advice is seriously given for the consideration of those who can command the time for such a thorough process of restoration. Nor should any weight be given to the objection that the body is in too enfeebled a state to make it safe to venture upon such an experiment. Account for it as physiologists may, it is certain that the debilitating effects of leaving off opium much more rapidly pass away from the lower extremities than from the rest of the body. At no time subsequent to my mastery of opium have I found any difficulty in accomplishing the longest walks; on the contrary they have been taken with entire ease and pleasure. Yet to this day, any considerable exercise of the other muscles is attended with extreme debility. In the absence of facilities for walking, gymnastic exercise is not wholly without benefit, and if this exercise is followed by a cold bath, some portion of the insupportable languor will be removed. Walking, however, is the great panacea, nor can it well be taken in excess. So important is this element in the restorative process that it may well be doubted whether without its aid a confirmed opium-eater could be restored to health.

It is useless for any person to think that he can break off even the least inveterate of his habits without effort, or the more obstinate ones without a struggle. Wine, spirits, tobacco, after years of habitual use, require a degree of resolution which is sometimes found to be beyond the resources of the will. Much more does opium, whose hold upon the system is vastly more tenacious than all these combined, call for a resolute determination prepared to meet all the possible consequences that pertain to a complete and perfect mastery of the habit. It should be remembered, however, that the experience here recorded is that resulting from years of large and uninterrupted use of opium. The entire system had necessarily conformed itself to the artificial habit. For years the proper action of the nervous, muscular, digestive, and secretory system had been impeded and forced in an unnatural direction. In time all the vital functions had conformed as far as possible to the necessity imposed upon them. Scarce a function of the body that had not been daily drilled into a highly artificial adaptation to the conditions imposed upon the system by the use of opium. Nature, indeed, for a time rebels and resists the attempt to impose unnatural habitudes upon her action; but there is a limit to her resistance, and she is then found to possess a marvellous power of reconciling the processes of life with the disturbance and disorder of almost the entire human organization. This power of adaptation, while it unquestionably lures on to the continued indulgence of all kinds of bad habits, is, on the other hand, the only hope and assurance the sufferer from such causes can have of ultimate recovery from his danger. If it requires years to establish bad habits in the animal economy, why should we expect that they can be wholly eradicated except by a reversal, in these respects, of the entire current of the life, or without allowing a commensurate time for that perfect restoration of the disordered functions which is expected?

If this view of the case is not encouraging to the veteran consumer of opium, it certainly is not without its suggestive utility to that larger class whose use of opium has been comparatively limited both in time and quantity. Fortunately, much the greater number of opium-eaters take the drug in small quantities or have made use of it for only a limited period. In their case the process of recovery is relatively easy; the functions of their physical organization still act for the most part in a normal way; they have to retrace comparatively few steps and for comparatively a short time. Even to the inveterate consumer of the drug it has been made manifest that he may emancipate himself from his bondage if he will manfully accept the conditions upon which alone he can accomplish it. In the worst conceivable cases it is at least a choice between evils; if he abandons opium, he may count upon much suffering of body, many sleepless nights, a disordered nervous system, and at times great prostration of strength. If he continues the habit, there remains, as long as life lasts, the irresolute will, the bodily languor, the ever-present sense of hopeless, helpless ruin. The opium-eater must take his choice between the two. On the one hand is hope, continually brightening in the future--on the other is the inconceivable wretchedness of one from whom hope has forever fled.

DE QUINCEY'S "CONFESSIONS OF AN ENGLISH OPIUM-EATER."

Under this title an article appeared in the "London Magazine" for December, 1821, which attracted very general attention from its literary merit and the novelty of its revelations. So considerable was the interest excited in these "Confessions" that the article was speedily republished in book form both in London and this country. The reading public outside of the medical profession were thus for the first time made generally acquainted with the tremendous potency of a drug whose fascinations have since become almost as well known to the inhabitants of England and America as to the people of India or China. The general properties of the drug had of course been familiar to intelligent men from the days of Vasco de Gama, but how easily the habit of using it could be acquired, and with what difficulty when acquired it could be left off, were subjects respecting which great obscurity rested on the minds even of medical men. Such parts only of these "Confessions" as have relation to De Quincey's habits as an opium-eater, have been selected for republication; such extracts from his other writings are added as embody his entire experience of opium so far as he has given it to the world.

* * * * *

I here present you, courteous reader, with the record of a remarkable period of my life. According to my application of it, I trust that it will prove not merely an interesting record, but in a considerable degree useful and instructive. In that hope it is that I have drawn it up, and that must be my apology for breaking through that delicate and honorable reserve which for the most part restrains us from the public exposure of our own errors and infirmities.

Guilt and misery shrink by a natural instinct from public notice: they court privacy and solitude; and, even in the choice of a grave, will sometimes sequester themselves from the general population of the church-yard, as if declining to claim fellowship with the great family of man, and wishing--in the affecting language of Mr. Wordsworth--

'Humbly to express A penitential loneliness.'