What a Long Strange Trip It’s Been Carrie Fisher
My phone sends me a message that Carrie Fisher had drugs in her system when she died. I receive a second notification that Carrie’s daughter, Billie, has released an elegant statement about Carrie’s very public struggles with substances and mental illness, openly sharing this last part of her mother’s story. Carrie Fisher who was having another fame moment, with her role in the New Star Wars movie, her book based on her Star Wars journals, and her gorgeous role on the Amazon series Catastrophe, had died with opiates, cocaine and MDMA in her blood. The toxicology report becomes a kind of a one note epitaph in a truly vivid life.
The news leaves a sinking feeling and we are disappointed that our Princess hadn’t conquered the dark forces in her life with a story book ending. The truth is that we have no idea what the drug use means or meant to Carrie Fisher, and if this is a failure or a conscious choice weighing out the fun with the risks; the self medicating comfort that drugs can offer with the rabbit hole they can take you down. The truth is also unlikely that Carrie Fisher found a helping professional to offer her a meaning-making conversation that helped her maximize her self care when renewed drug use was an option she was considering or something that apparently she chose.
There is a another issue here, beyond the life story of addiction and recovery and stigma and a death too early. Aging and ageism are actors in the choices around substance use for older adults, navigating the challenges in a culture that overvalues youth and renders older adults to stereotype. This is the unspoken, largely un-researched aspect of aging. Seniors today live longer with more disability, and are more likely to have their own back story and experience with drug use as never before. This expanding crowd of over- sixties grew up in the 1960's and are more likely to turn to recreational drugs as they travel the unfamiliar path to what’s next? Self medication, what the fuck, or what’s it all about Alfie — all play a role along with chronic disease, loss, loneliness, pressure to be relevant, and a healthcare system that has little interest in cohesiveness and real meaning-making as one approaches the Big D. (That’s death campers). Let’s add in financial instability and a reality-television government of clowns who are behind closed doors pulling the affordable health care rug, mental health parity and stigma-busting out from under a population of 45–64 year olds.
Ageism along with the other stigmas, including the idea that abstinence is the only honorable choice in a life story that contains a past history of substance problems, causes a plethora of missed opportunities to address recreational and self medication decisions in older adults.
Care for aging adults mostly resides in families who are famously ill equipped to have conversations about harm reduction, comfort, pleasure and fun. Guess what else? Doctors, nurses and most health professionals suck at these conversations too. Even many well trained counselors are ill- equipped to bravely explore the grey areas around elder life, (no pun intended).
Older people grow more invisible as they leave the flow of activities in the world. Current elders are living longer but with more disability and loss. They must adapt to loss of partners, community, choices, sensory pleasures, roles and resources. They fear the loss of cognition more than anything,and ironically, may seek to escape cognition with substance use in this fear. They must adjust to asking for help, and also at times, having help thrust upon them without attention to preserving dignity and autonomy. Every adult is on a moving sidewalk to confront their own internalized stigma about getting old and what that means in a world that broadcasts a million images a day of one idealized life on a variety of social media platforms. We only post cropped and well lit photos that remind us of our inner representation…so we look most like the age that we were when we liked ourselves best. Articles about aging are mostly statistics. The population of seniors is expected to double, then almost triple by 2050. If you are approaching 40, you may want to be nice to the millennial waiting on you in the resturaunt. They will be talking care of you as you grow into your elder body.
In one of my consulting jobs, more than 80% of the heavy users of the emergency department are behavioral and substance patients trying to make a broken healthcare and economic system work for their day to day struggle. Chronic pain, depression, anxiety, along with other chronic conditions are likely to increase self medication. In addition to depression and anxiety which are significant, also boredom and lack of purpose may inspire late in life adventuring with substances. Hallucinogens are the latest craze in anxiety and PTSD treatments. Alcohol is still king and many seniors are moving into planned communities where alcohol problems only are addressed when they explode on the grapevine. Opiates are number two for older adults in chronic and emergent pain. As everyone with a television knows the medical community has been most effective at fragmenting pain management and disrupting the doctor patient relationship so that people’s pain needs are under managed. This lack of compassionate care is driving isolated patients to the heroin dealer and other shadow solutions. Marijuana, legal in many states now comes in super-power concentrations and cute little edibles. It maybe an effective pain management substitute but little is know about its effects on cognitive impairment. Researchers are not motivated to study much about drug use and aging. In fact, the beautiful report by the surgeon general on substance use disorders only notes one single study with seniors and this is about treatment not neurobiology.
Older adults are likely to develop mental health symptoms especially if they have never developed coping skills to address carried shame, secrets and trauma. If these need attention, they may be mistaken for physical illness along with layers of bio-behavioral health problems .
My mother began sneaking cigarettes late in her life as her dementia worsened. Later after speaking with a gerontology nurse, she mentioned that the bolus of dopamine released by the nicotine probably gave my mother some relief from her addled brain. Of course it did. People use drugs for reasons. While the fact that Carrie Fisher made some choices to use drugs in this part of her life, may feel disappointing, what is more disappointing to me, is that she likely had no place that she could think out loud about her needs, comforts, pleasures and reasons that substance use made sense to her. These kinds of conversations have the most likelihood to elevate drug use choices into self-efficacious ones or at least maximize the benefits and minimize the harms.
For me, as I think about Carrie Fisher, knowing now that she was asking drugs to assist her with something, I wonder who did she confide in about these last decisions regarding substance use. I look back on those charming interviews with that crazy looking dog and wonder. I see my own reticence to show anyone what aging is delivering to my doorstep as I crack another joke about it… how we will remake an entire health care business around this long strange trip of aging and dying? © annie fahy 2017