Saturday, September 06, 2014

The Importance of Routine (and Clean Living)....

There's a great essay in The New York Times that I'm sure you'll like -- it's written by Michael Hedrick, a journalist/photographer who discusses the difficult time he had in the year after he was diagnosed with schizophrenia.  Tormented by his symptoms, he spent his days at work and his evening drinking and smoking pot, until he lost his job then landed in court with a DWI charge.  Mandated to treatment (for substance abuse) and drug testing, Hedrick writes in Living With Schizophrenia: The Importance of Routine:

Maybe it was the shock of meeting with a D.U.I. lawyer, or the point after sentencing when I realized I’d be forced to make a daily call, first thing in the morning, to find out if I would have to pee in a cup that day. Maybe it was the fact that I’d need someone else, mainly my mom, to drive me anywhere for the next year. Or perhaps it was the consistent Saturday morning drug and alcohol therapy group or Wednesday and Thursday afternoons of community service that kicked me into a groove.

The groove of it eventually turned into a routine, one that wasn’t marked by indulgence but instead by forced commitment that eventually I would grow to respect.
During that time, I quit smoking pot, I quit drinking and I got some of the best sleep I’d gotten since my diagnosis. Trips to the bar on Monday afternoons turned into extended hours at coffee shops where I finished my first novel.

For some reason, it gave me joy to recite my routine to whoever asked. I would wake up at 7, get coffee and a bagel with plain cream cheese, check Facebook, write until I had 1,000 words, get lunch, do errands in the afternoon, return home, get dinner, take my pills (with food), watch TV and get to bed around 9.

It might all sound tremendously boring. But this regimented series of events was always there; they’d always carry over. And with time, it gave me great comfort to not have to deal with the unexpected. I had a set plan for most days, and there was already too much chaos in my head.
Maybe it's not just for people with schizophrenia or for people with substance abuse problems.  Routine is comforting to all of us, and clean living helps.  I almost missed this one and I'm glad I didn't, it's was worth passing along.  


Steven Reidbord MD said...

I often talk about this with patients who suffer depression and/or anxiety, and who are unemployed, disabled, or otherwise have a lot of time on their hands. It's hard for anyone to feel good when they have nothing to do, no reason to get up in the morning, no place they have to be. If work isn't an option, consider volunteering. Establish an exercise routine (or yoga, or meditation, or just taking a walk on a regular basis). Maybe plan to go shopping (or window-shopping), or at least be in public with other people a few times a week. Some people read the Bible daily and go to church every Sunday. Feel free to substitute the reading and ritual of your choice.

In addition to whatever else it does, regular therapy appointments help establish a weekly routine. An hour a week is far from sufficient, but for those who really lack structure simply coming to therapy helps get the ball rolling. And I'm always happy to hear when a formerly depressed patient has become so busy that he or she can no longer find time to see me.

Anonymous said...

Well, I'm glad he didn't kill anybody on his DUI. It's fantastic when somebody gets clean and sober, but it tends to bode better for their long term recovery when they show some real remorse for the effects of their behaviors on the people around them. And Hedrick's article was all about HIM HIM HIM.

Also, it didn't mention that pot is notorious for triggering schizophrenic delusions. Perhaps he is simply feeling better because he is no longer a stoner. Not to discount the effects of routine and good psychiatric care, but one of the things to fear as increasing legalization of marijuana leads to increased social acceptance and increased smoking is that more people primed for schizophrenia will have their first episodes younger.

But obviously, clean living is a necessary first step. One wonders, when someone says that their psych meds aren't working, if maybe they aren't secretly drinking or smoking a lot more than they are letting on to their shrink, and if this isn't canceling out the effects of their treatment. Not that the psych meds are perfect, but social drinking and being a stoner are never wholly benign....

The Alienist said...

There are some people who love routine and retreat into it when under stress. There are others who hate routine and must be forced into it. And, of course, there are all shades in between.

It seems to me that as people mature and individuate, they move from extremes to more flexible, inclusive attitudes. Those who love routine learn to let go. Those who love freedom learn the comfort of routine. Sometimes people find this out on their own, but sometimes they need to be led to it by others.