My patient’s drinking masked a new form of grief after the bushfires

Hester Wilson

17/02/2020 1:39:03 PM

What was dragging this patient down? The state of the world, Dr Hester Wilson writes.

World map in a beer
With the state of the world on his mind, George turned to alcohol.

Over the years, I’ve treated George for minor issues – self-limiting illnesses and sports injuries, that sort of that thing. At 35, he was in good health.
But this time was different.
He came in and sat down. ‘What you would like to talk about?’ I asked. George shrugged.
‘My mate told me to come,’ he said. ‘He’s worried about me.’
What, I asked, was his friend worried about.
George paused. He then admitted that he’d been going out partying and drinking a great deal.
‘Sometimes I get into fights. Sometimes I drink so much I can’t find my way home. Often I can’t remember what I did the night before,’ he said. ‘Every weekend I think to myself, “I’ve gotta stop this”, but then I do it again.’
George was finding it hard to meet my eyes. He instead focused on a corner of the room and kept talking.
‘It feels out of control and at the same time I want to keep doing it,’ he explained. ‘My mate says that I drink differently to him. Sometimes he wants to call it a night, but I convince him to stay out.
‘Other times, he feels he has to stay or I’ll get myself into trouble. He’s already had to break up fights I’ve got into.
‘I’m just so angry all the time.’
George’s story surprised me. If you looked at him or spoke to him, you’d never guess it. But why, I wondered, was he so angry?
He grimaced.
‘I feel so ashamed. I can’t believe my life, I can’t believe what is happening in the world,’ he said. ‘I feel like I hate everyone and everything and the world is falling apart.
‘I can’t see any future. Christmas in Sydney was awful, the smoke and the heat, I’m so fearful of everything. I’ve been arguing with my girlfriend because she wants to have kids and I can’t see any future and climate change is going to kill us all and the world is controlled by right-wing idiots who do nothing to stop the destruction.
‘And the bushfires, I watch the news and see the destruction, the millions of animals killed, the lives lost, the blame game that means nothing is done.
‘I guess I want to drink so I don’t feel this bad.’

Dr Wilson believes GPs will be faced with more and more patients who turn to alcohol or other drugs in the face of a rapidly changing world. (Image AAP) 

I ask more about George’s background.
He says he’s been fine before this. There’s no history of mental health issues or alcohol or other drug problems in his family. He’s never had any issues with his mental health in the past, or used cannabis or any other drugs. And, before this year, he’s always been ambivalent towards alcohol.
George describes himself as not much of a drinker.
‘I might have had a couple of beers on Friday night, but nothing else. Sometimes I wouldn’t even have one when my mates were,’ he said. ‘Until now, I’d always felt I could take it or leave it. Not anymore.’
I ask more questions. He’s fit and takes no medications. He had a happy childhood, did well in school and completed a master’s degree. He’s been working since his graduation and enjoyed life with lots of friends and family around him.
Try as I might, I can find no other triggers or difficult personal experiences to explain his drinking and the abiding sadness he feels now.
His drinking and sadness seems to have been caused by a deep sense of loss and anger for the state of the world now.
George is the first person I’ve treated whose mental state has been so directly affected by climate change. He won’t be my last.
I can’t say I blame him. His grief is from paying attention to the news and seeing the change that is upon us. And George makes me wonder about those in our community more directly affected by climate change, by the catastrophic fires blazing around our country as I write and the floods that have come directly afterwards. Of the impact that has on those who have lost their homes, livelihoods, their farms, their animals. Of those who have lost loved ones. Of people who – despite doing everything they could – have lost a great deal.
What do you pack to take with you if you have to leave, knowing you may never see your home again? Do you wonder if you made the right decisions? And what of the anxiety of families split up, not knowing if they will see each other again?
I wonder at how this Black Summer will play out over time. How it will affect wellbeing and resilience. How does it affect the firefighters and their families?
But right now, with George in front of me, I worry about how to treat an existential crisis. Sure, we can say that this is a depressive illness. We talk about his alcohol use and I’m following him up to support that change and get him some counselling. But I’m left wondering if that’s enough. Was I just treating the symptoms, not the cause?
It feels a little like Nero fiddling while Rome burns. How much can our community take? And how much can we take as practitioners seeing this, how much does it affect us? How many of our patients and how many of us will succumb to alcohol or other drugs, or to depression and despair?
A situation like George’s can feel overwhelming as a GP. 
After this summer, we need to check in with all our patients and ask about their substance use. Substances like alcohol, tobacco and opioids are old well-known friends to our species – quick fixes that relieve the immediate suffering, but often at a long-term cost.
So far, George has been lucky. He hasn’t been arrested, hasn’t been seriously injured, and hasn’t lost his relationships. But he could if he doesn’t work this out. And we as GPs need to step up to help our patients in this situation.
George is resourceful, with high health literacy. He’s seeking help and able to explain his distress. That gives me hope for him – it is likely he will do well, with support to move on for the place he finds himself now.
But I believe that George will be joined by others in his instinct to turn to alcohol or other drugs. This is, after all, only the start.
So how do we do it? How do we respond to this grief, and to the substance use that can accompany it?
We need to look after ourselves. We can only take on what we have capacity to do. We can work to build our capacity. And we can ask for help.
The RACGP is rolling out its ‘Alcohol and other drugs GP education’ program this year to help GPs with this work. 
I have been involved in planning this program and will assist with facilitating it. We have all tried to make it as useful and practical for all GPs as possible. I encourage you all to take a look.

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Dr Christopher John Hazzard   18/02/2020 2:49:24 PM

Thanks, Dr. Wilson.
I am observing these symptoms in myself. I began to reflect, "Why do I feel so angry? So sad? So helpless?"
I think that many are suffering a collective loss as a result of the fires, even when we as individuals may have not been directly impacted. For those who have lost their homes, their animals, their possessions the grief must be even more.
My approach for myself will be to manage it as a grief reaction. Talk about it, validate the feelings, comfort others. Lastly, give myself time and when I am ready, do something constructive.
As a GP I will be keeping a high degree of awareness for somatic symptoms masking depression in my patients.