Windows and Waves. “We dedicate ourselves anew daily.” —…
By: Washington Irving
Tags: Benzodiazepine Withdrawal, Benzodiazepines, Alcohol Withdrawal, Alcohol, Substance Abuse

“We dedicate ourselves anew daily.”

— Cormac McCarthy

When the world went to shit, my world was down there waiting for it. Have a seat, it said. I’ll put on some coffee.

This past spring, unforeseen circumstances compelled me to quit benzodiazepines. I’d been taking them on a daily basis for the better part of two years. This is not advisable. Do not try this shit at home.

I didn’t take benzos for the purpose of getting high, though this was sometimes an ancillary benefit. I took them because panic was keeping me from leading a meaningful life. I took them once in the morning, in order to function, and once at night, in order to sleep.

By the time it came time for me to quit, I was no longer a babe in the woods: alcohol withdrawal had very nearly killed me any number of times, and I well knew that benzodiazepine withdrawal was the ultramarathon of withdrawal experiences. Years of life on the fringe had granted me an honorary doctorate in pharmacology: I knew the very real peril that I faced. I knew (roughly) the neurochemical reasons why that peril was so grave, and why that peril needed to be confronted and overcome. I knew, in short, exactly what I’d gotten myself into. I’d bought the ticket; now I was about to take the ride.

I also knew that I needed to taper down slowly in order to survive. Cold turkey is not an option with benzodiazepines. Unfortunately, the medical reluctance to prescribe benzodiazepines to that end is matched only by a widespread ignorance of what, exactly, benzodiazepine withdrawal entails.

My GP refused to help. She told me that my world would “feel like it was crashing down around me,” but that I’d get through it no problem. I was told to suck it up. I was told that I’d made my bed, and that it was now time for me to lie down in it. I was not told that I might die, though I certainly knew this to be a realistic possibility. In my case, it was more of an inevitability.

Benzodiazepines plug into the GABA receptors in our brains, the receptors responsible for gobbling up the inhibitory neurotransmitters that dull the excitatory responses of our nervous systems. By so doing, they bring about a sense of calm, relaxation, stability, sanity. Benzos fit into the GABA keyhole with an especial snugness. They fucking work, and there are plenty of good reasons for prescribing them — you’ve probably been prescribed benzos for a fear of flying, for a panic attack, or prior to surgery or an MRI. Their efficacy is precisely why they are so addictive and (in the long run) so very deadly.

The human brain is a bean counter, a right stingy little twat: if the brain can skimp on infrastructure in order to shave a buck or two off the quarterly budget, it will always skimp. So a long-term benzo habit results in the brain pruning away those precious GABA receptors. If we’re getting the stuff for free, reasons the brain, why the hell are we wasting our hard-earned tax dollars on all these freeloading GABA receptors? And so all that delicate machinery gets flushed out, the stimulus package gets trimmed down to a $600 cash payment, and the brain reinvests in Building The Wall. But just so long as we’re still getting the good stuff from an outside supplier, all is very well, indeed.

When that supply is abruptly cut off, the brain is left exposed to the elements, as though the roof of the skull has been peeled away; the brain is left totally naked, like a joint stripped of cartilage. All manner of outside stimuli, all manner of internal quivering; all that is frightening, all that is taxing, all that is surprising or stimulating or existentially dreadful becomes suddenly and infinitely moreso; all electrical signals within the brain are run through an overdrive pedal that is run through an effects board that is run through an amplifier that is turned up to 11. The state of mind that results is analogous to madness, or schizophrenia, or a seizure disorder — or all three rolled into one.

This was the state that I’d hoped to avoid by tapering off of the stuff. But tapering was not an option that was afforded to me. By the time I found myself in the clutches of withdrawal, it was already much too late. There was nothing to be done: I had passed beyond the event horizon, and was sucked irretrievably into the yawning mouth of the black hole.

Benzodiazepine withdrawal (like alcohol withdrawal and unlike opiate withdrawal) can be (in and of itself) fatal. You can’t just shut the benzo addict up in a cupboard for three days and expect her to survive. Those untamed excitatory responses I mentioned can trigger seizures, and those seizures can and will kill you.

I had four months of alcohol-free living under my belt by the time benzo withdrawal arrived. So it was a cruel irony that (in the absence of medical treatment) I needed to drink again in order to survive. Booze dulled things down just enough to where I could put one foot in front of the other without dying. I was no longer drinking to elevation: I was drinking to keep myself from having a seizure and dying alone in my apartment.

This all must be very strange to read. It was doubly strange to experience. As I sat at the edge of my bed trying to drink my way to sobriety, I couldn’t help but wonder just how in the hell I’d gotten to where I’d wound up. As with many another personal disaster, it happened gradually; then, it happened all at once.

As I stumbled my way into my thirties, the sort of anxiety I’d been dealing with — the anxiety that drove me to take benzos in the first place — was not the sort of anxiety you experience before a test, and not the sort of anxiety you feel about public speaking. Neither was it context-dependent: it was not brought on by stress, by lack of sleep, by crowds of people, by solitude or darkness or the fear of death or by frightening encounters with wild beasts or murderous hoboes, though these were all aggravating factors. This was causa sui panic, panic that spiraled out from itself, spawning yet more panic and boundless fear of that selfsame panic: meta-panic, if you like. The panic emanated from the interior of my own skull with no regard for what was going on outside of it. The call was, as it were, coming from inside the house.

I’d tried therapy, medication, meditation, booze, sobriety, exercise, relaxation, radical extroversion, radical introversion, fasting, gluttony, supplementation, detox, and just about everything short of autolobotomy. It was desperation that drove me to benzos, and it was benzos that, in the end, brought me to the very peak of desperation.

Just as there is a qualitative difference between anxiety and panic, there is a qualitative difference between fear and the sort of horror that awaits one in the depths of benzo withdrawal. Ordinary visual experiences — the sight of a tree, of a human face, of the front of a house — turn twisted and monstrous, become the very embodiment of pure terror; isolated thoughts swing like fists, then spiral into themselves, whirling into a kind of singularity that pulls your consciousness down with it into a tornadic abyss of self-referential horror. Sudden movements threaten to jolt your skeleton out of its body, and your brain right along with it. Time becomes both elastic and inescapable, like a tight little cage woven together out of bungee cords.

The moods and thoughts and emotions you might experience over the course of an entire day are compressed into ten seconds, and those ten seconds feel like weeks.

I’ve heard this phenomenon described as “windows and waves,” which is about as apt a description for the experience as I think is possible, short of writing the sort of twelve-page dissertation that I am now subjecting you to, dear reader.

The early stages of subacute benzodiazepine withdrawal consist of a series of existential waves, and the wavelengths of these oscillations (if you survive the first few peaks and valleys) lengthen as you go along.

The first week or so is subdivided into ten-second increments: ten seconds of unmitigated horror, ten seconds of guarded optimism, ten seconds of unmitigated horror — rinse, wash, repeat.

At first, that sense of optimism dupes you into believing that the end is just around the corner, that the next ten seconds will be smoother than the ten seconds that came before, that things will improve. But that is not the nature of the beast. The next ten seconds may in fact be better, but they will just as often be much worse. Your hopes are, every ten seconds, born anew and dashed to pieces. Over time, you learn to use those ten seconds of relative tranquility to gather your strength for the next onrushing wave; there is no longer any time for optimism, nor is there much reason for it; you are in the belly of the beast now, and you will need every last bit of strength that you can summon in order to endure the next ten seconds.

By the end of the second week, if all goes well, those oscillations will have lengthened to five minutes or so: five minutes of unmitigated horror, five minutes of guarded optimism.

By the end of your first full month, you’re measuring out your life in hours: an hour of horror, an hour of hope, back and forth until you pass out from exhaustion. During that hour of horror, you dread all sorts of things: having a seizure, having a stroke, shitting your pants, freaking out in public, suffering a heart attack (your heart has been churning along at a machine gun clip for thirty consecutive days by then; this fear is not wholly unreasonable); perhaps most of all, you fear losing your mind. The fear of insanity is constant, and it is the desire to remain sane (almost more than the desire to live) that sustains you, keeps you on your Ps and Qs. Throughout, there is the sense that to simply let go — to lose oneself to unconsciousness, to death, to madness — would be far easier than to endure another second of this wretched form of existence that you have willed upon yourself.

But if you’re lucky, you do not succumb to that thirst for capitulation. I was fortunate (and heartened) to find deep within myself a bottomless reservoir, an inexhaustible and non-negotiable desire to keep living, to keep pulling and dragging myself forward into the next instant, no matter what horrors that instant brought along with it. In the blackest moments of that stripped-down mode of being — beneath several murky layers of consciousness, beneath thoughts of my friends and family, beneath thoughts of myself, beneath all notions of the world around me — when all of my thoughts and values and memories had evaporated, all that remained was a nameless, colorless, formless desire to keep going. It ran deeper than spirituality, went beyond reason, beyond good and evil, beyond the reach of any god known to man: it was the naked will to survive, no matter what form that survival took. And when my mind and my body failed me and I found myself truly and undeniably alone in the universe, it was that humble thirst for life, that flickering little spark that lit my way and beckoned me forward, on to the next instant, and the next one, and the instant after that. Breathe in, breathe out. Do that again. Keep breathing.

The desire to live is what kept me alive.

In the depths of it, I lost the ability to walk, and could not leave my bed. (I could not go anywhere, and you’re welcome to imagine how gnarly that got to be after a week or two.) I discovered with much amplified and infinitely reverberated horror that I had lost the ability to type. I could still speak and, very weirdly, found that I was suddenly capable of singing in a rather pretty (if also rather affected) baritone — but there was now a disconnect between the words churning around in my mind and the words I wished to put on paper. I could find the letters, but could not piece them together into words. I could not work a keyboard and could not wrap my mind around a phone, so I could not communicate any longer with the outside world, unless it were to a person a few feet away — and in the state I was in, very few people wanted to be anywhere near me.

All sorts of bizarre physical and psychological sensations: for a day or two in the early stages, I felt positively and inexplicably high, as though I were on a threshold dose of psilocybin, privy to certain secrets of the universe that (as with all such illusory secrets) I could not articulate but knew to be true. This did not last very long; I would pay for this fleeting euphoria in spades.

My abdomen grew unbearably sensitive, such that the slightest touch or the merest brush caused me to cry out. During my infrequent bouts of sleep, my cat (who was beyond sweet through the whole thing) would knead my belly and send me into paroxysms of nervous shock.

I could not bear change. New sources of stimulation were uniformly terrifying to me. I listened to the same anodyne five-minute stretch of my favorite sports podcast over and over again, hundreds, perhaps thousands of times. The next five minutes of the podcast touched on the coronavirus pandemic, and this was a reality too horrific for me to confront, so I kept listening to my five minutes of idle chatter on an infinite loop.

After a month, I was gradually able to watch stupid movies again — or bits of them — and treated myself to nightly 3 AM screenings of Rudy and Field of Dreams, lying there bawling and muttering to myself the words “go the distance, Ray — go the distance.”

After two months, I cycled between hours of relative normality and sporadic flickers of terror. It was a summer of sorts for everyone else. I started going on walks along the Keystone Trail: ten minutes out, and then I’d hustle back home lest I lose my mind in public. Then twenty minutes out. Then forty. Then an hour and a half. Then I would set out for the day with a pocket full of Kind bars and an audiobook in my ears and walk around for hours: aimlessly, miraculously.

I had to relearn how to type, relearn how to think, relearn how to exist. Everything was burned down to the ground and built back up from nothing, scaffolding exposed, dusty old bricks layered upon that foundational drive to live.

Memories of the month of April leap out at me now from behind a warped pane of glass. I wound up in the emergency room more times than I can now remember. Each time, I’d be kept around long enough to receive one or two or three doses of Ativan, Librium, Lyrica, spaced out at six-hour intervals. Then I was clapped on the back by a physician who, with a winning smile, made me promise that I’d never wind up there again. I wouldn’t, I’d tell him. I promised him I wouldn’t. And I meant it. Then, after a day or two of sipping Mike’s Hard at the edge of my bed, beating back escalating waves of convulsions and terror and madness, I’d find myself hobbling half-dressed across the courtyard to the team of paramedics waiting for me in the parking lot.

At one point, I did have a seizure. Or we think I did. In any case, I lost consciousness and woke up on the floor covered in blood. The medical folks concluded that I had experienced an “event,” which was certainly true enough.

A psychologist at UNMC saved my life. She, more than anyone else had up until that point, listened to me, and understood me, and took me at my word. She assessed my situation and did what no one else had been willing to do: she took a risk. She told me that we were going to try out a medication called hydroxyzine. From my years in the insurance racket, I knew that this was an antihistamine, and that it was prescribed primarily for the treatment of chronic itching in oldsters, and (less often) for anxiety.

I did not have much faith that it would work. Benzodiazepine withdrawal was not, to my knowledge, treatable with anything other than benzodiazepines — and prescribing an antihistamine seemed like using a garden hose to put out a forest fire raging down in the very bowels of Hell. But I trusted this doctor because she had trusted me. And at the end of my six-hour shift, when the convulsions started to come on and the fear came uncorked from my amygdala, I took my hydroxyzine and sat down by the window and waited.

An hour passed. I watched the gray smoke come billowing out of the red brick chimneystack across the way, watched it play across the pulsing neon Charlie Graham sign.

The neon sign that kept me company, dear reader.

I was restless, twitchy, and terrified — but it was manageable. I could deal with it. Six hours passed and I took another pill. Same. This was doable. I was supposed to stay in the hospital for another three days, but I didn’t have anything to read and I grew frightfully bored the next afternoon — the first time I’d been bored all year. I politely asked whether I might be able to leave. I was discharged the following morning. I haven’t been back.

I’m one of the lucky ones. These days, when I’m able to put down Hannah Arendt and pull my head out of my ass, I reach out to people who are (right now) stuck in the same space that I inhabited for two impossible months. And I reach out to people who never quite left that space: one, two, three years on down the road, and they’re still not back to normal; plagued by panic, unable to sleep, unable to work, unable to think, or unable not to think; teetering on the edge of madness, cobbling it all together with pipecleaners and electrical tape, voicing their grievances by way of eliding suicide for the moment; a sense of having been broken, electrocuted, lobotomized, amputated, cut off from themselves and the rest of the world.

I suffered my share, and terrified everyone I know, and saw things within myself that I never wanted to see and never care to see again. But I’m one of the lucky ones. I got out alive, and sane, and healthy, and intact. And I know enough to never go back to where I was. I am now, in my own especially relativistic way, very much back to normal. I sit in on my weekly group therapy sessions and say stupid things that make all the old coke fiends laugh. But mostly I just listen, and learn.

I’m one of the lucky ones: lucky to have a compassionate family and compassionate friends and the means and the desire to seek out help and to seek out treatment. I enjoy life again. I’m one of the lucky ones. I read until I’m crosseyed. I grunt at myself in the mirror as I work my glutes. I still can’t bring myself to give a shit about football. I drift off to sleep midway through the second quarter, start nodding off in the middle of a paragraph, get lost in a daydream and find that the sun has set on another bleary pandemic day without even the feeblest stirring of anxiety. The anxiety that had consumed my life before, and had driven me to benzos in the first place, is no longer part of my life.

The horrors of an uncontrolled plague and an autocratic breakthrough are not lost on me, but neither are they all-consuming. I weather them much as you do. I have no desire to use benzos or alcohol or anything else; I am one of the lucky ones. But I must always remain vigilant. This was all eight months ago now, but it may as well have been just yesterday, and it is helpful to think of it as though it were. The pandemic is terrifying; the blob man is terrifying; but I am, same as I ever was, palpably more terrified of making awkward eye contact with the Amazon delivery guy as he shuffles his way past my window and up to my porch to drop off more Hannah Arendt.

In their way, these misadventures within were an extension of my misadventures abroad. When I, as a misguided twentysomething, set out to explore the watery parts of the world, it was from a desire to find some semblance of truth somewhere out there, and with the conviction that certain truths could not be found within the confines of a cubicle stashed in the basement of a mirror-windowed rectangle way out in West Omaha.

This notional truth about truths is, of course, a falsehood: truth is everywhere, so long as you know where to go looking for it.

Dissatisfied with the truths without, I turned to plumbing the truths within. Drugs were (of course) involved, and there was much reading and brooding and altogether too little writing. I got to know quite a lot about myself in the process.

But this inward pursuit, too, proved more destructive than constructive. Certain truths remain forever unattainable; certain truths are just straight-up undesirable. And an often overlooked part of seeking out truth involves creating truth: of taking those truths you have unearthed at great cost and sharing them for the benefit of other truth-seekers like yourself; of speaking the truth where you can, of challenging the falsehoods you encounter and, in the act of creation, generating new truths that you may not yet be aware of, not even in the instant that you voice them.

I have overused the word “horrors” here, but there is not a better way of describing these experiences. And I would not take back a single moment of those horrors I have imposed upon myself. My existence would not be complete if I had not experienced them. But they are not experiences that anyone else should seek out. Perhaps that is part of why I write about them: a cautionary tale, abandon all hope, ye who enter here.

On hope: perhaps that is the most lasting impression I have taken from the whole experience, a little lesson I learned about myself and about human nature.

Hope is often conflated with the hope for change. We hope under the assumption that things can and will and often do get better. But what I discovered is that, even when no such reason for hope exists — when time feeds back into itself, and there can be no beginning because there is no conceivable future — hope nevertheless persists. Hope is there whether it deserves to be or not, whether you will it into being or not. Whatever its root causes — whether misguided optimism, or misplaced faith, or a raw and naked animal desire to survive and procreate and all the rest — those causes do not matter, because hope exists even in the absence of reasons for it to exist. Especially in their absence.

Hope exists despite all, and when you really tap into it, you will find that you were granted an inexhaustible supply. It’s easy to lose track of it, or to forget that it exists. But it’s there. You just have to listen real close for it.

Listen.