San Francisco as the epicenter of loss: Part 1

Keith  Haring, Untitled, 1983 The Political Line: Keith Haring, De Young Museum,  San Francisco, Ca.,  November 8, 2014- February 16, 2015
Keith Haring, Untitled, 1983
The Political Line: Keith Haring, De Young Museum, San Francisco, Ca.,
November 8, 2014- February 16, 2015

It was 1981 and I was at the underground MUNI Van Ness Station in San Francisco. The platform was sparsely occupied. Who knows where I was going. Public transportation was a part of my daily routine.

I had had my struggles in emerging from a very self-destructive lifestyle (to say the least) to one in which I was trying to stop using drugs and alcohol. My success at this endeavor was intermittent at the time but I was making an effort to change my course in life. This cost me friendships with people who I hung out with. I knew I would never stay clean if I continued to see them.

My friends defined me in my 20’s which, I think, is pretty much the case for most people. The loss of my party friends was a major loss for me as I began my recovery. A treatment program somewhat prepared me for this. I had no warning or preparation for the other overwhelming loss that was to take place in my social sphere.

It was not unusual in those days to run into someone you knew from the nightlife especially if you were taking a train to the Castro, the gay hub of San Francisco. I was standing on the platform when a familiar face came into view. My friend, Spider, approached. (At the time many people had odd nicknames that described their personality, some aspect of their appearance or how they made their living — Flamingo, Peaches, Rusty Nails.) He was the most drug-addled of all the people I knew. His name fit him well; he had a removed and sinister air about him and was at the center of a literal web of people in the gay drug scene.

He was, on this rare occasion, not under the influence of a drug. That struck me as strange in itself. He said he had been ill lately and chalked it up to a case of the flu. We had the most mundane of conversations. We caught up. I explained that I was trying to get out of the party scene and so had not been in touch or returned his calls. He seemed to understand. I watched as he ascended the MUNI stairs towards the street level. There was a fatalistic air about him that made me quite uneasy but I passed it off as a relic of our shared past.

Three days later I got the call. A mutual friend informed me that Spider had been admitted to the hospital and transferred to the intensive care unit. He had a severe pneumonia which was very difficult to diagnose; it turned out to be pneumocystis. He was intubated and in critical condition. While he could still speak he had asked that some friends be notified.

During this time a number of gay men had been getting deathly ill. No one really knew what was wrong; people were saying that it was the “gay plague”. Most people were misinformed and naive. Paranoia was the order of the day. Who might have it and how you got it were mysteries. AIDS was a diagnosis that was not even on the radar yet. We were still in unknown territory.

I called a physician friend who had treated both myself and Spider and we hurried over to Ralph K. Davies Hospital in the Castro. I was only 27 and had never been in the presence of anyone critically ill. We stood at the bedside in shock. Spider was unable to breathe on his own and was no longer conscious. We did our best to say goodbye. He died soon after our visit. It was very quick. In those early days there was not a lot they knew about prolonging life when you had the illness.

AIDS decimated the gay community in San Francisco from 1980 to 1995. Spider was the first friend I lost. He would be far from the last. My circle of friends became ever smaller as the noose tightened. Virtually all the gay men who I knew from the 70’s, save one, would be dead in a fifteen year span….

Are you ready to change?

Are you ready to change?

We all have bad habits that get in the way of our enjoyment of life. These habits can be highly self-destructive; heroin addiction is an example. Or they can be small things that might hold us back such as watching too much TV. Whatever the case, you may be wondering how people go about changing; understanding change might make it easier to do.

Quite a number of years ago now, Prochaska and DiClemente (1983) came up with a model of change that explains how people modify a problem behavior or acquire a positive behavior. Initially it was applied to smoking cessation and is now used to explain changes in behavior in general. The primary organizing principle in this model is called the Stages of Change; it describes a person’s readiness to change in 5 stages. Let’s look at how this might apply for someone with an alcohol problem.

Precontemplation

In this stage a person is not even thinking of stopping their use of alcohol. Either the consequences of use are not grave enough or the person is willing to deny the seriousness of the problem despite evidence to the contrary.

Contemplation

As problems multiply due to excessive alcohol use a person may begin to accept that they have a problem. As a result of their drinking they may have financial, relationship or work difficulties or they may develop a health or mental health issue. Essentially, at some point, negative consequences may allow a person to develop some insight into the nature of the problem.

Preparation

Contrary to what many people think, most people do not stop drinking in a vacuum. An often overlooked issue is that people have more success when they PREPARE to stop using once they have acknowledged a problem. Preparation could include decreasing how often or how much they drink each day, changing their social circle, changing their everyday routine so they don’t walk by their favorite bar, or beginning a meditation practice. They may decide on a stop date. The manner in which a person decides to prepare to change their drinking habit is as individual as they are.

Action

At a certain point enough supports are in place to enable the drinker to decide to stop or modify their use. This does not only include elimination of a problem behavior but also includes the addition of positive behaviors. In short, a bad habit is replaced by a good habit. For example, it is not unusual for people to become involved in some kind of sport or exercise regimen as a replacement for their alcohol use.

Maintenance

A person becomes more confident about the changes they have made when they have a period of sustained abstinence or non-problematic use of alcohol. They are actively using strategies that they developed in the action phase and are able to maintain and build upon positive changes, preventing relapse.

Relapse is not included in the original model but can be considered to be a sixth stage. It is important to remember that relapse is very common and that a great deal can be learned from what precipitated the relapse. It is advisable to examine what may have preceded a return to problematic drinking so that the person can develop strategies to cope with this in the future.

On the path?
I have described a way that people change that has been validated by the research and by many people’s experiences. If you want to change a behavior it helps to know what the terrain looks like as you move forward. Nothing changes unless you do the footwork….

REFERENCES
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Norcross JC1, Krebs PM, Prochaska JO. Stages of change. J Clin Psychol. 2011 Feb;67(2):143-54. PMID: 21157930.

Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51, 390-395.

DISCLAIMER
This information is for educational purposes only and should not in any way be considered a substitute for professional help. If you are in need of immediate help please contact your local psychiatric emergency services.