Khyaati Tapadia
Where I’m Calling From is a short story written by Raymond Carver in a collection by the same name. The setting is Frank Martin’s, a drying-out facility for alcohol addicts. The narrator gives us a glimpse of the lifestyle at the centre and takes us through the different journeys individuals go through with a focus on recovery. As demonstrated in the line “like the rest of us at Frank Martin’s, J.P. is first and foremost a drunk”, the narrator defines himself by his addiction; he shows a simultaneous acceptance, and a sense of loss of self-identity. Carver explores various symptoms of withdrawal in the short story, providing insights about the determinants of recovery, the importance of a support system and the various ways in which it can be found. This blog post explores the portrayal of alcohol withdrawal syndrome and the determinants of recovery through Where I’m Calling From by Raymond Carver.
As defined by the American Psychological Association, Alcohol Withdrawal Syndrome (AWS) refers to the physiological, biological and cognitive responses to the reduction or halting of alcohol use after a prolonged period of consumption or excessive intake. The short story shows multiple behavioural patterns to expose the reader to the variety and range of symptoms found in different subtypes of withdrawal syndrome. These include trembling and shaking, loss of appetite, seizures and deliriousness.
Trembling and shaking
J.P., a new inhabitant having abstained for a few days, starts feeling jitters in his hands. The narrator states that “the shakes will idle down. And they will. But it takes time” (Carver, p.191). According to APA, tremors are also a symptom of a withdrawal syndrome known as Delirium Tremens or DT, which can last for up to 10 days after the last drink. However, DT is a severe and fatal withdrawal syndrome, and tremors are a common symptom found in milder withdrawal syndromes as well (Bayard et al., 2004).
Seizures
Tiny, having abstained for two weeks at Frank Martin’s, expresses the lack of desire to drink. As he becomes hopeful to be able to go back home, he experiences a seizure that replaces his optimism with despair. The severity of withdrawal seizures has been shown to have a positive correlation with prior episodes of withdrawal from alcohol (Becker, 1994). Thus, if this was Tiny’s first seizure from withdrawal, it can be predicted that if he relapses and undergoes abstinence for the second time, he may experience more severe seizures as a symptom. Moreover, withdrawal seizures and epileptic seizures have different trigger zones, which means that different areas of brain are affected by seizures in case of withdrawal and epilepsy. Thus, the treatment for withdrawal seizures has to be unique as well (Jesse et al., 2016).
Loss of Appetite
The narrator mentions the return of his own appetite while drawing a parallel with Tiny’s lack of appetite post seizure. Loss of appetite is another common manifestation of withdrawal. Nausea and vomiting are constructs used to measure the extent of withdrawal symptoms, however, we won’t find mentions of these in the short story.
Withdrawal symptoms can contribute towards relapse and increase the chances of further abuse (Becker, 2008). The increase in dopamine levels during withdrawal can lead to manifestations of hyperarousal and hallucinations in some cases (Jesse et al., 2016). Thus, there is potential for deliriousness in severe cases where the likelihood of co-morbidities such as liver disease existing is high (Grover & Ghosh, 2018). Now, these are extreme and severe cases. Most users exist in the moderate drinking range, and this is well depicted by Carver. By not showing extremes, he has shown people who were somewhere between moderate to heavy drinkers. The narrator is shown to be a moderate drinker and realises that his addiction may have relapsed before it became obvious to the passerby when for a few days, he “didn’t eat anything but salted nuts” (Carver, p.198). Moderate-use caused addiction appears to be overlooked and underestimated, especially due to the prevalence of extreme-use caused addiction in pop culture. Thus, Carver’s work is an important contributor in the larger discourse of addiction and the myth of just “how much drinking will or won’t get you addicted?”
Carver shows contributory factors towards the addiction through bringing in backgrounds of childhood trauma, physical and emotional violence, and lack of support system in families and friends. At the same time, he also shows the presence of support and solidarity at Frank Martin’s. Although the Centre is just a drying-out facility, there is a sense of understanding and empathy for one another. Moreover, because the inhabitants live there voluntarily and have to show proactive behaviour against addiction, there clearly exists the willpower to get rid of the urge to use substances. The facility advises “two weeks or a month” of minimum stay, though a time period of abstinence can help the individual to recover to some extent, it does not address any of the contributory factors that originally led to addiction. The contributory factors can include intergenerational influences, environmental influences and the proximity or availability of the substance from the individual.
The inhabitants of Frank Martin’s undertake several activities to distract themselves. They cook, interact with one another and read. They also smoke cigarettes and cigars. These methods are not necessarily therapeutic but are used in therapy along with medications at times. At the facility, these methods do not directly address any of the co-morbidities or contributory factors towards addiction but provide an escape to the escapist that has turned to alcohol use. “I’m listening. It’s helping me relax, for one thing. It’s taking me away from my own situation”, says the narrator as he urges J.P. to continue his story (Carver, p.195). Through J.P.’s story and the disrespect with which his family leaves the facility as it seemed like “they couldn’t wait to wash their hands of all this”, the narrator accepts the shame and guilt of being an addict. There is an emphasis on low self-esteem and the projected shame associated with addiction. Moreover, there is a sense of loss of self-identity, which can be seen through the lack of introduction and context the reader is provided with. The distraction is clearly not enough to deal with the bigger agenda at hand.
Frank Martin provides the inhabitants of the facility with solidarity, support and hope. It does not provide them with medical facilities and the residents are expected to patiently await recovery from withdrawal. The narrator has come to Frank Martin’s for the second time, making the reader question the effectiveness of the, rather informal, methods undertaken for recovery. Is willpower enough for recovery? Clearly, it is not as simple as that. Carver portrays the different kinds of support that can help individuals dealing with addiction while giving the reader insights into the factors contributing to addiction and relapse. He does not delve into the methods of recovery, and the validity of it, and leaves the reader to decide whether there is a definite and legitimate way to recover from addiction. The different journeys taken by the characters show that the routes to recovery must also be manifold.
References
American Psychologic Association. Delirium Tremens. APA Dictionary of Psychology. https://dictionary.apa.org/delirium-tremens
American Psychological Association. Substance Withdrawal. APA Dictionary of Psychology. https://dictionary.apa.org/substance-withdrawal
Bayard, M., McIntyre, J., Hill, K., & Woodside, J. (2004). Alcohol Withdrawal Syndrome. American Family Physician, 69(6), 1443-1450. https://www.aafp.org/pubs/afp/issues/2004/0315/p1443.html
Becker, H.C. (1994). Positive relationship between the number of prior ethanol withdrawal episodes and the severity of subsequent withdrawal seizures. Psychopharmacology (Berl), 116(1), 26-32. 10.1007/BF02244867.
Becker, H.C. (2008). Alcohol Dependence, Withdrawal and Relapse. Alcohol Res Health, 31(4): 348–361. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3860472/
Carver, R. (1989). Where I’m Calling From: Selected Stories. New York: Vintage.
Grover, S., & Ghosh, A. (2018). Delirium Tremens: Assessment and Management. Journal of clinical and experimental hepatology, 8(4), 460–470. https://doi.org/10.1016/j.jceh.2018.04.012
S. Jesse, G. Bråthen, M. Ferrara, M. Keindl,E. Ben-Menachem,R. Tanasescu,E. Brodtkorb, M. Hillbom, M.A. Leone, & A.C. Ludolph. (2017). Alcohol withdrawal syndrome: Mechanisms, manifestations, and management. Acta Neurologica Scandinavica, 135(1), 4-16. https://doi.org/10.1111/ane.12671
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