A PAINFUL TRUTH ABOUT THE RELATIONSHIP BETWEEN RETIREMENT AND ADDICTIVE ILLNESS

Caroline Ridout Stewart, MA, MSW, LCSW

During the last three years of my employment as a psychotherapist for a psychiatry program in a busy medical school practice, I found that my pending retirement at age 70 was inviting a number of referrals for same-age individuals not coping well with retirement. Now we all know the common beliefs about retirement; that Mondays are simply a glorious extension of the weekend. That being said, did you know that many individuals develop the onset of debilitating anxiety and worsening drug and alcohol consumption as they face a long Monday with nothing to do? I have found some patterns that should interest you if you are contemplating full retirement.

A number of my senior patients had been successful, engaged and goal-directed workers their whole lives. These patients were almost always proud to tell me that they had been the highest producer in their division; that they always got the job done and that they were known for the high quality of their service. Some of my highest functioning clients were bench scientists, engineers and physical plant managers. They all shared the mission of contributing to a belief that the UCSD Medical School was one of the finest in the world, and worthy of their dedication and excellence. Alas, many of my older patients with retirement-related anxiety and increased patterns of substance use met the definition of what we therapists call “farmers” or individuals with exceptionally high goal-directedness. I am, myself, a farmer. I wake up every morning with some healthy anxiety that fuels my need to scope out what obligations I have before me, how best to sequence the problems I am working on, and generally, how to do right by all those who look to me for answers. The metaphor of “farmer” is apropos because farmers work long hours days on end with little or no reward holding a mental picture in their mind’s eye of future reward. Think of a farmer toiling in the field day after day, envisioning the new tractor he hopes to buy when he takes his crop to town. My patients who struggle with a high degree of intrusive anxiety were all farmers during their active working years. And, yes, these same patients often turned to alcohol and prescription anxiety medications at the end of the day “to calm down” from perfection-informed anxious arousal.

In clinical terms, the so-called farmers are individuals with obsessive-compulsive personalities. These are folks who use their chronic anxiety as a honing tool to assure an exceptional final product. Good enough thinking is second-best in this individual’s mind. Ironically, it is not simply alcohol or prescription medications that alleviate anxiety for this population. The very work itself, what we therapists call “healthy distraction” helps to divert the individual’s attention away from their physical discomfort (throat constriction, tachycardia, sweaty palms, fatigue) to the task at hand. In other words, this farmer has a pattern of workaholism because the work, itself, pulls one’s attention away from the related endogenous anxiety that fuels the effort.

I have sadly noted that my farmer-worker-bee patients, once retired, appear to retreat into their homes and perform what might be called cocooning. I even have some patients who have developed full-blown agoraphobia, now unable to leave the house even to go to the grocery store. I find that these formerly engaged and abnormally active individuals now find themselves at loose ends. The anxiety builds as the perception of being uprooted prevails. I enjoy sharing with my patients the fact that Erik Erikson the father of developmental psychology, wisely found that every stage of human development has an endogenous, healthy mission. The mission of a newborn is to engage his mother. The mission of a toddler is to “differentiate” and to say “no” for the first time. That being said, throughout human development, we have a common mission. For adults, our primary mission is to be “generative.” That means that our primary goal must be to teach, create and nurture; in short, to generate something as opposed to consumption. Many of us accomplish this important task through parenting. When I taught my son how to ride a bike, I was manifesting my best generativity. Many of us are child free but we can achieve generativity through the sharing of art, teaching and, yes, even farming. We spend our adult lives “generating ideas, food, art and knowledge about how to live a ballpark healthy life. Employment for both parents and non-parents is a major venue in which we manifest our generativity. Some occupations are highly generative. I have already mentioned teaching but most employment allows for some generativity.

The problem with retirement, therefore, is often that it is both the end of our opportunity to be generative at the very time that we are losing our regular activity of “healthy distraction.” I guess you could call this a double blow. That, however, is not the end of our sources of anxiety. While I write this little essay as a clinician, I cannot avoid the equally important issue of existential grounding or what I choose to call an awareness of one’s “core self.” The vast majority of us are soothed by the fact that we know who we are, where we are and what our mission is on Earth.

I recall a few years ago learning of an upscale dude ranch in Wyoming that had one big rule: Do not tell people what you do for a living. I am thinking that the point of this restriction was a hoped for state of” communitas” in which “the sons of kings and slaves are equals (Martin Buber).” That being said, however, I doubt sincerely that there were individuals at the pricey dude ranch who were “slaves.” In other words, I am guessing that the dude ranch folks feared that people would “talk shop” all day long contaminating the essence of vacation. Frankly, I found this rule absurd as a large component of our self-concept lies with our core mission. While I have been a psychotherapist for the past 35 years, I must admit that I take extra satisfaction sharing with others the fact that I taught anthropology for a decade before changing professions. I feel deeply grounded by my core identity as an anthropology instructor and as a therapist. When retirement takes away our core identity, we feel as if we are floating above the ground; both untethered and free of constraint. Prior to actual retirement, we create fantasies about freedom from restraint and tethers. I recall dreaming about unscripted days of gardening and reading. I am now doing a lot of gardening as I find that it, like employment, is a healthy distraction, but I find myself feeling guilty when reading mid-day wondering if there isn’t something more productive to do.

The demise of one’s core identity along with the cruel tide of aimlessness, horrifically, worsens the anxiety that existed before retirement. Retirement is, therefore, what we might call a “perfect storm” with several variables lining up to increase the use of pathological mechanisms to quell anxiety. Along with anomie, many individuals in retirement decide to simplify their lives with a geographic move, further weakening important social network supports. Some of my own family members, once retired, moved from our urban neighborhood to a small desert community east of our city. The cost of housing was hugely more resonant with a retiree’s income but the move found these family members mired in boredom and isolation. Prior functional alcohol use imploded into all-day drinking episodes with all of the tragic related outcomes. Loss of core identity, social isolation, the loss of healthy distraction, the continued drumbeat of obsessive-compulsive perfectionism and too much free time, these are all unfortunate fueling agents for worsening substance abuse. Add shame, and the perfect storm becomes a hurricane with closeted day-time alcohol use and requests for Xanax refills. I am guessing that there is not a single reader reviewing this essay who does not know someone struggling with this unfortunate phenomenon.

So what might one do to counter this worsening post-retirement anxiety and related substance misuse? Clearly, unending days with nothing to do are anathema for us farmers. In lieu of pining to be “off the grid” and to lie for hours on a beach, we would do better to find some structured task with at least a small component of obligation. Structure and obligation are intimately entwined and you will be hard-pressed to have one in your life without the other. If we have a small goal-directed mission, our days on the beach would be relaxing and enjoyable. Our post-retirement strategy must be to create structure, to have an opportunity for generativity, to support a life-style in which we have a mission and feel “grounded,” to stay connected to others and to maintain a healthy body and mind. We need harm reductionist group meetings for seniors that provide transportation and engagement. The bottom line is that identity and engagement are essential to sobriety. A busy farmer is more often than not a sober farmer.

Caroline Ridout Stewart recently retired from the UCSD Department of Psychiatry where she was a Clinical Instructor and Psychotherapist for over twenty years specializing in the treatment of anxiety and addictive illness. Caroline continues to be a harm reduction provider in her private practice where she enjoys working with those struggling with opioid misuse. She is the mother of a son who suffers from a co-occurring disorder and leads the local NAMI Co-Occurring Support Group for Family Members whose children suffer from both mental and addictive illness. Caroline has been the President of the board of A New PATH (Parents for Addiction Treatment and Healing) for 17 years promoting community Naloxone distribution. She is an artist and essayist.
www.anewpath.org, art@lacostasoberliving.com