Smoking yourself to Death
Today I found yet another reason for smoking: Smoking yourself to death. This client could not stop smoking. She tried, and it worked for a few days, and she just had to start again. It is a very common smoking pattern. It is always because of some underlying psychological problem.
Normally, I can talk to the client, dig into the childhood, and find out what is so threatening that she needs to smoke to escape from it.
In this case, when I started digging, the most horrific story of family violence and abuse emerged. My client grew up in an ethnic minority household. Everything was deeply religious, and secretive, and closed to outsiders. She described growing up in a family where her mother was mentally unstable. Nothing and nobody was ever good enough for her mother. Her mother was totally wrapped up in herself. She had no interest in the children. As a little girl my client felt rejected and worthless, and was constantly told "Shut up and be quiet. Stop making it all about you!"
Overcoming inter-generational abuse
Eventually, my client learned why there was always a cloud of secrecy around the family. Her mother was the result of incest. Because of the huge taboo, her mother married the first man who would have her. He turned out to be a wife beater and drunkard.
So she grew up in this dysfunctional household, emotionally abused by both her mother and her father, and ended up convinced that she was worthless and stupid, and constantly told she was no use to anybody.
And yet, somehow, she overcame all this. She got married and had children. Her children were loved and cherished and gradually she began again. Through heroic efforts she got an education, went to university, and became a schoolteacher. "If I am a teacher, I can't be dumb!"
Reason for Smoking yourself to Death
She was doing well in her family life and her work life when a catastrophe happened. She learned that her own husband had been sexually abusing two of her daughters for many years. My client had no idea it was going on. Nobody believed her. "You must have known something was going on." She was devastated.
They immediately divorced and she began again as a solo mother. Her daughters grew up, married, moved away and started their own families.
And then to her horror, the whole cycle started again. It turned out that one of the relatives of her daughter's husband had started sexually abusing one of the granddaughters. This caused the whole extended family to split into factions. The whole issue of sexual abuse and incest was brought up again and again, fingers were pointed, wild accusations made. And now nobody is comfortable talking to anyone. Most of my client's daughters will not talk to her at all. And to top it off, my client has now been forced economically to move in and share a house with her mother.
Nothing to live for, might as well keep smoking.
She feels her life was ruined. A wonderful family that gave her fulfillment and happiness has been torn apart by sexual abuse. She now blames herself for not seeing her own daughter's abuse, and her granddaughters abuse. Nobody loves her, or wants her. Now she has no role to play, she is barred from seeing her own grandchildren. Her daughters are alienated and won't talk to her.
The outcome is that she feels she has nothing to live for. She is consumed with guilt, and regret, and can see no way out of it. So she actually said "I'm smoking because I don't want to be here any more". I couldn't believe my ears. I said, "You are smoking yourself to death?". "Yes, that's right. I don't deserve to live".
She wasn't suicidal, but she saw smoking as an acceptable way to kill herself slowly and get out of this bind. Well, I wasn't about to allow that to happen. The basic problem appeared to be displaced guilt. So I started on therapy to allow her to see her situation for what it was, and clear away any blame. The session went very well and I think I have been able to get rid of that feeling that "is crushing my heart ".
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