October 2015

The Medicine

A former smoker’s lament

By Karen Hitchcock
Why do we smoke and why do we quit?

I started smoking in high school and happily dedicated myself to the practice for ten years. Ex-smokers adore reminiscing – our favourite brands, when we started and stopped, the best cigarette of the day, what it was like to exhale a magnificent plume on a freezing cold morning. We’re like nostalgic diggers who discover we all knew the same guy, a most loyal and lovable soldier, and are desperate to share our tales. Friends who were never smokers listen with what-the-fucks plastered all over their faces.

In June, there was a riot in a men’s prison in Melbourne, apparently in response to a statewide smoking ban due to take effect the following day. The prison sits on a body of barren government land, Ravenhall, a few hundred metres from where I grew up. When I was a kid, my dad was mates with a sheep farmer who rented Ravenhall for his flock. Dad kept an eye on the property during the weekends, pulling out lambs stuck mid birth, shooting hundreds of rabbits for dinners. My grandmother owned the land next door, until the government hit her with an involuntary-acquisition order, razed her almond orchard and built a women’s prison next to the men’s one. I imagine them all, locked behind concrete, apparently being rehabilitated, on the paddocks of my youth. And now they can’t even smoke.

There was an enormous drainpipe near my childhood street that stretched for 2 kilometres under houses and roads and paddocks until it stopped at a little chimney you could climb up into and peer out straight into Ravenhall. My friends and I would skip school and make the trek through the pipe, a voluntary, illicit entrapment that felt like freedom. We always made sure we had cigarettes in our pockets, but we never actually smoked them in the pitch black of the drainpipe. It’s a funny thing about smoking I’ve often discussed with my ex-smoker friends: there’s little pleasure if you can’t see the smoke coming out of your mouth. That smooth stream of white – a willed act of creation, like art.

I recently took a friend to see the pipe. We found the opening barred with a heavy iron grate. Maybe to keep the kids out. Or – thinking of drug-lord El Chapo’s tunnel escape from a Mexican jail earlier this year – maybe to keep the prisoners in.

In 2010 I read Susannah Hunnewell’s interview with Michel Houellebecq. Hunnewell noted that throughout the two days she spent with the French author he continually smoked something she called an electronic cigarette. “It glowed red when he inhaled, producing steam instead of smoke.” I’d never heard of electronic cigarettes and I hadn’t had a cigarette for 16 years, but my pulse quickened. I researched online. The steam was repeatedly described as “harmless water vapour”. Imagine, I thought, being able to once again form those great white plumes, without getting emphysema. It was years before every hipster at a tram stop would be holding elaborate vaping devices, blowing steam like bearded dragons. They weren’t yet available in Australia, so I ordered a few kits from the US. I chose the elegant, pencil-thin black devices and imagined myself swanning to breakfast at Tiffany’s. Unfortunately, the taste was oily and repugnant, and it seemed to me that the stuff going in and out of my lungs contained a lot more than water.

By 2013 all the large cigarette companies were marketing and selling e-cigarettes. And they’re using the same old tricks they’ve used for decades to promote combustible tobacco: funding consumer-rights groups, fudging health claims, lobbying regulatory agencies, deploying celebrity drones. Studies to date show that while these devices are likely less harmful than real cigarettes, they do contain multiple toxins, usually don’t lead to smoking cessation, and probably initiate young people into smoking the real thing. Yet another corporate promise of safe, easy pleasure shattered.

As a child, cigarettes were an integral part of my nascent identity. They were potent symbols of freedom, a small act of rebellion against what were hundreds of adult-generated interdicts. Adolescence: one long riot. Now, I read about Big Tobacco and hear them declare their “commitment to harm reduction” and find it troubling that I might be writing a kind of love song to their evil goods. How much of the rebellious freedom I felt while I smoked was the result of their insidious marketing? Was it simply a case of addiction?

The word “addiction” has always made me twitchy. It seems like one of those words specifically designed to arrest thinking. A word you can wield like a lasso, simplifying and reducing any individual to whom it is applied into a silent, captive beast: “I accidentally smoked ice and now my brain cells are forcing me to continue.” The websites of addiction specialists argue that any non-neurobiological explanation is moralistic. It’s all in the brain, it’s all about reward centres and dopamine feedback loops.

Countless international professorial hours over decades have been spent debating exactly what term to use to describe and thus diagnose someone’s problematic use of a substance. “Addiction” was dumped for “dependence”, and now the preferred terminology is “substance use disorder”. According to DSM-5, if the use or desire for a substance leads to clinically significant distress or impairment, you’ve got a disorder.

My beloved period of smoking caused me no distress beyond the occasional school detention and has left me with no significant impairments. So I suppose I escape a psychiatric diagnosis. I quit – and stay quit – because I really don’t want to die. But if I wasn’t lucky enough to desperately want to live – and if I hadn’t forged better ways to assert my freedom – I know I’d still smoke my guts out. And were I in prison, I too would riot.

Karen Hitchcock

Karen Hitchcock is a doctor and writer. She is the author of a collection of short fiction, Little White Slips, and the Quarterly Essay Dear Life: On Caring for the Elderly.

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