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Art by Ariana Nouri

Paul is just shy of 20 years older than me. He is a very successful entrepreneur that found his way to my office while in his early days of sobriety. Part of what I do automatically when I meet a new potential patient is that I visually take him in. His body language, what he is wearing, the look on his face, the tone of his voice; everything I can before he even begins speaking.

He sat on my L-shaped couch closest to the door. This part of my couch is the only part without a back cushion, so naturally, no one likes to sit there. Paul, I believe, is the only patient who ever sat there. Of course, I took that as meaning one of two things: he either was so uncomfortable being in my office that he felt safest sitting next to the door, or, he felt he didn’t deserve cushioning on his back. Probably the truth was a combination of both.

Other than where he sat, I was struck by his posture and body language. He was in his first days of recovery. I’m used to seeing how miserable men and women look during their first days of sobriety, but Paul didn’t just look miserable. He looked utterly defeated.  He felt, as he later described to me, “deflated.”

Paul’s story, which he revealed to me slowly over many sessions, was not a typical one. He’d had a couple of years of frequently experimenting with drugs during his late teens and early twenties. It didn’t bode well for him. He ended up accidentally losing a small chunk of his body, and spent a year in a psychiatric ward because the drugs had made him severely mentally ill. I’m grateful on his behalf that his brain recovered from that bout of abuse. I’ve seen kids in their teens and twenties that have completely “fried their brain,” meaning they have lost or damaged enough of their brain that full cognitive recovery is impossible. Fortunately for Paul, he was more resilient and his brain recovered fully.

He did not enlist in a recovery program back then. He was not taught the saying “once an addict, always an addict.” He didn’t use hard drugs ever again, but he continued to drink “socially.” He managed to keep it at the social drinking level for many years. It is hard to decipher when one has gone from social drinking (entrepreneurs drink with their colleagues and clients at all events, which can occur daily), to problem drinking, to frank alcoholism. He would say he had been at least four or five years an alcoholic before deciding to quit.

No one in his family or friends knew about his problem. He was what is called a “functioning alcoholic.” Meaning he was working and accomplishing his daily activities and doing a good job at that, and was drinking himself almost to a stupor every night. No one could ever suspect that his alcohol consumption was destroying him at so many levels. The last straw was one night on a business trip in a hotel room, when he returned to his room from a night of drinking, tripped over himself, fell, broke a rib, and the fractured rib damaged his lung. So he was “deflated.” As he said to me, “physically, emotionally, and spiritually.”

That is how he ended up on my couch, closest to the door, hunched over his tall figure, speaking mostly to the ground under my feet rather than me, looking utterly hopeless and defeated. He told me he was “desperate” to find his spirituality, and that he didn’t have “a spiritual bone” in his body. It took less than an hour of talking to him to understand that underneath that defeated, deflated, hopeless shell of a man, was a very determined and spiritual being. Somehow, from our first encounter, we both knew we would work well together.

This time he elicited all the help he could. He enrolled in the highest level of recovery, joined Alcoholics Anonymous (AA) and went daily, found himself a sponsor, and came to me for intensive psychotherapy. He reached out to all of the resources available to him.

He walked out of my office that first day taller than he had walked in. Ever since that first meeting, he never sat close to the door again, and I had the pleasure of watching the glow of sobriety as it grew on him over the months. In my job, many times I experience the heartbreak of watching my patients relapse, but the light and new life that I see in my patients that accomplish long term sobriety always makes it worth while, and I never give up on any of them. Paul did all the hard work himself. He made my work easy for me.

Sayeh Beheshti, M.D.