Unit 5  Section 1Exercise 2 The experience of addiction Smoking
Richard Selzer was once a surgeon at Yale. He went on to write numerous books, many of them about doctoring. The following passage is from one of his earlier works, Mortal lessons, which contains a series of exuberant essays, written in a somewhat florid language. For brief biographical information about this prolific writer, see http://www.albany.edu/writers-inst/webpages4/archives/selzer.html and the wikipedia entry: http://en.wikipedia.org/wiki/Richard_Selzer
Richard Selzer's "Smoking"
What some people will not do to assure themselves that they exist! A woman dabs her neck with perfume, then walks abroad. [Here Selzer links the woman’s scent to the irrefutable affirmation of her being. He goes on to talk about whistlers, and how making noise has the same effect. He says of the woman “I am really here” and of the whistler “His presence cannot be denied.” Same goes for tenors and tuba players. He is now ready to make his argument for smoking.] I do it myself by smoking. And let no meddlesome man caution me against the extravagance, the injuriousness of tobacco. I am addicted in a way more fundamental than any mere physiologic craving. To deny me my smoke is to extinguish me as utterly as would death itself. It is to butt me into cold ashes.
Consider the act of smoking. It is constituted, is it not, of inhalation and exhalation? To draw deeply upon a cigarette, to fill the tracheobronchial tree with smoke, is to feed an empty space deep within, a space that twenty times a day cries out for appeasement. As nature abhors a vacuum, so does that cavern yearn for repletion. Should it, by some unhappy circumstance (you have run out of cigarettes in the dead of night) remain empty for too long a time, then the yearning becomes palpable. There is discomfort. The hollowness becomes an ache. One may perish of it.
I am not so vain, nor so uniquely neurotic, as to believe I am alone in the world with such a hungry hole, a pit in search of something to enclose. Nor will mere fresh air suffice. For this interior sack is no mere biology, gut an urbane bag for whom taste has been deliciously refined. It needs smoke. And smoke it shall have. Smoke is, after all, little enough. Time was when a man could, with the forthrightness of a child, enjoy a healthy expectoration, the passage of some audible flatus, or the scratching of his personals. But civilization has come to mean the narrowing of what we are permitted to do in public. Little Bo-Peep has gone away, and in her place the Iron Maiden of Etiquette shepherds us along toward good deportment.
Smoking is good for the dumpish heart; lights up the gloomies, you know? Let the innumerable sad circumstances of humiliations past, of stumbles yet to come, crowd in on me; then, out of the night that covers me, I grope for that thing with which to tampon the leak in my soul. All at once there is the scratch of a match. A pretty flame breaks. It swings to the touch. Ignition! And there blows a very wind from paradise.
There are circuits in the brain and lung that are triggered by the shifting of blood….at the end of our exhalation there is a small but measurable rise in the level of carbon dioxide. This is noted by the respiratory center of the brain. The order is issued to the lung: inhale. Oxygen is taken in, the carbon dioxide level falls. In a moment it will rise again. Now: exhale. The muscles of expiration, those strips of meat between and overlying the ribs, are commanded to contract. They close in upon the chest cage, compressing it. The leaves of the diaphragm billow upward, further encroaching upon the lungs, which twin sponges are squeezed towards the trunk of the windpipe.
The larynx, too, assumes a posture, its little muscles squeezing to hold open the glottic chink at the top of the trachea to let out the smoke. Aaah…and out it comes, now a slow-blown wisp, now a fat cloud. It rises about the face. That which was a moment before deep within pours to the out-of-doors, the soul becomes punctually visible. See it diffuse, coiling fainter and fainter into the general atmosphere. Here is proof—one need no more—you exist, are here, because smoke, that gaseous testimony, is there.
One is. This smoke is the ultimate assurance.
Here I am, I say to myself…and take another puff. It’s me.
From Richard Selzer's "Smoking"
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Study questions
1. The author provides details about the physiology of breathing. Compare this description to the details of Haydn Carruth’s on the experience of emphysema. What purpose do these descriptions have, respectively.
2. Enumerate the author's reasons for smoking. Which reason seems most important to him?
3. How would you go about helping this patient quit? Hint: familiarize yourself with the Stages of Change model before answering this question.
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