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Why I'm still dying for a cigarette
Leading psychologist Oliver James has had a love-hate relationship with the weed (ed: tobacco) for most of his life. He now says smoking is a symptom - treat the cause
Sunday December 29, 2002
The Observer.
Life as a 49-year-old smoker is increasingly embarrassing. When at home, to spare my wife and baby daughter the unpleasantness of my habit I do it in the car, trying not to catch the eye of neighbours. Out to supper, there are rarely ashtrays on view and I must ask if it's OK to light up. It's usually only me fagging it before the meal, and afterwards, when other diners cadge one, I get filthy looks from their partners for having reopened the nicotine wound.
In every sense, we smokers are a dying breed. Whereas half of adults puffed in 1974, one-quarter do so today. Among grown-ups of my social class, only 16 per cent smoke (and only 4 per cent have more than 20 a day). When I get the packet out, my friends are thinking: 'How strange to see someone killing himself. He's got an 11-month-old baby, for God's sake. He must be mad.'
Which I am. A raft of new studies proves you don't have to be mad to smoke but it jolly well helps. Half of smokers are depressive, 16 per cent anxious, 14 per cent angry and irritable. Clinically depressed people are four times more likely to smoke than the mentally healthy; 90 per cent of schizophrenics and alcoholics smoke.
Overall, 80 per cent of smokers do it primarily to self-medicate emotional problems. They are using cigarettes as a form of antidepressant or tranquilliser, a drug of solace for negative emotions. The definitive study proving this was published this year.
David Gilbert, an American psychologist, measured the neuroticism and depressiveness of 96 women smokers for five weeks. Afterwards, half the women were offered $400 to abstain from smoking for a month, ensuring an 80 per cent success rate. The other half were left to carry on smoking.
Long after the nicotine was out of the abstainers' bodies, when they were interviewed again a month after giving up, they were still suffering increased levels of emotional distress. The more neurotic or depressed the smoker had been before quitting, the greater the increase in these symptoms after doing so.
The inference is that smoking helped to keep their problems at bay because, even when the nicotine withdrawal was over, they were still more disturbed. Three-quarters of people with a history of depression become depressed after quitting, compared with 30 per cent of people with no such history.
Months or years after giving up, we still crave nicotine because, as with Prozac or Valium, it improves our mood. Cigarettes do have a dramatically beneficial effect on the emotional state of people who need that kind of help. Fags also improve concentration and performance on tasks that demand these. No wonder January is the month with the highest suicide rate - it's when everyone tries to give up smoking. People who attempt suicide are 12 times more likely to be smokers than the non-suicidal.
Readers of 'how to quit' books will not welcome the news that smoking brings them substantial mental health benefits as they prepare for the New Year's Day give-up-fags-athon. The authors of the books try to persuade you that you con yourself into believing you enjoy smoking. Telling yourself this may work for the 20 per cent of smokers who are not using nicotine to improve their mental health and who, as a result, are twice as likely to succeed if they try to give up. But for the 80 per cent of us for whom it's a case of 'smoke or go bonkers', it's a lie exposed by our repeated inability to stay off the weed.
My own smoking history is salutary but there are few duller subjects than someone else's addictions, so I shall be brief.
Having started in the usual manner at school (except it was up chimneys rather than behind the bike shed), I sustained a 20-a-day habit until the age of 26. That was when I fell in love with a non-smoker; before moving in with her I took up jogging and gave up smoking. Non-smokers and smokers rarely nest together: only 18 per cent of those who have never smoked have a smoking partner, compared with three-quarters of smokers. Alas, the course of true love did not jog true. Within 18 months I was back on the fags and returned to bachelorhood.
Gilbert has demonstrated that responses to thwarted love and nicotine withdrawal are almost identical. In both cases, there is likely to be depression, irritability, restlessness, insomnia, lack of concentration and overeating. In both cases too, smoking helps to ameliorate the symptoms.
In numerous large samples, smokers have suffered more stressful events in the past month or year than non-smokers - such as losing a job or having an accident. Greater stress, along with lack of education, largely explains why the poorest are two and a half times more likely to smoke than the richest.
One study found that uneducated smokers who had become physically ill were liable to increase their smoking to deal with the anxiety. They were likely to be more neurotic than the educated but they were also more likely to perceive themselves as impotent victims of external forces.
I have many excuses for my failure to eliminate gaspers from my life but I cannot pretend to a lack of education or poverty. Heart-breaking love affairs happen to most of us, yet they are the occasion for a visit to the tobacconist in only a minority: nearly half the population have never smoked a single fag. None the less, increased stress has certainly played a big part in my restarting.
Still nursing my broken heart, I waited nine years before giving up again, in 1988. Then aged 35, I moved into a new flat, gave up alcohol and took up nicotine gum. For six months I chewed successfully and was able to last a year more after that completely free of nicotine.
This was a period of intense work pressure exacerbated by daily visits to an unhelpful psychoanalyst. I might have coped with these problems without smoking but going on dates tipped me over the edge. They entailed drinking (does anyone sleep with someone for the first time without alcohol?).
Since 1990 I have been nicotine-free for seven periods of between six months and a year. The rest of the time I have chewed nicotine gum, sucked nicotine inhalers, smoked cigarettes or, for one expensive year, smoked cigars. I managed to give up around the time of our wedding in 2000, only to capitulate again six months later in response to a pitched battle with my new book.
The prospect of the birth of our first child enabled me to give it up again but the strain of sleepless nights in the early months of her life soon did me in. The good news is that, apart from the rare occasions when I drink and go out socialising, I can keep my consumption down to four cigs a day and even when out on the town it never exceeds 10.
So what is it that makes smoking so rewarding? As an anti-depressant, nicotine produces a brief, euphoric sensation by boosting dopamine, yet it also seems to affect serotonin levels (serotonin is the brain chemical that is low in depressives and is boosted by anti-depressants such as Prozac).
Nicotine also affects levels of cortisol, a hormone that plays a vital role in the response to dan ger. Neurotic people may have high levels. Alternatively, if you have low levels they may need boosting to make you more reactive and alert.
Nicotine seems to affect cortisol levels differentially - if they are too low, it raises them; if too high, it drops them. This probably explains why smoking is more common in people who are anti-social, rebellious, impulsive and risk-taking.Interestingly, being anti-social when young is the single strongest predictor of later smoking. Rebelliousness and risk-taking at 11 predict smoking at 18.
We smokers tend to feel normal rules do not apply - an element of 'Sod it, I'll smoke if I want to'. Behind that is a desire for autonomy and control which we feel we lack and which each smoke briefly returns to us.
But, above all, smoking is a self-chosen treatment for the frustration, anger and despair that come from early infantile deprivation. Smokers are babies. We are made jumpy by being kept waiting because when we needed to be fed or cuddled or have our nappies changed, our mothers were not empathic enough. We find the risk of being let down if we depend on others almost intolerable. We have thin skins and need a cloud of smoke to hide behind.
There are unimpeachable studies implicating childhood. The most dramatic proved the smoking behaviour of 9,000 Americans from the general population could be caused by childhood maltreatment. It found a relationship between the number of early adverse experiences, such as parental divorce or physical or verbal abuse from parents, and smoking. Adults in the sample who had four or more such events were five times more likely to smoke and to be depressed than those reporting none.
That cortisol levels are damaged by poor parental care has also been proven. If your mother was depressed when you were very small, you are liable to have abnormally high or low levels later on. This is not primarily due to genes because the levels were normal at birth and shortly afterwards. Both my parents smoked and maternal smoking during pregnancy (as my mum did) is related to offspring doing so.
Peer pressure is often cited as a prime cause but this is largely bogus. The depressive, the anti-social and the smoker tend to hang out together. But the key factor is not their effect on each other so much as the fact they were attracted to such people in the first place.
Early parenting sets your pat terns of brain chemistry and electricity, like the thermostat of your central heating system. Most of us are born with normal levels, the genetic exceptions being some cases of extreme mental illnesses, such as schizophrenia and autism.
If early care is stressful, allostasis occurs, in which new setpoints of electro-chemistry are established. In the case of cortisol levels, if you are constantly being attacked by parents, your levels are either blunted low, or they are jammed high, creating a gibbering wreck expecting crisis at all times. It's as if your emotional thermostat has been reset to assume the weather will be permanently desert-hot or arctic-frozen.
Once you understand this, you understand why smoking is so attractive: from the moment you were old enough to get your hands on a fag, it became an instant remedy for your abnormal cortisol, dopamine or serotonin levels. When you try to give up, the idea of a ciggy remains hugely attractive - unless you do something about your deeper emotional problems.
Thermostats can be changed. True, it's easier for me to flick the thermostat switch during a cold spell than it is to reset my default patterns of brain electro-chemistry. The earlier the adverse experiences occurred in early childhood, the more resistant they are to change.
Although therapy is a lottery, I know of many people who have been transformed by it. However you do it - taking up knitting, joining the Tory Party - look on your smoking as a symptom and treat the cause.
· Oliver James's book They F*** You Up - How to Survive Family Life is published by Bloomsbury (16.99).
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