Reflections on Laugharne and Alcohol

Beginning my first web log the phrase "To begin at the beginning" came to mind which I recollect is a phrase (or paraphrase) of Dylan Thomas. It was on a hot summer's day, similar to today, some years ago that I sat on the short wall adjacent to the path leading to the boathouse where Dylan Thomas once lived with his family in Laugharne, South Wales - a spot that overlooks the shifting sands of a most picturesque estuary. Laugharne is worth visiting not only for its natural beauty, but because it will probably make you curious to read Dylan Thomas' work, and soon after read about the man. Visit Laugharne.

I have yet to follow it up but one aspect of Dylan Thomas' life that is of medical interest is his use of alcohol and quite how it contributed to his death. My recall of reading the book, "Dylan Thomas in America", (by Brinin) a dozen years ago is that the account made it difficult to make a clear link between his drinking and his death from the description given. Well how can people who drink excessively die? The answer is in a number of ways:-

The first is through accidents while inebriated - literally tripping up and suffering a head-injury - pavements, stairs or virtually anything.

Another is through drinking a prodigious amount such that the level of consciousness is progressively impaired - brain stem centres become affected such that respiration may be impaired, however of greater risk on the way there is aspiration of the gastric contents as the protective reflexes that protect the lungs from inhalation of solids or liquids are impaired. Sometimes this causes suffocation, sometimes aspiration pneumonia - an extremely dangerous situation in which gastric contents come into contact with the delicate lining of the lungs causing severe compromise. Sometimes steroids and antibiotics can save the person. Two groups come to mind as being vulnerable to this situation, young people and individuals apprehended drunk by the police and locked up in cells without regular observation. People should never be left to "Sleep it off" but should be observed regularly and ideally put in the recovery position so sickness would not be inhaled.

I remember another case where a woman experienced alcohol withdrawal seizures - generalized epilepsy - during detoxification and died. Alcohol dependent individuals are prone to withdrawal epileptic seizures and probably a percentage of these result in death, as in idiopathic (of unknown cause) epilepsy. Obstruction of the throat through "swallowing" the tongue, aspiration, and other mechanisms operate in this situation. The aim in "detoxifying" an individual is to give sufficient medication, usually chlordiazepoxide, to inhibit the manifestations of alcohol withdrawal and prevent seizures. The difficulty the prescribing physician has is to get the balance right between an exccess prescription with its attendant problems and giving too little and risking breakthrough symptoms and risking the occurrence of epilepsy. It is one of the relatively few situations where to slightly overprescribe is probably the safer course.

Another cause of death is what has been called the Refeeding syndrome. Alcoholism is often associated with malnutrition and when that is extreme there is a metabolic syndrome triggered by the person taking too much food too quickly, rather than building up their nutritional replenishment. It can trigger thiamine deficiency and cardiac failure, or phosphate and other electrolyte deficiencies causing cardiac arrest. These are not uncommon, though often missed by unsuspecting physicains or psychiatrists. one of the few potential causes of sudden death in an acute psychiatric inpatient unit.

There are many other causes of death from drinking - end stage cirrhosis of the liver being a notable and common cause.

Well I am not sure what affliction contributed to Dylan Thomas' sad demise in the States; I hope to review the accounts again in the future to see if there are actually any better descriptions of the role of alcohol, direct or indirect - there probably are.

Alcohol is dangerous stuff. Where to read about drinking - I suggest "the Treatment of Drinking Problems" by Edwards and others, now I believe in its third edition. It is very accessible and full of reliable, practical good sense which reflects mainstream opinion. I would go as far as saying you can't really help yourself or anyone experiencing alcohol related problems without having read this paperback.

Not much "Emotional" health in this first entry you might observe very correctly - indeed alcohol has massive effects on the emotional expression of the drinker and of course is often an important recourse for the individual faced daily with an abnormal emotional climate. Psychiatrists often make reference to the "biological" perspective - taking a physical, pharmacological or "organic" approach, as opposed to a more "psychological" or psycho-social perspective. In this web log I will move between the too - both are equally familar to me and in my clincal work I am constantly changing hats. Indeed in my training I have been fortunate in having long periods of exposure and training to masters of both. Today I have been drawn to the biological.

"Emotional" health requires consideration as a term. The OED seems to define the word "emotion" as referring to instinctive natural feelings. The aim of the observations, ideas and reflections in this site is to contribute to the wider understanding and acquisition of healthy natural feelings, healthy character, and healthy behaviour and communication.

See also - An "Alcoholic" or an Individual with Alcohol Dependence Syndrome

See also - Why are the Rich, Famous, and Influential Inadvertently Disadvantaged when it comes to the Management of their Emotional Health?