In the benzo community, some observations have almost become clichés. These include "every one is different," "it's dependence not addiction," or even "we do heal, in time." Then there are the ones about certain doctors and pharmaceutical companies — but I think it's better not to repeat those here.
That being said, there are also a few other observations I have seen which are a bit more complex, and perhaps not as frequently discussed around the water cooler, or whatever the virtual version of that is today. I've noticed one observation stand out over the past couple of years; one which appears to be relatively consistent with many individuals I've worked with.
While many of us — yours truly included — talk about "acceptance" in our blogs and videos and support groups, rarely do we discuss the source of that concept. "Acceptance" is actually the fifth and final stage of a process that many individuals experience when something traumatic has happened in their life. But, what about the other four stages? These too are quite common in benzo withdrawal and BIND, and I think it is wise to take a few minutes here to understand them better.
The Five Stages of Grief were originally introduced in the book, "On Death & Dying" by Elisabeth Kübler-Ross, MD, published over 50 years ago. She lists the five stages as Denial, Anger, Bargaining, Depression, and Acceptance. This book was not only a massive best-seller, but it became a standard text book in classrooms across the nation. It even inspired entire courses which adopted the book's name. How do I know this? Well, I actually took a class titled "On Death and Dying," based on Kübler-Ross' work, back in high school.
Yes, in case you were wondering, we had books back then.
Benzos and the 5 Stages
What does a book on death and dying have to do with benzodiazepines? Great question. I'm glad I asked it.
A terminal illness, or the death of a loved one, are two of the most significant events in a person's life, and often the most traumatic. But, death is not the only cause of this type of trauma. Other life events like disaster, loss of career, and non-terminal illnesses can also trigger a similar reaction. And that is where BIND comes in.
Today, I want to take a look at the fives stages as Dr. Kübler-Ross originally defined them, and discuss how they present themselves for those of us who have experienced benzodiazepine dependence, withdrawal, and BIND.
And as we step through them, it is important to keep in mind that this is not necessarily a linear process. Some individuals start with anger, some with depression, some even skip stages altogether or double-back more than once. While the road map presented here may be the more common progression, it is definitely not the only one.
Let's move on to the first one...
Among the over 200 patients interviewed for her book, Dr. Kübler-Ross noted that "most reacted to the awareness of a terminal illness at first with the statement, 'No, not me, it cannot be true.'" As human beings, we have a natural predisposition of avoiding difficult news. It's a protection mechanism.
Denial, at least partial denial, is used by almost all patients, not only during the first stages of illness or following confrontation, but also later on from time to time. — Elisabeth Kübler-Ross, "On Death and Dying"
Does any of this sound familiar? Most individuals I have worked with in the benzo community resisted the thought that they might be dependent on a long-term medication. It's not a comfortable position to be in.
When I learned that the clonazepam (Klonopin) my doctors prescribed me for over12 years may have seriously altered my body and mind, I freaked out. I had an all out panic attack, didn't sleep for days, and thought that my world had collapsed around me. I wanted nothing more than to get this drug out of me immediately.
Thankfully, I did not quit cold turkey, but instead educated myself and found the support I needed.
But, the panic attack was not my only reaction. Most of all, I wanted a way out. I wanted for this not have happened. I wanted to wake from this nightmare. But, that wasn't possible. It wasn't a nightmare. I wasn't sleeping. This was real.
We sometimes avoid knowing things, as a way of coping. Denying it happened is a protection mechanism. It's a way for our minds to say, "wait a minute, this is more than I can handle at this time." Rather than face what could be life-altering news all at once, we can block our understanding temporarily, and ease into it.
But eventually, it does sink in, and then we quite often... get mad.
I think we all know this one. When it comes to benzodiazepine dependence, anger is very common.
We're mad at God. We're mad at ourselves. And most often, we're mad at the doctors who prescribed the drugs and the pharmaceutical companies who made them. The experiences that so many have faced in doctor's offices border on horrendous at times. Individuals ignored, distrusted, and even forced to quit their drugs cold turkey. All while the pharmaceutical companies — who made billions from these same drugs — ignore the patients' stories and pretend their medications are perfectly safe.
The search for a "benzo-wise" doctor is a common one. In fact, the most common request I receive through the Benzo Free Podcast is, "how do I find a doctor who can help me?" I provide these individuals some references, such as BIC's Cooperative Doctors List — but in all honesty, we don't have a very good solution. Still, I wouldn't have to answer this question so often if more doctors were educated on proper prescribing and deprescribing protocols for benzodiazepines. Unfortunately, that is not the case.
When the first stage of denial cannot be maintained any longer, it is replaced by feelings of anger, rage, envy, and resentment. The next logical question becomes: "Why me?" — Elisabeth Kübler-Ross, "On Death and Dying"
Anger is a normal and expected emotion during this time. It is also a difficult stage to move past. So many of us in the benzo community are still trapped in this stage. We get mired in the frustration and the blame and the rage and find it difficult to leave those emotions behind. We might even tell ourselves that "we are justified in our anger," so why would we want to let it go.
There is one key reason why letting go of the anger is important. Because, it is not a friend to healing. As long as we hang on to the blame and the hate, healing can't move in. There's just not enough room. At some point, most of us realize that we need to move on.
But, even if we move past the anger, we still may not be ready yet to accept what has happened. And, we might be looking for another way out.
If denial and anger don't work, it's time to make a deal. It's time to bargain. It's time to ask God, or someone else with enough power, to take this away from us. It's time to beg for this not to be. At least, that's what our minds tell us.
...maybe we can succeed in entering into some sort of an agreement which may postpone the inevitable happening... — Elisabeth Kübler-Ross, "On Death and Dying"
In BIND, bargaining takes a variety of forms. Here are just a few examples:
"Please God, Doctor, or whatever powerful entity you wish to bargain with, I'll do anything if..."
"...I'm not dependent on this drug."
"...my taper goes smoothly."
"...these symptoms would just stop."
"...I could have one good night's sleep."
"...I could just think straight for one minute."
Or, perhaps the most common...
"...this was all over tomorrow."
For so many of us, this is a desperate time. We'll do anything to stop the anxiety, the akathisia, the tremors, the burning, the muscle pain, the tinnitus, or whatever your most severe symptoms are — we'll do anything to stop them. And thus, we are willing to make a deal.
Sometimes this is just a request, "please do this for me." Sometimes it includes a bargaining chip, "I'll donate to charity," or "I'll spend more time with my family," or "I'll eat right, exercise, and take better care of myself." It doesn't matter the bargain, it's about us being at the end of our rope and willing to do anything to make this go away.
But, it's usually a futile ask. And then, we hit the next stage...
Depression is perhaps the one stage that makes the most sense, considering what we are going through. For those of us dealing with severe withdrawal or BIND, our lives have changed for the worse. There's no skirting around that fact. Life is going to be harder for a while. Perhaps a long while. And this can be a very depressing fact.
When the [patient] can no longer deny his illness, when he is forced to undergo more surgery or hospitalization, when he begins to have more symptoms or becomes weaker and thinner, he cannot smile it off anymore. — Elisabeth Kübler-Ross, "On Death and Dying"
In the three research papers we published from the Benzodiazepine Survey of 2018-2019, we reported not only on the common symptoms of withdrawal and BIND, but also on the adverse life effects. These include the negative effects on relationships, loss of job, loss of house, loss of a business, violent thoughts, and perhaps one of the most common, financial struggles.
In Kübler-Ross' book, she spoke about the financial strain that terminal illness can place on a family, and this is equally as relevant to BIND. Financial burdens "have forced many patients to sell the only possessions they had; they were unable to keep a house which they built for their old age, unable to send a child through college, and unable perhaps to make many dreams come true."
When you combine the symptoms common in BIND, sometimes severe, the duration that these symptoms may last, sometimes years, and the strain this can place on the individuals and the people around them, sometimes unseen and often unsupported, it is no surprise that depression is a common result. And this rarely effects only the individual, but instead the entire family unit and/or support team.
During this time, suicidality is also a serious concern. Suicidal ideation and threats of suicide should never be taken lightly, especially when benzodiazepine dependence is involved. If you, or someone you know, is experiencing thoughts of suicide, please get professional help immediately. We have a list of suicide prevention resources on our website for your reference.
Finally, we get to the somewhat mystical stage, of acceptance. Acceptance is spoken of quite regularly in the benzo community; and in my opinion, for good reason.
If a patient has had enough time and has been given some help in working through the previously described stages, he will reach a stage during which he is neither depressed nor angry about his "fate."
Dr. Kübler-Ross defines acceptance as a stage of accepting the inevitable fate, which, considering the target audience of her book, is often death. Benzos are different. Benzodiazepine dependence and BIND is not a death sentence — although for some of us it seems like that. It's a hardship. A severe hardship, for some, but a hardship none-the-less. And all hardships can be overcome. And "acceptance" is where this takes place.
I have spoken about acceptance on my site and podcast many, many times. In my book, "Benzo Free: The World of Anti-Anxiety Drugs and the Reality of Withdrawal," I wrote a whole chapter on "Managing the Fear of Benzo Withdrawal." I also dedicated episodes 3, 4, & 5 of the Benzo Free Podcast to the same topic. In both of these, I share the five areas where we can improve to help manage our fear. These include responsibility, positivity, mental and physical activity, kindness, and finally, acceptance. Acceptance was a cornerstone of healing from benzos over four years ago when I published my book, and it still is today.
Finding acceptance is about moving past the anger, the frustration, even the depression, and accepting that this happened to you. It's no longer about avoiding it, it's no longer about bargaining your way out of it, it's not even about blaming others for it — it's about accepting it. This has happened to you. There is nothing you can do to change that. Now you must decide how you are going to handle it.
Finding acceptance for me was about healing:
That's all that benzo withdrawal really is; it's your body healing. And healing is a good thing. In fact, it's an amazing thing. Our bodies heal even from some of the most horrendous injuries. It's an incredible piece of biochemical engineering. And the best thing I could do was let it do its job. — D E Foster, Benzo Free: The World of Anti-Anxiety Drugs and the Reality of Withdrawal.
Why did I write this article? Well, the primary reason was so that we can recognize the stages some of us may go through during benzo withdrawal and BIND. When we can recognize these stages, we can have a better understanding of them, and ultimately, learn how do deal with their effects in a healthy manner.
BIND is a mental game. Sure, many of us experience a series of physical symptoms ranging from mild nuisances to debilitating effects, but the area where we can make the most positive change, is in our mind. It's all about "mindset." Learning about what happened to us, finding acceptance for what happened to us, and ultimately, rising above and making the most out of what happened to us; that's where we can make the most gains.
Well, that should wrap things up. I hope this helped. And thank you again, for allowing me to be part of your healing journey.
Kübler-Ross, Elisabeth. "On Death & Dying: What the Dying Have to Teach Doctors, Nurses, Clergy, & Their Own Families." New York: Scribner 1969.
Foster, D. E. "Benzo Free: The World of Anti-Anxiety Drugs and the Reality of Withdrawal." Erie, Colorado: Denim Mountain Press 2018. https://easinganxiety.com/book.
Foster, D E. "Managing the Fear of Benzo Withdrawal (Part 3 of 3)." The Benzo Free Podcast. February 20, 2019. https://www.easinganxiety.com/post/managing-the-fear-of-benzo-withdrawal-part-3-bfp005.
Ritvo AD, Foster DE, Huff C, Finlayson AJR, Silvernail B, et al. (2023) Long-term consequences of benzodiazepine-induced neurological dysfunction: A survey. PLOS ONE 18(6): e0285584. https://doi.org/10.1371/journal.pone.0285584.
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This article was written by a living, breathing, human person. No A.I. was utilized in its creation.