How true it is!

• Mission Statement by Jessica Broitman, 11/9/96
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    • Guilt could be making your job harder! by Jessica Broitman, 2/6/97
      
      

Sorry it has taken about 3 months to continue this thread. However, I have been passively thinking the important points you raised. From a global perspective, guilt is indeed making my life harder (but it may be more of a personal issue!)

Guilt is really a very interesting issue and I'm never quite sure how to approach it with someone who has just had an MI. I usually err on the conservative side by seeing what they raise in the session. My standard line of thinking is that most people become addicted to nicotine during teen years and there is a difference between blaming oneself for smoking vs taking responsibility for changing behavior as an adult. (I bet I'm repeating myself from previous posts). Anectdotally, lots of folks have tremendous regret about wishing they had taken better care of their bodies (not smoked, not drank so heavily, put more emphasis on family instead of work). Quite a number of the smokers I see in the cardiac unit also have cancer of one type or another. The mean age of the patients that I see is 54 (range 27-83) and often there is a focus on mortality. Usually I leave feeling as though quite a bit gets accomplished during that 45 minute time period. At the 6 month follow-up, our outcome data from the first 65 cases look quite good when we compare the usual care group to the intervention group.

You raised the 12 step approach. I'm all for that approach for people when they want it, but I never suggest it. I have kind of an existential perspective which has never allowed me to feel very comfortable with the disease or addiction model of smoking. The physiological component represents just one dimension of smoking behavior and in terms of longterm relapse-to me it is the least important dimension.

These days I am starting to see outpatients in our preventive cardiology department for smoking cessation. It is very new and kind of interesting as well. Truly I enjoy hearing the perspective of CM and find this type of intellectual discourse lots of fun. Sorry for the long delay in response. Hopefully we can get some comments from others. It would be great to hear from others who have personal experience (past or current smokers, people with heart disease or whatever) to add to the discussion.

Just a thought!

Ellen

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