Physicians are often asked whether it is harmful to smoke three cigarettes a day, or five, or fourteen, or a pack; people seem to seek a standard measurement. If they exceed it that would be bad; if they smoked fewer than the standard that would be all right. But no such figure can be set. For several of my patients, one cigarette a week would be too many cigarettes. A better way to respond to questions about cigarette smoking, then, is to speak not of quantities but of habit patterns. You are smoking to excess if you do any one (or more) of the following: Reach for a cigarette the first thing in the morning or the last thing at night. Light a cigarette without realizing it, find yourself smoking, and wonder why you lit it and when. Claim that you are unable to enjoy certain situations without a cigarette - your morning coffee, food, reading the paper, playing cards, and so on. Feel it necessary to explain the number you smoke with such phrases as "They help me relax" and "I only take a puff or two, forget it, and then light another." Become severely upset when you find yourself in a "no smoking" area - certain theatres and public buildings, for example - and feel compelled to "duck out for a quick cigarette," or are ready to risk public disapproval or punishment by "sneaking" a few puffs. Find it almost unbearable when you are out of cigarettes, and are unable to tolerate the situation; instead, are willing to go to some lengths (dressing, walking to the corner store, stopping a stranger) to get a cigarette. Feel that you have to smoke to show that (a) you are one of the gang, or (b) "adult." If with any degree of regularity you act or react in any of the ways described above, you are smoking to excess. "Excess" means "more than what is right, proper or necessary." When used in medicine, it means "more than is good for continued good health" We can eat too much, work too much, drink too much (including non-alcoholic liquids), sleep too much, and so on; and while any such excess is potentially troublesome, some excesses are worse than others. Smoking must be put in that category, because it has vastly increased the incidence of lung cancer and coronary artery diseases, and because it plays a significant role in increasing the mortality rate in other pathologies. Some people do more than one thing excessively; for example, they may smoke excessively and drink excessively and perhaps also work excessively. Since there is a reason for everything we do, there are reasons for this pattern of behavior. Usually the excess acts as an "escape mechanism" from an emotional problem. If the habit is removed but the cause is not, another habit generally develops. That is where the psychiatrist can make his unique contribution; he can seek out and remove the basic cause or causes for that particular emotional problem. Excess can also be the result of an endless circle of action and reaction. An emotional problem causes anxiety; the anxiety itself causes greater anxiety. And as the anxiety continues to mount, feeding on itself and breeding itself, an escape mechanism becomes necessary. Relaxation effectively prevents this dangerous accretion of anxiety and tension, and one bonus you can achieve as the result of reading this book is learning how to relax. Excess, we've seen, can take many forms. Psychology shows us that the individual makes an unconscious "choice" of his particular escape mechanism (or mechanisms), and that his choice is usually made through an unconscious association with what he thinks will bring gratification - excessive eating, drinking, playing, sleeping, working, or so on.
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