I know my father died of drink. I watched him

Her father died in agony after years of drinking, but alcoholism was not recorded as the cause of death. Why?
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The Independent Culture
My father died from chronic alcoholism but I cannot prove it. I cannot prove that in July 1982, when my father had been in intensive care for three days and the plug was pulled on his life, alcohol was the cause of his death. I cannot prove it because nowhere on his death certificate is alcohol even mentioned.

My father's death is not included in the statistics of alcohol-related deaths in England and Wales for 1982. In that year, the official number of alcohol-related deaths in England and Wales was put at the very low figure of 2,624. Those statistics are not going to put alcoholism very high up on anybody's agenda, or shock the nation for that matter, but those statistics are wrong.

Alcohol is no respecter of persons, of internal organs or of bodily functions. But although research has improved since 1982, and official statistics have risen, there still exists a web of denial, ignorance and confusion in assessing the true picture of alcoholism, illness and mortality. Difficulties in collection of data, collusion between families, individuals and the medical profession which incorporates the stigma still associated with the word "alcoholic" are factors in masking the problem's real nature. If someone dies from alcohol-related causes, it is unlikely to appear on the death certificate.

The debate within the medical profession - and within society as a whole - about the effects of alcohol abuse is based on poor understanding fuelled by inadequate research; an area as murky as the dregs in the bottom of a bottle of inferior plonk.

How do I know what killed my father? Because I was there. I was there for years. I brought him his last bottle of strong liquor. He was not eating then. He could not. He was in terrible physical and mental pain. I witnessed his physical and mental decline over a period of years as he drank his way through a minimum of two bottles of Scotch a day. He never mentioned suicide, but his life was ebbing away pitifully each day. It was not just the physical disintegration but also the mental degeneration that was so horrific. His spirit was atrophying.

In the two years before his death, my father's body was bloated, and his skin a greyish colour. His face was jowly and ill-kempt. His eyes were bulbous and yellow. He could not walk without extreme pain in his legs. He smoked, but this was not all to do with smoking. It is known that chronic alcoholism causes polyneuropathy - tender calf muscles, discomfort in walking, numbness, weak legs, tingling in feet and hands and can lead to paralysis of the legs.

His name was William, and he had once, some 30 years before, been a fit and wiry fitness instructor in the RAF. At the age of 45 he was made redundant, and dealt with his anxiety and disappointment in life with drink. He moved the family to a house next door to a pub and when he was not drinking there, he was brewing up pear wine and consuming it before it had fermented. It was the kind of stuff you used to get under the counter in the Gorbals. Moonshine. 100 per cent proof that could also be used as paint stripper.

The violent mood swings, such a consistent pattern in the early years of his drinking, in the later stages, changed to an all-enveloping depression. As his body and his mind weakened he withdrew into a space few could penetrate. He spent most of his last days in a council bungalow, staring into the middle distance. His memory came and went.

He began to believe that he had fought in the Second World War, when in fact he had not been old enough to do so. This type of confabulation is documented. Extreme cases are known as "Korsakoff's Psychosis".

On a hot July day in 1982, my father was found by a friend of the family who was passing by his home. He was sitting naked and shivering on a kitchen chair. He had removed all his clothes for they, like every sheet and towel in the house was covered in a foul bloody liquid, which he was passing from his bowel and mouth. The family friend recalled the look of abject fear on my father's eyes as the ambulance took him to hospital.

That was the last time anyone saw him conscious. Soon after arrival at the hospital his oesophagus ruptured and his stomach erupted. His brain was monitored in intensive care. It had been severely damaged. He was 56 years old when he died.

In the Liver Unit of King's College Hospital, it is the nurses who witness most of the agonising death throes of the alcoholic patients; the foaming at the mouth in alcohol-induced epileptic fits, the swelling of the brain from inflammation. If the patient survives then he or she may become one of those placed in a psychiatric hospital, the so-called "wet brains" who do not know who they are or where they have come from, and whose brain damage is irreversible. For those with chronic liver disease who are in physical agony, a painkiller may not always be administered because death may be caused by the drug itself.

All death and its details make grim conversation but there is a particular aura of shame and taboo which surrounds the subject of alcoholic death. Moreover, the medical terminology used to describe physical states leading to death shrouds the subject further with clinical objectivity, and removes the emotional shock from a general public who might wish to avoid hearing about the gruesome details. The horrific nature of the alcoholic death - from cerebral atrophy or liver disease for example - is confirmed by Dr Sarah Jarvis of Alcohol Concern's medical committee. "It is, without doubt, one of the most unpleasant deaths imaginable," she says. "Of course it is the hardened alcoholic who ends up in hospital - the hopeless case - and I think this gives doctors a very distorted view of the whole subject of alcoholism in our society."

But why is it the case that accurate statistics are so hard to come by? Dr Peter Anderson of the World Health Organisation says: "There is reticence on the part of the medical profession to put alcoholism down as a cause. This is perhaps partly to do with a certain ambivalence in the profession, because of the way alcohol is used by the profession itself. There is also the added desire to protect the family afterwards from the associated social stigma."

Dr Jarvis agrees and says that collusion has meant it is hard to come up with accurate statistics. Researchers have had to develop systems of analysis of an epidemiological nature, by looking at the relationship between drink and ill health or accidents related to alcohol consumption.

"A lot of death certificates are written out in the primary health care setting where the doctor will have known the family. The truth might strain the doctor-patient relationship." There may also be financial reasons. Lucy, is an example of what often happens. Her husband died in a London hospital at the age of 29. He had fought a battle with drink for nine years.

Lucy accepted he was dying of alcoholism, but it did not appear as the cause of death. If it had, it may have jeopardised the life insurance which enabled her to pick up the pieces of her shattered life after his death.

Statistics do matter. 100,000 a year is the figure for smoking-related deaths. But Drs Jarvis and Anderson agree it is easier to assess smoking- related illness, and even with changes in attitudes, there is not the same social stigma associated with smoking oneself to death. Part of the problem is recognising early signs in the pathology of the patient. Many illnesses caused by alcohol could have been caused by something else.

Despite the commonly held belief that the consequences of alcohol misuse are well understood, expert evidence suggests this is not true. Figures vary between 4,000 and 40,000 deaths per annum in England and Wales. Dr Anderson quotes a figure of 28,000 deaths (Lord President's Report, Action on Alcohol Misuse, 1991).

It is these statistics, of course, which when waved in front of Government Health Departments influence the importance assigned to any particular health problems.

Since the University of York's Centre for Health Economics report in May 1992, which put the annual alcohol-related mortality rate at between "8,700 and 33,000", there has been no change in the statistical data. But more recently the Government has proposed, in its Healthier Nation White Paper, a strategy designed to tackle the whole issue. Alcohol Concern is in the process of developing a body of work which will help to inform that strategy. Perhaps the key statistics here are financial. Alcohol misuse costs British industry an estimated pounds 2bn per annum; and alcohol- related crime costs an estimated pounds 50m a year.

It is to be hoped that financial considerations will influence strategy in such a way that death and alcohol become a more transparent subject. We must overcome our squeamishness and shame. It is the tragic human consequences of such illness and death which needs to be revealed if more lives are not to be wasted.

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