Mental Illness and Addiction: Changing the Narrative

I’m finishing up a popular memoir called Hillbilly Elegy, by J.D. Vance, and while the book isn’t about mental illness and addiction, per se, Vance’s story of unlikely success grows out of his disgust toward his mother’s endless addictions to both men and drugs. Over the course of Vance’s 31 year life, his mother has been married five times and her drug habits have gradually devolved to the point of entering rehab for heroin use.

The mental illness in Vance’s family is undiagnosed, mostly because “hillbillys” are highly unlikely to talk to a therapist about their problems. But as a child, Vance’s mother seemed most negatively impacted by her own parents’ screaming matches and her father’s alcoholism. While her two siblings stood up to the chaos without losing a sense of self, Vance’s mom would cower on the floor and cover her ears, much like she would do when yet another man left her. One could certainly diagnose PTSD and inevitably, there would be other valid mental and emotional disabilities to be medicated or counseled. So, while I know I’m painting with a broad brush, for the purposes of what I want to say here, I’m going to simplify matters and say that in Vance’s life, in my life, and in so many other lives, mental illness and addiction go hand in hand and are culturally regarded in very much the same way.

Toward the end of the book, Vance does an informal survey of his extended family about why his mom’s struggles ruined her. He primarily wanted the opinion of his mom’s two siblings. Both of them take the attitude toward their sister that typifies what I perceive to be our national attitude toward both mental illness and addiction: “Yes, these are real ‘diseases,’ but the cure for them is primarily to quit whining and get your life together. The struggle is probably real, but the cure is willpower.”

Some examples:

1. The Atlanta Falcons recently hired a new Offensive Coordinator who lost his last job because of multiple alcohol related incidents, including showing up to his head coaching job drunk. On TV, a sports commentator’s jaw was nearly on the floor with disbelief that anyone would hire this man. But if alcoholism is a disease, shouldn’t the attitude be different – something more like, “I’m thrilled that this man is back on his feet and is doing what he needs to to stay healthy.” If he had come to work and passed out from not tending to his diabetes, would anyone guffaw that he could get another job after such irresponsibility?

2. A friend of mine suffers from crippling depression; she hasn’t worked in years. Her very gracious brother supports her financially, but he also incessantly tells her she needs to exercise and volunteer. Those are, in fact, very good suggestions. However, they are coming from a place that misunderstands the hurdles that have to be jumped to get to the gym or to sign up to volunteer. This is a woman who has a PhD, who adopted a child as a single mother, and who has held many high-powered jobs over a forty year career. She didn’t become lazy all of a sudden. Something changed in her brain, and getting to the gym for her can be like asking someone who’s petrified of heights to jump out of a plane – unless there’s someone strapped to their back, they ain’t jumping out of that plane.

I can hear the objections to my points through the internet waves. Or maybe it’s just that I have those same objections buried in my own brain from a lifetime of training. They are saying to me: “Tim, you’re letting people off too easy. Are you saying that we have no power over mental illness and addiction? Are you saying we can all excuse our bad behavior because we’re “just wired this way”? Are you saying we should let people come to work drunk and hold their hair back while they puke in the trashcan during an important meeting? To which I say, “Of course not! Alcoholics should wear their hair in a bun.”

But really, I am not saying that. People, even those with mental illness and addiction problems, have a responsibility to manage their conditions. Our treatments for these ailments are embarrassingly rudimentary, but people who suffer still need to seek treatment until they’ve run out of options (and many do, sadly). What I’m addressing here isn’t so much how some boss should handle an employee’s first absence due to depression or anxiety. I’m more interested in the systemic attitude that I hear from Vance’s aunt and uncle about their sister…as well as from many of my own family and friends. Essentially, they say this, “We grew up in the same house/school/town/neighborhood; we made it and succeeded; what’s YOUR problem?”

That is the misguided attitude that has to change.

It’s the same attitude you see in rich, white people toward inner city black kids who “aren’t taking advantages of their opportunities.” At first glance, it seems like a brash, arrogant attitude. But in reality, I think it is a fearful and defensive one. We all want to believe that our successes are because of our own merit – that anyone could do what we have done but we wanted it more, had a better work ethic, or slayed a few more dragons by their bravery. It’s scary and unsettling to think that our success of which we are so proud might have a good bit less to do with our own acts of will than we think. So we call others, those who do not have what we have, weak, broken, or even depraved. That allows us to remain the “good guy” who has it all together by the strength of her own will.

Another way of putting it: Michael Jordan isn’t just tall and athletic; he was also wired for endless hours in the gym and for intense competition. I could have the same exact physique as him or I could have the same intensity or the same competitive spirit, but unless I had all of them combined, I could never be as good as he was. But if I looked just like him and had the same athleticism, inevitably people would say I had wasted my talent. If I’m not wired for all those hours in the gym, though, and like to read instead, does that make me a wasted, would-be Michael Jordan? I think that’s far too simplistic. It’s the same with mental illness and addiction. What looks one way might be something starkly different.

Maybe I’m only making this argument because I’m a forty-year-old, privileged, white man who is trying to start over. Maybe I just don’t want to believe that I failed and that it’s my fault. Maybe the masses are right about me and every other addict and mentally ill person: Sure we have a real illness on our hands, but if we were strong enough people, we’d fight our way out of the messes we find ourselves in. Are all of us just weaker – sure to be destroyed evolutionary principles that cause the fittest, not the weakest, to survive: Slowly, we’ll annihilate ourselves by suicide, overdoses, and a lack of desire to pass on genes. Is that what’s happening here?

I’ll leave that to you to answer, but I ask you to think twice the next time you think that someone needs to just get her act together. People say we need to walk a mile in each other’s shoes, but I don’t think that would do the trick. What we really need is to actually walk a mile in that person’s DNA – to think their thoughts, to feel their fears, to be haunted by their traumas, and, of course, to have their experiences. This might enable us to offer more grace to others, not only who are haunted by mental illness and addiction, but also our plain old, every day brothers, sisters, friends, and family.

For further reading:

A good piece about attitudes toward addiction: http://www.cmaj.ca/content/184/2/155
And one about attitudes toward mental illness: https://www.rethink.org/news-views/2013/11/attitudes-to-mental-illness

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How To Help Someone with Mental Illness

supportIt can be awfully hard to know how to help someone with mental illness! Take me for example: Saturday morning, I was comatose with depression on my couch for four hours, hoping for a stray meteor to find its way to me. Today, I’m overflowing with so many exciting ideas for how to solve the world’s problems that I would challenge Steve Jobs to a Battle of Creativity. This, my friends, we call Bi-Polar (type 2 to be exact). You can imagine what fun my wife and kids have playing the “what mood will daddy be in ten minutes from now” game (for now, Ann has a small lead over Josiah, and for some reason Ellie Ruth isn’t very good at the game…she’s way behind, but I’m starting to develop some special signals for her so she can catch up).

So perhaps I’m the wrong person to write this post, since I haven’t had to be the supporter in any substantial way. Thus, what follows is simply the advice of someone WITH mental illness(es) to those who, thanklessly, painfully, fearfully…are supporting someone with mental illness.

A friend of mine recently called looking for advice on how to support his deeply depressed wife. Like many people who are NOT mentally ill, he was frustrated and baffled by his wife’s behavior and her unwillingness to listen to reason. He continued attempting to have conversations with her about how he could help, but he was thwarted by her erratic answers – sometimes she simply told him, amidst sobs, that she didn’t know how he could help; other times, the “saner” moments, she was reluctant, even embarrassed to discuss her previous behavior and couldn’t/wouldn’t offer much in the way of advice to her husband about what she needed when she was in “that place.” My friend was stumped, scared, and frustrated.

Perhaps you’ve been there if you’re reading this…You want to help, but you don’t know how, and the person you are trying to help behaves so inconsistently that you never know if you should leave them alone, hug them, take them to the hospital, or tell them to snap out of it. I’m quite sure my amazing wife, Ann, would understand your frustration as she has felt it with me (but not for at least an hour or two!).

I certainly can’t speak for everyone with mental illnesses, but I’d like to offer a few pointers that might be of help:

    1. Take charge lovingly. Recognize that you are the one who is seeing the world more clearly than your mentally ill loved one, and take charge of the situation lovingly with that in mind. For example, my young children wear me out mentally. I’m just not cut out to be with small people for prolonged periods of time without becoming extremely overwhelmed and ultimately depressed/angry. But I want to be a good dad/husband, so I often am with them for long periods of time, thus becoming overwhelmed, depressed, and/or angry. My wife knows when I’ve had enough based on how I speak to the kids, and she is usually kind enough to ask me, “Do you need a break?” But here’s the problem: My broken brain can’t see straight in those moments, so guilt usually wins out over my mental health and I say, “No.” The truth is, and I’m not saying that this is fair, that I want Ann to say to me: “Tim, you need a break. Go take 15 minutes of alone time and then we can reassess.” I would take her up on it 100% of the time, but when I’m left to make the choice for myself, I’m not able to think reasonably, “You know, I do need a break, and yes, my wonderful wife, I’ll accept your offer!” Again, that’s not necessarily fair, but if you, the healthy one, will take charge of the situation, I for one would appreciate it, and I suspect others with a mental illness want the same thing.
    2. Don’t expect them to be reasonable. Once again, I’ll use my children as an example. When one of my children throws a temper tantrum, I, of course, get frustrated by their behavior. Despite having plenty of evidence that you can’t reason with a small child who is throwing a tantrum, I continue to try to reason them out of this behavior by saying things like, “You’re not helping the situation” or “You’re making your own life worse by acting this way.” Any reasonable person would understand what I mean, right? Of course! But a tantrum-throwing child isn’t in a reasonable state of mind, and “fighting” a tantrum with reason will only lead to frustration for both parties. The best solution when a child throws a tantrum is to literally put them in a safe place so they can “process” their anger without hurting themselves, your dog, their sibling, or your eardrums. It’s the same thing with a mental illness: Help the person get to a place, literal or figurative, where they can feel what they’re feeling safely and productively. Having dealt with OCD my whole life, I am well aware that my obsessive thoughts are unreasonable…that’s why they’re so disturbing! But that hasn’t enabled me to stop them from running through my mind. This is where this piece of advice ties back to #1: You, the sane one, need to lovingly take charge. If someone is in the throes of depression, don’t tell them to look at the bright side. Instead, gently insist that they go do the thing(s) that tend to help them improve. For me, it’s time to myself to think and write…it almost always helps. If not that, then working with my hands on a tangible project will sometimes do the trick. Sometimes, there’s nothing that helps, but when I’m in the midst of depression, it’s virtually impossible for me to stand up for myself and to take what I need. I can’t be reasonable, but if someone around me can push me in the right direction, it might help me get back to a good place more quickly.
    3. Set boundaries about how you will respond to their struggles. As you probably know if you’re reading this, it’s exhausting to support someone with any illness, especially one that is unpredictable and turns your normally-rational loved one into an irrational mess. The friend I mention above confided in me that his wife is not above a little melodrama, so he’s never sure how much of her behavior is attention-seeking and how much is authentic. My advice to him was to tell his wife that he had no choice but to take her at her word…the stakes are too high. Thus, if she says she’s suicidal, he should tell her that he will take her to the hospital because he can’t take the chance that she’s just being dramatic. Another important boundary involves the mentally ill person taking his/her pain out on the care-taker. I’ll use myself as an example here: When my OCD regarding my wife (see my book for more on this) is raging, one of the natural compulsions is to think that talking to her about it might help me get to the bottom of my concern. It won’t! Ever. And it’s entirely unfair for me to talk to her about my negative thoughts about her. All that will do is to hurt her deeply. In this case, we have a boundary that when I’m obsessing about her, if I need someone to talk to, I need to pick one of the other close friends (or a therapist) to discuss this stuff with. The scenarios are endless for what boundaries you might need to set, but start paying attention to yourself, and know that the best way to love someone is to be the healthiest version of yourself so you can be there for them when they need you most. It might take time to figure out the appropriate boundaries, but don’t feel guilty for needing to set them. It’s ONLY by setting them that you can help your mentally ill loved one thoroughly.
    4. When they’re feeling good, ask them how they want/need to be dealt with in the bad moments. Most people with a mental illness have their good days and their bad days. As someone who offers support to a mentally ill person, your best resource might well be that very person, but only when they’re in a good place. This will have to be an ongoing conversation about what is and is not helpful to your loved one, but every day, week, and month you gather more data that can be used to help both you and the other person move forward to a more healthy place. As I’ve mentioned before, one thing I need when I’m in a bad place is for my wife, who is quick to recognize it these days, to take the lead and tell me what to do. In my case, she needs to tell me to take some time away to hit the reset button. When I’m in that bad place, I’m nearly incapable of taking care of myself, but by staying physically present with my wife and kids when I’m not doing well can cause a lot of unnecessary damage – a lot more damage than would be caused by my taking a “time out” to get my head clear. Your loved one might not know how you can best help them right away, but tell them to ponder and pay attention to what they need when they’re not doing well. Maybe it’s a hug; maybe it’s a time out; maybe it’s a trip around the world on a Disney Cruise ship…who knows? But let your mentally ill loved one be your most helpful resource when they are in a healthy enough state to think clearly about what they would want/need in their bad moments.
    5. Take care of yourself. This goes back to #3, but I can’t say enough about it. If you’re not healthy, you can’t be of very much help. Think of it this way: If you were taking care of someone with the flu, you’re not much good to them if you run yourself so ragged that you get sick, too. Not only do you endanger their health further, your own ability to respond to the sick person promptly and thoroughly is diminished if you aren’t healthy. The same goes for mental health. Figure out how to fill up your own gas tank so you can help the person you care about. If your tank is empty, you’re of no real use to them.
    6. Give grace…to yourself and your loved one. Start with yourself. This shit is hard! It ends friendships, marriages, and even lives. Don’t fall into the trap of blaming yourself for not always knowing the right thing to say or how to be of the most help. Instead, literally say this to yourself, “I’m doing the best I can, and that’s all I can do.” It sounds corny, but having been forced by a therapist to do this myself, I can say it actually works: Look in the mirror and affirm yourself for trying, for loving someone who isn’t always easy to love, and for demonstrating the truest version of love – the unconditional kind. And don’t forget to give grace to your mentally ill loved one, too. Hopefully, they’re trying as well, and some day down the road, we’ll be better and figuring out exactly what part of a person’s brain is malfunctioning. Those x-rays or images will make it easier to understand that the person isn’t necessarily choosing to be an erratic ass. Most likely, they’re similar to a person with a broken leg trying to walk without a cast or crutches. If the bone was sticking out of their leg, it wouldn’t be hard to give them grace for going a bit slower than normal or yelping in pain every few steps. But mental illnesses aren’t visible…yet. So whatever metaphor helps you recognize that they’re dealing with something that really is physical and that really can’t be just wished away, try to remind yourself that you can’t expect someone with a broken brain to process life the same way you do. And once again, when you fail, give yourself grace. Then try again. That’s the best you can do.

 

**People often ask if it’s okay to share what I write with others, as if I am trying to keep it private. Uh, yes, it’s okay since I do publish this on the interweb. But really, I’d be most appreciative if you share this blog (or post) with others. Who knows where it will lead? Thanks for your help!

Other articles you might enjoy:

Amy Glynn reflects on Robin Williams’s suicide in a compassionate and helpful way, acknowledging that we should wish our friends who commit suicide had been equipped to stay around longer, but we should never simplify their behavior as “selfish” or “a permanent solution to a temporary problem.” A refreshing piece! http://www.pastemagazine.com/articles/2014/09/twenty-five-years-after-dead-poets-society.html

“7 of the Most Helpful Things You Can Say to Someone with Depression” An excellent piece that “gets it right” about how to help someone who is depressed.

(This post is also a page on the blog. It can always be accessed from the top menu.)

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A New Acronym for Tim: PTSD (On top of OCD, ADD, MDD, and JKLMNOP)

Acronym postOver the course of my journey with mental health problems (my whole life but only 15 years since I saw a doctor for the first time), I’ve been diagnosed by various doctors with the following mental health problems: OCD, Anxiety, ADD, Depression, Bi-Polar II, and just recently, PTSD. This is NOT to say that I necessarily have all of these issues, as any decent doctor will admit that diagnosing mental health issues is a moving target. Even the best doctors in the field can never be entirely sure what diagnosis someone’s symptoms mean. As my doctor says, “I treat symptoms, not diagnoses.” I appreciate her honesty.

So the PTSD diagnosis came from my trip to the Amen Clinic to have my brain scanned…not that they know what to do with the pictures of my brain, but hey, us Type-A folks need to feel like we’re making progress, ya know. Through the conversations, tests, and scans, the Amen Clinic doctor added a new diagnosis (should I call it a “guess” instead?) to my profile: PTSD (Post Traumatic Stress Disorder).

Hmmmm. I’ve never been to war or robbed at gunpoint or left alone with a drunk clown…In other words, I’m not sure exactly how I could have PTSD as my life is largely trauma free, other than the fucked up brain. Then again, as I’ve researched PTSD, I’ve come to realize that the actual traumatic event isn’t even necessary. What matters is how one responds to his/her environment.

Example: Baseball practice.

As a child, I was mortally afraid I would be abandoned by my parents – obsessively afraid might be a more apt description. Because of OCD, when I was left anywhere by my parents, I immediately began to obsess about whether they would return or not. I watched the clock as I imagined how it would all go down: Everyone else’s parents would gradually come for them; the adults who were supposed to wait until everyone was picked up would need to leave for some reason, reassuring me as they left me waiting alone, “they’ll be here soon, I’m sure. Gotta run! See you next time.” Then I would wait and wait and wait, growing increasingly terrified that my worst nightmare had come true. In the coming days and weeks, no one would believe my story and help me find my family. Instead, I’d become truly homeless, truly alone. (Yes, I’m well aware this is/was illogical. What, are your fears all entirely warranted? Don’t be all judgy, please.)

For some reason, this fear was particularly acute at baseball practice. It was so bad, in fact, that I remember the year I quit playing baseball. The decision wasn’t an easy one because I really loved playing baseball. But the torment of practice – the lead-up; the drop-off filled with questions about when and where my parents return would happen; the inability to pay attention to anything during practice because of the scenes running through my head; the terror that increased when my parents weren’t the first or second or third parents to retrieve their child; the holding back or hiding of tears that would make me look like a sissy to the coach and the other kids…the all-consuming relief when they finally arrived; the shame I felt when I assumed that they could see right through me and must be thinking, “Were you seriously afraid…AGAIN!!!…that we wouldn’t come back?!”; the internal promise that that would be the last time I let my brain torture me like that; and then, the next day, the dread of next week’s practice would begin, unceasing, until I saw my parents’ car returning for me the following week, and the few moments of relief would begin again. Oh, and the shame.

So after a few years of trying to quit being such a damn baby, I gave up and decided that simply quitting baseball would be the simplest solution. I made something up about why I wanted to quit that sounded more credible (cue the obsessive fears of having told a lie and being damned to hell) than “because practice scares the shit out of me,” and I never played organized baseball again because the trauma of going to practice.

Wait. There it is: Trauma. Not the kind that everyone would see as trauma, like surviving a landmine explosion that leaves the people on either side of a soldier dead. But here’s what I’ve come to learn as I’ve studied this: Like beauty, trauma is in the eye of the beholder.

If someone is traumatized by the Slinky that chased him down the stairs as a child, who am I to judge him for his refusal to drive within a mile of a Toys R Us? If we’re all honest, we all have irrational fears. But some are more traumatic than others thanks to the way our various brains process them. All that matters is that the person with PTSD experienced something as traumatic.

(Amusing side note and a true story: I once had a friend who was so petrified of cockroaches that she stayed with her parents (this was a grown woman) after waking up in the middle of the night to something tickling her face. It could’ve been her hair or her sheets, but because it also could have been a roach, off she raced to her parents’ house where she would be safe from the trauma of roaches. Supposedly.)

Funny, no? Unless you’re the one whose terrified of something that others don’t give any thought to.

As I’ve pondered it, I’ve realized that I don’t have PTSD, I have PTsSD: Post Traumas Stress Disorder. There’s no singular trauma that caused this doctor to diagnose me with PTSD, in other words. My traumas were the small sort that an overly frightened child experienced as he went to baseball practice. Oh, and school, and Sunday school, and friends’ birthday parties, and well, just about anyplace that didn’t involve his parents’ presence.

Itsy bitsy teensy weensy daily, hourly, minute-ly, second-ly, baby traumas that raised my antennae to high alert. All. The. Time.

And there you have one of the key components of PTSD: hyper-vigilance. Like a soldier who can never feel at peace because that landmine went off when he wasn’t paying attention, so if he just pays attention ALLTHETIME he’ll avoid the next landmine, I, too, pay attention allthetime because the things I’m afraid of can “explode” out of the jack-in-the-box at any moment. I live on high alert for indications that people might abandon me as a friend, that I might get fired, that my children might die suddenly…that something atrocious WILL happen if I’m not alert. It’s sort of like a superstition that tells me, “Tim, it’s the people who don’t pay attention to whom disaster happens. Keep paying attention and you’ll ward off the horrific TRAUMA through your vigilance. But you’d damn well better stay vigilant. OR ELSE!”

So because of all this, I’m trying a new and very funky form of trauma therapy: EMDR (Eye Movement Desensitization and Reprocessing). Here’s how it works: I bring to mind a specific traumatic moment from my past and a therapist moves his finger back and forth while I am supposed to “track” his finger AND keep the trauma in mind. That’s it. I think of a trauma and move my eyes, and I pay $150 an hour for it, too.

As crazy as it sounds, it’s a highly researched and promising new form of trauma therapy. The current theory is that the eye movement has a similar effect in our brains as REM (not the band, the Rapid Eye Movement) sleep. For whatever reason, moving our eyes back and forth triggers something in the brain that helps it process information in a healthy way. Feel free to Google it if you think I’ve been hoodwinked by a snake-oil salesman into expensive “therapy” sessions that will do nothing more than leave me with tired eye muscles. It may not work for me, but it’s certainly a growing form of therapy in a field that needs to make some progress quickly! I’ll write a future post or two about EMDR’s impact, but for now, as always, it’s nice to have a semblance of hope that something might actually help fix my brain. We shall see.

At the end of the day, the reality is that we all have irrational fears and “baby traumas” in our lives, so I don’t write this to complain or to prove how badly my brain functions. It’s just been eye-opening for me to take note of how hyper-vigilant I am, and thus how “on track” this new diagnosis might well be. And since writing about things helps me to process them, I share this with you who might be encouraged by my over-sharing ways. Mostly, I write because it helps me (yes, I’m selfish like that). And because it might help someone else (this part makes me feel better about myself). Whatever the reason these sorts of burdens are placed on various shoulders (I’m the farthest thing one could be from a “God-gave-me-this-struggle-so-I-can-help-others” person…happy to share the flaws in that way of thinking with you in a different conversation), perhaps my attempts to process my own confusing existence can be of help to you or someone you know.

Finally, let’s have some fun with our fears…

I’m hesitant to put this out there for fear (irrational?!) that no one will respond, but I think it could be both amusing and relieving to other readers if some of you would share your irrational fears. If you’re up for it, post a comment with your irrational fear. Feel free to use a pseudonym if that helps you get past your irrational fear of responding to this post for everyone in the world to see, thus causing you to become a Monica Lewinsky-like pariah whose only hope for a future job is to write a memoir about what life in hiding is like and what possessed you to do something so foolish as to put your irrational fear on the internet in such a cavalier manner.

But really, I can say with 37% certainty that you won’t regret it as much as Monica regrets her indiscretions.

(Scroll down and take the poll)

 

 

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