Dual Diagnosis

“He thought of the PET scans he had studied, always looking for his mother, hands in his pockets, nodding as the radiologists spoke, and sometimes tears twinkling behind his lids–the enlargement of the amygdal, the increase in the white-matter lesions, the severe depletion in the number of glial cells. The brains of the bipolar.”From Olive Kitteridge by Elizabeth Strolt

One of the reasons finding your own mental illness is so hard is that the medical profession doesn’t share all it knows with a patient. The radiologist knows what the brain of a bipolar looks like but has no way to communicate this to the affected patient. He isn’t a psychiatrist–the mental health expert. And guess what, the psychiatrist if this is his diagnosis will prescribe medication as an attempt to “cure” the patient. It doesn’t cure the patient.

As much as I love the 12 steps for addiction recovery, they didn’t help me at all with my depression recovery. In fact, I think they slowed down my realizing I had a dual diagnosis. Because the steps are focused on self-recrimination, those of us who use them for recovery tend to think of ourselves as responsible for all of our problems. If we have depression, we seem to be unable to get well.

I had clinical depression for two years–1986 to 1988–when I was 10 years into addiction recovery. It was a very shocking experience. I didn’t know how to talk about it. Whatever I said in AA meetings, I was advised to work the steps harder. I was going to a daily noon meeting where I felt safe and secure. But outside, in the real world, I was having a very tough time functioning. Drinking or using was never an option. I call living with addiction and depression recovery the “double whammy”.

Denial is a tricky companion. In 1988, after being sober for 12 years, I was working at a psychiatric hospital in marketing giving lectures about depression in geriatric homes. One day I looked at my giant flip chart of the 18 symptoms of depression and realized I had at least 15 of the symptoms. It was OK for me to be a recovering alcoholic, but not OK to have depression. I left that lecture and went back to the hospital, looked up my favorite doctor, and told him that I needed help. Within 3 weeks, I felt better than I had ever felt in my life. So I had lived with depression for as long I could remember. I used alcohol to self-medicate.”

I now know that for most of those of us–at least 50% in recovery who live with a dual diagnosis–we have lived for most of our lives with it. So the mental illness is part of who we are. We are expected to be able to know that we are ill. We are asked, “Are you depressed?” If you have always lived this way, how can you possibly know it is abnormal?

I remember how long it took me to wrap my head around the fact that I had self-hatred. I kept rationalizing that I thought of myself as a good person. I didn’t accept it until I read in the ACA Red Book (ACA is Adult Children of Alcoholics) about my hatred coming from not being able to heal my family of origin while I was a child.

These deep-rooted faulty self-concepts kept me looking for people to “save” for almost 70 years. I guess I had quite a Messiah complex. Talk about a slow learner and a hard head. I believe these self concepts added to my depressive personality from my childhood. If you carry the weight of the family on your shoulders, it is hard to lighten up and let life flow.

Responsibility is a wonderful quality to have but over-responsibility kept me from becoming all I could be. So I have lived with the double whammy.

I have been gifted with what I call the double whammy–depression and addiction. I believe my wound is depression and addiction was the bandage. We are each our own mental health ‘doctor”. We each have our own answers. And mental health ebbs and flows. So change is not only necessary but is also vital if we want to be truly human, truly alive.

The 12 steps taught me the way out of addiction. But they didn’t help me with depression. Luckily, for me, I have dysthymia which is milder than other depression types and it comes and goes. I have had to learn everything about my depression by myself. I am sure that is true for most of us with co-occurring or dual diagnosis. The mental health field can provide labels, medication, and sometimes, if you are very, very lucky, good counseling. But we have to become our own mental health expert. There is no one size fits all for depression recovery. It is an individual journey.

From “Runs in the Family” from Michelle:

However, I can say with more confidence that anxiety does run in my family. It is especially common in the women. One of my aunts has received medical attention and medication for anxiety. When some of the others talk about their worries, I’m able to recognize the unhealthy thought patterns. I recognize them because I have them myself.

But here’s the thing: we don’t talk about it, not really. Something might be mentioned in passing. Nobody comes out and says “I have an anxiety disorder.” For whatever reason, talking about it isn’t something we do. I’m really no better than the rest of them. I’ve never told anybody in my family my diagnoses. None of us are necessarily hiding the truth, but we don’t face it head on either.

And I wonder how much of the anxiety is learned behaviour. My mother is a worrier. She’ll keep herself up all night worrying about things. I’ve done it a time or two (or three, or four – I’ve lost count) myself. Did I pick up on her bad habits? Did I subconsciously learn to be afraid of things because I sensed that she was afraid?

From “When Someone Mocks Your Mental Illness” by Jeanne Croteau:

When you live with mental illness, there may be times when you feel utterly powerless and unsure how to go on with your life. It can feel so much worse if you lack a strong support system. If you are on your own, there are ways that you can take action.

  • Seek SupportIf you are dealing with mental illness, reach out for help with managing the symptoms.Develop coping strategies that work for your specific situation. Always remember, however, that what’s right for one person may not be right for another. If you end up feeling shaken by something someone said, seek out additional support to get you through the tough times.
  • Change Your Circle – It could be family, friends, acquaintances or coworkers. If someone refuses to invest time in understanding your condition and mocks your struggle, they need to leave your life. Set healthy boundaries to protect yourself from anyone who will add to your already heavy burden. Make it clear that they are unwelcome in your life as long as they continue to treat you that way — and then move on.
  • Stay True to You – No matter what anyone says, you know the truth about your journey. Do not let anyone knock you off your path. Instead, stick with what has been working. Take up a new hobby. Get outside. Whatever you do, just don’t give up!