The illness assumption.

anxietymentalhealthillnessbipolarI know and love people who struggle with various forms of mental illness. They are caring and beautiful souls, who just happen to be afflicted with a chemical imbalance in the brain. Sometimes these imbalances are easily kept in check with medications or therapy and sometimes these people fight for years to find a treatment to successfully counter their disease, just as is true for people who battle a whole host of other diseases. Almost without fail, though, my friends and loved ones who battle with mental illness are also confronted by the stigma we so readily attach to it. In that way, mental illness is a cruel two-pronged attack: first a chemical imbalance, followed closely by shame, blame, and misunderstanding.

Whenever we experience a tragedy like the one in Charleston, particularly (only?) when the assailant is a white guy, we immediately hear people making judgments about the shooter’s mental health. “Obviously he was sick,” we say. “Clearly, he’s mentally ill.” “He must have slipped through the mental health cracks,” we posit. Sometimes, particularly from a certain demographic, this alleged early focus on mental illness is an effort to not talk about other issues, like racism or the proliferation of guns. This demographic is easy to pick out of the crowd, because they are the same ones who oppose extending health benefits, mental or otherwise, to people at large. They are also often the same people who declare the shooter was “obviously” mentally ill, but they don’t think we should bolster background checks on weapons.

Sometimes, though, for a lot of us, the assumption of “mental illness” is simply because the events seem so unimaginable that we’re left to assume there must have been some sort of profound defect in the killer’s brain. How else can we explain such unspeakable horror, after all? In the crosshairs of our assumptions, though, are real people who daily struggle with diseases that most of don’t understand. They are people who are, statistically, far more likely to be the victims of violent crime than the perpetrators of it.

All of our mental health suspicions might well be proven to be true about Dylann Roff as the investigation unfolds and actual mental health professionals — ones with specific knowledge of this case, not paid pundits on cable news — begin to weigh in. But what we actually know right now is that Roff was a racist with deadly racist intentions, independent of any sort of mental illness. We also know that racism is not a mental illness caused by some chemical imbalance in the brain. Instead, the hatred of racism is a learned behavior. It’s something we teach.

The good news — if there ever is good news to be found in the midst of horror — is that we all, each and every one of us, have the power to turn the tide on pervasive and systemic racism in this country. It doesn’t even require an act of Congress to begin the process; it just requires an honest and willing look at the condition of our hearts.

May the families of the Charleston victims find peace in the coming days from whatever soothes their hearts and comforts their souls.

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Rescued.

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I knew something wasn’t right when it was a struggle to get the door open. We were coming home from my wife’s first infusion treatment, which had been a disaster of epic proportions, and were looking forward to nothing more than collapsing in bed. For whatever reason, though, the rug in our entry was balled up and shoved under the door, the first obstacle in our quick-to-bed plan. Once we finally were able to get inside, we realized the extent of the destruction left by our normally well-behaved mutts who had been left alone far longer than intended when we said goodbye that morning. The two of them — Suki with her intense separation anxiety and Honey with her increasingly severe senior needs — left evidence of their displeasure, a mixture of shit and shredded paper towels, from one end of the house to the other. It was the final indignity at the end of an unbelievably stressful day, leaving us with the option to either laugh or cry. So we did both.

We’d been leaving Honey alone less and less, mostly because her health’s decline seemed to be picking up speed in recent months. What started as mere mobility issues — her hips and joints plagued by the sort of arthritis than one might expect in a dog of her age — was now more complicated by her increasing loss of vision (she’d lost her right eye to a cancerous tumor years earlier, but now the remaining eye was failing, too), a frequent inability to control her bodily functions, and a growing cognitive deterioration that often left her confused and very anxious. On this particular day, though, after getting my wife tucked in bed and the house returned to acceptable-if-not-spotless standards, I sat on the floor and had a heart-to-heart with our favorite fifteen year old dog. I explained that she was going to need to pull it together and hang on for a bit longer because as anyone could plainly see, we were already at our stress capacity. Then I kissed her nose and gave her a few treats. She seemed to understand.

Honey loved these heart-to-heart discussions of ours, mostly because she seemed to love any opportunity to monopolize my time and attention. For the last year or so, once it became increasingly difficult for her to get up and greet me at the end of a work day, I’d make sure to take a few minutes to lie down on the floor next to her and have a moment, just the two of us. It had become our new thing and I was just fine with it. After all, at her age, she’d certainly earned this shift in routine.

We had another of these great discussions a little over a week ago, when I came home early so Honey and I could sit by the pond and enjoy the sunshine. Her deteriorating health over those prior couple months had been building to this inevitable day and to this most important heart-to-heart. We used to walk the pond’s perimeter all the time, back when Honey was far more mobile and willing. Sometimes we’d use the opportunity to discuss the day or bitch about those infernal geese, but most of the time we wouldn’t need to talk at all. On that particular afternoon just a handful of days ago, though, I’d have to help her to the pond, as the short walk was more than she could manage on her own. I did it all selfishly, because what I needed was for her to do the talking this time, to turn to me like some cartoon dog and speak in perfect English. Maybe she would be able to tell me that she trusts us to do the right thing — the hardest thing — for her. Maybe she would tell me that she’s tired, ready. Or maybe she would be able to say the perfect thing to somehow make it all less sad. Of course, that’s not the way it happened. Honey had spent the better part of a decade bringing joy to our lives, but on that day, it was clear that the heavy lifting was going to be mine.

Honey coming into our lives wasn’t part of some grand master plan. My wife was at the vet’s office with our other dog at the time, an American Eskimo mix named Paige, where she learned that a local collie rescue group was in desperate need of foster homes for an unusually high number of dogs-in-crisis. It wasn’t a great time for us to take on any new responsibility, much less a dog, as we were still in the earliest stages of rebuilding our lives after my wife’s long battle out of addiction. In fact, if we’re being honest, the timing was terrible. We were still fractured from the whole experience in every conceivable way, but my wife also thought that fostering a dog for a short time might be a healthy distraction from her own internal chaos and a meaningful way to give of herself. So, without much additional thought or added fanfare, Honey, a six year old collie, came to live with us.

Make no mistake, Honey was what my mother-in-law would lovingly call a “hot mess.” A puppy mill rescue, Honey was malnourished, routinely abused, and in such poor physical health that she was missing both a lot of her hair and teeth. Confined to a small cage for the first years of her life, she was in a shattered emotional state, as well. She didn’t know how to walk in grass, much less on our wood floors, and she was scared of everything and everyone. So, yeah, we were broken, but she seemed broken, too.

In those first few weeks and months with Honey, her physical health began to slowly improve with the assistance of countless vet visits and a variety of medications. We spent that time working on her other issues a lot, too, such as trying to teach her to trust humans again, even though she’d suffered at their hands for so many years. That’s the truly amazing thing about dogs — specifically, rescue dogs — you see. They somehow have this seemingly undaunted ability to trust and to give of themselves, even when everything in their life experience might have taught them to withdraw instead. We were amazed at how quickly Honey did just that, how soon she was able to express love and trust that it would be returned. It was, as we would only later realize, the exact lesson our own shattered souls needed to learn…. trust, give, receive. In that way, she was a great teacher who saw that we were broken, then lovingly pushed us on a journey back to wholeness. In the process, we became unrepentant “foster failures” and she became an integral part of our family.

Nearly a decade later, we knew that having to say goodbye to our sweet one-eyed friend would not be easy. We’d been having versions of the “what we need to do” conversation with each other for weeks, probably months, in an effort to both come to terms with the reality of the situation, but also to make sure that we were on the same page. Eventually, we would make The Appointment with the vet, at the same office where my wife first saw the flier requesting foster homes. It was on that day of our appointment — just over a week ago now — that Honey and I would make that last trip to the pond.

It was important to us that we both be there with Honey when she took her last breath, to offer any comfort we could as she transitioned from this life to the next. Even though we knew it would be incredibly difficult, we did exactly that, huddled together on the floor of the vet’s office, my arms extended around both my wife and my dog. Those first moments after she peacefully took her last breath were almost unbearably sad, of course, but the experience also cracked the dam a bit on a lot of other nonsense we’d been keeping under lock and key in recent months. I think we’d been so focused on being “strong” and “positive” throughout my wife’s diagnosis and treatments, or maybe just so concentrated on the task at hand because it was all the energy we had in the moment, that we may have forgotten to allow a bit of our dreaded humanity to leak out, too. And so there we were, on the floor of the vet’s office, wallowing inconsolably in our pent-up humanity. Once again, it was Honey to the rescue, showing us the way out of our brokenness.

Love story.

running_away_by_z00m483-d37ilwkI contemplated running away today. The truth is, it wasn’t even the first time I’ve done so since this whole ordeal began a handful of months ago. But don’t misunderstand. I hadn’t devised some sort of game plan, I didn’t have a specific destination in mind, and there was no bag packed and waiting by the door. I simply let my mind wander to a far-off place.

You see, the other day, a friend was asking about my wife’s unfolding medical condition, so I found myself going over the exhaustive litany of doctors and diagnoses, schedules of upcoming tests and procedures, and the looming eventuality of additional treatments and surgeries. She asked how we were keeping it all straight and not crumbling under the pressure, then she commented on our apparent ability to weather life’s storms while always seeming so “together.” That was the word she used: together. Somehow, she said it all without even a hint of detectable irony, while I stood there feeling like a completely exposed and unraveled mess. My friend, to be sure, was offering nothing but a sincere kindness. And yet, all I could think was… yeah, but I’ve thought about running away.

I won’t, of course. We’re both in this for the long haul, whatever form “this” may take, and so even when it gets difficult, it’s still part of our sacred, shared history. It’s our for better or worse, richer or poorer, sickness, health. This — today, tomorrow, right now — is the continuation of our story.

So, sure, I daydreamed about being alone in a far away location, kept company only by a beautiful sunset and a distinct lack of worry. But then, I reached out to a friend and asked for help, this new thing I’m trying on for size. I ate an entire pan of brownies, drank a glass (maybe it was two) of some cheap wine that I don’t even like, and watched a couple hours of mind-numbing YouTube videos when I desperately should have been sleeping. Tomorrow, we face another day full of some unexpected combination of challenge and humor and heartbreak and hope. And we’ll face it together.

Because the story of a love is not always a Hallmark movie with beautiful cinematography and an uplifting soundtrack. Sometimes a love story looks a little more like this.

The deepest well.

dark_river_by_kuru93I was driving along the winding river just a mile or two from our house when I found myself completely lost in the idea of letting go of the wheel and plunging my car straight into the water, a desperate internal plea for the sort of peace that I hoped the consuming rush might bring. The nightly drive home from the office that summer had become my scheduled time to let the darkness take hold after an exhausting day of pretending that everything was fine. It was my time to think, over-think, and more often than not, sob. But on this particular evening years ago, and on several more that would follow that summer, despite beautiful sunsets in the making, all I could see and feel was incredible, soul-crushing darkness. All I could imagine, all that my mind would allow in those blackened moments, was a singular desire to somehow have it end.

What I wouldn’t realize until months later — after therapy, intense introspection, and the sort of emotional distance that sometimes, if we’re lucky, can come with time — was that I had fallen into a deep depression. I had fully lost myself in the heartache of my wife’s addiction, her rocky and incredibly destructive initial battle for sobriety, and the resulting shambles that had come to define our marriage (and by extension, me). At some point, a switch had been flipped from relentless attempts to micromanage everything to the stunning realization that I no longer controlled anything, not even my own thoughts. I was at the mercy of an inexorable helplessness that had turned dark. And then, most maliciously, even darker still.

While I would never claim to know the sort of life-long depression that could cause someone like Robin Williams to take his own life, my experience in despair’s deep well that summer changed how I will always view people suffering in mental health’s darkest recesses. While I once might have viewed depression as a “choice” (can’t you just cheer up?) or thoughts of suicide as “selfishness” (a narrative that I’ve seen play out already with regard to Mr. Williams, with at least one prominent news anchor characterizing Williams’ suicide as “cowardly”), I now know how the mind can betray us when we’re at our most vulnerable. Maybe even especially when we’re at our most vulnerable.

I also know how fortunate I was to still have people in my life who may not have known the depth or the details of my situation — by design, few did — but instinctively knew enough to remind me, in both words and deeds, that I had value. I may not have believed them at the time (I most certainly did not), but there was something sustaining about their acts of thoughtfulness and empathy just the same. Their efforts, whether they realized it or not, gave me emotional energy when I had none, preventing my dark flirtations on those summer evenings from taking root and festering into action. Thankfully, it was the gift of enough strength to allow me to eventually seek help and, ultimately, crawl out of the abyss.

But I realize that I was lucky. Many people suffer far longer and far greater than I did that summer, developing an intense clinical depression that prides itself on being impervious to the sort of encouragement that made a difference for me. And yet, we must be vigilant, because life quite literally hangs in the balance. We know that depression lives in the shadows and feeds on stigma, so we have a responsibility to be good stewards of our relationships, shining a light and extending a hand, even when the person in the well wants nothing more than for us to go away.

* * * * * * * * * * * * * * * * * * * * * * * *

If you or someone you love is having thoughts of helplessness and/or suicide, please tell someone. You can contact the National Suicide Prevention Hotline at (800)273-8255 or suicidepreventionlifeline.org. Another fantastic organization that I’ve come to support over the years is To Write Love On Her Arms (TWLOHA), a non-profit movement dedicated to presenting hope and finding help for people struggling with depression, addiction, self-injury, and suicide. To learn more about TWLOHA, visit their website at twloha.com.

You are not alone, and this is not the end of your story.

The anonymous tether.

LifeRaft


“I can see the beauty of glass objects fully
at the moment when they slip from my hand.”

–Andrew Solomon

Since going public with our addiction/recovery experience on this blog, I’ve received a lot of correspondence from people who find themselves in a similar situation. Some have come from family members or close friends, but often the notes come from people I barely know. The theme is universal: “I don’t know who to turn to, but I’m at the end of my rope. I’m worried and scared. This is destroying me.” These are people looking for a life raft.

Each and every time I read one of their stories, I’m flooded with the sense memory of all of those same feelings. I understand the desperation because I lived it… not for a day or a month, but for years. I know the feeling when frenzied chaos becomes the new norm, the warped filter through which everything is viewed. I know what it’s like when those feelings stop and numbness, no less desperate, begins to rule to the day. So when these people write to me, looking for anything that might be helpful, I understand.

And yet, I feel ill-equipped to offer a real solution. I usually talk about the importance of taking care of yourself, even in the midst of a loved one’s addictive free fall (prioritize mental/emotional/physical rest, eat even if you don’t feel like it, don’t be ashamed to seek out anti-depressants, consider seeing a therapist on your own), but invariably, in my rambling prescription of something — anything — that might help, I mention twelve step programs. Maybe if their addict loved one would be willing to attend a meeting or perhaps you could find some people in the same situation in an Al Anon gathering, just for a sense of “you are not alone,” might those things help? Sure, I guess they might. However, I also know based on everything I’ve read and, even more importantly, my experiences with twelve step groups, that these programs are not the actual answer to much of anything, certainly not long term. [A recent Salon article on the subject, found here, details a lot of my concerns.]

Early in my wife’s quest for sobriety, we encountered a whole host of different counselors, therapists, and “experts.” Almost without exception, each and every one of them recommended that my wife attend twelve step meetings (AA, NA, and the like). In fact, some of those experts required it as a condition of continued treatment. This is not uncommon. Additionally, it was routinely communicated that if I, as the non-addict spouse, wanted to “be a participant” in my wife’s recovery, I should “commit to a program,” too. Pursue my own “recovery,” I was told. For either of us to do otherwise would indicate some sort of moral failure or, at the very least, a sign that we weren’t somehow willing to do the work.

To her credit, my wife eagerly committed to the rigorous — “90 meetings in 90 days” is commonly suggested — schedule of meetings. She fully immersed herself in the schedule, the dogma, the literature, and the anonymity. Her life was filled with meetings (two and three times a day, if needed), phone call “check-ins” with fellow recovering addicts, faux-counseling sessions with her sponsor(s), and group study sessions to review/read/discuss the various twelve step texts. There were reading assignments and homework to be completed, too. It was all of the time and it was always under the veil of anonymity. It was, in my estimation, a (secret) religion.

Soon, after years of feeling that I might lose her to her various addictions, it now became clear that I would lose her to sobriety. Throughout the process, I was cast as the outsider, someone who wouldn’t (couldn’t!) understand. Perhaps I was even someone who was holding her back from the sober life that she could have, as long as she stayed in the program with the people who understood her and continually “worked the steps.” Everything else (read: our marriage) and everyone else (read: me) was but a distraction in her program-approved quest for wholeness.

When I’ve talked to friends at length about our journey, I’ve often said that, at least for me, the first year of my wife’s sobriety was worse than all the years of her addiction combined. “It gets worse before it gets better,” I commonly tell people on the cusp of a similar journey. I think that’s true for a variety of reasons, not the least of which involves an addict trying to navigate his/her way through every (usually amplified) human emotion without the numbing power of substances, often for the first time in their adult lives. However, in the case of our marriage, it also got substantially worse due to the influence of twelve step dogma, some of the specific (damaged) participants in those programs, and their unflinching focus on brokenness and its corresponding prescription of separatism.

Let me be clear. I know people who swear by AA (and similar twelve step organizations). Some of these people believe their sobriety hinges on their continued participation in “the program” and, as much as I might disagree with that sentiment, I acknowledge the value of sobriety over a life of addiction. I also know people who credit twelve step programs for turning their lives around, all while managing to strengthen existing family ties. It’s worth noting, though, that I also know people who became less of themselves because of their involvement in these same groups. I know people who would go on to eventually lose their fight to addiction, despite years of dedication to various meetings, programs, and rehabs. To say that results vary is an understatement.

I’d like to believe my wife would have found her way to sobriety even without those first few agonizing months and years in twelve step programs, but I can’t be sure. I do know there was no real healing for us, or for our marriage, until her involvement in them ended. Even still, I am hesitant to reject their potential positive influence completely. I realize that for some, these programs seem like a tether to a new life, sometimes the only tether within grasp. More than anything, I understand that when times are desperate — if you know someone who is losing a battle with addiction before your eyes, yes, times are desperate — you’ll try almost anything to stem the tide. Maybe that’s a value of the program that I can recommend: it’s something to disrupt the vicious downward spiral of addiction.

The next time someone asks for my advice, I will undoubtedly be faced with the same dilemma. Do I mention twelve step programs as a potential life line, even though everything in my being and in my experience tells me something to the contrary? The truth is that I probably will. At the end of the day, if I know nothing else, I know that addiction is a formidable and complex enemy, requiring a formidable and complex response. As such, a prescription of whatever works — whatever keeps the addict alive and encourages a life better lived —  is all I have to offer.

For more information on this subject:
Salon | The Pseudo-science of Alcoholics Anonymous
NPR | With Sobering Science, Doctor Debunks 12-Step Recovery

Vigilance.

PSHThe details started to leak out, as they do in this TMZ age, in the immediate hours following his death: He was found in the bathroom of his apartment, wearing just a t-shirt and shorts, with a needle still in his arm. There were dozens of bags of a specific well-known street brand of heroin, as well as various prescription pills, strewn around his home. There were theories that the heroin might have been cut with fentanyl, an extremely dangerous and potentially lethal drug combination. (Preliminary tests would then indicate that there was no fentanyl found in the heroin.) At the time of his death, his three young children were at a playground just a block and a half away. He’d separated from his long-time partner, the mother of his children, months earlier and had subsequently moved into the very apartment where he would be found dead. He reportedly appeared “drunk and disheveled” in the days leading up to his death. At a recent film festival, he told a reporter that he was a heroin addict. And, of course, people in the know had been worried.

Despite all of these bullet points, when I started learning more about the unfortunate death of Philip Seymour Hoffman, my singular focus was on the fact that he had a couple decades of sobriety under his belt when he reportedly relapsed sometime last spring.

Early in my wife’s sobriety, she kept meticulous track of her “days.” This information is so important that it becomes a vital part of one’s introduction — “hello, my name is… and I have 27 days sober/clean” — in the world of Anonymous meetings. It was important to us, too. We were sure to celebrate all of the anniversaries (it’s been three months, now a year!) as though we were marking notches on a door frame, each mark slightly more hopeful than the last.

When my wife relapsed and The Count had to start over at Day One, we had discussions about how important this day tracking thing even was. For her, I think it was initially as devastating as the relapse itself, this feeling that all of that work had been in vain or somehow now “didn’t count.” There would be the shame of telling people, particularly her friends in recovery, as her introduction (and thus, her position in the hierarchy) would now require an important revision. For me, it meant reverting back to a routine of waiting by the phone whenever she was out of my sight, refusing to sleep at night “just in case something happened,” replacing planning-for-the-future language with the recommended one-day-at-a-time rhetoric, and the return of the same soul-crushing anxiety that had just started to abate.

What we learn from the Philip Seymour Hoffmans of the world, though, is that the disease of addiction can be a persistent and calculating enemy-in-wait, no matter how many days, months, or years one has acquired. This isn’t necessarily new knowledge, of course, as it’s one of the fundamental tenets of any Twelve Step program, but it’s a point driven home when an accomplished man with a young-adult-worth of sobriety cashes it in for a needle in the arm, and then dies.

The challenge becomes learning how to live — and I mean, truly live — in addiction’s enemy-in-wait reality. We must find a way to celebrate all of the gifts and possibilities that recovery has to offer, without allowing ourselves to succumb to the arrogance of complacency when the last relapse becomes a increasingly faded memory. More than anything, we must learn to be ever-vigilant without being ever-fearful. It’s a delicate balance that I’ve not yet mastered.

But I’m working on it.

Troubled.

cory-monteithMaybe his death was drug related and maybe it wasn’t. After all, there was nothing in the immediate reports to suggest one way or another, as the only accounts are that he left the hotel with friends earlier in the evening, then returned back to his room late and alone. There won’t even be an autopsy until sometime this week, I imagine, with any official results coming days or weeks after that. And yet, mere hours after the initial reports that Cory Monteith, one of the stars of the television show Glee, was found dead in his hotel room, adjectives like “troubled” started being added to the headlines announcing his demise.

“Troubled actor dead at 31.”

I’ve never really been a big fan of Glee. (Perhaps there is something about the idea of misfit kids in an Ohio high school show choir that hits a bit dangerously close to home.) I have been familiar with Cory Monteith, though, and the rather eloquent way he would periodically talk about his past battles with addiction. I admired the way he spoke about his journey — drug abuse by age 13 or so, a hard-fought battle for sobriety, then landing an acting gig on a big show — with both candor and gratefulness. When there were stories in the news about him checking himself back into a substance abuse program this spring, I quietly pulled for him in the way that you do for complete strangers when you have loved ones of your own who have walked the same path.

I understand that when an otherwise healthy 31 year old dies, particularly one who had been vocal about his battles with substance abuse, it’s natural to wonder if addiction played a role in the end. What bothers me, though, is the way we allow the stigma over addiction to become a pejorative in those wonderings. Monteith, who wasn’t known for the sort drug-fueled antics or arrests that have become commonplace with young Hollywood, suddenly becomes “troubled” in death.

We don’t handle other diseases this way, immediately casting blame at the feet of the deceased. We don’t respond to the news of a beloved actor dying of a heart attack with headlines about his shitty diet or lifestyle (“Fat Guy Who Refused To Exercise”…) and we wouldn’t so callously lead the news of a death due to lung cancer (“Two Pack A Day Smoker Dies”…) before the family had even been given a chance to digest the horrible news. You see, in almost every other situation, we just wouldn’t dream of labeling people “troubled” when their disease ends up taking their life. In fact, it’s often quite the opposite. When someone passes away after a hard-fought (but ultimately unsuccessful) battle with cancer, we rightly talk about how courageous they were, even in the midst of setback and defeat. Courageous until the end, we often say. Yet, when it’s addiction? “Troubled actor dead at 31.”

I don’t know what caused Monteith’s death, but I can tell you this much. From everything I’ve read about him over the years and from everything I know about the ravages of addiction, Monteith fought a long, courageous battle against a pertinacious enemy.

Let that be a headline.