Saturday, 22 May 2021

Dual diagnosis. Mental health and addiction.


Mental health and addiction

Dual diagnosis is the name given to describe both a mental health condition and addiction occurring together.  I have no other qualifications to talk about this but lived experience, and that counts for a lot these days.  Observational lived experience as I do not suffer from dual diagnosis myself, but someone I know does and it has been a very powerful learning curve .   

When I was growing up, I had thought all addicts were the same.  It was their choice to take drugs. They were feckless and if they became a lost cause, well, it was all their own fault.  Addicts were shadowy people on the outskirts of normal life, and always very different to me. I on the other hand, was a better kind of person because I was not a drug taker and I was not an alcoholic though in the early days, an addict in my opinion was simply a drug user.  Alcoholics were always old people and always lying on the streets, whereas drug users were younger but lived in a different world to me. I did not come across many drugs even at university.  They were probably there, but I did not notice them.  A person who took drugs was, in my mind, dangerous and violent.  And, you could tell who they were because they looked like tramps.  I hoped I did not have to meet one. It was that simple.

When I look back to how black and white my thinking was then, I understand that I had no idea about this terrible other world of drugs that nice girls like me did not have to know about.  I had no experience of life being intolerable, no idea of mental illnesses, no conception of taking something to help make the world go away, or the pain less awful, or life easier to live.  I think too, that when I was younger the choice of drug was much more limited than today.  There was weed, and speed, and magic mushrooms, and LSD.  Oh, and heroin, there was always heroin.  And alcohol but it took me a while to equate it with addiction, there were drug addicts and alcoholics and I don't suppose I ever considered that alcoholics could take drugs and drug addicts could drink alcohol.  

Only in the last few years have I come across the term dual diagnosis. There has been addiction in my world over the last decade or so and what a rude awakening it has been to that shadowy side of life that I had only imagined when young.  What a hard and shattering journey for everyone involved.  Of course now, with hindsight, it makes sense, that mental illness and addiction go together.  It is very serious and very troubling.  In my limited experience with addiction, mental health and dual diagnosis, I get how hard it is to keep going with depression, mental illness, psychoses and disorders that make the sufferer feel apart from the rest of humanity.  When life is really hard inside your head, it is made worse by feelings of isolation.  So many of these illnesses and disorders come with cognitive and behavioural problems.  It is hard for parents and teachers, for co-workers and colleagues, for family members and all of us in the big wide world out there to cope with any kind of challenging differences in others.  Without knowing that there is a reason, or a diagnosis of some disorder or other, it is easy to put it down to willful, anti social and often aggressive lack of self control.  Even with a diagnosis of mental, behavioural or personality disorders, it can be hard to know how to respond.  It is really hard to know what to do.

But if this is you, and life is distressingly confusing and frightening, there are countless situations in which substances offer longed for relief from life.  A vulnerable person does not always present as meek and helpless.  Vulnerability may be expressed in explosive rage, in seeking danger and taking insane risks, in self harm or harming others.  That vulnerability comes from an inability to know who to trust, to be easily manipulated, to be unable to judge danger or consequence, to be impulsive or compulsive and to make life difficult for themselves and everyone around them. If this person found something to make all their difficulties go away and make some of the pain stop, then of course, they would take it. And if it made people like them, and gave them the courage to be sociable in a way that got them lots of attention, why not? Why, if the the struggle is so hard and the stuff they take brings such a buzz and freedom from pain, would they not take it?  The thing is, self medicating works.  It makes the world go away. It becomes disastrous when addiction takes hold, but at least in the beginning, it works.  And there are no shortage of people who make a very good living out of making sure the most vulnerable get a go of drugs.

Maybe all addicts suffer from dual diagnosis and have crazy mental health disorders. Perhaps if they did not start out with one, by the time they are addicted they certainly do.  They have many.  

No one with an addiction holds it together very well.  At some point, life unravels.  We all know the image of someone who once held down a good job, looked well and happy against the image of them later, having lost everything, looking unkempt, bleary eyed and thin.  It is people like this I saw in the methadone clinics when I spent time accompanying someone in addiction.  Everyone came into the centre trying to look as if they were ok, when it was obvious they were not.  They were withdrawing and needed their next script.  Withdrawal is awful, and not a pretty sight.  Some came in scruffy suits as if holding on to an image of normality, which did not work and I could not work out whether it was poignant, embarrassing, distressing or funny.  Some came in quietly, some not. Some came in clothes they must have been wearing for weeks, some came in clean and new outfits.  But none were able to sit still, all exhibited signs of increasing agitation and some became aggressive and uncontrollable if they had to wait even a short time.  It was here I saw how mentally unstable an addict is, whether with a dual diagnosis or not.  It seemed that there was no such thing as just mental health problems or just addiction, only dual or triple or multiple diagnoses with addiction.  It was all a big, horrible, mess.  And later, meeting other people in addiction, I was no more than a prospective means for them to get what they wanted.  Whatever I thought from my perspective as a non user and not in this game at all, to the addicts I met I was a means to get for themselves what they wanted because that is what addiction is.  An addict is a master manipulator and even the nicest of addicts knows how to play you.

A personal post script.

The person I knew in addiction started out with difficulties. This person was deeply intelligent with a very high IQ (we found out later) but always felt different, was always difficult to manage and understand and eventually managed to get a mental health diagnosis of something or another.  I say it like that because this person was a product too of their family, and though there was a mental health problem with this person, in that it was most evident in them, the whole family could have done with guidance and a few diagnoses too.  Naming this person's problem was never going to work in isolation, nothing much changed for them.  The whole family needed help.

It was not inevitable that this person would become a drug user but like many youngsters who are angry and feel too different, misjudged, abused and ignored, it happened.  It happened in the clubs and streets that seemed a better option to them than home. Fast forward many years and the madness and chaos that seemed to follow so quickly in this person's life has created deep physical and mental illnesses that may never be sorted entirely.  That early diagnosis does not seem relevant any more, it almost feels like an excuse of a diagnosis in their early life to make them go away.  Now, this person is older and the consequences of so much medication and booze is not pretty.  In a way, when this person was younger - a teenager perhaps - it was attractive and powerful amongst their peers, but now, older, there is a sadness and a coarseness to all the years of struggle against so much poison.  The mental health conditions are now many and complex, and the physical health is fragile and has been life threatening.

But here is something else I have learned.  An addict is not just their addiction.  They are also the person they have always been inside though of course, it may be very hard to see it.  There are times when this person has profound insights into not only themselves, but the world around them.  There is a strange wisdom in this person now, mixed with a total dependency on all and any medication that makes the world go away.  I keep away, mostly, now.  I do not belong in that world, and they do not belong in mine. Though of course, I always hope. 



I have written this to go alongside my exhibition about addiction, details below.

"Addicts And Those Who Love Them" - Behind every addict is someone traumatised by loving them.

An exhibition of portraits and words by me, and photographs by Michael McAlister. 

Showing as part of the Brighton Fringe Festival, the exhibition is supported by Arun Exact, a peer led relapse prevention scheme from Littlehampton, and Adfam, a charity offering support, advice and education for families with addiction.

On from Tuesday 8 June to Sunday 13 June, midday to 8pm daily.  Entrance free. 

The Fishing Quarter Gallery, 201 Kings Road Arches, Brighton BN1 1NB

I wrote this guest blog which puts the exhibition in context for the drugs support charity Adfam

All welcome at the exhibition.  


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