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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Saturday 8 May 2021

Do you do any jolly art?


I did not do this.

 My friend Deb asked me this last night, after dinner.  If you had to create an exhibition about something jolly, she asked, what would it be? 

In the warmth of the fading evening sunlight, sitting at my kitchen table next to all the flowers in colourful jugs and containers next to the spotty salt and pepper pots, with all my bright and motley collections of mugs, plates, saucers and bowls stacked up on shelves around the kitchen, I was stumped for an answer.  Deb looked at me, and I raised my eyes to the ceiling in order to think.

"HIV?" I said.  

"That's not very jolly," said Deb and a thoughtful silence filled the room. 

"Your house is jolly," Deb said next, "and you're jolly. Think again.  You can do it.  If you had to do a jolly exhibition, what would you do it on?"

But I could not think of a whole exhibition of jolly art.  I can do one off happy, light hearted paintings, I love a bit of colour and fun, I have done fairies and angels but as Deb tried to get me to a point where I could say Yes!  I can paint funny kittens! it became obvious that I did not have it in me. 

I have tackled death and dying (The A Graceful Death exhibition ) and am currently working on an exhibition on addiction (Addicts And Those Who Love Them) and so I see why Deb was thinking about something lighter.  She herself was talking about birth for a project she'd like to work on, and though it is true that I am jolly, upbeat, optimistic and extrovert, all I could see were still births, unwanted babies, sick babies and post natal depression.  It was then that Deb asked the jolly art question.  "Could you do it?" she asked, and I found myself saying, "No." I did not feel too comfortable admitting it, and of course it made us both laugh, because what have I become that my idea of light and uplifting art is a project on HIV?    

I will unpick this now.  I cannot leave you all thinking I take HIV lightly, or that Deb and I laugh at it.  

From A Graceful Death

I am drawn to difficult things.  Not all difficult things, it seems I have to have had some experience within the subject to want to take it further through art.  Though I have had no experience of HIV, I am moved by accounts from friends who went through it when it was new, and very dark. There is something about the way fear and the not-knowing created untold cruelty and suffering back in the 1980s when AIDS first appeared, that makes me want to know more about the people who died in isolation and in total pain.  Dame Cicely Saunders, founder of the hospice movement, came up with this description of pain for her patients facing the end of life.  Total pain includes a whole experience of pain - physical, emotional, social and spiritual.  It describes the power of pain itself, and for all those people who died alone and rejected, total pain seems to me to sum up their experience. If I were to create a project on HIV and AIDS, perhaps I hope for something to be redeemed by remembering people I have never met, through paint and words, though they are, possibly, in a much better place of light now, if that is what one believes.  Which I do. 
From the Addiction exhibition

Perhaps I explore these subjects because I want to find a space in them for healing.  Art can find a way into our minds, start us thinking, and sometimes there is a divine whispering, a new insight coming up that may include compassion, or understanding, or connection.  All the work I do is intended to unlock some self knowledge, at whatever level it happens.  Because I have no answers, I am very drawn to ask the people I work with on these projects, to explain themselves to me.  I remember saying to the people I painted and interviewed for the A Graceful Death exhibition, "Who are you? What do you want to say?" From those questions all manner of stories, accounts and wonderful things emerged.  I use those questions in all the projects I do now.

Of course, I really explore these subjects for myself.  I want to understand something of the humanity of the people involved.  How can we understand another person's humanity?  I don't really know, but we have to have a go.   The journey of a thousand miles begins with a single step, as an ancient Chinese proverb says.  I am drawn to this work, these subjects, this exploration, this journey.  Everyone on the journey teaches me something.  It all comes down to me, then.  What do I learn?  What can I do?  How can I use this knowledge?  Much of the knowledge is perhaps "total knowledge", as in Dame Cicely Saunders using the phrase "total pain".  It is physical, mental, social and spiritual.  That kind of knowledge rubs off on people that are around it, and gathering the stories of people who have experienced, and are still experiencing, difficult stuff, can be very powerful.  I have found that we all benefit.  In the telling of the story, the listening to the story and the showing of the story.          

And so, now, back to painting jolly things.  Why am I not interested in doing any?  Perhaps because my life is quite jolly, and I need a bit of an internal push to paint.  My life outside the studio is like this. 

  1. No one lives with me.  Done the Mum thing. 
  2. My house is full of all my favourite stuff. My daughter says it is like my creative brain has exploded onto the walls.
  3. Living alone, I can eat what I want, when I want, and experiment with all manner of nice treats.  Like seeing what peanut butter and jam sandwiches are like in the bath at 3am.  
  4. My garden is filling itself with new buds, flowers, lush new growths of young strong green foliage and it makes me feel delighted with life. (I may have love fits about the garden but it is actually my friend Chris who works hard in it, he makes it thrive.  I just coo about it and commune with nature as if I had done it all)
  5. I have my fourth grand child, born last week, to adore.  Still doing the Grandma thing.
  6. I have lots of ideas for lots of projects, so there is never a dull moment.  A wonderful gift in getting older is that I don't actually have to do them.  It is enough to sit on my soft red sofa and simply think about them. I can then chose the easiest.

 I wonder if I am taking all the jolly things for granted, and simply enjoying them.  But perhaps, thinking about it even more, I respond to the tightrope balance between harmony in my private life and a wish to explore the darkness beyond it.  I have only arrived at a modicum of harmony in my own life by knowing and experiencing huge disharmony.  My life has not been easy, but it has been amazing. There is something very real, very true, about people when the chips are down.  That is where the truth is.  That is where the insights are.  That is where the hard work is.  That is where I want to discover more about life itself.  I have been there so often myself, and may still return - life is unpredictable.  But at the moment, there is enough jolly in my home and life that I do not want to explore it through art.  I simply want to have it, and gain courage from it and carry on exploring.

A jolly painting, "Jesus on the Tube" has been a firm favourite for many years. See, I can do it.

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