Why won’t mentally ill people act like well people?
I have been a practicing counselor with a master’s degree in clinical psychology for many years. I fully accept:
The main purpose of reviewing all these points is to remind myself and, you, the reader that even though most of us can relax and know that if we take reasonably good care of ourselves and do not have certain neurological disorders we can rely on the brain being able to make what most would consider logical decisions. While healthy people may passionately disagree about a specific concept, perception or what seems a logical decision or conclusion, individuals with certain conditions including addiction to alcohol and other drugs, are unable to consistently think in a logical order. Those dealing with active addicts get very confused because the addict may seem able to develop and execute elaborate plans to insure that they can procure or gain access to their drug of choice. On the other hand, even though they may hate the consequence of their active addiction they are often unable to make a clear and consistent as well as persistent decision to stop using/abusing alcohol or other drugs (for the purpose of this discussion I am choosing to not discuss the similarities and differences in neurological functions with other addictive behavior, I. e. gambling, sexual, eating),
The active alcohol or other drug addict who is beginning to let go of alcohol or other drugs of abuse, are dealing with these facts:
Given all of this is it any wonder that the addict has a difficult time accepting that recovery is a real possibility and that it is worth it. There is often, at this point, nothing in the function of his/her sick, dysfunctional brain which says that point A will lead to point B will lead to point C.
The United States is a country where many pride themselves on independence, being able to make one’ own decisions, the right to protect oneself and the promise of freedom from unjust commitment to an institution. Although we often determine justice by the quality of the defense one can afford in legal proceeding, the habits or practices of a particular judge, the extensive power we give to people within prisons and jails to increase the length of incarceration, and other factors, the stated goal is to refrain from laws which limit one’s freedom. There was a time when commitment to a psychiatric facility was relatively easy. If, for example, a woman wanted to divorce her husband (even in the case of domestic violence which was blamed on the abused person – frequently the woman) she might find herself in a state mental hospital under deplorable conditions for an indeterminate amount of time. Conditions at many state mental hospitals were often inhumane, without adequate treatment staff, and poorly run. The movie “One Flew Over the Cuckoo’s Nest” may be the best known movie about being in a state hospital. The one size fits all solution was to close state hospitals, make it very difficult to commit someone against their will and ultimately make jails/prisons the new mental health facilities where treatment is often very limited (there are, of course some wonderful exceptions). Community mental health centers were initially staffed by idealistic and passionate professionals who worked tirelessly on behalf of their client/families. Often, however, they were poorly run financially which, in too many instances, resulted in a current emphasis on making the financial stability the chief priority and mainly serving the indigent or those with only the limited coverage of Medicaid. Frequently the clients/patients are busy with survival and have to face the fact that if they do not “behave” no one will care for them medically.
For some years now one can only petition to have someone committed to a mental health facility if they pose an immediate threat to their own life or the life of someone else. If one does manage to get an addict committed for a brief period, they may sound “sane” and be released at the end of the brief commitment. The family who may have initiated the commitment is then subject to the increased anger of the committed family member. No one wins and the addict resumes his or her addictive, life- threatening behavior. Sometimes, if a person is a minor, commitment may be easier. This system is also open to misuse and the commitment facility may seem more like a jail than a hospital.
The 12 step programs such as AA say that the addict has to reach his or her bottom before they will seek treatment. In other words, the consequences of the addictive behavior have to be so terrible (devastating) that they will endure all the discomforts and unpleasant issues to stay clean or sober one day (minute) at a time. There is a significant truth to this approach and for some lucky few it works. For many others death – active or passive – may seem preferable.
Through all of this family and friends of the addict move between anger, fear, sadness, and frustration. They are often accused of doing too much for the addict (CO-DEPENDENT) or too little. They expect the addict to be the logical, sane person that they often were prior the addiction taking over. When an addict is successfully treated the family may be heard to say, “Thank God. Susie or Johnny is back. My child has been returned to me.” This may happen especially after an extended treatment period. Sadly, unless one has a considerable amount of money their family member will not benefit from long term treatment.
Of course, there are those miracles – those folks who go to short-term treatment or straight to a 12 step program and are able to stay clean/sober and in recovery (learning to think differently) for the next 30 to 60 years. That is indeed a miracle which often cannot be explained. Even as a certified addiction counselor who has been working with addiction since at least 1970 I do not know why these miracles of seemingly immediate return to rational thinking happen to/for those few.
The bottom line for family members of the addict:
Written September 8, 2016
I have been a practicing counselor with a master’s degree in clinical psychology for many years. I fully accept:
- The functioning of our brains and, thus, how it processes information varies a lot with and between individuals.
- Biologically, because of genetic predisposition or for other reasons, how or if a particular brain can process information and make what is commonly considered a rational decision varies.
- Many factors including alcohol, other drugs, illnesses such as cancer and Alzheimer’s, nutritional intake or lack thereof, fluid intake, environmental factors, sleep, and others can affect how our brain processes information.
- Habits, compulsions and addictions are cousins but reside, in part in different parts of the brain.
- A person with a brain dysfunction may appear, at times, to have a highly functional brain thus making it seem as if they “should” be able to make what healthy people consider logical or common sense decisions which will then lead to behavior which is not acutely self-destructive.
- The instructions for habits are stored in the basal ganglia which also plays a key role in the development of emotions, memories and pattern recognition. Decisions are made in the prefrontal cortex.
- “The cerebellum ("little brain") is a structure located at the rear of the brain, near the spinal cord. It looks like a miniature version of the cerebral cortex, in that it has a wavy, or convoluted surface…
The main purpose of reviewing all these points is to remind myself and, you, the reader that even though most of us can relax and know that if we take reasonably good care of ourselves and do not have certain neurological disorders we can rely on the brain being able to make what most would consider logical decisions. While healthy people may passionately disagree about a specific concept, perception or what seems a logical decision or conclusion, individuals with certain conditions including addiction to alcohol and other drugs, are unable to consistently think in a logical order. Those dealing with active addicts get very confused because the addict may seem able to develop and execute elaborate plans to insure that they can procure or gain access to their drug of choice. On the other hand, even though they may hate the consequence of their active addiction they are often unable to make a clear and consistent as well as persistent decision to stop using/abusing alcohol or other drugs (for the purpose of this discussion I am choosing to not discuss the similarities and differences in neurological functions with other addictive behavior, I. e. gambling, sexual, eating),
The active alcohol or other drug addict who is beginning to let go of alcohol or other drugs of abuse, are dealing with these facts:
- Intense emotional and physical discomfort of withdrawal or the emotional and/or physical pain they may have been running from.
- The “automatic” habit of using ways and means to get more alcohol or other drugs when one begins to experience physical and/or emotional discomfort. It is important to remind ourselves that habits are extremely resistant to change. This is a positive design factor for the most part. One does not want to hourly think about how to drive, how to dress, how to hold a pen, or the many other habitual tasks of daily living.
- A distorted experience of “reality”. If, for example, alcohol, is the drug of choice, as a depressant, it is forcing the brain to focus on negatives and preventing that same brain from experiencing discomfort as temporary.
- The acute effects of malnutrition.
- The stress of dealing with the mess of their lives which the addiction has caused – relationships, finances, legal issues, and employment.
- The emotional distress of believing (and many others believing) that addiction was/is a choice and they have failed at life. The often feel worthless.
Given all of this is it any wonder that the addict has a difficult time accepting that recovery is a real possibility and that it is worth it. There is often, at this point, nothing in the function of his/her sick, dysfunctional brain which says that point A will lead to point B will lead to point C.
The United States is a country where many pride themselves on independence, being able to make one’ own decisions, the right to protect oneself and the promise of freedom from unjust commitment to an institution. Although we often determine justice by the quality of the defense one can afford in legal proceeding, the habits or practices of a particular judge, the extensive power we give to people within prisons and jails to increase the length of incarceration, and other factors, the stated goal is to refrain from laws which limit one’s freedom. There was a time when commitment to a psychiatric facility was relatively easy. If, for example, a woman wanted to divorce her husband (even in the case of domestic violence which was blamed on the abused person – frequently the woman) she might find herself in a state mental hospital under deplorable conditions for an indeterminate amount of time. Conditions at many state mental hospitals were often inhumane, without adequate treatment staff, and poorly run. The movie “One Flew Over the Cuckoo’s Nest” may be the best known movie about being in a state hospital. The one size fits all solution was to close state hospitals, make it very difficult to commit someone against their will and ultimately make jails/prisons the new mental health facilities where treatment is often very limited (there are, of course some wonderful exceptions). Community mental health centers were initially staffed by idealistic and passionate professionals who worked tirelessly on behalf of their client/families. Often, however, they were poorly run financially which, in too many instances, resulted in a current emphasis on making the financial stability the chief priority and mainly serving the indigent or those with only the limited coverage of Medicaid. Frequently the clients/patients are busy with survival and have to face the fact that if they do not “behave” no one will care for them medically.
For some years now one can only petition to have someone committed to a mental health facility if they pose an immediate threat to their own life or the life of someone else. If one does manage to get an addict committed for a brief period, they may sound “sane” and be released at the end of the brief commitment. The family who may have initiated the commitment is then subject to the increased anger of the committed family member. No one wins and the addict resumes his or her addictive, life- threatening behavior. Sometimes, if a person is a minor, commitment may be easier. This system is also open to misuse and the commitment facility may seem more like a jail than a hospital.
The 12 step programs such as AA say that the addict has to reach his or her bottom before they will seek treatment. In other words, the consequences of the addictive behavior have to be so terrible (devastating) that they will endure all the discomforts and unpleasant issues to stay clean or sober one day (minute) at a time. There is a significant truth to this approach and for some lucky few it works. For many others death – active or passive – may seem preferable.
Through all of this family and friends of the addict move between anger, fear, sadness, and frustration. They are often accused of doing too much for the addict (CO-DEPENDENT) or too little. They expect the addict to be the logical, sane person that they often were prior the addiction taking over. When an addict is successfully treated the family may be heard to say, “Thank God. Susie or Johnny is back. My child has been returned to me.” This may happen especially after an extended treatment period. Sadly, unless one has a considerable amount of money their family member will not benefit from long term treatment.
Of course, there are those miracles – those folks who go to short-term treatment or straight to a 12 step program and are able to stay clean/sober and in recovery (learning to think differently) for the next 30 to 60 years. That is indeed a miracle which often cannot be explained. Even as a certified addiction counselor who has been working with addiction since at least 1970 I do not know why these miracles of seemingly immediate return to rational thinking happen to/for those few.
The bottom line for family members of the addict:
- Do not expect logic or common sense.
- Do not take the behavior of the addict personally.
- Do not trust the addict to BE ABLE to consider the needs of others. The NEED to feed one’s addiction is primary.
- Do not judge the addict.
- Vote for people at all levels of government who are committed to improving the laws and facilities for treatment of addiction and other mental illnesses.
- Be grateful for the ability to think and act logically (most of the time!).
Written September 8, 2016
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