Mental Illness and Addiction: Changing the Narrative

I’m finishing up a popular memoir called Hillbilly Elegy, by J.D. Vance, and while the book isn’t about mental illness and addiction, per se, Vance’s story of unlikely success grows out of his disgust toward his mother’s endless addictions to both men and drugs. Over the course of Vance’s 31 year life, his mother has been married five times and her drug habits have gradually devolved to the point of entering rehab for heroin use.

The mental illness in Vance’s family is undiagnosed, mostly because “hillbillys” are highly unlikely to talk to a therapist about their problems. But as a child, Vance’s mother seemed most negatively impacted by her own parents’ screaming matches and her father’s alcoholism. While her two siblings stood up to the chaos without losing a sense of self, Vance’s mom would cower on the floor and cover her ears, much like she would do when yet another man left her. One could certainly diagnose PTSD and inevitably, there would be other valid mental and emotional disabilities to be medicated or counseled. So, while I know I’m painting with a broad brush, for the purposes of what I want to say here, I’m going to simplify matters and say that in Vance’s life, in my life, and in so many other lives, mental illness and addiction go hand in hand and are culturally regarded in very much the same way.

Toward the end of the book, Vance does an informal survey of his extended family about why his mom’s struggles ruined her. He primarily wanted the opinion of his mom’s two siblings. Both of them take the attitude toward their sister that typifies what I perceive to be our national attitude toward both mental illness and addiction: “Yes, these are real ‘diseases,’ but the cure for them is primarily to quit whining and get your life together. The struggle is probably real, but the cure is willpower.”

Some examples:

1. The Atlanta Falcons recently hired a new Offensive Coordinator who lost his last job because of multiple alcohol related incidents, including showing up to his head coaching job drunk. On TV, a sports commentator’s jaw was nearly on the floor with disbelief that anyone would hire this man. But if alcoholism is a disease, shouldn’t the attitude be different – something more like, “I’m thrilled that this man is back on his feet and is doing what he needs to to stay healthy.” If he had come to work and passed out from not tending to his diabetes, would anyone guffaw that he could get another job after such irresponsibility?

2. A friend of mine suffers from crippling depression; she hasn’t worked in years. Her very gracious brother supports her financially, but he also incessantly tells her she needs to exercise and volunteer. Those are, in fact, very good suggestions. However, they are coming from a place that misunderstands the hurdles that have to be jumped to get to the gym or to sign up to volunteer. This is a woman who has a PhD, who adopted a child as a single mother, and who has held many high-powered jobs over a forty year career. She didn’t become lazy all of a sudden. Something changed in her brain, and getting to the gym for her can be like asking someone who’s petrified of heights to jump out of a plane – unless there’s someone strapped to their back, they ain’t jumping out of that plane.

I can hear the objections to my points through the internet waves. Or maybe it’s just that I have those same objections buried in my own brain from a lifetime of training. They are saying to me: “Tim, you’re letting people off too easy. Are you saying that we have no power over mental illness and addiction? Are you saying we can all excuse our bad behavior because we’re “just wired this way”? Are you saying we should let people come to work drunk and hold their hair back while they puke in the trashcan during an important meeting? To which I say, “Of course not! Alcoholics should wear their hair in a bun.”

But really, I am not saying that. People, even those with mental illness and addiction problems, have a responsibility to manage their conditions. Our treatments for these ailments are embarrassingly rudimentary, but people who suffer still need to seek treatment until they’ve run out of options (and many do, sadly). What I’m addressing here isn’t so much how some boss should handle an employee’s first absence due to depression or anxiety. I’m more interested in the systemic attitude that I hear from Vance’s aunt and uncle about their sister…as well as from many of my own family and friends. Essentially, they say this, “We grew up in the same house/school/town/neighborhood; we made it and succeeded; what’s YOUR problem?”

That is the misguided attitude that has to change.

It’s the same attitude you see in rich, white people toward inner city black kids who “aren’t taking advantages of their opportunities.” At first glance, it seems like a brash, arrogant attitude. But in reality, I think it is a fearful and defensive one. We all want to believe that our successes are because of our own merit – that anyone could do what we have done but we wanted it more, had a better work ethic, or slayed a few more dragons by their bravery. It’s scary and unsettling to think that our success of which we are so proud might have a good bit less to do with our own acts of will than we think. So we call others, those who do not have what we have, weak, broken, or even depraved. That allows us to remain the “good guy” who has it all together by the strength of her own will.

Another way of putting it: Michael Jordan isn’t just tall and athletic; he was also wired for endless hours in the gym and for intense competition. I could have the same exact physique as him or I could have the same intensity or the same competitive spirit, but unless I had all of them combined, I could never be as good as he was. But if I looked just like him and had the same athleticism, inevitably people would say I had wasted my talent. If I’m not wired for all those hours in the gym, though, and like to read instead, does that make me a wasted, would-be Michael Jordan? I think that’s far too simplistic. It’s the same with mental illness and addiction. What looks one way might be something starkly different.

Maybe I’m only making this argument because I’m a forty-year-old, privileged, white man who is trying to start over. Maybe I just don’t want to believe that I failed and that it’s my fault. Maybe the masses are right about me and every other addict and mentally ill person: Sure we have a real illness on our hands, but if we were strong enough people, we’d fight our way out of the messes we find ourselves in. Are all of us just weaker – sure to be destroyed evolutionary principles that cause the fittest, not the weakest, to survive: Slowly, we’ll annihilate ourselves by suicide, overdoses, and a lack of desire to pass on genes. Is that what’s happening here?

I’ll leave that to you to answer, but I ask you to think twice the next time you think that someone needs to just get her act together. People say we need to walk a mile in each other’s shoes, but I don’t think that would do the trick. What we really need is to actually walk a mile in that person’s DNA – to think their thoughts, to feel their fears, to be haunted by their traumas, and, of course, to have their experiences. This might enable us to offer more grace to others, not only who are haunted by mental illness and addiction, but also our plain old, every day brothers, sisters, friends, and family.

For further reading:

A good piece about attitudes toward addiction: http://www.cmaj.ca/content/184/2/155
And one about attitudes toward mental illness: https://www.rethink.org/news-views/2013/11/attitudes-to-mental-illness

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5 thoughts on “Mental Illness and Addiction: Changing the Narrative

  1. You are absolutely right, Tim, in that we cannot know what it is like to be in another’s place. I do think that support groups for people with mental illness have much to offer. I also read Hillbilly Elegy and wondered how the author made it out of his culture. Being from the mountain part of the south, I could relate to him. He owes his grandmother a lot for being there for him when his mother was not able to be there. I think he also realizes that he can’t go home again, as I do.

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