Mental Health and Addiction - A thought experiment

Mental Health and Addiction - A thought experiment

I could, if I wanted, post a whole collection of stats here about the number of people in Australia who suffer from poor mental health. I could bore you to tears with the number of billions sucked from the Australian economy in lost productivity. Or I could attempt to be genuinely useful and discuss how we develop better attitudes in these areas (and hopefully better policy). To that end I ask you to accompany me on a little thought experiment - a journey into the unknown.

But before we set off, I need to get a few things straight.

Guiding principle number 1: You've got physical health and you've got mental health.

Well, duh! But they are more similar than we tend to think. When it comes to your physical health, sometimes it's tremendous, sometimes it's terrible, and usually it's somewhere in between. And it's impacted upon, pretty much in equal measure, by your genes, your environment and your choices. And your mental health? Well, sometimes it's tremendous, sometimes it's terrible, and usually it's in between. And it's impacted upon by, you guessed it, your genes, your environment and your choices. Simple!

Guiding principle number 2: Alcohol and other drugs have always been there and always will be.

Whether we are talking about the big killers in Australia tobacco and alcohol, the wide range of illicit drugs that are easily available, or prescription medications that are now causing hundreds of overdoses annually in Australia, we're talking about a situation that will never fundamentally go away. And while there are unhappy people there will always be people who look to dampen life's blows and alleviate life's injuries with narcotics, chemical stimulants and hallucinogens. This too is pretty simple.

Guiding principle number 3: Deep addiction is generally a long-term and painful response to trauma. It is a health issue that must be treated with compassion and dignity.

If you disagree with that statement then all I can tell you is that based on 13 years of working in a mental health and addiction services hub (conversations with clients, conversations with clinicians, and many hours pouring over our statistical data) my experiences support the conclusion. Yes, people can fall into a hole through a few wayward years and a spiral of risk taking, but most people can pull themselves out of that hole if their sense of self is undamaged by serious trauma.

So, back to the thought experiment. Picture this . . .

It is a beautiful spring day in [insert city of residence here]. The sun doth shine, the wind doth gently blow and you're feeling like the day can only yield beautiful things. You just popped into your favourite local cafe, your favourite barista was there, the banter was particularly upbeat and the coffee was perfect.

You're walking in the sun, with purpose though not at all in a rush, towards the train station. Your travelling companion (did I mention you have a travelling companion?) is a 10 year old girl called Jasmine. You see Jasmine once a month as part of a Big Brother Big Sister program, and it really is a highlight in your life. Jasmine’s life is all sorts of complicated. She’s already with her third foster family, has almost been expelled from school on two occasions, is struggling academically and is having great trouble making friends. But, after a first couple of nervous meetings, the two of you are getting along beautifully, and to you she’s a bright-eyed, curious young person with a unique way of looking at the world and a flair for drawing. It’s her talent in the visual arts that has led to this excursion, into the city to the gallery.

You wait at the station, chatting about this and that, hop on the train when it arrives, and start to tell Jasmine about your favourite parts of the gallery. She’s interested and you’re feeling not only happy but also important. Life just couldn’t get any better.

Two stations later, someone gets on the mostly empty train, but you don’t really notice them. Then suddenly you hear a loud female voice say “Where’s my fuckin’ phone?!” 

That’s it. Your bubble is burst, and your mood is suddenly heading south. With trepidation you look up to see a very dishevelled woman in her early 30s (maybe, it’s hard to tell) who is clearly very intoxicated (which you assume is normal for her) and looking pretty pissed off at the world (which you also assume is normal).

Why did she have to get on this train!? Will she ask for money? Is she dangerous? Why can’t she look after herself!? What’s wrong with people these days!? 

Everything about this woman annoys or even disgusts you. You know it shouldn’t, but it does. She’s clearly vulnerable, probably had a shitty life, certainly needs help, but your heart is devoid of compassion at this moment.

Then something very strange happens. The train and everyone in it appears to slow to a halt. A strange light enters the carriage and everything is blurred out except Jasmine and this woman. Suddenly, in a supernatural moment of epiphany, you realise that this woman is Jasmine. Not metaphorically, but literally, and somehow you’ve been given a glimpse. This woman is Jasmine after 3 school expulsions, 17 foster homes and 2 group homes where she was sexually abused. After 5 years spent in prison for attempted murder of a man who wouldn’t stop dealing drugs to her little brother. After 10 more years in and out of the prison system, mostly on drugs charges. After numerous failed and often violent relationships, no steady employment and an infinite variety of unstable living arrangements including rough sleeping.

The thought experiment pauses here.

So, why is it that you feel so much affection, admiration and hope for the young girl, but nothing positive for the young woman? Why does our heart break for child victims of sexual abuse but not their adult manifestations? Don’t feel bad about it – it’s a completely natural response. She appears to value nothing that you find important: looking after yourself, treating others with respect, education, making a contribution . . . the list goes on. In young Jasmine you see potential and hope and your instinct for social justice urges you to help. In the adult you see only failure (of the individual and of the state), despair and ugliness. Your natural compassion has been stretched beyond its limits.

So, when our instinct and emotions fail us, we need to turn to the intellect. Luckily, we have those three guiding principles that we learnt earlier on. Let’s apply them now.

  1. You’ve got physical health and you’ve got mental health, and they go up and down. Okay, so maybe this woman is not always like she is now. Maybe you’re not seeing her at her best. Maybe she has potential to improve. Maybe she's been on a bender since her testimony to the Royal Commission last week. And after all, you’re not perfect either.
  2. Drugs and alcohol will always be there. Okay, so she abuses substances. ‘There but for the grace of god’ could I go if I got kicked in the teeth enough times, right?
  3. Deep addiction is a long-term response to trauma; a health issue that deserves compassion and dignity. Okay, so whatever has happened to this woman, it’s probably deeply traumatic, and what she needs is help.

Now, I’m not suggesting the average person is in a position to help directly, but a position of compassion and adherence to the following belief, is an excellent starting point:

Everybody deserves every chance to turn their lives around.

(This incidentally is the first core belief at First Step, a mental health and addiction services hub where I work)

Without knowing any more about the adult Jasmine, we can also say that the influences on her are her genetic makeup, her environment and her choices. We’re born with our genes, our environment is hard to alter, but why do some people keep making such terrible choices? Can’t they see that it doesn’t add up:

Me-as-I-am-now + dangerous/self-harming behaviour ≠ me-better

That’s obvious isn’t it? So, why would anyone keep indulging in those dangerous/self-harming behaviours if they simply make their situation worse? Well, there’s an assumption in that equation that is so fundamental, that most of us don’t even see it. And that is that ‘me-better’ is something we should strive for because “I am a good person.”  If the Royal Commission (into Institutional Responses to the Child Sexual Abuse) has taught us anything, it’s that serious abuse does instant grave damage to a person’s sense of self-worth. Ongoing abuse often does irrevocable damage. If I am worthless, then why should I strive for improvement in my circumstances (‘me-better’)? What’s more, finding the motivation for long-term goals (of disputed value) over short term alleviation of pain is a very big challenge.

But the simple fact is that everyone’s mental and physical health can improve. Everyonecan reduce their reliance on alcohol and other drugs. Everyone can receive support from skilled clinicians and slowly turn their lives around. Whether the example is extreme (like Jasmine), or, like most First Step clients, less complex, the potential exists to triumph, inch by inch, over tremendous adversity. And when that is achieved, the result is not only better for everyone (the individual, the family, the community, the world) but actually heroic.

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