Illness or Character Defect?

A reader asks:  Lydia, I’m new to your site and much of it makes sense. How ever with the defect issue I have one thing that bothers me. That would be the influence of anyone with a mental illness. To be clear I’m talking about a diagnosis from Mental Health professional and not one of self diagnosis. I struggle with this. Depression for one is an illness and not a defect in character. I struggle with the concept of defect in relationship to mental illness. Where is the line between a defect and an illness? Maybe you addressed it in another post regardless I would be interested in your take on this.
Thanks Doug

******Extremely important disclaimer:  All that’s written here is my opinion only.  I have no special training or credentials.  I have lots of opinions, and when someone asks, I usually will give it.*******

I gave this question a lot of thought, for many reasons.  Critics of AA find fertile ground here.  AA members span the spectrum on what they think about these things.  As I hope we all know, AA is not an inherently safe place, and people can find someone to say just about anything there.

And that’s part of the problem.  Mental illnesses (including alcoholism), physical illnesses, terrible life situations, bad luck.  Alcoholics can and do use all of these to manipulate people including doctors and therapists.  They can and do use all of these things to manipulate the people in their lives.  They can and do use these things to avoid sobriety, to avoid work, to obtain drugs, to get or avoid attention.

I have personally been pregnant and given birth, I’ve had teeth removed and a dental implant, I’ve gone through bad emotional crises in sobriety and I’ve been offered drugs that I didn’t need and that are dangerous to me by doctors who I’ve specifically asked not to do that.

For me, it is incredibly dangerous.  Once the drug enters my system, my ability to think clearly is compromised.  My brain reacts in a way that does not care if my tooth actually hurts beyond my ability to bear it.  It craves the sensation of those drugs and once it has some it wants more.

Sitting here now, sober, I can recognize and avoid all that.  But “what if” I actually need the drug and have to take it?

What if I don’t actually need it and want to take it?

I know people who have gone out and died because of needed pain killers.  I know people who have not been able to bear the psychic pain of depression and who have killed themselves.

Is “depression” a character defect?  I think so, yes, for just about everyone.  Depression as a mental illness is something else that only some people experience.  Personally I absolutely cannot judge what someone else is going through, and this troubles me very much when I’m asked to counsel or sponsor someone who needs to take psychoactive drugs.  I know that they can be easily abused and misused and cause death.  I know that a lack of effective treatment for some mental disorders can cause death.  What I don’t know is the mind of the person I’m talking to, or thinking about.

People who have serious mental illnesses, including depression, or serious physical disorders, in my opinion, may face a much more difficult time achieving and maintaining sobriety than people who do not have those things in addition to alcoholism.  I try to move very very cautiously when I listen to those people.  I’m afraid I usually end up on the side of not being tough enough in my questions about, “Do you really need this drug?”

The thing is it’s just so, so dangerous to take them.  If there’s any way to avoid it, I’m for that.  But of course I realize there is more danger, for some people, to not take them.  Problem is, all of us alcoholics in some way want to be the person who has to take the drug.

So, to answer the question, is there a line between the illness and the character defect?  I think there is, but it’s a dotted line, not a solid line.  A person who has the mental illness can still suffer from the character defect, and probably does, as we all do to some degree.  It may be harder for that person to deal with the character defect.  That said, in my real life I do know some people who have mental illnesses including depression who are successfully sober for long periods of time in AA.  I can’t pretend to know what they go through, but from my staunchly pro-AA standpoint it seems to me they have lives that are so much richer because they work the steps and participate in the fellowship of the program that was in large part designed, by the way, by a famous depressive, Bill W.

October 18, 2014 (this day)

IMG_1217It is so hard to photograph black animals!  This picture from last year’s getaway sent me down the road of thinking about the year.  Last year, we probably exposed the dog to the ticks that gave her Lyme’s.  I don’t know for sure, but she had a bit of a rough year physically.  She may be about ten years old now, getting up there for a dog her size.  She doesn’t follow me up and down the stairs every single time I go now, just most times.

 

Last year at this time, my work partner and her husband took a vacation that would be their last.  He had symptoms that finally compelled him to see a doctor, too late.  His cancer was diagnosed in December, and he died in March.  I spend my days with her and I have done so for 15 years.  She’s ten years older than me, and I try to ready some little part of my heart to accept working without her, to accept living without this dog.  I know that I may not experience these losses, but that I probably will.  If I’m lucky I will.

 

We made that trip last year with some women from AA.  One spent the year since then drinking, on and off.  She’s sober now, back in the fold, trying to embrace AA again as the only lasting answer.  I think, briefly, of what her life would have been like had she stayed sober.  I wonder if she could go back and do it again if she’d be able to stay sober.  I remember the lie my brain – my disease? – would tell me that alcohol would make me feel better, even when it didn’t, even when it hadn’t.  Reality was just too much to bear.

 

Really.  And my reality has never been all that terrible.  Maybe it’s not reality that I couldn’t bear, but just my undrugged self, my real self, my raw self.

 

I’m reading a book about lying.  I’m reading it because, as an investigator, I’m often trying to discover the truth about what happened from people who would rather I didn’t.  Reading about the way we individually view lies and lying made me jump to the program of AA.  I was raised in an average way for my time and place.  I wasn’t raised with strong morals or a serious code of ethics, beyond the regular WASPy-upper-middle-class values that predominated my neighborhood and my schools.  But in AA I learned to consider honesty as a character trait I would like to have, dishonesty as something that is bad and that will lower the quality of my life.  Active alcoholism taught me to lie as much as I needed to get what I wanted, which was a slow kind of suicide.  AA taught me to tell the truth in ever-increasing circumstances and situations and to consider carefully the content of my character.

 

So back to my friend who spent the past year drinking, on and off.  I think that if she had stayed sober that whole time, she’d be at least a little bit further down the road that values concepts like honesty and teaches us how to live them in the real world.  Instead she stayed still, or moved a little farther down the road of death and destruction.

Amends – how, when, what?

A reader asked, “I’m wondering if you would consider writing some posts about making amends… how, when, what…? Thanks for considering it.”

 

The amends of Step Nine are an effort to clear away wrong-doing of the past, to make those things right in as much as that is possible.  I believe that many people have difficulty staying sober when they think about the bad things they’ve done, the people they’ve hurt.  Alcoholism as I understand it works this way.  I feel bad and guilty, so I drink to suppress or forget those feelings, or to black out entirely.  This causes more bad behavior.  This is bad behavior in itself.  So I drink more to deal with those feelings.  Making amends is an effort to break that cycle.

amends: reparation or compensation for a loss, damage, or injury of any kind; recompense. 

make amends, to compensate, as for an injury, loss, or insult.

 

It’s a stark and ugly realization for many of us that we can’t actually undo the harm we’ve done.  But if we want to live, we can’t take that hopelessness as an excuse for further drinking.

The Big Book and the 12 and 12 have many suggestions for how, when and what.  It’s important to discuss these with someone else because this stuff is so emotionally laden it is easy to go wrong.  How is in the most tangible way possible.  Pay back money, that sort of thing.  Recently some women in the program and I had the chance to care for the pets of someone in rehab.  I saw it as a kind of way to make amends to the cat I had while I was drinking.  When would be as soon as possible.  Sometimes it’s possible right away, other times it’s never possible.  What can also be difficult.  As I’m about to help someone with this step, I’m concerned that she will either apologize for too much, or not enough.

 

The step can’t be done perfectly and more can always be added in the future.  Part of the not so fun part of recovery can be remembering things we’d rather forget, sometimes years later.

Of course the important part, the part I can control, is the changing part of amends.  I am to try as I can to not repeat my bad behavior of the past, and not find new ways to behave badly.

Part of our literature describes a time when Dr. Bob went around making amends to everyone he could think of, the day of his last drink.  We can see now that he surely had changed permanently, but I’m sure there were some doubters at the time.  Whatever he felt was different for him, inside, he expressed on the outside as a true and lasting change for the better.

October 2, 2014 (this day)

IMG_0582The weather has been absolutely perfect for a long time now.  Windows open day and night.  Mostly sunny, not too hot, and even a little rain to keep things hydrated.

Carole and I, and two other AA friends, have been helping care for the cats of a friend of ours who is in rehab.  When we tried to convince her to go, the first thing she said was, “My cats . . . ”  We promised we’d care for them and we have.  We’ve strengthened our sobriety in many ways, by knowing that it could easily have been and still could be us who needs rehab and pet sitters.  I feel that in this way we’ve also made amends to the pets we had when we were drinking, who we neglected or didn’t treat right in other ways because drinking, it was all about me.  Taking care of the pets of an alcoholic who can’t do it makes sense to me.  And we’ve shown our friend and her family that AAs will do lots to assist the sobriety of someone who asks for help.  I’m so hopeful about her life after rehab.  She was clearly going down, getting worse, insanely hoping to still figure out how to drink successfully.

 

I was at a meeting where they were talking about how drinking kills people.  I thought of my uncle, and of my ex, and of my father.  I had my ex’s girlfriend’s Big Book.  She died years ago, in her 30s.  My father died in his 30s.  My uncle and my ex died in their 60s.  All ugly, painful, unnecessary and sad deaths.  I once her heard it put this way, that some of us would rather die than live a spiritual life.  Anyway, our friend in rehab does not have to die that way.  With the alcohol out of her, I believe she has a choice, and I hope she chooses to live.  If she’s like me, once she picks up, her choice is gone and she’s compelled to continue.

 

So with the perfect weather I’m doing my best to enjoy a perfect, serene, wonderful life for this day.  And I have very high hopes for tomorrow as well.