As I read about Britney’s hospitalization last week, her increasingly erratic and bizarre behavior, and her deteriorating mental and physical health, I react with the simultaneous disgust and sympathy that most people (who have a heart) do: “Get some sense, woman!” and “God, I feel for you, woman.”
Because, even as I’m disheartened by her decisions, I realize, on some level, that she is sick. So very sick. As reader Cathy eloquently said in response to my earlier Britney post: “She has no sense of herself in the world anymore.”
When I was a sophomore in college, my therapist suggested I read Colette Dowling’s book “You Mean I Don’t Have to Feel That Way?” It forever changed the way I viewed mental illness, alcoholism, and the relationship between the two.
Early in chapter seven, “When Sobriety Isn’t Enough,” she quotes Daniel Goleman, who back in 1990 was a science writer at The New York Times:

For several years, scientists have suspected that at least some drug addicts suffer imbalanced in brain chemistry that made them vulnerable to depression, anxiety or intense restlessness. For such people, addiction becomes a kind of self-medication in which drugs correct the chemical imbalance and bring a sort of relief.

Dowling goes on to say that scientists believe that identifying an underlying psychiatric disorder and intervening medically will help treat the addiction as well as the disorder. After reading the following paragraph I finally understood why I craved booze from the time I experienced my first buzz, and what that had to do with the biological underpinnings of my depression:

Scientists think that in predisposed humans the production of endorphins and enkephalins in the brain is abnormally low from birth. Low levels of these mood-regulating chemicals result in anxiety and a feeling of need that is extremely uncomfortable. It is this bad feeling that makes people susceptible to the brief mood-lifts provided by drinking and drug taking. They are not really look for euphoria. What they long for, what their bodies are trying to achieve, is the state of chemical balance that those of us enjoy who are fortunate to have enough neurotransmitters in the first place.

The fact that the two—addiction and mental illness—are codependent is no surprise. What’s complicated is how to treat a person with a dual diagnosis because the treatment cultures are so different. According to Dr. Ken Duckworth, M.D, who I interviewed for my Friday series “How Do You Move Beyond Blue?” it sucks to be a family member of a person who is simultaneously suffering from addiction and a mood disorder (he didn’t use those words) because in the substance abuse culture, the person is generally viewed as the agent of the problem and are held accountable for their relapses (“Dude: get it together!!!”) but in the mental illness culture, the person is regarded as the victim of her illness (“Baby doll: come to mama”).
Thus our divorced, disconnected response: “Get it Together! Come to Mama!”
Says Duckworth:

Now what I have experienced, when the person has both substance abuse and a mental illness, people don’t know how much to do for the person, and how much to have them be accountable, and to have them learn from their mistakes because in this case, when you have both together, the mistakes could easily be lethal.
You can see this dichotomy. And when I work with families dealing with both conditions, my heart really goes out to them because in the AA world, and in the substance abuse culture, they are encouraged to have the person hit bottom and be accountable, but that’s not the case in the mental health world.

Once you throw in the stigma of mental illness, you get even more confused. I can hear the conversations among all of Britney’s peeps in Hollywood (talent agents, public relations folks): “God no, not bipolar. Let’s stick with addiction. I agree, addiction is much better. People get addiction.”
When I stopped drinking in high school, I had no problem telling people I didn’t drink. All I had to say was that the same phenomenon that happened in Michael Jackson’s music video “Thriller” would happen to me when I drank large quanties of alcohol: I grew chest hair, my nails curled, and I’d do stupid things like provoke cat fights in bars.
“Oh … cool,” was the response. I got a few raised eyebrows, but nothing like when I drop the B word: bipolar.
“Ack! You BELIEVE in bipolar???! We all know that’s a make-believe diagnosis for people who can’t get beyond their childhood crap, are too sensitive to function in this world, or don’t know how to properly train their thoughts. Really, just swallow some fish-oil capsules, get yourself to yoga, focus on your blessings, and you’ll be fine!!!”
What’s really fun for me to watch, as a person afflicted by both addiction and bipolar disorder, is when the “experts” like Dr. Phil weigh in. I’m intrigued by the diagnoses and treatment plans thrown out for the same reason we, as a culture, are obsessed with this stuff: we get to see on national TV the familiar struggles we fight within ourselves and with family members every day.
But, in fairness to Hollywood, just when I can’t stand to read another tabloid story, I’ll stumble onto a gem like Craig Ferguson’s poignant monologue on the topic, which I’ll sum up with the words: “There but by the grace of God, go I.”
That, in my opinion, is the best response of all.