Since today is not only St. Patrick’s Day, the biggest drinking day of the year, but also my 21st anniversary of sobriety, I wanted to talk to Patrick about dual diagnosis, since he is also a recovering alcoholic.
I asked him this:
I’m intrigued by your recovery from addiction and how that colors your perception of mental illness. Awhile back I interviewed Dr. Ken Duckworth, medical director of NAMI. He helped me tremendously understand the culture clash between recovery from alcoholism, the AA way, and recovery from a mental illness. Said Duckworth: “In the substance abuse culture, the person is generally viewed as the agent of the problem, and they are held accountable and have consequences for their relapses. In the mental illness culture, the person is often viewed not as the agent of the problem, but as the victim of their illness. We tend to hold people a little less accountable for bio-chemical processes.” As you did your research, did you run up against that clash yourself?
Patrick replied:
Yes, the idea was that we alkies sort of brought this on, whereas schizophrenics had it done to them. I think this question opens up a big philosophical debate that depends on one’s point of view. I tend to come down on the side that says while no one is to blame, ultimately we are responsible for our own recovery.
My family is a portrait in dual diagnosis. We are a study in the intersection between recovery from the experience of hearing schizophrenia’s voices and recovery from the experience of hearing alcoholism’s voices. I began to wake up to my alcoholism in my mid-twenties, a good five years after my sisters tumbled into what is considered the most severe form of mental illness. So my frame of reference for “insanity” was a bit skewed from what most people have in mind when they see the second of the twelve steps up there on the wall for the first time. The suggestion that there was something that could “restore us to sanity” really troubled me because it implied that I had “schizophrenia.”
I got an immediate resentment because, as I looked around the room, I did not see what I’d seen on the psych wards. I saw no one talking to invisible friends. I saw no one twitching and drooling from the side effects of meds. So in my mind, I saw no insanity and felt the second step mocked my sisters by not taking them seriously. This resentment kept me out on the lash for another twenty years, basically.

Meanwhile, the booze made me forget about my problems in a way no therapist could. And then it stopped working, my medicine turning on me. The mounting paranoia, and the anxiety was making me snap, the cocaine induced psychosis, seeing imaginary cops in trees, on my knees literally staring through keyholes looking for cops. Mad stuff that shot me to the moon and left me there.
So when I finally made it back in, I believed I was myself insane. I no longer had issues with the verbiage.
I could finally see that the very issue that fueled my drinking problem–my resentment at losing my two sisters to schizophrenia–was the very thing that was pushing me off the edge of sanity myself. When I saw that, I came to a screeching halt.
“Stalking Irish Madness” only breezes over those years because I felt it was off-topic from schizophrenia and did not want to make this book all about me. That said, I did learn a big lesson that helps me each day. And that is the notion that mental illness may differ for each of us, but mental wellness is largely the same. However we get there–and yes, we are all heading back to the shore from different points at sea–is ultimately a matter of how we swim with these voices in our heads. Whether they are the voices that tell the “alcoholic” to have a drink, or the voices that tell the “schizophrenic” to take his own life, we all have voices.
Your average, ordinary, bog-standard alkie like myself hears the first-person voices of the superego that we all hear. My sisters hear these voices, but they also hear third-person voices. They hear full conversations and this puts their experience outside the medical model. If we are honest, then it’s clear that even the most well screwed on among us struggles with voices of one kind or another–voices of self doubt or regret or guilt or despair or envy or anger or the thousand forms of fear that comprise the human condition.
The important thing is that we are able to acknowledge the power of the voices in our heads, and that we feel free to talk about the voices in our heads. We need to share with each what the voices are telling us if we are serious about mental well being. We need to manage our voices so that they don’t manage us.
It’s the wisdom of the ages–a problem shared is a problem halved. Or as Jesus said, whenever two are gathered in my name. We need each other, obviously. Stars are born of other stars.

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