Re-examining attitudes towards addiction

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“Addicts are the lepers of the 21st Century.”  So said Dr. Garrett O’Connor in his keynote address at the September California Society of Addiction Medicine conference in Anaheim, California.

They are difficult. They break the law. They can be violent and dishonest. Their conduct affects everyone around them. It destroys families and relationships. Society shuns and incarcerates them. But the fact is that close to 50 years after the War on Drugs was declared, drugs are winning. We’re doing something wrong.

Dr. O’Connor’s address was entitled Recovery and Spirituality. As our nation has become more secular we have become in many ways less logical. The default response to these issues by civil society has been incarceration; the most expensive option, rather than compassion and treatment, the most sensible.

Once addiction takes hold of an individual most are helpless without spirituality and faith. Over 1,200 medical professionals listened to Dr. O’Connor’s address but the medical profession is in general skeptical of the spiritual.

However, the empirical evidence of the effect of spirituality in the treatment of illnesses including addiction is incontrovertible. Dr. Harold Koenig and others have done extensive work on understanding how stress affects the body and how many people with faith achieve significantly superior outcomes to illnesses than those without strong faith. In a study of 100 medical research papers in 2001 conducted by Dr. Koenig, 79% of those papers reported a significant positive association between religious involvement and improved well being. Dr John Graham has also written extensively on the subject.

In addiction medicine Alcoholics Anonymous and the Salvation Army’s programs are recognized as the most successful alcohol abuse treatment programs. Both recognize that the addict cannot kick their addiction on their own. It takes a higher power, which most of us call God, to  grant the strength and will and fight the pain and anxiety. And yet as a society we refuse to recognize the importance of spirituality in recovery.

Last March, Saddleback Church and the Roman Catholic Diocese of Orange sponsored the Gathering on Mental Health, a call to the Church to provide effective and compassionate support to those faced with the challenges of mental illness and addiction. The first person many families turn to when faced with this trauma  is often their pastor or other spiritual guide.

And yet in the high complex environment of dual or multiple diagnoses and  the spectrum of addiction and mental illnesses, education is sadly lacking. Dealing with mental illness is difficult and with addiction even more so.

The stigma isolates the individual when they most need help. This stigma must be removed if we are to successfully address these deeply complex issues.Recovery is a long term process that never ends. So why is it that if we know Joe or Sally is in recovery that we cannot have compassion when they fall?

“There are five words that are part of every addict’s vernacular.Five words that come from the darkest place imaginable. To call it defeat would oversimplify the absolute loss of humanity. This is it; the disintegration of the soul.The point at which the body has no fight left. When helpless becomes hopeless and hopeless becomes despair.This is the moment in the game when there are no more plays. No more outs. No more options. This is the place every addict eventually gets to. The thought of living our lives without addiction is unthinkable. Even worse than the thought of living our lives with it. So when we say these five words it doesn’t come from a place of fear. It doesn’t come from a place of sadness.It comes from the core of our soul, the burning hot center that has begun to go cold.The place where nothing lives but the truth. These five words are so simple. Five little words. “I wish I was dead.”

The Cleaner

The essence of the Catholic Sacrament of Reconciliation is the confession of sins and absolution. Both psychologically and spiritually, the penitent is given a second chance. It is that absolution and the spirit of compassion and forgiveness that allows even the greatest sinners to go forth and sin no more.

Addiction is a crisis of the soul and the mind as well as physiological and biochemical. The whole human must be healed. Medication, therapy, treatment and counseling are all parts of the solution and must be recognized as such.

The addict is perhaps the most difficult to treat. They are not sympathetic in many cases. But neither were lepers up until the last century.

So if we know empirically that spirituality works why is it not given a greater role in recovery? At that point where the addict wishes they were dead isn’t that the time for the greatest compassion? We have to go with what works.

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Maxwell Chorak – Rest in Peace

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Sunday November 2, 2014

Today is All Soul’s Day, the Dia de Los Muertos. It is an especially painful day for our family this year.

On June 10th I was called out of an early evening meeting and told that my step-son, Maxwell, had committed suicide. He had jumped from a 5 story sky bridge at UC Irvine a few hours earlier that was known as a site for suicides. The parking structure had suicide prevention tiles with hot line numbers cemented into the walls from the third floor upwards.It was the culmination of every parent’s worst nightmare.

But it had been a long time coming. Susan, my wife, and I had been living in fear of “the call” for years. She thought that it might be drugs but had never thought of suicide. We are still deeply grieving. What we do know is that the system let him down badly.

Max - 6

How does one deal with the sudden, traumatic death of a child? There are no guidebooks. It is the worst sort of emotional blow. His sister and brother are distraught. We were all deeply concerned for him but the cold reality of such a violent death at a young age is searing. But somehow we must go on and help change a broken system.

Maxwell exhibited his first signs of mental illness at the age of ten. He would act out. He raged. He sometimes became violent. When the Sheriff’s deputies got to the house they did not know what to do. At the time, my wife as a single mother was on her own trying to chart new territory. There was no place in the county to which a ten year old child could be taken to be treated for mental illness. There still isn’t.

She eventually found a psychiatrist who tried to “get” him and he was treated for bipolar/schizophrenic disorder but not formally diagnosed. But Max was using street drugs to self-medicate and the doctors pulled back.

Maxwell entered high school but it didn’t last long. He was brilliant. He was bored. He was different. But he also had charisma. He was a handsome young man with a very gentle way most of the time. But by his sophomore year he was out. His erratic behavior, drug use, and inattention just were not going to get Max through a conventional education.

He was a wonderful young man. He would take his last dollar and spend it on a gift for his brother or take his 90 year old aunt out for a pedicure and manicure. He was kind. He wanted nothing more than to hang out with his family. He loved his brother and his sister devotedly. And then the voices would whisper in his ear and it would get scary.

He was too smart for his own good. He could argue the most absurd point until even a well educated person could be fooled. He could also listen to a guitar riff or even a whole song just once and play it back brilliantly. His guitar was his refuge. He could pick up a cello never before having touched one and play it better than his mother, who had studied for years.

Maxwell took the GED test without studying and passed with flying colors. He entered the local community college. He wanted to be a doctor. Shortly before he died he was discussing textbooks for the next semester.

Clonazepam is a drug used to control seizures. Usually an adolescent is given one pill and would sleep for 18 hours. They gave Maxwell five once and still had to restrain him. Marijuana has been well documented for its terrible effect on individuals with schizophrenia. The literature discusses adverse or paradoxical effects. You bet there are.

Maxwell would eventually learn to study the side effects of the various drugs prescribed for his treatment in order that he could tell the doctors that he was having them in order to avoid the drugs. The prescription drugs left him feeling lethargic and hemmed in. At least some of the illegal ones gave him a brown haze to find refuge in.

I call him Max because it was what my grandmother called me. She too suffered from mental illness. She had a nervous breakdown in the 1930’s after being thrown out on the Brooklyn streets one too many times with her 5 children after her husband had once again squandered his plumber’s salary on booze.

She ended up at a place called Creedmoor in Queens, NY for 40 years and it was only when Thomas Szasz and his accomplices in government closed the psychiatric hospitals in the 70’s that she came to live with us. Creedmoor had been her safe place. Now her life was disrupted. When she came to live with us it was a wonderful experience because of my mother’s love and compassion. She taught us to be kind and caring.

So I had a lot of empathy for Maxwell. He had no place to be safe. There was no safety net. We have since the 1970’s gutted out mental health care programs.

His condition was slowly deteriorating. It was only when he became 17 that the handbook of the American Psychiatric Association allowed him to be formally diagnosed as schizophrenic. By that point he had been in in-patient programs in Southern California and Idaho to help treat his condition.

Max - 25

By the age of 18 he had been in the local hospitals for six 5150’s, which refers to the section of the California Welfare & Institutions code which allows for an individual to be detained for up to 72 hours for psychiatric observation.

And through all of this, Max’s friends and family became isolated from him. His mom and his family visited him when he was in treatment, but the loss of human contact was deeply upsetting. We loved him, but one of the things one encounters with the mentally ill and addicted is that it is difficult to love them in a normal manner. It is sometimes impossible to be close and to be there for them. You often don’t know what to expect and a lot of what you do expect is bad.

He was arrested for petty crimes and began the cycle of being in jail and on the street. 40% of America’s jail and prison population have mental health issues. Experts here in Orange County have told me that it is more like 70% -80% in our local jail. It is a cycle that we somehow have to break.

Maxwell was homeless at times. His interactions with law enforcement bordered on the absurd. While he was in jail he was sentenced for a “failure to appear”. He spent several months at a local mental health facility which is outsourced by the county. And then he would end up back in jail for another petty offense. He began to hear voices, holding conversations with them and laughing to himself. He would end up in the psychiatric unit.

The drugs, especially those that were self prescribed, left him in a haze that was better than the suffering, but psychoactive drugs do not affect the mentally ill the way they do others.

For most of his last 18 months Max was either at one of the very few facilities for the mentally ill in California, a drab forbidding site in Riverside, or in jail. Maxwell was a prime candidate for long term care. But there is almost none available. There are 5,900 acute mental health care beds in a state of 34,000,000 people. There are almost no long term facilities. And there are an estimated 1.5 million Californians with serious mental illness.

When he was released from the facility (you really can’t call it a hospital) in Riverside he stayed with his father. He saw his brother and mom and things were looking up. He had a great day with an old friend just hanging out. He left his father’s house one night and didn’t come home.

He was found the next day in a catatonic state in a local park and taken to the emergency room. He was then transferred to UCI Medical Center, the regional acute mental health unit, where he stayed for 9 days.

When we were informed of his admission to UCI his mother immediately contacted the doctors and nurses regarding his care. Maxwell did very poorly on Haldol, the drug of choice for the zombification (aka control) of the symptoms of schizophrenia in state run facilities. We knew this from years of experience. Haldol can cause severe depression.
We knew that Risperdal was more effective for Max and told his doctors so. The nurse responsible for him told my wife “It doesn’t make any difference since they don’t stay on their meds when they leave here anyway.” They put him on a maximum dose of Haldol.

She had requested that she and Maxwell’s dad be notified before he was released. This did not happen. Max was released at @ 1:30PM on the day of his death with the clothes on his back and a bus pass given to him by the hospital. He took the bus directly to the main campus of UCI several miles away and jumped almost immediately. After his mother found out and after collapsing, she called the hospital to ask why he had been released. There was silence at the other end of the line.

To this day we don’t know if Maxwell jumped because he was disoriented on Haldol or because of other factors. We will never know. That hurts.

The system is broken. Many of the professionals are callous and uncaring. There are petty jealousies and a lack of communication. The system as designed and implemented is malevolent. Our brothers and sisters with mental health issues are warehoused in our jails and in a very limited number of beds. We read daily of misdiagnoses and maldiagnoses and even misconduct in psychiatric care.

Treating mental illness is a matter of the physical, the mental, and the spiritual. It is perhaps the most difficult of illnesses. With the mentally ill there are often no good answers. As a society, we don’t want to know. We don’t want to deal with them on a concrete level. The mentally ill are often stigmatized. And at the most basic family level it can be heart wrenching.

But Max is gone. He will be a statistic to most but he will have left a massive hole in the hearts of his family and friends. There is little understanding left except that he was deeply, fatally mentally ill in a world that does not treat those who suffer from this very well. He is at peace now.

We can honor him by doing better, as individuals and as a society.

“Let us touch the dying, the poor, the lonely and the unwanted according to the graces we have received and let us not be ashamed or slow to do the humble work.”

Mother Teresa

© Matthew Holzmann 2014