I’m really frustrated by recent experiences interfacing with the mental health system for myself and for my teenager. For them, it’s really atrocious. There may be effective options for the upper classes, but they aren’t accessible to me.

This is inspired by @X08’s recent [post] (https://tildes.net/~health.mental/1iia/unable_to_feel_progress_lack_of_happiness_and_not_finding_motivation_to_keep_investing) . Obviously I don’t know about their particulars, but I’ve certainly had the experience of being a part of a group where it appears others are progressing while I am not. Partly this is a problem of how we perceive, measure, and judge “success.” “Don’t compare my insides to others’ outsides,” as the saying goes. But it is possible to a more faithful and reflective comparison, and it does happen that others similar to me* make progress where I don’t, and it’s really frustrating. I’m often wondering, what’s wrong with me that I can’t change and grow?

I don’t have a great answer, although my exceptionally shitty childhood certainly plays a great role.

What I really want to comment on, though, is how insensitive our current mental health system is to the impact disparate causes have on creating similar symptoms, and how that should inform treatment approaches. A gifted psychiatrist (of which there are shockingly few) once put it like this (paraphrasing): Before we look at treatment for depression, we have to make sure the patient isn’t just surrounded by assholes.

But it’s a real problem. CBT is touted by a lot of “weighty” authorities as a valid gold standard treatment for a wide range of MH symptoms, and is claimed to be effective regardless of causes. And it’s my opinion that there is a lot of reasonably scientifically rigorous research backing that claim up. But, it’s not all rainbows, and it’s not working for lots of people. For one, a lot of folks claiming to do CBT are really not. Actual CBT involves a lot of homework, and a lot of recipients don’t have home support and don’t do the homework. This is extra true for children and adolescents living in dysfunctional homes. But more than just patient effort, the research marking CBT as so favorable is mostly based on subjects who are only mild to moderately distressed.* The end result is everyone involved in the “evidence based” healthcare chain is signing sufferers up for CBT when that might not be the best approach. There are lots of other criticisms too. If a practitioner is not well-trained and dedicated, the practice can be very invalidating. It seeks to make the sufferer’s more cognitive process more ‘rational,’ but when that person’s experiences are really, objectively bad, it’s very rational to conclude the world is hostile and unsafe. The tool itself is prepared for this, but it takes a really effective therapist to pull off. Also, it’s not enough by itself, grieving and other healing is also required for success.

The same thing happens in 12 step groups. AA/NA is resoundingly helpful-for a certain set of alcoholics/addicts. Those who don’t make it are often exhorted to become more honest, more open-minded, or more willing.*** My observation, though, is that most of the ones that make it come from intact families with resources. This is not universally true, it’s important for me to point out that there are enough examples of success among folks with no such background to say that there is something valuable in that approach that transcends socio-economics. There are also plenty from well-resourced families who don’t make it, but many of those families are highly dysfunctional. Of this last group, folks from dysfunctional families, some of us find success in other groups. This is because AA/NA are designed for sociopaths, ACA**** is designed for the product of sociopathic parents (who are filled with shame).

I don’t know what the solution is. A lot of malaise, addiction, “maladaptive” behaviors are, I think, born in a dysfunctional society, and so long as that society remains dysfunctional, no individual focused therapy solution will create a permanent fix. I think right here and now, too, we are at one of humanity’s “high tides” of self-destruction, a result primarily of runaway capitalism (is there any other kind?). We also just came through a really nasty global trauma, everyone is feeling it some kinda way.

Thanks for attending my TEDz talk.

*Of course, when talking about something as complex as a human life, there may no way to determine how similar is enough to make valid comparisons

**Also, let’s not talk about the various biases and implementation problems with what those studies refer to as ‘validated’ assessments used for measuring level of distress

***I am, technically, an NA success story

****Adult Children Anonymous, aka Adult Children of Alcoholics and Dysfunctional Families, more info at adultchildren.org.

In three days, I will have 7 years clean from opiates including heroin. I've actually been talking about it quite a bit on Tildes recently due to a lot of mental health threads popping up, but outside of this forum, I don't really think or talk about my previous life very often. For me, putting that life in the rearview and disengaging from the recovery community was the best way to stay clean.

However, around anniversaries, I usually take a bit of time to reflect. I consider where I was, where I am now, how I got there, and how I got here. I think about how different my life is now that I have an amazing career, a house, a wife, and a beautiful infant son.

This anniversary, I've been thinking about the Siren's song, the Faustian bargain, the devil in a dress. In other words, I've been thinking about how enticing false promises can be.

I think back to when I had my hydrocodone prescription for a knee injury right around the time I started partying pretty hard - toward the end of high school and early college. The people I started hanging out with were incredible to me. They were early in their addictions, so they were on top of the world. They had jobs, cars, unlimited drugs, and were surrounded by attractive women. They had zero side effects from their drug use and were living a crazy lifestyle that looked more fun than anything I'd ever imagined. They worked all day to pay the bills and sold small amounts of drugs to fund their own habits - use half, sell half at a party. Easy. This was when I started incorporating hydrocodone into my partying routine. I knew I liked opiates, but I didn't know you could be high all the time with zero consequences. (Spoiler alert, you can't. You all know where this is going).

Soon after, I became the guy I thought I wanted to be. I was the one who was carrying around a pharmacy in my backpack and was able to get my hands on any drug you can think of. I had a hundred friends and a million buddies. I was dating and having sex with women who I felt were "out of my league." I was getting my degree, and I was having a ton of fun pretty much every single day and night. When I look back at photos from this time in my life, I still have a hard time believing it was real. I have stories for days. Insane, amazing, hilarious stories. These were some of the best times of my life in many ways. At the time, I wanted it to last forever and thought maybe it could. This was the Siren's song working its magic. I was trapped by this point.

This lasted longer than you'd think. But eventually, I started experiencing withdrawal when I wasn't high. Then I had to start going on more and more "side quests" to get money for drugs since I could no longer satiate the craving by selling half and keeping half. I noticed that the people I once looked up to weren't doing so hot. A few of them overdosed, a few of them got arrested, and a few packed their bags to get away and get clean. My friends either got into drugs with me or distanced themselves.

Things started getting really dark after college. Now I was getting high alone most of the time and the parties were fewer and farther between. Things got really really dark when I was doing crazy shit like driving from NY to Texas without sleeping and buying black tar heroin. I often found myself in the open-air drug market in my city buying drugs at 4 in the morning from people with guns, found myself stealing pills from loved ones, started selling my belongings, crashed two cars, lost three jobs, etc. You get the picture.

If anyone has ever wondered why addicts go to such great lengths to get high, it's mostly because withdrawal is the most unpleasant thing you could ever imagine. Movies and TV don't even begin to show how unbearable it really is. Imagine a full body flu, kicking, shaking, puking and wishing you were dead. But that's not the worst part. The worst part is that your brain literally can't produce happy chemicals, so you can't feel a sliver of happiness or optimism. You can't even remain logical about the situation. Your brain is telling you that life is meaningless and without joy for now and for always unless you get high. Between that and the physical symptoms (both of which last weeks/months) it's way too easy to use the panic button and take a hit, which instantly makes everything beautiful and wonderful again.

I look at my life now and I cannot believe how fortunate I was/am. I managed to escape that hell with no felonies, no diseases, and few long-term consequences. This good luck allowed me to move on and build a better life with fewer obstacles than most. I feel immense sadness for the many others who weren't so fortunate. I can name 10 people I knew personally from those years that ended up losing their lives to fentanyl. I can name many more who have criminal records that make them hard to employ. I know that, of those of us who got clean, there are at least a handful that will continue to struggle, relapse, and possibly die. It's hard to imagine how something that makes you feel so unbelievably good can leave a pile of bodies in its wake.

I tell this story because I have been thinking about three interesting memories/concepts lately:

1. The Siren's Song - something that seemed pure and beautiful was the worst thing to ever happen to me.

2. The incubation period of addiction - this early phase where you found something you love and you want everyone to experience it. This is when addicts are the most dangerous I think. This is when they hook their friends and loved ones by demonstrating to others that they too can manage this amazing life just fine with no consequences. Like a virus, I was already infected and contagious, but since I wasn't showing symptoms, people didn't know to stay away from me.

3. A conversation I had with my drug counselor when I first got clean. I was beating myself up, telling her I blamed myself because I knew better than to get hooked on drugs. She got very serious and said to me, "Stop. Don't ever say that again. You didn't know. You might have heard, but you didn't know. I've seen hundreds of addicts, and none of you knew what you were getting into. If you had known, you wouldn't have done it. Simple as that."

I don't have any deep insights or points to make - just reflecting and wanted to open the floor for discussion. Have any of you ever had any experiences with a Siren's song?

I don't want to say I'm an alcoholic but I might be. Over the last several years, my drinking has increased from once or twice a week to daily, to the point where I'd start my day off in the weekend with a drink. I knew it wasn't good, but it was a habit I fell into.

Obviously I'm aware enough about it to do something. I've quit smoking cigarettes, so I at least understand the quitting process, but I also don't want to (and don't think I could) give up drinking forever like I did with quitting cigarettes.

My wife is also a drinker, but is much more moderated about it. Thing is, it meant that even if I didn't buy drinks for me, there's always been drinks in the house and so... I drank that. I've finally convinced her that for financial and dietary reasons it would be beneficial to us to stop buying drinks for at home. For my own self, I know that if I don't have a drink around I just won't drink.

This works great but, I find myself lost and listless now! It's a frustrating feeling that I remember well from when I was quitting cigarettes, and I know I just need to work through those moments and keep myself busy otherwise. With the nice weather, I've been biking a lot more and spending more time outside with my kids. At night is when it's toughest - those times after everyone else is asleep and before I go to bed.

I'm not really looking for advice or anything, I just want to share somewhere my experience so far, because it feels good to write about it and express my feelings. Maybe it'll help.

Also if anyone has a suggestion for something to replace beer, I'd appreciate it. I don't like fruity, or soft drinks. Currently I'm getting by with enormous amounts of sparkling water but sometimes I want some flavor, but most drinks that aren't beer are cloyingly sweet and disgusting.