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[24 Jun 2009|02:02am] |
Do you find it easier to work with addicts than you did working with seriously mentally ill people (I know both cross into each other's territory with regularity...)?
Actually I think it's more difficult to work with addicts and alcoholics, to be totally honest with you. Addicts and alcoholics, especially when they have been abstinent for a little while, seem normal. You don't start seeing the deep-rooted insanity until after you work with them a while - usually a month, sometimes more. And they certainly don't see the deep-rooted insanity that is addiction. So the first step (literally, speaking in 12-step terms) is to help them to see and admit that they have an illness in the first place, which can be, frankly, agonizing. Then after they figure out they have an illness, they go straight into denial, and you have to work through that. And then the addiction tries to take hold again, repeatedly, using different ways to insert itself back into the person's life and reappear. And this cycle goes on and on and on, the addict/alcoholic fighting you, himself, and anybody else who tries to help him for a good long time.
People who are seriously mentally ill, unless they are very acutely ill, generally have some idea that they are mentally ill, even if it's just a suspicion. A good number of the seriously mentally ill people I worked with were willing to talk to a sympathetic ear, even if what they were talking about didn't make much sense at first, and a surprising number of them could be reasoned with, at least up to a point. Mentally ill people are seldom senseless. They have a reason for what they do, even if that reason doesn't make a whole lot of sense. "If I don't wear this Braves hat, the brain bats of Venus will kill me because Satan told them to, because I am the son of the Angel Gabriel" is at least logical on its own terms, in their universe. There is also a good chance that seriously mentally ill people will respond to medication, sometimes quite dramatically. The biggest challenge is to persuade them to keep taking their medication. One of the most helpful things to do for them is to help them think about the contrast between their lives with and without medication.
Alcoholics and addicts do things that are frighteningly suicidal, things that don't make sense to any other non-addicted person. They will drink even though they know, and they can tell you clearly, that the last time they went on a bender they ended up vomiting blood and the doctor told them flat out that if they go on another drinking binge, they will die. They will throw away jobs, wives, lovers, children, family, friends, careers, vast amounts of money and possessions, all for the sake of a drink or a rock or a shot, in the full knowledge that the high is temporary. Their drug of choice will wear off, and they will be absolutely miserable again when it does, and they will have to go out and do something (usually something horrible and demeaning) in order to get loaded again. And they will do it - just to get loaded again.
That, to me, is baffling. And there is no medication that can bring a lot of relief. 12-step programs help, but they don't help everyone, and there isn't one program that helps everybody. It's just that the 12 steps seem to help people get well more consistently than things like harm reduction or having your blood replaced in Switzerland or any of the 6,298, 312 treatment programs and methods that people have come up with. And that being said, the 12-step program doesn't really have that good a record as far as relapse prevention. The person in recovery has to work hard, and continuously, for a long time, in order to remain in recovery.
So compared to that huge thing, honestly, I do find that working with severely mentally ill people is easier, if such a thing can be said to be easy. There are, honestly, some days when I wonder why in the hell I ever took up counseling, and if I wouldn't be better off working at Ben and Jerry's or Borders or something. Like in Spinal Tap.
Nigel Tufnel: [on what he would do if he couldn't be a rock star] Well, I suppose I could, uh, work in a shop of some kind, or... or do, uh, freelance, uh, selling of some sort of, uh, product. You know...
Marty DiBergi: A salesman?
Nigel Tufnel: A salesman, like maybe in a, uh, haberdasher, or maybe like a, uh, um... a chapeau shop or something. You know, like, "Would you... what size do you wear, sir?" And then you answer me.
Marty DiBergi: Uh... seven and a quarter.
Nigel Tufnel: "I think we have that." See, something like that I could do.
Marty DiBergi: Yeah... you think you'd be happy doing something like-...
Nigel Tufnel: "No; we're all out. Do you wear black?" See, that sort of thing I think I could probably... muster up.
Marty DiBergi: Do you think you'd be happy doing that?
Nigel Tufnel: Well, I don't know - what're the hours?
Then again my dad confided in me the other day that he never had a job he actually liked, he worked because he had to. I'm wondering if the idea that people have jobs that they enjoy is just a myth sold to us by some sort of capitalist corporate psychology developed in the grey flannel suit 1950s - 1960s to make more little drones for the corporation. At least in this job I'm trying to do something good for people. Whether I succeed or not is really entirely up to them; like someone who works at Ben and Jerry's or Borders, I offer a product, really. Or maybe not a product. But in either case, I offer something. People can take it or leave it. And they do leave it.
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