FIRST UNIVERSALIST SOCIETY OF CENTRAL SQUARE, A UNITARIAN-UNIVERSALIST CONGREGATION. Website design by Terri Snowball. Site powered by Wordpress

Preacher: Reverend Andrea Abbott

Filling the Whole
At one time, not long ago, it was news. Now it seems as if an epidemic that ravaged our community no longer shocks us. The epidemic I’m talking about is drugs, painkillers, meth, various forms of synthetic drugs, heroin. The kind of drugs that spell death at an early age. And there’s another epidemic that has also been silently destroying our homes and our communities. Speaking broadly, very broadly, this is the epidemic of mental illness. These two epidemics overlap, very much so, as people whose lives have been fatally damaged by poverty, by abuse, by despair, are caught in the deadly cycle of addiction.
For most of my adult life, I have been a witness to both of these epidemics. At different times, I worked briefly at hospitals for the mentally ill and later I spent most of my working life as a prison librarian, coming into contact with those who had been most beaten down by these twin epidemics. I’ve been retired for awhile, but these two epidemics have not retired. If anything, they are more vital than ever, whether or not they have been shoved from the headlines.
I say this knowing that many people, my family included, have loved ones who deal with mental illness and so I know the shame, the isolation, the feelings of failure, the despair. I have friends whose children and grandchildren are casualties of drug addiction. So my interest is more than professional and I have read, as I can bear to read, a lot of works on these two scourges throughout the years.
There is always debate about whether both of these epidemics are increasing or whether people, like myself, are more willing to talk about them. I waded through a number of online statistics and came up with some numbers concerning addiction such as:
• According to the National Survey on Drug Use and Health (NSDUH), 21.5 million American adults (aged 12 and older) battled a substance use disorder in 2014.
• Almost 80 percent of individuals suffering from a substance use disorder in 2014 struggled with an alcohol use disorder, NSDUH
• Over 7 million Americans in 2014 battled a drug use disorder, per NSDUH.
• One out of every eight people who suffered from a drug use disorder in 2014, according to NSUDH, struggled with both alcohol and drug use disorders simultaneously.
• The Substance Abuse and Mental Health Services Administration (SAMHSA) publishes that in 2014, almost 8 million American adults battled both a mental health disorder and a substance use disorder, or co-occurring disorders.
• Drug abuse and addiction cost American society close to $200 billion in healthcare, criminal justice, legal, and lost workplace production/participation costs in 2007, the Office on National Drug Control Policy (ONDCP) reports.
Statistics on mental illnesses are even more confusing. What counts as a mental illness? Are more people going for treatment who would not previously done so? No matter where I turned for numbers, however, it was a sobering picture. The most quoted figures indicated that between 25% to 50% of all Americans have been treated for mental illness at some point in their lives. This makes the relative silence on this topic even harder to understand. It seems like something that should be in the headlines every day. It seems like something that should receive a huge amount of funding, both for research and treatment. This is not the case and, as with drug addiction, the fact that there are these numbers indicate that there is something seriously wrong in this country. Something about the reality of life is not bearable for large numbers of our fellow citizens.
I think there is some truth to the idea that more people are willing to admit to having problems and to seeking treatment. And I think this is a good thing. In addition, I think that both mental illness and addiction have less stigma than they did before. They are gradually becoming seen as a medical problem rather than a moral deficit. But at the same time, this revolution has come about not because we have become more compassionate and understanding than our ancestors but because these problems have become so widespread and because they have been acknowledged to affect middle class and wealthy white people, not just marginalized groups. When it hits the family rooms of Central Square or Baldwinsville, it becomes more of an issue than if it were seen to be the domain of the South Side of Syracuse or the trailer parks of Phoenix.
I should, then, be grateful to the progress of understanding about these problems. I should be grateful, and I often am, than I can explain my son’s condition as a medical one, an imbalance in his brain chemistry, as diabetes is an imbalance in the body chemistry, rather than as his failure in life. I should be grateful that friends with alcoholism or drug issues can find understanding rather than reproach, can see that they were dealt a particularly bad genetic hand rather than that they are weak or evil. Lives already under intense stress do not need more isolation, more shame.
So why did I find myself questioning these compassionate analyses of these issues, these scientifically endorsed reasons? Could it be I’m just perverse and am compelled to question conventional wisdom? Could it be the UU gene? Did I really want to open the possibility of going back to the bad old days? Why didn’t the explanations satisfy me?
One reason was the numbers. No matter what spin we put on the numbers, the fact that this many people have something that makes them live in misery, that compromises their chance to function, is something that seems to me to be unprecedented. The other is that, no matter what the explanation, the numbers are increasing. If these were diseases of the body, I’d like to hope we would see battalions of scientists seeking the explanation and further battalions of doctors and nurses administering cures. Contrast the response we have to these problems with the response to Ebola.
Further, in reading, particularly about mental illness, I began to come across books that revived some old debates. In particular, they pointed out that mental illness might not be an illness at all. It might be a response to unbearable conditions. This was a movement that challenged accepted psychiatric thinking that I remembered from the late 1960’s and 1970’s, when I worked in psychiatric centers. One branch of that movement that people had a right to work through their mental distress, including psychoses, in a supportive environment and, further, that the rest of us could learn from those people, who had mystical insight. This was the movement most associated with R.D. Laing, a Scottish therapist. Another branch said that people had a right to be free of psychiatric intervention, up to and including, the right to commit suicide. The latter branch, called the antipsychiatry movement, was spearheaded by Thomas Szasz, at Syracuse University and was seen as an outgrowth of libertarianism. I had some problems with both of these theories but, having worked with people forcibly hospitalized, often in degrading and degraded circumstances, it was easy to see that psychiatric care often did more harm than good.
About that time, the next big change in the care of the mentally ill occurred. Psychotropic drugs began to gain traction as the cure. The big mental hospitals were emptied, quickly and with little forethought, and what happened next was even worse than what happened in those snake pits. The original intent of community mental health was to replace the institutions with community care and to reintegrate patients back into mainstream life. That, in itself would have been a challenge, but the money originally intended to accomplish this often disappeared. People with no coping skills were on the street. And the lack of significant money for research and treatment continues to be a problem. There is, however, one source for funds for research and that is the pharmaceutical industry. Not so surprisingly, research promoting the use of drugs to treat mental illness is the only form of research that is funded. There is some effort to make researchers disclose the source of their funding but little money to counter the claims of this one, easy, quick solution. A solution that does not seem to be working as drugs are piled on drugs. The funding for therapies that involve human connection, human communication, human communities, are scarcer and scarcer.
Two books, Chasing the Scream and Lost Connection, both by Johann Hari, my latest crush, really capture a lot of the disquiet that I’ve felt about both mental illness and addiction. I love books that make me rethink my assumptions and both of these books do.
There is a lot to challenge some of what I thought about drugs. A lot of the popular ideas about the dangers of drugs, even hard drugs, are exaggerated. Many countries successfully treat the use of drugs with a combination of maintenance and legalization but the history of the war on drugs in this country has kept us from this approach. This history began right after the end of prohibition and was often more politically motivated than medically sound. Hari contends that drug addiction is made worse, not better, by criminalization. But very powerful forces are arrayed against changing to a more humane and compassionate policy. Forces such as the vast amount of money which illegal drugs generate and which also fuel a great deal of political corruption, in other countries most visibly, but also here. In addition, established programs have little interest in change. Their careers are at stake.
The main result of criminalization is to drive people out of mainstream culture and into criminal culture, isolating them from the very sources that could help them return to functional lives. Now, paradoxically, and most to the point I’m hoping to make today, many people who become addicts find it difficult to leave this life because they have found a sense of belonging within this outcast community, a community they have never found anywhere else. So, though I find myself concerned about the effects of legalizing all drugs, treating all drugs as we do alcohol, regulating, helping those who cannot limit their use, the argument that our present system is doing more harm than good is pretty compelling. But what about the causes of addiction, the need to seek relief from either pain or alienation through drugs or alcohol, what about that? Why do so many people find themselves seeking community in all the wrong places?
Sadly, for those who are mentally ill, there is no community. Isolation is both a cause and an effect of people struggling with depression and anxiety. But in this, how different are they from the rest of us? Not at all because, remember the statistics, 25% to 50% of the population has struggled with mental illness. They are not strangers, they are us, us or those we love. So how can so many people feel this isolated, in so much distress?
Not only in the books I mentioned but in other works, autobiographies of those diagnosed with mental illnesses, the accounts of their loved ones who have watched them suffer, professional who deal with the effects of mental illness every day of their working lives, people were challenging the medical model, the idea that pills would make everything all right. They were starting to see that the way we live was creating anxiety and depression, two of the commonest forms of mental distress.
By every measure, we far exceed the rate of addiction and mental illness of other industrial countries. Many people are saying there is a relationship between our culture that has destroyed the ideals of community and compassion, connection to others and these rising rates of misery. The problem may not reside in our individual brains but in our disconnected lives.
When we work, we mostly work at unfulfilling jobs. We are filled with insecurity about our future or our children’s future, as jobs become more and more temporary and as people find themselves not knowing whether they will be working a week even a day from now, no matter how hard they try. Extreme poverty is growing and with it the unbearable stress of trying to live on less and less. We also have the widest gap between rich and poor. More and more people feel hopeless and insignificant.
We have lost connection with others. We can only see fragmented, individualistic solutions that may be purchased. No wonder we find ourselves trying desperately to buy our way to happiness, to consume and to buy anything, including substances that promise us release from the pain of our day-to-day lives. We are so accustomed to thinking of ourselves as separate units, as people with no connection to each other, that we are not able to see that the way we live is making people crazy. Making people addicted. And so the opposite of addiction, the opposite of anxiety and depression turns out to be human contact, human community.
This solution asks us to see those with mental disorders, see them not as flawed and ill human beings but as people under extreme stress in the flawed and ill society in which we live. How, then, do we embody our principles in a world in which the worth and dignity of every person is so under attack and in which we are blind to the effect that this is having on all of us, not only those who are in the greatest need.
I have lived fairly well in this society. But I see behind me an invisible community, the people I’ve known in poverty programs, in prison, in psychiatric centers, and I see the misery of their daily lives. This is not a society who has their interests at heart. This is a society that is all too ready to write them off, at best, keep them quiet. As this dis-ease, the dis-ease of anxiety, depression, despair, addiction, spreads, what will be our response to it? How will we develop communities that support people, that make people feel their lives are significant, are purposeful? Can we find ways to reconnect with ourselves and with others? Will we listen to the tragic songs of those who are the canaries in the coalmines and say it is time to change, time to end the isolation of the worship of individualism.
We all need to feel wanted, secure, purposeful and connected to each other. We need a community that forges connections between people, a community that binds people together. Is it significant that the phrase “A place where everybody knows your name” from the old TV show Cheers involves a community set in a bar? Maybe the community we need is the one we are building here. Maybe we, here, right here, will be the model that will fill the hole in people’s lives. Maybe we can create a way for all of us to be whole.