Answer Addiction

Author: The Fix

  • How Those With Obsessive-Compulsive Disorder Cope With Added Angst Of COVID

    People with OCD face uniquely difficult mental health battles, including trying to distinguish concerns brought on by their conditions from general fears shared by the public about COVID-19.

    Before the COVID-19 pandemic took hold in the United States, Chris Trondsen felt his life was finally under control. As someone who has battled obsessive-compulsive disorder and other mental health issues since early childhood, it’s been a long journey.

    “I’ve been doing really, really well,” Trondsen said. “I felt like most of it was pretty much — I wouldn’t say ‘cured’ ― but I definitely felt in remission or under control. But this pandemic has been really difficult for me.”

    Trondsen, 38, a Costa Mesa, California, therapist who treats those with obsessive-compulsive and anxiety disorders, has found himself excessively washing his hands once again. He’s experiencing tightness in his chest from anxiety — something he hadn’t felt in so long that it frightened him into getting checked out at an urgent care center. And because he also has body dysmorphic disorder, he said, he’s finding it difficult to ignore his appearance when he’s looking at himself during his many Zoom appointments with clients each day.

    From the early days of the coronavirus outbreak, experts and media have warned of a mounting mental health crisis as people contend with a pandemic that has upended their lives. A recent KFF poll found that about 4 in 10 adults say stress from the coronavirus negatively affected their mental health. (KHN is an editorially independent program of KFF, the Kaiser Family Foundation.)

    But those with obsessive-compulsive disorder and other serious anxieties face uniquely difficult mental health battles, including trying to distinguish concerns brought on by their conditions from general fears shared by the public about COVID-19. People with OCD have discovered one advantage, though: Those who have undergone successful treatment often have increased abilities to accept the pandemic’s uncertainty.

    Dr. Katharine Phillips, a psychiatrist at NewYork-Presbyterian and professor at Weill Cornell Medicine, said it’s possible that patients who have been in consistent, good treatment for their OCD are well protected against the stress of COVID-19.

    “Whether it’s excessive fears about the virus, excessive fears about possible repercussions to the virus, whether that’s financial effects ― good treatment protects against relapse in these patients,” Phillips said.

    Those with OCD feel compelled to repeatedly perform certain behaviors, such as compulsive cleaning, and they may fixate on routines. OCD can also cause nonstop intrusive thoughts.

    Carli, who asked that her last name be withheld because she feared professional repercussions, can trace her OCD to age 6. The coronavirus pandemic has sent Carli, a 43-year-old from Jersey City, New Jersey, into a spiral. She’s afraid of the elevators in her building, so she doesn’t leave her apartment. And she’s having trouble distinguishing an OCD compulsion from an appropriate reaction to a dangerous pandemic, asking those without OCD how they’ve reacted.

    “The compulsions in my head have definitely gotten worse, but in terms of wearing a mask and cleaning my groceries and going into stores, it’s really hard to gauge what is a normal reaction and what is my OCD,” Carli said. “I try to ask people, Are you doing this? Are you doing that?”

    Elizabeth McIngvale, director of the McLean OCD Institute in Houston, said she has noticed patients struggling to differentiate reactions, as Carli described. Her response is that whereas guidelines such as hand-washing from the Centers for Disease Control and Prevention are generally easily accomplished, OCD compulsions are usually never satisfied.

    McIngvale was diagnosed with OCD when she was 12, with behaviors like taking six- to eight-hour showers and washing her hands for so long they bled. McIngvale receives therapy weekly.

    “It’s just a part of my life and how I maintain my progress,” McIngvale said.

    Lately, she’s found herself consumed with fears of harming or infecting others with the COVID-19 virus — a symptom of her OCD. But, generally, with the tools she’s gained through treatment, she said she’s been handling the pandemic better than some people around her.

    “The pandemic, in general, was a new experience for everybody, but for me, feeling anxiety and feeling uncomfortable wasn’t new,” McIngvale said.

    “OCD patients are resilient,” she added. Treatment is based on “leaning into uncertainty and so we’ve also seen patients who are far along in their treatment during this time be able to manage really well and actually teach others how to live with uncertainty and with anxiety.”

    Wendy Sparrow, 44, an author from Port Orchard, Washington, has OCD, agoraphobia (fear of places or situations that might cause panic) and post-traumatic stress disorder. Sparrow has been in therapy several times but now takes medication and practices mindfulness and meditation.

    At the beginning of the pandemic, she wasn’t fazed because she’s used to sanitizing frequently and she doesn’t mind staying home. Instead, she has felt her symptoms worsening as her home no longer felt like a safe space and her fears of fatal contamination heightened.

    “The world feels germier than normal and anyone who leaves this house is subjected to a barrage of questions when they return,” Sparrow wrote in an email.

    Depending on how long the pandemic lasts, Sparrow said, she may revisit therapy so she can adopt more therapeutic practices. Trondsen, too, is considering therapy again, even though he knows the tools to combat OCD by heart and uses them to help his clients.

    “I definitely am needing therapy,” Trondsen said. “I realized that even if it’s not specifically to relearn tools for the disorders … it’s more so for my mental well-being.”

    Carli has struggled with finding the right treatment for her OCD.

    But a recent change is helping. As the pandemic intensified this spring, many doctors and mental health providers moved to telehealth appointments — and insurers agreed to cover them ― to cut down on the risks of spreading the virus. In April, she started using an app that connects people with OCD to licensed therapists. While skeptical at first, she has appreciated the convenience of teletherapy.

    “I never want to go back to actually being in a therapist’s office,” Carli said. “Therapy is something that’s really uncomfortable for a lot of people, including me. And to be able to be on my own turf makes me feel a little more powerful.”

    Patrick McGrath, a psychologist and head of clinical services at NOCD, the telehealth platform Carli uses, said he’s found that teletherapy with his patients is also beneficial because it allows him to better understand “how their OCD is interfering in their day-to-day life.”

    Trondsen hopes the pandemic will bring increased awareness of OCD and related disorders. Occasionally, he’s felt that his troubles during this pandemic have been dismissed or looped into the general stress everyone is feeling.

    “I think that there needs to be a better understanding of how intense this is for people with OCD,” he said.

    View the original article at thefix.com

  • The Hidden Deaths Of The COVID Pandemic

    A recent analysis predicted as many as 75,000 people might die from suicide, overdose or alcohol abuse, triggered by the uncertainty and unemployment caused by the pandemic.

    BROOMFIELD, Colo. — Sara Wittner had seemingly gotten her life back under control. After a December relapse in her battle with drug addiction, the 32-year-old completed a 30-day detox program and started taking a monthly injection to block her cravings for opioids. She was engaged to be married, working for a local health association and counseling others about drug addiction.

    Then the COVID-19 pandemic hit.

    The virus knocked down all the supports she had carefully built around her: no more in-person Narcotics Anonymous meetings, no talks over coffee with a trusted friend or her addiction recovery sponsor. As the virus stressed hospitals and clinics, her appointment to get the next monthly shot of medication was moved back from 30 days to 45 days.

    As best her family could reconstruct from the messages on her phone, Wittner started using again on April 12, Easter Sunday, more than a week after her originally scheduled appointment, when she should have gotten her next injection. She couldn’t stave off the cravings any longer as she waited for her appointment that coming Friday. She used again that Tuesday and Wednesday.

    “We kind of know her thought process was that ‘I can make it. I’ll go get my shot tomorrow,’” said her father, Leon Wittner. “‘I’ve just got to get through this one more day and then I’ll be OK.’”

    But on Thursday morning, the day before her appointment, her sister Grace Sekera found her curled up in bed at her parents’ home in this Denver suburb, blood pooling on the right side of her body, foam on her lips, still clutching a syringe. Her father suspects she died of a fentanyl overdose.

    However, he said, what really killed her was the coronavirus.

    “Anybody that is struggling with a substance abuse disorder, anybody that has an alcohol issue and anybody with mental health issues, all of a sudden, whatever safety nets they had for the most part are gone,” he said. “And those are people that are living right on the edge of that razor.”

    Sara Wittner’s death is just one example of how complicated it is to track the full impact of the coronavirus pandemic — and even what should be counted. Some people who get COVID-19 die of COVID-19. Some people who have COVID die of something else. And then there are people who die because of disruptions created by the pandemic.

    While public health officials are trying to gather data on how many people test positive for the coronavirus and how many people die from the infection, the pandemic has left an untold number dying in the shadows, not directly because of the virus but still because of it. They are unaccounted for in the official tally, which, as of June 21, has topped 119,000 in the U.S.

    But the lack of immediate clarity on the numbers of people actually dying from COVID-19 has some onlookers, ranging from conspiracy theorists on Twitter all the way to President Donald Trump, claiming the tallies are exaggerated — even before they include deaths like Wittner’s. That has undermined confidence in the accuracy of the death toll and made it harder for public health officials to implement infection prevention measures.

    Yet experts are certain that a lack of widespread testing, variations in how the cause of death is recorded, and the economic and social disruption the virus has caused are hiding the full extent of its death toll.

    How To Count

    In the U.S., COVID-19 is a “notifiable disease” — doctors, coroners, hospitals and nursing homes must report when encountering someone who tests positive for the infection, and when a person who is known to have the virus dies. That provides a nearly real-time surveillance system for health officials to gauge where and to what extent outbreaks are happening. But it’s a system designed for speed over accuracy; it will invariably include deaths not caused by the virus as well as miss deaths that were.

    For example, a person diagnosed with COVID-19 who dies in a car accident could be included in the data. But someone who dies of COVID-19 at home might be missed if they were never tested. Nonetheless, the numbers are close enough to serve as an early-warning system.

    “They’re really meant to be simple,” Colorado state epidemiologist Dr. Rachel Herlihy said. “They apply these black-and-white criteria to often gray situations. But they are a way for us to systematically collect this data in a simple and rapid fashion.”

    For that reason, she said, the numbers don’t always align with death certificate data, which takes much more time to review and classify. And even those can be subjective. Death certificates are usually completed by a doctor who was treating that person at the time of death or by medical examiners or coroners when patients die outside of a health care facility. Centers for Disease Control and Prevention guidelines allow for doctors to attribute a death to a “presumed” or “probable” COVID infection in the absence of a positive test if the patient’s symptoms or circumstances warrant it. Those completing the forms apply their individual medical judgment, though, which can lead to variations from state to state or even county to county in whether a death is attributed to COVID-19.

    Furthermore, it can take weeks, if not months, for the death certificate data to move up the ladder from county to state to federal agencies, with reviews for accuracy at each level, creating a lag in those more official numbers. And they may still miss many COVID-19 deaths of people who were never tested.

    That’s why the two methods of counting deaths can yield different tallies, leading some to conclude that officials are fouling up the numbers. And neither approach would capture the number of people who died because they didn’t seek care — and certainly will miss indirect deaths like Wittner’s where care was disrupted by the pandemic.

    “All those things, unfortunately, are not going to be determined by the death record,” says Oscar Alleyne, chief of programs and services for the National Association of City and County Health Officials.

    Using Historical Data To Understand Today’s Toll

    That’s why researchers track what are known as “excess” deaths. The public health system has been cataloging all deaths on a county-by-county basis for more than a century, providing a good sense of how many deaths can be expected every year. The number of deaths above that baseline in 2020 could tell the extent of the pandemic.

    For example, from March 11 to May 2, New York City recorded 32,107 deaths. Laboratories confirmed 13,831 of those were COVID-19 deaths and doctors categorized another 5,048 of them as probable COVID-19 cases. That’s far more deaths than what historically occurred in the city. From 2014 through 2019, the city averaged just 7,935 deaths during that time of year. Yet when taking into account the historical deaths to assume what might occur normally, plus the COVID cases, that still leaves 5,293 deaths not explained in this year’s death toll. Experts believe that most of those deaths could be either directly or indirectly caused by the pandemic.

    City health officials reported about 200 at-home deaths per day during the height of the pandemic, compared with a daily average 35 between 2013 and 2017. Again, experts believe that excess is presumably caused either directly or indirectly by the pandemic.

    And nationally, a recent analysis of obituaries by the Health Care Cost Institute found that, for April, the number of deaths in the U.S. was running about 12% higher than the average from 2014 through 2019.

    “The excess mortality tells the story,” said Dr. Jeremy Faust, an emergency medicine physician at Brigham and Women’s Hospital in Boston. “We can see that COVID is having a historic effect on the number of deaths in our community.”

    These multiple approaches, however, have many skeptics crying foul, accusing health officials of cooking the books to make the pandemic seem worse than it is. In Montana, for example, a Flathead County health board member cast doubt over official COVID-19 death tolls, and Fox News pundit Tucker Carlson questioned the death rate during an April broadcast. That has sowed seeds of doubt. Some social media posts claim that a family member or friend died at home of a heart attack but that the cause of death was inaccurately listed as COVID-19, leading some to question the need for lockdowns or other precautions.

    “For every one of those cases that might be as that person said, there must be dozens of cases where the death was caused by coronavirus and the person wouldn’t have died of that heart attack — or wouldn’t have died until years later,” Faust said. “At the moment, those anecdotes are the exceptions, not the rule.”

    At the same time, the excess deaths tally would also capture cases like Wittner’s, where the usual access to health care was disrupted.

    A recent analysis from Well Being Trust, a national public health foundation, predicted as many as 75,000 people might die from suicide, overdose or alcohol abuse, triggered by the uncertainty and unemployment caused by the pandemic.

    “People lose their jobs and they lose their sense of purpose and become despondent, and you sometimes see them lose their lives,” said Benjamin Miller, Well Being’s chief strategy officer, citing a 2017 study that found that for every percentage point increase in unemployment, opioid overdose deaths increased 3.6%.

    Meanwhile, hospitals across the nation have seen a drop-off in non-COVID patients, including those with symptoms of heart attacks or strokes, suggesting many people aren’t seeking care for life-threatening conditions and may be dying at home. Denver cardiologist Dr. Payal Kohli calls that phenomenon “coronaphobia.”

    Kohli expects a new wave of deaths over the next year from all the chronic illnesses that aren’t being treated during the pandemic.

    “You’re not necessarily going to see the direct effect of poor diabetes management now, but when you start having kidney dysfunction and other problems in 12 to 18 months, that’s the direct result of the pandemic,” Kohli said. “As we’re flattening the curve of the pandemic, we’re actually steepening all these other curves.”

    Lessons From Hurricane Maria’s Shifting Death Toll

    That’s what happened when Hurricane Maria pummeled Puerto Rico in 2017, disrupting normal life and undermining the island’s health system. Initially, the death toll from the storm was set at 64 people. But more than a year later, the official toll was updated to 2,975, based on an analysis from George Washington University that factored in the indirect deaths caused by the storm’s disruptions. Even so, a Harvard study calculated the excess deaths caused by the hurricane were likely far higher, topping 4,600.

    The numbers became a political hot potato, as critics blasted the Trump administration over its response to the hurricane. That prompted the Federal Emergency Management Agency to ask the National Academy of Sciences to study how best to calculate the full death toll from a natural disaster. That report is due in July, and those who wrote it are now considering how their recommendations apply to the current pandemic — and how to avoid the same politicization that befell the Hurricane Maria death toll.

    “You have some stakeholders who want to downplay things and make it sound like we’ve had a wonderful response, it all worked beautifully,” said Dr. Matthew Wynia, director of the University of Colorado Center for Bioethics and Humanities and a member of the study committee. “And you’ve got others who say, ‘No, no, no. Look at all the people who were harmed.’”

    Calculations for the ongoing pandemic will be even more complicated than for a point-in-time event like a hurricane or wildfire. The indirect impact of COVID-19 might last for months, if not years, after the virus stops spreading and the economy improves.

    But Wittner’s family knows they already want her death to be counted.

    Throughout her high school years, Sekera dreaded entering the house before her parents came home for fear of finding her sister dead. When the pandemic forced them all indoors together, that fear turned to reality.

    “No little sister should have to go through that. No parent should have to go through that,” she said. “There should be ample resources, especially at a time like this when they’re cut off from the world.”

    View the original article at thefix.com

  • Intervention

    I did not know that the next time I held her body, it would be chips of bone and gritty ash in a small cardboard box.

    The following is an excerpt from The Heart and Other Monsters by Rose Andersen.

    I cannot remember my sister’s body. Her smell is gone to me. I do not recall the last time I touched her. I think I can almost pinpoint it: the day I asked her to leave my home after I figured out she had stopped detoxing and started shooting up again, all the while trying to sell my things to her drug dealer as I slept. When she left, she asked me for $20, and I told her that I would give it to her if she sent me a picture of a receipt to show me she spent the money on something other than drugs. “Thanks a lot,” she said, sarcastically. I hugged her, maybe. So much hinges on that maybe, the haunting maybe of our last touch.

    The last time I saw my sister was at an intervention at a shitty hotel in Small Town. Our family friend Debbie flew my stepmother and me there in her three-seater plane. The intervention was put together hastily by Sarah’s friend Noelle, who called us a few days beforehand, asking us to come. There were little resources or time to stage it properly—we couldn’t afford a trained interventionist to come. Noelle told us she was afraid Sarah was going to die. I agreed to fly with Debbie and Sharon because Small Town was far away from home and I didn’t want to drive.

    Debbie sat in the pilot’s seat, and I sat next to her. My stepmother was tucked in the third seat, directly behind us. It wasn’t until takeoff that I realized with my body what a terrible decision it was to fly. I am terrified of heights and extremely prone to motion sickness. I was not prepared for what it meant to be in a small plane.

    I could feel the outside while inside the plane. The vibration of chilly wind permeated through the tiny door and gripped my lungs, heart, head. It would have taken very little effort to open the door and fall, an endless horrifying fall to most-certain death. From the first swoop into the air, my stomach twisted into a mean, malicious fist that punched at my bowels and throat. For the next hour I sat trembling, my eyes shut tight. Through every dip, bounce, and shake, I held back bile and silently cried.

    When we landed, I lurched off the plane and threw up. I do not remember what color it was. My stepmom handed me a bottle of water and half a Xanax, and I sat, legs splayed on the runway, until I thought I could stand again.

    My sister vomited when she died. She shit. She bled. How much is required to leave our body before we are properly, truly, thoroughly dead? I dreamed one night that I sat with my sister’s dead body and tried to scoop all her bodily fluids back inside her. Everything wet was warm, but her body was ice-cold. I knew that if I could return this warmth to her, she would come back to life. My hands were dripping with her blood and excrement, and while begging her insides to return to her, I cried a great flood of mucus and tears. This I remember, while our last touch still evades me.

    My sister was late to her intervention. Many hours late. Seven of us, all women, five of us in sobriety, sat in that hot hotel room, repeatedly texting and calling Sarah’s boyfriend, Jack, to bring her to us. I realized later that he probably told her they were going to the hotel to get drugs.

    The hotel room was also where Sharon, Debbie, and I would be sleeping that night. It held two queen-size beds, our small amount of luggage, and four chairs we had discreetly borrowed from the hotel’s conference room. I sat on one of the beds, perched on the edge anxiously, trying not to make eye contact with anyone else. I didn’t know many of the other people there.

    When I told my mom about the intervention days before, I had immediately followed with “But you don’t need to come.” There were so many reasons. She has goats and donkeys, cats and dogs who needed to be taken care of. She didn’t have a vehicle that could make the drive. She could write a letter, I said, and I would give it to Sarah. The truth was, I didn’t feel like managing her now-acrimonious relationship with Sharon. I didn’t want to have to take care of my mom, on top of managing Sarah’s state of being. It occurred to me, sitting in this crowded, strange room, that I might have been wrong.

    Sitting diagonally across from me was Sarah’s close friend Noelle, who had organized everything. Sarah and Noelle had met in recovery, lived together at Ryan’s family home, and become close friends. They had remained friends even when Sarah started using again. Helen, a fair-haired middle-aged woman who was not one of the people Sarah knew from recovery but rather the mother of one of Sarah’s boyfriends, sat on the other bed. Sarah’s last sponsor, Lynn, sat near me. I had to stop myself from telling her how Sarah had used her name on her phone. Sitting in one of the chairs was the woman who was going to run the intervention. I cannot remember her name now, even though I can easily recall the sound of her loud, grating voice.

    The interventionist had worked at Shining Light Recovery, the rehab Sarah had been kicked out of about a year and a half before, and was the only person Noelle could find on short notice. She had run her fair share of interventions, she told us, but she made it clear that because she hadn’t had the time to work with us beforehand, this wouldn’t run like a proper intervention. She smelled like musty clothes and showed too many teeth when she laughed. She talked about when she used to drink, with a tone that sounded more like longing than regret. When she started to disclose private information about my sister’s time in rehab, I clenched my hands into a fist.

    “I’m the one that threw her out,” the woman said. “I mean, she’s a good kid, but once I caught her in the showers with that other girl, she had to go.” Someone else said something, but I couldn’t hear anyone else in the room. “No sexual conduct,” she continued. “The rules are there for a reason.” She chuckled and took a swig from her generic-brand cola. I felt hot and ill, my insides still a mess from the plane ride. We waited two more hours, listening to the interventionist talk, until Jack texted to say they had just pulled up.

    Intervention

    When my sister arrived, she walked into the room and announced loudly, “Oh fuck, here we go.” Then she sat, thin, resentful, and sneering, her hands stuffed into the front pocket of her sweatshirt. Oh fuck, here we go, I thought. The interventionist didn’t say much, in sharp contrast to her chattiness while we were waiting. She briefly explained the process; we would each have a chance to speak, and then Sarah could decide if she wanted to go to a detox center that night.

    We went in turns, speaking to Sarah directly or reading from a letter. Everyone had a different story, a different memory to start what they had to say, but everyone ended the same way: “Please get help. We are afraid you are going to die.” Sarah was stone-faced but crying silently. This was unusual. When Sarah cried, she was a wailer; we called it her monkey howl.

    When we were younger, we watched the movie Little Women again and again. We would often fast-forward through Beth’s death, but sometimes we would let the scene play out. We would curl up on our maroon couch and cry as Jo realized her younger sister had died. For a moment I wished for the two of us to be alone, watching Little Women for the hundredth time. I could almost feel her small head on my shoulder as she wailed, “Why did Beth have to die? It’s not fair.” She sat across the room and wouldn’t make eye contact with me.

    I addressed Sarah first with my mom’s letter. I started, “My dear little fawn, I know that things have gone wrong and that you have lost your way.” My voice cracked and I found I couldn’t continue, so I passed it to Noelle to read instead. It felt wrong to hear my mother’s words come out of Noelle’s mouth. Sarah was crying. She needs her mom, I thought frantically.

    When it came time to speak to her myself, my mind was blank. I was angry. I was angry that I had to fly in a shitty small plane and be in this shitty small room to convince my sister to care one-tenth as much about her life as we did. I was furious that she still had a smirk, even while crying, while we spoke to her. Mostly, I was angry because I knew nothing I could say could make her leave this terrible town I had driven her to years before, and come home. That somewhere in her story there was a mountain of my own mistakes that had helped lead us to this moment.

    “Sarah, I know you are angry and think that we are all here to make you feel bad. But we are here because we love you and are worried you might die. I don’t know what I would do if you died.” My sister sat quietly and listened. “I believe you can have any life you want.” I paused. “And I have to believe that I still know you enough to know that this isn’t the life you want.” The more I talked, the further away she seemed, until I trailed off and nodded to the next person to talk.

    After we had all spoken, Sarah rejected our help. She told us she had a plan to stop using on her own. “I have a guy I can buy methadone from, and I am going to do it by myself.” Methadone was used to treat opioid addicts; the drug reduced the physical effects of withdrawal, decreased cravings, and, if taken regularly, could block the effects of opioids. It can itself be addictive—it’s also an opioid. By law it can only be dispensed by an opioid treatment program, and the recommended length of treatment is a minimum of twelve months.

    “I have a guy I can buy five pills from,” Sarah insisted, as if that was comparable to a licensed methadone center, as if what she was suggesting wasn’t its own kind of dangerous.

    “But honey,” my stepmother said gently, “we are offering you help right now. You can go to a detox center tonight.”

    “Absolutely not. I am not going to go cold turkey.” Sarah was perceptibly shaking as she said this, the trauma of her past withdrawals palpable in her body. “I don’t know if I can trust you guys.”

    She gestured to my stepmom and me. “I felt really betrayed by what happened.” The heroin in her wallet, the confrontation at Sharon’s, Motel 6, breaking into her phone. “You guys don’t understand. Every other time I’ve done this, I’ve done this for you, for my family.” She sat up a little straighter. “For once in my life, it’s time for me to be selfish.”

    It was all I could do not to slap her across the face. I wanted desperately to feel my hand sting from the contact, to see her cheek bloom pink, to see if anything could hurt her. She wasn’t going to use methadone to get clean. She just wanted us to leave her alone. 

    I made an excuse about needing to buy earplugs to sleep that night and walked out. I did not hug her or look at her. I did not know I would not see her again. I did not know I would not remember our last touch. I did not know that the next time I held her body, it would be chips of bone and gritty ash in a small cardboard box.
     

    THE HEART AND OTHER MONSTERS (Bloomsbury; hardcover; 9781635575149; $24.00; 224 pages; July 7, 2020) by Rose Andersen is an intimate exploration of the opioid crisis as well as the American family, with all its flaws, affections, and challenges. Reminiscent of Alex Marzano-Lesnevich’s The Fact of a Body, Maggie Nelson’s Jane: A Murder, and Lacy M. Johnson’s The Other Side, Andersen’s debut is a potent, profoundly original journey into and out of loss. Available now.

     

    View the original article at thefix.com

  • Drinking Surged During The Pandemic. Do You Know The Signs Of Addiction?

    While some people may be predisposed to problematic drinking or alcohol-use disorder, these can also result from someone’s environment.

    Despite the lack of dine-in customers for nearly 2½ long months during the coronavirus shutdown, Darrell Loo of Waldo Thai stayed busy.

    Loo is the bar manager for the popular restaurant in Kansas City, Missouri, and he credits increased drinking and looser liquor laws during the pandemic for his brisk business. Alcohol also seemed to help his customers deal with all the uncertainty and fear.

    “Drinking definitely was a way of coping with it,” said Loo. “People did drink a lot more when it happened. I, myself, did drink a lot more.”

    Many state laws seemed to be waived overnight as stay-at-home orders were put into place, and drinkers embraced trends such as liquor delivery, virtual happy hours and online wine tasting. Curbside cocktails in 12- and 16-ounce bottles particularly helped Waldo Thai make up for its lost revenue from dine-in customers.

    Retail alcohol sales jumped by 55% nationally during the third week of March, when many stay-at-home orders were put in place, according to Nielsen data, and online sales skyrocketed.

    Many of these trends remained for weeks. Nielsen also notes that the selling of to-go alcohol has helped sustain businesses.

    But the consumption of all this alcohol can be problematic for individuals, even those who haven’t had trouble with drinking in the past.

    Dr. Sarah Johnson, medical director of Landmark Recovery, an addiction treatment program based in Louisville, Kentucky, with locations in the Midwest said that, virtual events aside, the pandemic has nearly put an end to social drinking.

    “It’s not as much going out and incorporating alcohol into a dinner or time spent with family or friends,” Johnson said. “Lots of people are sitting home drinking alone now and, historically, that’s been viewed as more of a high-risk drinking behavior.”

    There are some objective measures of problematic drinking. The Centers for Disease Control and Prevention defines heavy drinking as 15 or more drinks a week for a man or eight or more for a woman.

    But Johnson said that more important clues come from changes in behavior. She explains that, for some people, a bit of extra drinking now and then isn’t a big deal.

    “If they are still meeting all of their life obligations, like they are still getting up and making their Zoom meetings on time, and they’re not feeling so bad from drinking that they can’t do things, and taking care of their children and not having life problems, then it’s not a problem,” Johnson said. “It’s when people start to have problems in other areas of their life, then it would be a signal that they are drinking too much and that it’s a problem.”

    But there are signs to watch out for, she says. They include:

    • Big increases in the amount of alcohol consumed
    • Concern expressed by family or friends
    • Changes in sleep patterns, either more or less sleep than usual
    • Any time that drinking interferes with everyday life

    Johnson noted that for many people, living under stay-at-home orders without the demands of a daily commute or lunch break could be problematic.

    “Routine and structure are important to overall mental health because they reduce stress and elements of unknown or unexpected events in daily life,” Johnson said. “These can trigger individuals in recovery to revert to unhealthy coping skills, such as drinking.”

    Johnson explained that while some people may be predisposed to problematic drinking or alcohol-use disorder, these can also result from someone’s environment.

    Johnson said that people who are unable to stop problematic drinking on their own should seek help. The federal Substance Abuse and Mental Health Services Administration runs a 24/7 helpline (800-662-HELP) and website, www.findtreatment.gov, offering referrals for addiction treatment.

    Peer support is also available online. Many Alcoholics Anonymous groups have started to offer virtual meetings, as does the secular recovery group LifeRing. And for people who are looking for more informal peer support, apps such as Loosid help connect communities of sober people.

    Darrell Loo at Waldo Thai said that he has been concerned at times about people’s drinking but that he generally has seen customers back off from the heavy drinking they were doing early in the pandemic.

    Loo and others in the Kansas City restaurant business are pushing for the carryout cocktails and other looser laws to stay in place even as restaurants slowly start to reopen.

    “This will go on for a while. It’s going to change people’s habit,” Loo said. “People’s spending habit. People’s dining out habit. So there’s definitely a need to keep doing it.”

    This story is part of a partnership that includes KCUR, NPR and Kaiser Health News.

    View the original article at thefix.com

  • Why cellphone videos of black people’s deaths should be considered sacred, like lynching photographs

    Likening the fatal footage of Ahmaud Arbery and George Floyd to lynching photographs invites us to treat them more thoughtfully. 

    As Ahmaud Arbery fell to the ground, the sound of the gunshot that took his life echoed loudly throughout his Georgia neighborhood.

    I rewound the video of his killing. Each time I viewed it, I was drawn first to the young black jogger’s seemingly carefree stride, which was halted by two white men in a white pickup truck.

    Then I peered at Gregory McMichael, 64, and his son Travis, 34, who confronted Arbery in their suburban community.

    I knew that the McMichaels told authorities that they suspected Arbery of robbing a nearby home in the neighborhood. They were performing a citizen’s arrest, they said.

    The video shows Arbery jogging down the street and the McMichaels blocking his path with their vehicle. First, a scuffle. Then, gunshots at point-blank range from Travis McMichael’s weapon.

    My eyes traveled to the towering trees onscreen, which might have been the last things that Arbery saw. How many of those same trees, I wondered, had witnessed similar lynchings? And how many of those lynchings had been photographed, to offer a final blow of humiliation to the dying?

    A series of modern lynchings

    It may be jarring to see that word – lynching – used to describe Arbery’s Feb. 23, 2020, killing. But many black people have shared with me that his death – followed in rapid succession by Breonna Taylor’s and now George Floyd’s officer-involved murders – hearkens back to a long tradition of killing black people without repercussion.

    Perhaps even more traumatizing is the ease with which some of these deaths can be viewed online. In my new book, “Bearing Witness While Black: African Americans, Smartphones and the New Protest #Journalism,” I call for Americans to stop viewing footage of black people dying so casually.

    Instead, cellphone videos of vigilante violence and fatal police encounters should be viewed like lynching photographs – with solemn reserve and careful circulation. To understand this shift in viewing context, I believe it is useful to explore how people became so comfortable viewing black people’s dying moments in the first place.

    Images of black people’s deaths pervasive

    Every major era of domestic terror against African Americans – slavery, lynching and police brutality – has an accompanying iconic photograph.

    The most familiar image of slavery is the 1863 picture of “Whipped Peter,” whose back bears an intricate cross-section of scars.

    Famous images of lynchings include the 1930 photograph of the mob who murdered Thomas Shipp and Abram Smith in Marion, Indiana. A wild-eyed white man appears at the bottom of the frame, pointing upward to the black men’s hanged bodies. The image inspired Abel Meeropol to write the poem “Strange Fruit,” which was later turned into a song that blues singer Billie Holiday sang around the world.

    Twenty-five years later, the 1955 photos of Emmett Till’s maimed body became a new generation’s cultural touchstone. The 14-year-old black boy was beaten, shot and thrown into a local river by white men after a white woman accused him of whistling at her. She later admitted that she lied.

    Throughout the 1900s, and until today, police brutality against black people has been immortalized by the media too. Americans have watched government officials open firehoses on young civil rights protesters, unleash German shepherds and wield billy clubs against peaceful marchers, and shoot and tase today’s black men, women and children – first on the televised evening news, and, eventually, on cellphones that could distribute the footage online.

    When I conducted the interviews for my book, many black people told me that they carry this historical reel of violence against their ancestors in their heads. That’s why, for them, watching modern versions of these hate crimes is too painful to bear.

    Still, there are other groups of black people who believe that the videos do serve a purpose, to educate the masses about race relations in the U.S. I believe these tragic videos can serve both purposes, but it will take effort.

    Why cellphone videos of black people’s deaths should be considered sacred, like lynching photographs
    In 1922 the NAACP ran a series of full-page ads in The New York Times calling attention to lynchings. New York Times, Nov. 23, 1922/American Social History Project

    Reviving the ‘shadow archive’

    In the early 1900s, when the news of a lynching was fresh, some of the nation’s first civil rights organizations circulated any available images of the lynching widely, to raise awareness of the atrocity. They did this by publishing the images in black magazines and newspapers.

    After that image reached peak circulation, it was typically removed from public view and placed into a “shadow archive,” within a newsroom, library or museum. Reducing the circulation of the image was intended to make the public’s gaze more somber and respectful.

    The National Association for the Advancement of Colored People, known popularly as the NAACP, often used this technique. In 1916, for example, the group published a horrific photograph of Jesse Washington, a 17-year-old boy who was hanged and burned in Waco, Texas, in its flagship magazine, “The Crisis.”

    Memberships in the civil rights organization skyrocketed as a result. Blacks and whites wanted to know how to help. The NAACP used the money to push for anti-lynching legislation. It purchased a series of costly full-page ads in The New York Times to lobby leading politicians.

    Though the NAACP endures today, neither its website nor its Instagram page bears casual images of lynching victims. Even when the organization issued a statement about the Arbery killing, it refrained from reposting the chilling video within its missive. That restraint shows a degree of respect that not all news outlets and social media users have used.

    A curious double standard

    Critics of the shadow archive may argue that once a photograph reaches the internet, it is very difficult to pull back from future news reports.

    This is, however, simply not true.

    Images of white people’s deaths are removed from news coverage all the time.

    It is difficult to find online, for example, imagery from any of the numerous mass shootings that have affected scores of white victims. Those murdered in the Sandy Hook Elementary School shooting of 2012, or at the Las Vegas music festival of 2017, are most often remembered in endearing portraits instead.

    In my view, cellphone videos of black people being killed should be given this same consideration. Just as past generations of activists used these images briefly – and only in the context of social justice efforts – so, too, should today’s imagery retreat from view quickly.

    The suspects in Arbery’s killing have been arrested. The Minneapolis police officers involved in Floyd’s death have been fired and placed under investigation. The videos of their deaths have served the purpose of attracting public outrage.

    To me, airing the tragic footage on TV, in auto-play videos on websites and social media is no longer serving its social justice purpose, and is now simply exploitative.

    Likening the fatal footage of Ahmaud Arbery and George Floyd to lynching photographs invites us to treat them more thoughtfully. We can respect these images. We can handle them with care. In the quiet, final frames, we can share their last moments with them, if we choose to. We do not let them die alone. We do not let them disappear into the hush of knowing trees.

    [Insight, in your inbox each day.You can get it with The Conversation’s email newsletter.]

    Allissa V. Richardson, Assistant Professor of Journalism, University of Southern California, Annenberg School for Communication and Journalism

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

  • In Hard-Hit Areas, COVID’s Ripple Effects Strain Mental Health Care Systems

    Although mental health services continued largely uninterrupted in areas with low levels of the coronavirus, behavioral health care workers in areas hit hard by COVID-19 were overburdened.

    In late March, Marcell’s girlfriend took him to the emergency room at Henry Ford Wyandotte Hospital, about 11 miles south of Detroit.

    “I had [acute] paranoia and depression off the roof,” said Marcell, 46, who asked to be identified only by his first name because he wanted to maintain confidentiality about some aspects of his illness.

    Marcell’s depression was so profound, he said, he didn’t want to move and was considering suicide.

    “Things were getting overwhelming and really rough. I wanted to end it,” he said.

    Marcell, diagnosed with schizoaffective disorder seven years ago, had been this route before but never during a pandemic. The Detroit area was a coronavirus hot spot, slamming hospitals, attracting concerns from federal public health officials and recording more than 1,000 deaths in Wayne County as of May 28. Michigan ranks fourth among states for deaths from COVID-19.

    The crisis enveloping the hospitals had a ripple effect on mental health programs and facilities. The emergency room was trying to get non-COVID patients out as soon as possible because the risk of infection in the hospital was high, said Jaime White, director of clinical development and crisis services for Hegira Health, a nonprofit group offering mental health and substance abuse treatment programs. But the options were limited.

    Still, the number of people waiting for beds at Detroit’s crisis centers swelled. Twenty-three people in crisis had to instead be cared for in a hospital.

    This situation was hardly unique. Although mental health services continued largely uninterrupted in areas with low levels of the coronavirus, behavioral health care workers in areas hit hard by COVID-19 were overburdened. Mobile crisis teams, residential programs and call centers, especially in pandemic hot spots, had to reduce or close services. Some programs were plagued by shortages of staff and protective supplies for workers.

    At the same time, people battling mental health disorders became more stressed and anxious.

    “For people with preexisting mental health conditions, their routines and ability to access support is super important. Whenever additional barriers are placed on them, it could be challenging and can contribute to an increase in symptoms,” said White.

    After eight hours in the emergency room, Marcell was transferred to COPE, a community outreach program for psychiatric emergencies for Wayne County Medicaid patients.

    “We try to get patients like him into the lowest care possible with the least restrictive environment,” White said. “The quicker we could get him out, the better.”

    Marcell was stabilized at COPE over the next three days, but his behavioral health care team couldn’t get him a bed in one of two local residential crisis centers operated by Hegira. Social distancing orders had reduced the beds from 20 to 14, so Marcell was discharged home with a series of scheduled services and assigned a service provider to check on him.

    However, Marcell’s symptoms ― suicidal thoughts, depression, anxiety, auditory hallucinations, poor impulse control and judgment ― persisted. He was not able to meet face-to-face with his scheduled psychiatrist due to the pandemic and lack of telehealth access. So, he returned to COPE three days later. This time, the staff was able to find him a bed immediately at a Hegira residential treatment program, Boulevard Crisis Residential in Detroit.

    Residents typically stay for six to eight days. Once they are stabilized, they are referred elsewhere for more treatment, if needed.

    Marcell ended up staying for more than 30 days. “He got caught in the pandemic here along with a few other people,” said Sherron Powers, program manager. “It was a huge problem. There was nowhere for him to go.”

    Marcell couldn’t live with his girlfriend anymore. Homeless shelters were closed and substance abuse programs had no available beds.

    “The big problem here is that all crisis services are connected to each other. If any part of that system is disrupted you can’t divert a patient properly,” said Travis Atkinson, a behavioral consultant with TBD Solutions, which collaborated on a survey of providers with the American Association of Suicidology, the Crisis Residential Association and the National Association of Crisis Organization Directors.

    White said the crisis took a big toll on her operations. She stopped her mobile crisis team on March 14 because, she said, “we wanted to make sure that we were keeping our staff safe and our community safe.”

    Her staff assessed hospital patients, including Marcell, by telephone with the help of a social worker from the emergency room.

    People like Marcell have struggled during the coronavirus crisis and continue to face hurdles because emergency preparedness measures didn’t provide enough training, funds or thought about the acute mental health issues that could develop during a pandemic and its aftermath, said experts.

    “The system isn’t set up to accommodate that kind of demand,” said Dr. Brian Hepburn, a psychiatrist and executive director of the National Association of State Mental Health Program Directors.

    “In Detroit and other hard-hit states, if you didn’t have enough protective equipment you can’t expect people to take a risk. People going to work can’t be thinking ‘I’m going to die,’” said Hepburn.

    For Marcell, “it was bad timing to have a mental health crisis,” said White, the director at Hegira.

    At one time Marcell, an African American man with a huge grin and a carefully trimmed goatee and mustache, had a family and a “pretty good job,” Marcell said. Then “it got rough.” He made some bad decisions and choices. He lost his job and got divorced. Then he began self-medicating with cocaine, marijuana and alcohol.

    By the time he reached the residential center in Detroit on April 1, he was at a low point. “Schizoaffective disorder comes out more when you’re kicked out of the house and it increases depression,” said Powers, the program manager who along with White was authorized by Marcell to talk about his care. Marcell didn’t always take his medications and his use of illicit drugs magnified his hallucinations, she said.

    While in the crisis center voluntarily, Marcell restarted his prescription medications and went to group and individual therapy. “It is a really good program,” he said while at the center in early May. “It’s been one of the best 30 days.”

    Hepburn said the best mental health programs are flexible, which allows them more opportunities to respond to problems such as the pandemic. Not all programs would have been able to authorize such a long stay in residential care.

    Marcell was finally discharged on May 8 to a substance abuse addiction program. “I felt good about having him do better and better. He had improved self-esteem to get the help he needed to get back to his regular life,” Powers said.

    But Marcell left the addiction program after only four days.

    “The [recovery] process is so individualized and, oftentimes, we only see them at one point in their journey. But, recovering from mental health and substance use disorders is possible. It can just be a winding and difficult path for some,” said White.

    Seeking Help

    If you or someone you know is in immediate danger, call 911. Below are other resources for those needing help:

    — National Helpline: 1-800-662-HELP (4357) or https://findtreatment.samhsa.gov.

    — National Suicide Prevention Lifeline: 1-800-273-TALK (8255).

    — Disaster Distress Helpline: 1-800-985-5990 or text TalkWithUs to 66746.

    View the original article at thefix.com

  • Pandemic Presents New Hurdles, and Hope, for People Struggling with Addiction

    “There’s social distancing — to a limit…I think when someone’s life is in jeopardy, they’re worth saving. You just can’t watch people die.”

    Before Philadelphia shut down to slow the spread of the coronavirus, Ed had a routine: most mornings he would head to a nearby McDonald’s to brush his teeth, wash his face and — when he had the money — buy a cup of coffee. He would bounce between homeless shelters and try to get a shower. But since businesses closed and many shelters stopped taking new admissions, Ed has been mostly shut off from that routine.

    He’s still living on the streets.

    “I’ll be honest, I don’t really sleep too much,” said Ed, who’s 51 and struggling with addiction. “Every four or five days I get a couple hours.”

    KHN agreed not to use his last name because he uses illegal drugs.

    Philadelphia has the highest overdose rate of any big city in America — in 2019, more than three people a day died of drug overdoses there, on average. Before the coronavirus began spreading across the United States, the opioid overdose epidemic was the biggest health crisis on the minds of many city officials and public health experts. The coronavirus pandemic has largely eclipsed the conversation around the opioid crisis. But the crisis still rages on despite business closures, the cancellation of in-person treatment appointments and the strain on many addiction resources in the city.

    When his usual shelter wasn’t an option anymore, Ed tried to get into residential drug treatment. He figured that would be a good way to try to get back on his feet and, if nothing else, get a few good nights of rest. But he had contracted pinkeye, a symptom thought to be associated with the virus that leads to COVID-19, so the evaluation center didn’t want to place him in an inpatient facility until he’d gotten the pinkeye checked out. But he couldn’t see a doctor because he didn’t have a phone for a telehealth appointment.

    “I got myself stuck, and I’m trying to pull everything back together before it totally blows up,” he said.

    Rosalind Pichardo wants to help people in Ed’s situation. Before the pandemic, Pichardo would hit the streets of her neighborhood, Kensington, which has the highest drug overdose rate in Philadelphia. She’d head out with a bag full of snack bars, cookies and Narcan, the opioid overdose reversal drug.

    She’d hand Narcan out to people using drugs, and people selling drugs — anyone who wanted it. Pichardo started her own organization, Operation Save Our City, which initially set out to work with survivors of gun violence in the neighborhood. When she realized that overdoses were killing people too, she began getting more involved with the harm reduction movement and started handing out Narcan through the city’s syringe exchange.

    When Pennsylvania’s stay-at-home order went into effect, Pichardo and others worried that more people might start using drugs alone, and that fewer first responders would be patrolling the streets or nearby and able to revive them if they overdosed.

    So, Pichardo and other harm reduction activists gave out even more Narcan. A representative for Prevention Point Philadelphia, the group that operates a large syringe exchange program in the city, said that during the first month of the city’s stay-at-home order, they handed out almost twice as much Narcan as usual.

    After the lockdowns and social distancing began, Pichardo worried that more people would be using drugs alone, leading to more overdoses. But Philadelphia’s fatal overdose rate during the pandemic remains about the same as it was this time last year. Pichardo said she thinks that’s evidence that flooding the streets with Narcan is working — that people are continuing to use drugs, and maybe even using more drugs, but that users are utilizing Narcan more often and administering it to one another.

    That is the hope. But Pichardo said users don’t always have a buddy to keep watch, and during the pandemic first responders have seemed much more hesitant to intervene. For example, she recently administered Narcan to three people in Kensington who overdosed near a subway station, while two police officers stood by and watched. Before the pandemic, they would often be right there with her, helping.

    To reverse the overdoses, Pichardo crouched over the people who she said had started turning blue as their oxygen levels dropped. She injected the Narcan into their noses, using a disposable plastic applicator. Normally, she would perform rescue breathing, too, but since the pandemic began she has started carrying an Ambu bag, which pumps air into a person’s lungs and avoids mouth-to-mouth resuscitation. Among the three people, she said, it took six doses of Narcan to revive them. The police officers didn’t step in to help but did toss several overdose-reversal doses toward Pichardo as she worked.

    “I don’t expect ’em to give ’em rescue breaths if they don’t want to, but at least administer the lifesaving drug,” Pichardo said.

    In her work as a volunteer, she has reversed almost 400 overdoses, she estimated.

    “There’s social distancing — to a limit,” Pichardo said, “I think when someone’s life is in jeopardy, they’re worth saving. You just can’t watch people die.”

    Even before Philadelphia officially issued its stay-at-home order, city police announced they would stop making low-level arrests, including for narcotics. The idea was to reduce contact overall, help keep the jail population low and reduce the risk of the virus getting passed around inside. But Pichardo and other community activists said the decreased law enforcement emboldened drug dealers in the Kensington neighborhood, where open-air drug sales and use are common.

    “You can tell they have everything down pat, from the lookout to the corner boys to the one actually holding the product — the one holding the product’s got some good PPE gear,” said Pichardo.

    More dealers working openly on the street has led to more fights over territory, she added, which in turn has meant more violence. While overall crime in Philadelphia and other major cities has declined during the pandemic, gun violence has spiked.

    Police resumed arrests at the beginning of May.

    Now when she goes out to offer relief and hand out Narcan, Pichardo packs a few extra things in her bag of supplies: face masks, gloves and gun locks.

    “It’s like the survival kit of the ’hood,” she said.

    For those struggling with addiction who are ready to start recovery, newly relaxed federal restrictions have made it easier to get medications that curb opioid cravings and stem withdrawal. Several efforts are underway among Philadelphia-based public health groups and criminal justice advocacy organizations to give cellphones to people who are homeless or coming out of jail, so they can make a telehealth appointment and get quicker access to a prescription for those medicines.

    During the pandemic, people taking medication-assisted treatment can renew their prescription every month instead of every week, which helps decrease trips to the pharmacy. It is too soon to know if more people are taking advantage of the new rules, and accessing medication-assisted treatment via telehealth, but if that turns out to be the case, many addiction medicine specialists argue the new rules should become permanent, even after the pandemic ends.

    “If we find that these relaxed restrictions are bringing more people to the table, that presents enormous ethical questions about whether or not the DEA should reinstate these restrictive policies that they had going in the first place,” said Dr. Ben Cocchiaro, a physician who treats people with substance-use disorder.

    Cocchiaro said the whole point of addiction treatment is to facilitate help as soon as someone is ready for it. He hopes if access to recovery can be made simpler during a pandemic, it can remain that way afterward.

    This story is part of a partnership that includes WHYY, NPR and Kaiser Health News.

    View the original article at thefix.com

  • My Daughter / Myself

    I would spend a decade trying to reconcile two feelings: complete hatred for the stranger who was living in my daughter’s body and total surrender to my love for her.

    (The following is an excerpt from a longer work.)

    The following summer, Oscar developed such serious health problems that we had to put him down. In July, Angel came over to say goodbye to him. Then Carter and I walked him to the vet and held him down while he received his injection. Annie couldn’t bear to be there. As we were sobbing over his dying body, unable to leave, the aide gently suggested that we needed to let go of him. We left the building and Carter and I held onto each other all the way home. Annie stayed in her room and I tried, unsuccessfully, to reach her.

    “Annie,” I said, knocking on her door, “please let me in. I know how you feel; we’re all sad to lose Oscar. I just want to hug you and tell you it’ll be okay. Please don’t isolate yourself like this. Come out and get something to eat with me and Carter.”

    “Mom, I couldn’t eat a thing right now. I just want to go to sleep. I’ll see you in the morning.”

    I couldn’t eat anything, either. We were both stunned by the absence of our much-beloved dog and, not surprisingly, we lost our appetites. Even bulimics can lose their appetites, at least for a while, when they’re sad.

    Another letting go served to uproot us as Angel and I sold our large house a month later. We all seemed to scatter like the four winds afterwards. Caroline had moved to California and Carter was living with a friend in D.C. I moved into a condominium near my high school, and Annie moved into a friend’s apartment.

    Her first year of living independently seemed uneventful at first. Frequently visiting her in the apartment she shared, I took her furniture from her old bedroom so she would feel at home in her new digs. But there were signs that she was changing. She had never had many boyfriends in high school. Then one Sunday morning I arrived to find a friend of hers on the sofa, clearly feeling at home. Later I learned he was a bartender at a watering hole and drug hotspot in Adams Morgan. Well, she was on her own. And by now she was twenty-one; I felt I didn’t have much leverage.

    In the spring, though two courses short of her graduation requirements at George Mason University, Annie was allowed to walk with her class, cap and gown and all.

    Angel, his wife and I all dressed up for our second child’s college graduation in the spring of 2001, and we all viewed this ceremony as a symbol of hope that Annie was willing and anxious to embrace her adulthood and take on more responsibilities, like other young people.

    “Hey, Mom, I want you to meet my friend Shelly. She got me through statistics sophomore year.”

    “Hi, Shelly, nice to meet you. Thanks for helping Annie. Is your family here today?”

    “No. They had to work. No big deal for them anyway.”

    “Oh. Well I think it’s a big deal, so congratulations from me! It was nice to meet you, Shelly, and good luck.”

    Annie’s graduation distracted us from being curious about what she was doing in the evenings. Again, she went to a lot of trouble to cover up behavior that she knew would alarm us and might threaten an intervention.

    Just like her mother.

    At the end of the summer, she asked if she could move into my basement. Her roommate was buying a condo, she said, and their lease was up anyway. Later on, when I watched in horror as the tragedy unfolded in my own house, I wondered about the truth of that. I thought maybe the roommate saw where Annie was going and asked her to leave. No matter. She was in my house now.

    The circle was about to close.

    Then a shocking discovery—a bowl of homemade methamphetamine on top of my dryer! I had been wondering about the stuff she’d left in my basement laundry room. I read the label: muriatic acid. I looked it up on my computer. So that’s what she used it for!

    I moved the bowl up to the kitchen and put it next to the sink, where recessed lighting bore down on it. She couldn’t miss it when she came in the front door. I thought I’d be ready for the confrontation.

    At 4:30 in the morning, she exploded into my bedroom while Gene and I were sleeping. I’m glad he was with me that night.

    “How dare you mess with my things downstairs! Don’t you ever touch my stuff again, you fucking bitch!” she roared. I thought I was dreaming when I saw her there, animal-like, with wild, blood-shot eyes.

    Gene held onto me as I sobbed into my pillow. “Oh God, this isn’t happening, Gene, please tell me this isn’t happening!”

    A half hour later, pulling myself together, I went downstairs to make coffee. I still had to go to work.

    Annie stomped upstairs from the basement with a garbage bag full of her clothes and brushed by me without a word or a look. After she slammed the door behind her, I ran to the kitchen window and saw her get into her car.

    My daughter went from crystal meth, to cocaine, to heroin, as though it were a smorgasbord of terrible choices. Despite four rehabs and family love, her addictive disease continued. There were periods of remission, but they were short-lived. My daughter lived in one pigsty after another, her boyfriends all drug addicts. I would spend a decade trying to reconcile two feelings: complete hatred for the stranger who was living in my daughter’s body and total surrender to my love for her.

    Because of our superficial differences, I didn’t realize right away how alike we were.

    We’ve both suffered from depression since we were young. The adults in our lives didn’t always acknowledge our screams. We turned to substance abuse for relief: food, cigarettes, and drugs. I added alcohol to my list, but I’m not aware that she ever drank alcoholically. My daughter moved on to heroin.

    At least I cleaned up well.

    Though Annie was no longer living with me at that point, I tried to continue embracing her, accepting her, so she’d know she was still loved. But I couldn’t yet distinguish between helping and enabling.

    I did unwise, misguided, things: I gave her money; I paid her debts; I shielded her from jail when she broke the law.

    “Are you sure you don’t want us to contact the authorities about this, Mrs. Rabasa?” the rep asked me when she stole my identity to get a credit card.

    “Oh no,” terrified of her going to jail, “I’ll handle it.”

    And I did, badly.

    This was enabling at its worst. Convinced her addiction came from me, that guilt crippled me and my judgment.

    Placing a safety net beneath her only served to ease my anxiety. It did nothing to teach her the consequences of her behavior. I kept getting in her way.

    It felt like I was in the twilight zone whenever I visited her. My daughter was buried somewhere deep inside, but the addict was in charge. One body, split down the middle: my daughter, Annalise; and a hard-core drug addict. A surreal nightmare.

    Her apartment smelled of incense and dirty laundry. The soles of her shoes flopped until she could get some duct tape around them. She didn’t offer me anything to eat because there was no food in the refrigerator.

    Nothing.

    Twice while I was there she ran to the bathroom to vomit.

    Heroin. Dope sick.

    Annie was hijacked by a cruel disease—cruel because it robs you of yourself while you’re still alive. While destroying your mind, it keeps your body alive long enough to do a lot of damage before it actually kills you. For many drug addicts, it’s an agonizingly slow death.

    It was like looking at a movie of my life in reverse, erasing all the good fortune that brought me to where I was, leaving only the pain and ugliness—and hopelessness—of a wasted life. How I might have ended up.

    For better or worse, my life had been unfolding as many do with addictive personalities. But to see the same disease taking over the life of my child—to see that mirror up close in front of me—was threatening to be my undoing.

    Trying to hold it together, I was imploding. Like all addicts and families of addicts, survival can be reached from many places, but often from the bottom.

    Mine was waiting for me.
    Excerpted from Stepping Stones: A Memoir of Addiction, Loss, and Transformation, to be released on June 16 by She Writes Press. It is the sequel to the award-winning debut memoir, A Mother’s Story: Angie Doesn’t Live Here Anymore (Maggie C. Romero), available on Amazon and where other books are sold.

    View the original article at thefix.com

  • Avoiding Family Drama During the Covid-19 Pandemic

    When the pandemic broke out, for the first time since I left home, I felt conflicted between the need to learn my brothers are safe and my need to maintain a drama-free life.

    Several times since the Covid-19 pandemic broke out, I have wondered whether my brothers were safe. Knowing whether John*, my middle brother, was okay was easy. Although we’ve not talked to each other in 12 years, I found out through two of our mutual childhood friends that he was not one of the more than 350,000 people in his state who have contracted the virus.

    Finding out whether Marco* was okay took several weeks. Nobody in our family and none of my childhood friends can deal with him. He has bipolar disorder, and since his diagnosis 39 years ago, he has consistently refused meds. He’s verbally and physically abusive to most people he comes in contact with, especially women, which he came by honestly as the saying goes.

    I never needed a diagnosis to know something was seriously off with Marco. Looking back, he exhibited all the signs: stretches of mania followed by equally long bouts of depression, calculated and well-thought-out verbal and physical assaults, and rage that seemed to come from nowhere.

    When I was 10 (Marco is four years older than I) he planned out his first of two attempts to kill one of the neighbors in our Manhattan apartment building. He tied a thin wire across the top of the staircase. He then rang the doorbell and tried to lure this woman out of her apartment and down those marble stairs, where she would surely have fallen to her death. She saw the wire just in the nick of time and held onto the banister. Marco was hiding out of sight, snickering.

    He told our parents he did it because the neighbor wouldn’t let him play with her daughter. Laughing as he retold the story was creepy as hell.

    A few days later while staring out the window, Marco noticed the same neighbor climbing out of a cab. He had a 10-gallon garbage bag already filled with water, waiting beside the window. As she closed the car door, Marco dropped that 85-pound “water balloon” down 10 flights. It missed our neighbor by a hair and she did as anyone would do: she looked up and saw Marco looking out the window. He not only didn’t duck inside (as most people would have done), he yelled out to her, “Better luck next time!” Although none of us saw this happen, his version of events was identical to hers.

    With me Marco had a trigger hand, like our father. If our father didn’t like something I said or did, I would get knocked across the room. Our father beat all three of us whenever he felt like it, which was probably three to four times a week, as did his father to him growing up. When I was 14, I paid $25.00 from my babysitting money to a neighborhood kid to install a lock on my bedroom door. I couldn’t control the world outside my bedroom, but I could protect myself in my own room.

    And what was John doing as Marco was abusing his sister and trying to kill the neighbor? John has always been good at taking care of John and ignoring everyone else. Give him a substance and the world ceases to exist.

    Forgive and Forget Because Nothing is More Important Than Family

    Those who don’t know my family or think I’m exaggerating when I describe what it was like growing up usually say things to me like, “Nothing is more important than family,” “Whatever happened, just forgive him and move on” or “You’ll regret it when you get older.”

    The last comment has some merit. We are all in our 50s, and I’m acutely aware there are fewer years in front of us than behind. Our parents are now deceased, so they’re non-issues in the forgive and forget department. But for the living, reconciliation isn’t always so easy.

    It involves real work my brothers are too stuck to do. The apple rarely falls far from the tree, although the real mystery isn’t how one brother has bipolar and the other is an alcoholic. The question I’ve had my whole life is, why didn’t I become an alcoholic, have bipolar or both?

    Depression, bipolar disorder and alcoholism run on both sides of my family. My mother struggled with depression and used alcohol to self-medicate. She was a functional alcoholic—so functional that she was the editor for The New Yorker Magazine for years. While she rarely hit me, my mother was the queen of belittling. To give you an idea how biting her tongue could be, when I hit adolescence and my body started changing, she told me, “I don’t know what I did in life to deserve a mother, a best friend, a husband and a daughter who are all fat.”

    My father was a different variety of excrement. He just shit on everyone he knew and claimed to love. When he wasn’t confessing his mortal marital sins to my mother on a near-weekly basis, he was beating the crap out of us. He used whatever was handy: a book, a shoe, a belt, his fist, his legs to kick us, and when he was really frustrated, he’d throw things at us.

    My mother used to say, “Parents give their children unspoken commands their children learn to implicitly obey.” Marco and John learned at a young age to throw weapons instead of using their words. Their weapons of choice included a skateboard, a frying pan, scissors, lamps, glass bottles and a hammer. It amazes me they’re both still alive.

    Shorter and less muscular than Marco, John took up martial arts when he was 11. By the time he was 15, John was a black belt in three styles of Kung Fu. He was still shorter than Marco, but now his weapons became sharper, his hands and arms stronger, and he could inflict serious, life-altering damage. I lost count of how often I had to call the police because I wasn’t about to get in the middle of a fight between two rabid dogs.

    I used to pray for my parents and brothers to get arrested, so I could raise myself.

    Aleutian Islands: Same Name, Not Connected

    After I graduated from high school at 16, I rented a furnished room in the apartment of a different neighbor. By 17, I was in therapy, where I was diagnosed with PTSD and a panic disorder. I would end up spending seven years with Barbara, working through the damage of my childhood. Together, we dismantled me so we could put me back together. I was 24 when Barbara and I decided I was ready to go out into the world without an attendant.

    The first few years after I left home—especially while I was still in therapy—I hardly spoke with my parents or my brothers. I honestly didn’t know what Marco was doing, but I knew from various people he was fine and living with a woman in another state. Periodically, I’d run into John on the street. On those occasions we were cordial, but there was nothing to talk about. It was like seeing someone from my childhood I had nothing in common with now. We’d promise to catch up, knowing full well neither of us would make that call.

    Weeks turned into months and eventually years between check-ins with my brothers. I spoke with my parents every so often because, no matter how much work I’d done on myself, I was also raised with a sense of obligation, and daughters aren’t supposed to just cut off their parents. While they were still alive, I controlled the direction of the conversations to keep them from touching on areas that could trigger me.

    I once told Barbara in therapy that I felt like we were the Aleutian Islands. They were people I knew but had no connection to. I didn’t hate them; I felt nothing for them. My mother used to say, “The opposite of love isn’t hate. It’s indifference.” She was right.

    I met my husband in 1996 and we were married in 2001 while living in Southern California. Although all of my girlfriends who had previously gotten married and who were getting married opted to keep their maiden names, I couldn’t wait to change mine. Despite being every bit as feminist as my friends, for them the decision to keep their maiden name was about maintaining their identity. For me, the act of changing my last name meant adopting a new one.

    As important as leaving my home the first chance I got and staying in therapy for seven years (no matter how uncomfortable things got sometimes), changing my name allowed me to reinvent myself.

    The beauty of having a different last name is that, unless I tell people my maiden name, nobody knows I have any association with those people. It helps that I have an amazing relationship with my husband’s family, who have been my tribe for 23 years.

    Today, my husband and I live in Puerto Rico on an organic farm. We have rich relationships with people both in Puerto Rico and the States. When I think about the stark contrast between my life then and now, I’m reminded of a quote by Maya Angelou: “Family isn’t always blood, it’s the people in your life who want you in theirs: the ones who accept you for who you are, the ones who would do anything to see you smile and who love you no matter what.”

    Separate Lives in the Time of Covid-19

    My husband and I have talked with my brothers a handful of times over the last 24 years we’ve been together. My mother died in 1994 and, after my father’s death in 2002, I was named executor of my parents’ estate. I had to periodically be in touch with both brothers for signatures on this or that document required to sell our parents’ home, which we did in 2008. Between then and now, I had no desire to contact them.

    When the pandemic broke out, for the first time since I left home, I felt conflicted between the need to learn they’re safe and my need to maintain a drama-free life. Once I found John was alive, I felt I was halfway to feeling I wouldn’t need to expose myself.

    It took several weeks, but I was finally able to confirm Marco is also safe from Covid-19. I remembered a nickname he used to refer to himself when we were younger and during times he was manic. I started googling versions of the nickname and eventually came across his Twitter profile.

    He’s on his fourth wife, living somewhere in the Midwest. What I read were 75 tweets in rapid fire succession about everything that angers him that nobody reacted to or commented on. Based on my accelerated heart rate while reading them, I deduced he still isn’t treating his bipolar disorder. I got what I came for: I know he’s alive. Now that I know both my brothers are safe from Covid-19, and that I can continue to confirm it without reaching out to them, I no longer have to wonder and I can continue living my life.

    View the original article at thefix.com

  • Flattening the mental health curve is the next big coronavirus challenge

    Some recent projections suggest that deaths stemming from mental health issues could rival deaths directly due to the virus itself.

    The mental health crisis triggered by COVID-19 is escalating rapidly. One example: When compared to a 2018 survey, U.S. adults are now eight times more likely to meet the criteria for serious mental distress. One-third of Americans report clinically significant symptoms of anxiety or clinical depression, according to a late May 2020 release of Census Bureau data.

    While all population groups are affected, this crisis is especially difficult for students, particularly those pushed off college campuses and now facing economic uncertainty; adults with children at home, struggling to juggle work and home-schooling; and front-line health care workers, risking their lives to save others.

    We know the virus has a deadly impact on the human body. But its impact on our mental health may be deadly too. Some recent projections suggest that deaths stemming from mental health issues could rival deaths directly due to the virus itself. The latest study from the Well Being Trust, a nonprofit foundation, estimates that COVID-19 may lead to anywhere from 27,644 to 154,037 additional U.S. deaths of despair, as mass unemployment, social isolation, depression and anxiety drive increases in suicides and drug overdoses.

    But there are ways to help flatten the rising mental health curve. Our experience as psychologists investigating the depression epidemic and the nature of positive emotions tells us we can. With a concerted effort, clinical psychology can meet this challenge.

    Reimagining mental health care

    Our field has accumulated long lists of evidence-based approaches to treat and prevent anxiety, depression and suicide. But these existing tools are inadequate for the task at hand. Our shining examples of successful in-person psychotherapies – such as cognitive behavioral therapy for depression, or dialectical behavioral therapy for suicidal patients – were already underserving the population before the pandemic.

    Now, these therapies are largely not available to patients in person, due to physical distancing mandates and continuing anxieties about virus exposure in public places. A further complication: Physical distancing interferes with support networks of friends and family. These networks ordinarily allow people to cope with major shocks. Now they are, if not completely severed, surely diminished.

    What will help patients now? Clinical scientists and mental health practitioners must reimagine our care. This includes action on four interconnected fronts.

    First, the traditional model of how and where a person receives mental health care must change. Clinicians and policymakers must deliver evidence-based care that clients can access remotely. Traditional “in-person” approaches – like individual or group face-to-face sessions with a mental health professional – will never be able to meet the current need.

    Telehealth therapy sessions can fill a small part of the remaining gap. Forms of nontraditional mental health care delivery must fill the rest. These alternatives do not require reinvention of the wheel; in fact, these resources are already readily accessible. Among available options: web-based courses on the science of happiness, open-source web-based tools and podcasts. There are also self-paced, web-based interventions – mindfulness-based cognitive therapy is one – which are accessible for free or at reduced rates.

    Democratizing mental health

    Second, mental health care must be democratized. That means abandoning the notion that the only path to treatment is through a therapist or psychiatrist who dispenses wisdom or medications. Instead, we need other kinds of collaborative and community-based partnerships.

    For example, given the known benefits of social support as a buffer against mental distress, we should enhance peer-delivered or peer-supported interventions – like peer-led mental health support groups, where information is communicated between people of similar social status or with common mental health problems. Peer programs have great flexibility; after orientation and training, peer leaders are capable of helping individual clients or groups, in person, online or via the phone. Initial data shows these approaches can successfully treat severe mental illness and depression. But they are not yet widely used.

    Taking a proactive approach

    Third, clinical scientists must promote mental health at the population level, with initiatives that try to benefit everyone rather than focusing exclusively on those who seek treatment. Some of these promotion strategies already have clear-cut scientific support. In fact, the best-supported population interventions, such as exercise, sleep hygiene and spending time outdoors, lend themselves perfectly to the needs of the moment: stress-relieving, mental illness-blocking and cost-free.

    Finally, we must track mental health on the population level, just as intensely as COVID-19 is tracked and modeled. We must collect much more mental health outcome data than we do now. This data should include evaluations from mental health professionals as well as reports from everyday citizens who share their daily experiences in real time via remote-based survey platforms.

    Monitoring population-level mental health requires a team effort. Data must be collected, then analyzed; findings must be shared across disciplines – psychiatry, psychology, epidemiology, sociology and public health, to name a few. Sustained funding from key institutions, like the NIH, are essential. To those who say this is too tall an order, we ask, “What’s the alternative?” Before flattening the mental health curve, the curve must be visible.

    COVID-19 has revealed the inadequacies of the old mental health order. A vaccine will not solve these problems. Changes to mental health paradigms are needed now. In fact, the revolution is overdue.
     

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    This article is republished from The Conversation under a Creative Commons license. Read the original article.