The Toxic Romance of Mental Disorder and Substance Abuse

Walking through the day means nursing a universe of emptiness cradled between the chest and stomach

Photo: Jonathan Knowles/Getty Images

I’ve dealt with chronic depression and anxiety my entire life. The earliest memories of feeling “down” or having suicidal ideations started when I was 13 years old — around the time many people with a chronic disorder begin to experience symptoms.

I never knew what was wrong with me. The mental health language didn’t exist at the time, and at my age, I couldn’t yet wield the words needed to describe what I felt. The most I could muster was that I felt sensitive, sad, needy, and weak — like an emotional teenager. But this wasn’t just teen angst; it was the beginning of the path I had to walk.

It’s genetic: I have mental illness on one side of the family, and substance use on both. It’s the reason why my mother felt she couldn’t continue being my mother when I was 15 months old. It’s also one of the reasons I’m so proud of my father. Having this internal struggle is in my blood. It’s in my genes. I was made for this.

One in 25 Americans suffers from a mental health disorder, and 5.8% of them suffer from two or more. Many will turn to substance use as a coping mechanism. For us, walking through the day means nursing a universe of emptiness cradled between the chest and stomach with the incessant need to fill it. There’s a plea to pour in something that expands and fills and makes solid and whole all the parts that echo before they shatter. People may fill their empty echoing with food, sex, porn, drugs, or gambling. And many, like myself, will choose to fill themselves with spirits — alcohol.

Almost half of the people who experience a mental health disorder also suffer from substance use issues. This condition is known as a dual diagnosis or comorbidity. A standard treatment course is to abstain from any substance to isolate and better treat the disorder(s). But often, the tie between condition and the self becomes indistinguishable. You may feel like you’re disappearing completely. The idea of recovery is sold as meaning feeling “better,” but when your distortion is mental, your reality is a lie. You will find yourself questioning what recovery even means.

People in recovery will share stories of self-destruction and all the crashes that occurred as they abused whatever they abused to give them whatever they needed at the time, culminating in the ubiquitous rock bottom. When your self-destruction is your personality type, those rock bottoms become a face-to-gravel road grind that lasts miles and years, leaves scars on recollection, and keeps a taste of pooled blood under your tongue.

My last 15 years have been a spectacular exhibition of self-sabotage, leaving me with nothing left to examine but myself:

What is my problem?

It was more than the apparent excessive drinking.

There has to be something deeply defective with me.

I reflected on more than just my many bad decisions, but also how I viewed myself with others, the impulses I’d experienced over the years, and my self-esteem and self-image, in particular. My negative self-worth and overall self-hatred were such that I felt this couldn’t be “normal.”

With a disorder like BPD, self-destruction bounds you, and the concept of recovery is like throwing a new maze into the mayhem.

Having accepted the idea of depression, I looked further and discovered Borderline Personality Disorder (BPD). It’s one of the most challenging mental health disorders to diagnose; I’ve had a doctor tell me they didn’t “like” to diagnose BPD because there is no cure.

BPD characteristics include abandonment and attachment issues, an unstable sense of self, suicidal ideation or attempts, mood swings and anger, self-harm and self-destructive behavior, intense emptiness, extreme impulsivity, and binge/abuse behavior*. With a disorder like BPD, self-destruction bounds you and the concept of recovery is like throwing a new maze into the mayhem.

If you have a mental disorder, the very thing that brings you closer to death may bring you a little life along the way. “A little life” is a difficult thing to part with when a person’s default state is numb, empty, and fixated on oblivion. The danger isn’t when a substance puts you in a happy mood, but when it gives the illusory sensation of life. Andrew Solomon summed up this idea perfectly when he said, “The opposite of depression is not happiness, but vitality.” The lifeless posture of depression makes it easy to become possessed by spirits.

One sobriety strategy is to disassociate your memories or events tied to a substance, but everything is connected to a personality disorder. For those with an already unstable sense of self, who you are when you are under the influence may be the only self you can define. Even through the self-hatred, it may be the only self that you like.

When you’re finally forced to make a choice, sobriety may seem like an unrequited trade. Through all my fuckups, embarrassments, guilt, and shame, there were still smiles. There were still pockets of happiness. They might have been small, finite, and short-lived, but they were still there — a little life in all the red wine and brandy. I know I shouldn’t think like this, but since exploring sobriety, I haven’t smiled once. I’m constantly asking myself, “What am I actually recovering from?” The reality for those with a mental disorder is confusing and chaotic. It’s not black and white. It’s not gray. It’s a kaleidoscope.

Most chronic disorders don’t have cures, but there are ways to manage symptoms. Agreeing to one of the varied treatment methods requires a level of trust and faith that those dealing with a disorder will struggle to hold. BPD has no cure, is lifelong, and the only light of hope is that in 10 years, I have a 50% chance of getting to a “normal” that today I’m unable to describe, let alone recognize. What does a healthy and “normal” me look like when this is all I’ve been? It’s a bleak thought, and recovery becomes a life sentence of continuous labored maintenance. It’s a game of keeping busy and running away from yourself — a tin boat in an ocean of cresting and crashing impulses.

The process of recovery is self-resuscitation — breathing life into yourself. It’s disconnecting from what made you feel human, however fleeting and damaging. Recovery is a real journey into the unknown, predicated on a belief in a future you can’t envision yourself. But, for whatever reasons you have, you do it. It is blind faith personified. It’s a dark tunnel with no light at the end, a coal mine with no canary, and you’re left to search your deepest parts for a faith that solid ground will meet your steps. And when you step and connect and hear the dirt and gravel grind under your soles, you’ve made it.

That’s one step. Now let out a sigh of relief, take another deep breath, and step again.

*BPD is something I’m still exploring, so I have only discussed the symptoms I experience.

If you or someone you know is struggling, SAMHSA’s National Helpline is a free, confidential source of information: 1–800–662-HELP (4357).

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