I’m sure I’m not the only one who immediately thinks about chickens and eggs almost every time they hear the word comorbidity. But the first time I found a hash pipe floating around with my daughters’ clothes in the washing machine, chickens and eggs were the furthest things from my mind.
I grew up in a family who appeared quite normal on the outside and the inside. In the early ‘60s, watching your mother dress up for cocktail parties while easing down the final few puffs of her unfiltered Pall Mall was the norm. My father sitting with his after-work gin and tonic while he caught up with the national news was the norm. I didn’t grow up exposed to blatant alcohol abuse or drug use of any kind. We were all June and Ward Cleaver. Really, we were. Even as a teenager of the ‘70s, drugs barely phased my world.
Years later my husband and I continued the Cleaver tradition. Although I fell short of meeting him at the door in a pretty blue dress with my hair in a stylish flip, we raised our two girls in a very normal household. So when my two daughters suddenly turned from adorable little girls to unrecognizable teenage monsters with hash pipes and slips of paper decorated with curious, tiny, triangular squares in their pockets, we didn’t know how to respond, who to blame (other than ourselves), who to turn to for help, or how to stop the rollercoaster, eggshell crushing few years we were heading toward. Nothing in either of our lives prepared us for what was coming.
When my older daughter’s behavior turned from that of a slightly difficult child to that of an unmanageable teenager, many hours of useless guilt bantering between me and my husband ensued: “What did we do wrong?” “Do you think it’s drugs?” “Why does she feel the need to do drugs?” “What could we have done differently?” “Am I a bad mom?” And on and on. When she was ultimately diagnosed with bipolar disorder at the age of eighteen, we accepted this with a sigh of relief—at least this was something tangible, something “fixable.” By the time her younger sister started getting in trouble at school, doing drugs, acting oddly, becoming paranoid, and hearing voices, I could almost handle the double punch. By then I had educated myself, I had become involved in the National Alliance on Mental Health (NAMI), and I had become an advocate. But it was still hell—she was diagnosed with schizophrenia.
So where’s that chicken and where’s that egg?
Perhaps I should have been given a tiny ovum of foresight the first time our younger daughter woke us up in the middle of the night screaming in her little pink doll-baby pajamas with her moonlike eyes peering up at us without recognition and her face fixed in death-impending terror. But I was soothed by our doctor’s reassuring words: “Night terrors are very common. They are in no way related to future mental illness.” I now know that he was incorrect.
Perhaps my older daughter’s contention that she had ADHD in spite of her exemplary school performance should have sent up red flags. Maybe if I had known what I know now, I wouldn’t have placated her words: “You have no idea what goes on in my head!” But the fact is, other than a stubborn and sometimes difficult child at home, my older daughter was a perfectly charming, brilliant student who was well liked by her teachers and better liked by her friends.
Then there were the things I never knew about until later. Like the fact that my younger daughter used to sit in her second grade class and say, “Iron wall. Iron wall. Iron wall,” over and over to herself as she tried to limit the external stimuli flooding her young brain.
Then there was the time she was given steroids as a young child for a severe sinus infection and distinctly heard people talking to her. “Mom, someone just said clean-up in aisle seven in my head!” The moment the prednisone was decreased, the voices stopped.
So as these early prodromal symptoms grew, so did my children, and so did their access to things like weed and alcohol and random pills pilfered from grandmas’ medicine cabinets, thus providing them something like relief.
Yet my younger daughter did not become psychotic until after that bad LSD trip. My older daughter now admits that she was doing a lot of coke when she was most manic.
Egg. Chicken. Egg. Egg.
I think what we have here is the first and second hit. The first hit being the genetic propensity for these illnesses along with an increased sensitivity to certain medications and drugs. The second is environmental. Stress, drug use, hormones, a viral infection, and head trauma have all been theorized. I have no doubt that my children were vulnerable. I know now that both sides of our families are peppered with mental illness. The use of drugs to quell prodromal symptoms could have easily brought the predisposed mental illness to the forefront. Drug use absolutely made things worse. We were lucky. Thanks to the help of a great practitioner and people I met through NAMI, my kids were helped quickly. Proper treatment was initiated and my children recovered before any sort of drug or alcohol addiction took hold. Regardless of the accuracy of their initial diagnoses, the word comorbid was never part of the equation. Twenty to twenty-five percent of adults in the US will struggle with mental illness at some point in their lives. Over half of these individuals have a coexisting addiction. What can be done to decrease these percentages? How can we decrease that drug-induced second hit?
I believe early detection is the key—flagging those children who are genetically vulnerable, screening each and every child as we screen for other serious illnesses. We need to step in and treat those early prodromal symptoms before drugs and alcohol can take hold. This can be achieved by education, by open and frank discussions on mental health, by making it okay to talk, by decreasing the learned fear, and by promoting what is needed for recovery. Screening should be done on every child by pediatricians and family doctors. Mental health should be stressed and taught in our schools, starting at lower grade school levels. We should be talking to our children about our own struggles or those of other family members. I could never talk to my children because no one ever talked to me. I was forced to learn everything I now know about these neurological brain diseases out of desperation, out of despair, and out of necessity. What we went through as a family was unconscionable. We should have been educated and supported by our medical and human community rather than made to feel ashamed, judged, and helpless. Blame it on poor genes if you must, but these are no-fault neurological conditions that are not due to poor parenting or weak constitutions.
When it comes right down to it, eggs and chickens are not all that important. It really doesn’t matter if the egg predated the chicken or the chicken predated the egg, or even if they both occurred at the exact same time. What’s important is that we understand that both mental illness and addiction are often comingled. Both need to be acknowledged, understood, and treated. The cost of mental illness is huge; the cost of comorbidity is even larger—not only financially, but emotionally and physically. I believe the mental healthcare system is beginning to understand this. Now we just need to get the rest of the world to understand.
Karen Winters Schwartz, bestselling author of Where Are the Cocoa Puffs?: A Family’s Journey Through Bipolar Disorder (Goodman Beck Publishing, 2010) and Reis’s Pieces: Love, Loss, and Schizophrenia (Goodman Beck Publishing, 2012)