During one of my hospital stays at the renowned McLean Hospital, I became acquainted with an older Jamaican man who worked at the hospital in the unit where I stayed. His name was Marvin & he was a mental health assistant. His job was to have a "check-in" session every day with each of the patients he was assigned, which was always done privately. He was extremely sincere and gentle, so when he would ask me "How are you feeling today?", I was convinced that he genuinely cared and wanted to know. It seemed he had a commitment to his job that went far beyond the hospital walls, which is a very special quality in mental health & substance abuse treatment workers.
I was never someone to instantly have enough trust in someone that I would spill my true concerns, worries and mistakes, instead choosing to keep the proverbial wall up and not expose too much of my problems; this being in part, an issue of self-preservation as to not have others look down upon me, and part guilt and shame that I carried deeply over what I believed to be horrible mistakes that could only mean I was a terrible person. A large part of this guilt and shame I carried inside, like a leaden weight, dragged me down further into my depression, my suicidal ideas and my relapses. I was fully aware and conscious; I KNEW how detrimental this guilt & shame was to my health, my recovery and my very life, how it was holding me back by being unable to talk about it with anyone, but it was such a strong, all-consuming shame, that I didn't believe at the time, I could handle these thoughts being verbalized and thus open material to have a further conversation with. I was terrified that if I said out loud all the things I had done, to anyone else, no matter if it was their job to help me or not, that they would use that information to think poorly of me and agree with my idea that I was simply a bad person. I couldn't handle the thought of anyone looking at me as a flawed human being, that didn't already know my mistakes, only later to form the opinion that I was.
Most people who know nothing about addiction as a disease or know someone close to them that has suffered with addiction, look at in the way that, if our actions directly cause harm or hurt to those we love (which they do), then it can't be a true disease; no matter how much modern medical research shows to the contrary, they believe we are choosing our actions and therefore are very flawed in a moral way.....not in a sick way. This can explain why many addicts, even in recovery for years, even while in treatment facilities where their addiction is known about, they still keep up very high walls and let out very little information. We already feel terrible about ourselves, whether we may show it or not, so it would obviously hurt our self-image, our self-esteem much more, to have other people added to that list of how morally corrupt we are.
Although he already conducted his official "check-in" with me, Marvin approached me in the hallway and asked me if I would sit down. He sensed something was wrong. Marvin knew I was a mother. He knew I was having difficulties at home with my marriage. And from seeing me in tears walking in the hallways numerous times & bursting into tears after a telephone call, he knew that I felt guilty and ashamed that I was even in the hospital receiving the treatment I very much needed and that I did not feel I deserved it.
His question was a very simple, "Why?"
The center of what I'd been keeping behind "my wall" came flooding out; that I felt incredibly selfish for focusing on myself & being in the hospital getting treatment, when I should be home focusing on my son. I was selfish for even going to the hospital & my husband said things that made me feel this was validated. That stay had been my 3rd attempt at treatment, so my 3rd time away from home in just a couple of months. I was worried that when I got out, I would continue to be looked at as selfish for going to therapy, selfish for going to meetings, selfish for going to the outpatient program; spending so much time on recovery-based activities, that it appeared that I was all about "me". I had immense guilt over my stay in the hospital again & that I couldn't seem to get well and my addiction & depression kept getting worse.
I discovered while at McLean that past week or so, that I was definitely NOT alone in this line of thinking. Every single other woman admitted to the hospital on my unit, who was a mother, held the identical guilt & shame about spending any energy on their problems, their sickness, because they had been so used to sacrificing everything for their children. It is instinctive for a mother to feel selfish for directing any focus or energy towards themselves. And through so much reading I have done regarding addiction and depression over the last 7 decades or so, I have concluded that this is a more modern occurrence for mothers to have this guilt to the degree that we do today.
There is so much pressure on mothers to schedule a never-ending list of activities for their children to be engaged in, play-dates, classes, sports, family-involved activities, trips, vacations; a very unrealistic expectation of exposing your children to every kind of educational & extracurricular experience by the time they reach school-age, that simply did not exist just decades ago. There is surmounting pressure & criticism of mothers who choose to keep their careers and work full time outside of the home to practically spend every non-working second to meet the incredible expectations of the very idea of a mother today. There is the same but different pressure on stay at home mothers, to turn your home into a classroom, and try to teach their children skill levels that were unheard of for young children as little time ago as the 1980's.
The essential expectation of a mother today, no matter if a working mom or stay at home mom, is to play a central role in every single minute of your child's day, and if you as much as go to dinner with your own husband and leave your child with a sitter, moms today feel guilty for doing so. Never before, have children in these times spent so much of their young life engaging continuously with a parent, as their main "playmate" instead of other children. So it is no wonder at all, that when something goes seriously wrong with your health, be it mental illness or addiction as examples, that a mother is left with an unbearable amount of guilt and feelings of selfishness for focusing on themselves & following through with the services they require in order to recover. In the 5 more hospital stays I have had since that 3rd one, this is a guaranteed theme among the women hospitalized who are mothers and I feel it poses a huge risk and a level of dangerousness so severe that we will likely never know the impact it has had on women's lives when it comes to recovery. I had deeply rooted, self-imposed, as well as society-imposed pressures & guilt, like so many other women today.
When I began explaining this dilemma to Marvin, the tears were uncontrollably pouring from eyes and streaming down my face. It was what I had feared would happen when the day came that I would admit to my innermost feelings to another person; it was all out in the open and I honestly just wanted to leave the room and go to bed to cry myself to sleep, rather than have to hear the possibility of Marvin agreeing that I was this monster of a person.
But Marvin did not agree at all with this.
He instead, appeared as though he too was going to begin to cry. I could see the pain on his face that I brought out in him by my revealing how little self-esteem I had left & the mountain of guilt that I was carrying. He quite literally had tears in his eyes as he started what was to be a long meeting, explaining that I was undeniably wrong. Of course he told me that commonly given phrase of "you have to take care of yourself before you can take care of anyone else" and the analogy of how on an airplane they say to put on your oxygen mask first before assisting your children with theirs. But I had heard all of that before and to me it was just words and although I knew there was an intended meaning, I knew that the majority of people do not actually view those ideas as being true when it comes to something like addiction or depression. I had cared more about what "society", i.e. people I did not know, thought of me, more than what I thought about myself. Even more, I let those beliefs influence my own feelings of myself.
But then Marvin wrote on a piece of scrap paper for me, "a concrete life". He said in a way that was more powerful than I could ever hope to relay, that concrete can only be made and only be a fixed foundation, solid, etc., if all of the necessary ingredients are there. He wrote the following:
Cement = Medications Sand = Therapy Rocks = Conviction & Water = Yourself. And that Water makes up 60% of the mixture.
I got the message, and bear with me, for it may seem awfully simplistic, even cliché, but allow me to further explain and I guarantee you will have an a-ha moment. You can adhere to all of the recommendations, instructions & services that one is supposed to follow through with but without you believing in yourself and working on yourself outside of these external factors, you will not be solid; instead, without the conviction & belief in your ability to get well & deserve a great life, you can singlehandedly destroy every other "ingredient" until you're left with no assistance. Your low self-esteem, guilt, shame, feelings of selfishness, have the power to influence you to discard one or more of the external factors essential to your recovery.
This is the classic case we have all heard of so many times with people having mental illness or substance abuse...they discontinue going to therapy/counseling, stop taking their medications, stop going to their meetings, check out of rehab, detox, sober living without completing, possibly even quit a new job. There are many other areas a person will one by one "give up on". People do not do this out of laziness, they don't stop the services that are helping them because they are masochistic and want to suffer, it is not because they wish to relapse & go back to using (which is a common accusation), and while many people do go back to using after they discontinue treatment, it is not just because they "want" to use drugs or drink again. It is so much more complex than that, it is a feeling from deep inside that they most likely never show to anybody; a feeling of being undeserving of all the attention & treatment they are getting, feeling guilty about the consequences their illness has accrued and how its affected those they love, overpowering shame that they even ARE sick and need help, and so many other self-defeating thoughts & feelings that they have no way of managing. And it is often not because the person isn't enrolled in therapy where they teach you coping skills, because usually they are.
It all stems from that invisible wall we construct around us, where we make a sort of unspoken pact to ourselves, to never reveal the belief we hold of the terrible person we are. Society says we are bad people. Some of our own family & friends may say we are bad people. Even some doctors & other medical professionals, in the face of all the current, measureable physiological evidence of the effects of addiction & mental illness, still believe we are bad people. It is because of this, compounded by the fact that we naturally feel guilty and ashamed of being sick, that we also not just think we are bad people, but that we actually believe it to be the truth, a fact.
And so we might go to treatment, seek help because we have a moment of clarity and recognize that we need the help, but overall, the feeling of not deserving help, often outweighs our acknowledgment that we indeed need it. So we methodically, one by one, discontinue those external factors providing us with the tools to succeed; the medicine, the therapy, meetings, rehabs or sober living, even sober friends. We throw away the cement, pour out the sand, throw the rocks. All because the water is still contaminated. We give up on ourselves and stop believing that any external factors could ever make us better, make us well again.
Anyone who knows an addict has experienced this series of events. It is almost a guarantee for every addict to give up on themselves at some point while seeking treatment. So what is the answer? I think it is a complicated one. Most professionals will say that therapy is essential to improving self esteem. AA devotees will say that sticking to meetings is essential. And doctors will say that staying on your medication is essential. And all of them would be correct, but for a person to fix themselves and truly believe that they are worthy of a better life, that they actually can overcome their suffering, it has to come from within. And for all we know about addiction, the answers today are that the external treatments are the only way to accomplish this. So for now, it is absolutely crucial that an addict entering recovery, does adhere to all of their treatments. The best way to make that happen is through support. Family support, social support & group support and if an addict can have the needed support around them, building up their self-esteem enough so they adhere to the external factors of their recovery, then the chance is very good that they will succeed.