Dual diagnosis, Jekyll & Hyde and the Hulk
Above: Mark Ruffalo's Hulk from The Avengers. (Wired.com)
Bad news: You have a drug addiction or a mental illness.
Worse news: You have a drug addiction AND a mental illness.
That second scenario is known as dual diagnosis or co-occurring disorder (COD) or co-morbidity, and may exist in as much of half of all drug abusers, and a third of all people with mental illness or alcohol addiction. If both problems aren’t diagnosed and treated at the same time, there is little hope of curing either because they are probably related: one may be causing the other. Fix just one problem, and the other may make it recur.
Take Robert Louis Stevenson’s The Strange Case of Doctor Jekyll and Mister Hyde. Henry Jekyll lives his life as a good and respected doctor, but he has unnamed vices for which he feels guilty but can’t give up. So he devises a potion that splits his personality into two parts: the good doctor and the more licentious Edward Hyde. As Hyde’s crimes move from the merely immoral to the illegal, including murder, Jekyll tries to stop taking the potion, but he is addicted. He also has mental problems that today might be called multiple personality disorder (MPD). When Jekyll does stop taking the potion, Hyde returns anyway (like an acid flashback) because Jekyll hasn’t cured the mental illness/MPD. In the end, unable to become Jekyll and with the police closing in, Hyde commits suicide. Thoughts of suicide are among the symptoms of a dual diagnosis.
Or take the comic book and film character The Hulk. Dr. Robert Bruce Banner was exposed to gamma rays, and thereafter turned into a huge green brute, with little of the vocabulary or thought processes of Banner. Most of the time he seemed a different personality, but for years this wasn’t really addressed. Various attempted cures of Banner’s gamma radiation problem failed and he inevitably reverted to the Hulk.
Then a similarly irradiated psychiatrist (don’t ask) named Dr. Leonard Samson (or Doc Samson) tried to psychoanalyze the Hulk and determined he was actually a case of MPD all along. When he was a child he was traumatized by seeing his father accidentally kill his mother in a drunken rage. The gamma radiation only gave form to his other personality. That’s why the cures always failed.
The Hulk’s personality continued to evolve, eventually splitting into two personas: one green and child-like, the other gray, crafty and less moral.
Eventually all three personalities – green, gray and Banner – were re-integrated (for a time) into a large, green but intelligent persona. He wasn’t wholly any of his three personalities, but he was whole. However the gamma radiation problem remained untreated, and so Banner’s personality re-fragmented. At least once he attempted suicide for fear of what the Hulk might do.
In the Marvel Cinematic Universe film The Avengers, its version of Banner reveals that in his despair over turning in to the Hulk, he also tried to kill himself: I put a bullet in my mouth, he said, and the other guy spit it out. Suicide wasn’t even an option.
Before giving in to despair or resorting to suicide, seek dual diagnosis treatment in Texas or wherever you live or feel most comfortable.
Aging and prescription pill misuse and abuse
(Wikimedia commons)
Drug addicts are made not born. Aside from children born of drug addicted mothers, who are sometimes born addicted, drug addiction is usually created by the initial decision to take an addictive drug, and to continue to take it until you can’t function without it. But sometimes the decision isn’t the addict’s.
At the other end of the Ages-of-Man spectrum, elderly people are becoming addicted to opioids – painkillers such as OxyContin, Vicodin and Percocet – and benzodiazepines – anti-anxiety drugs such as Xanax and Valium. Although they make up less than an eighth of the population, people age 65 and older consume a third of the prescription drugs in the country. The majority of that is prescribed, but the greater prescription leads to the greater abuse, because it leaves more room for abuse, accidental and intentional.
Some of it is because of careless prescriptions by their doctors. Sometimes it’s because they have multiple specialists, who don’t know all the prescriptions that the patient is already receiving, or the interactions between all the drugs. The patient may accidentally take the pills too often or too many pills at one time in an attempt to stop the pain.
It is a fine line between pain management and drug addiction sometimes. And poor pain management is a big complaint about the current healthcare system, which seems more concerned about getting someone hooked on an effective but addictive painkiller, even a dying patient, but at the same time prescribes highly addictive drugs like they were candy, leading to the opioid painkiller epidemic.
Maybe doctors are overworked. Maybe they are even underpaid, though health costs keep going up and it seems we spend less and less of time in a doctor’s visit actually interacting with the doctor. Maybe we just expect too much of them. We don’t expect or like to hear a doctor say they don’t know why we have certain symptoms or what to do about them.
The size of the aging population might be part of the problem, too. Maybe people living longer means more things are going wrong that never had time to go wrong before. Doctors who haven’t received specialized training in elder care now may have a lot of elderly patients. The elderly experience drugs differently. Their metabolisms are slower, the effects more keenly felt.
If the patient is even slightly mentally impaired, confused or even just hard of hearing, they may not understand or listen to instructions about proper dosages either. One pill three times a day might be interpreted as three pills once a day. Enough Xanax to cope with anxiety becomes a crippling dose that can make the patient fall down, possibly causing injury.
Then, too, there is actual drug abuse by the elderly, especially if they abused drugs earlier in life. Your doctor needs to know everything you’re taking, legal and illegal, to treat your health properly. Even a patient using only legal prescribed drugs may not remember all of them when asked. It’s a good idea to have a list ready.
If an elderly patient is addicted, there is treatment for them just as there is treatment for younger people, inpatient and outpatient. Click here to find out more.
Janis Joplin and substance abuse
Edgar Allan Poe wrote that: The death of a beautiful woman is, unquestionalbly, the most poetical topic in the world. Add young and talented, and it also is among the most tragical.
Before Amy Winehouse self-destructed on a mixture of booze and drugs in 2011 at age 27, there was Janis Joplin. The Texas native abused many substances before she died in 1970 also at 27. Hardly anyone would have cared if she hadn’t been also an amazing singer.
At least two of the four albums on which she worked in her lifetime are iconic: Big Brother and the Holding Company’s Cheap Thrills and Pearl, the latter released posthumously. Since then there have been dozens of releases, recycling her small oeuvre and outtakes, supplemented by live concerts. She’s also been the subject of tributes – the documentary Janis, a line in Don McLean’s epic song American Pie (I met a girl who sang the blues, and I asked her for some happy news, but she just smiled and turned away …), her sister Laura’s memoir Love, Janis and the play based upon it – and fictionalized interpretations such as Bette Midler’s The Rose.
http://blog.hatena.ne.jp/StephenElite/personofsubstance.hatenablog.com/edit?sidebar=flickr
In her short life she consumed massive amounts of Southern Comfort, which she famously swigged from a bottle on stage; shot up heroin while waiting to go onstage at Woodstock; and injected methamphetamines (I didn’t know you could do that). She also was known as a speed freak. Viewed with hindsight, it seems obvious how she would die.
Even though rehab wasn’t so much a thing back then – though there have been inebriate homes and other drug and alcohol treatment centers back to the 19th century and Alcoholics Anonymous started in the 1930s – Joplin’s friends and family did stage an intervention, and she got clean several times only to relapse. Contributing factors were people and places that were enablers and triggers. She lived at the time in a hotel known to house drug dealers, as did one of her closest friends who was a drug user, too.
Joplin also was a rebel or a misfit, often teased by her contemporaries as a child, and had a difficult time establishing herself in the male-dominated world of pop music. Although her fatal overdose was probably partly due to a more potent batch of heroin than she was used to – allegedly several other people who bought heroin from the same dealer at the same time also O.D’d – and maybe an interaction with alcohol or other drugs, but a contributing factor may have been depression. Two friends who had promised to visit her that weekend never showed up, including her fiance (whom she learned had cheated on her in their own apartment). Maybe she over imbibed.
If the rehab system we have today had been available then, maybe she could have gotten and stayed clean. There are treatment plans for depressants such as alcohol, opiates such as heroin, and stimulants such as amphetamines and methamphetamines . She could have sought substance abuse treatment in her home state of Texas. For more information, visit http://www.willowspringsrecovery.com/substance-abuse/.
Janis Joplin - Last Interview on The Dick Cavett Show (August 3, 1970)
