Mental Disorders, Addictions and Dementia all Walked into a Thai Restaurant

In time for Dry January, the casual comment that changed my view of recovery and, with any luck, might change yours too

Dry January is seen as an entry point for the sober curious, which I can’t really relate to. I knew what sobriety was like, that’s why I preferred being wasted. That said, now if someone tells me they want to quit drinking or using as a way to lose weight/gain a lover/evade the courts or just out of curiosity, I’m all, Sidle up, the water’s warm. In short, long-term sobriety has changed me dramatically and unpredictably, and this story from the archives is one of the ways I’m writing into this gray area.

Nighthawks by Edward Hopper. Art Institute of Chicago.

My friend Mara and I were huddled over menus in an East Village Thai place barely wider than a doorway, deep in conversation about an ex of hers that pre-dated our friendship. She’d just returned from visiting him at a state-run hospital in New Jersey, where he’d been diagnosed with dementia.

“He hadn’t been washed or bathed in who knows how long,” she said, shaking her platinum locks. “He looks like he’s in his 70s, but he isn’t even 60.”

Dementia? In his 50s? My decade? Jesus.

“You want any drinks?”

The waiter had arrived and I’d barely begun processing. My life has been nothing if not a response to the fear that my brain might betray me. It’s why I’d quit alcohol decades before.

“Uhh…” I hesitated, already anticipating that moment of disappointment that crosses a waitperson’s face when you fail to pad the tab with booze. “Do you have any sparkling water?”

They had only flat, so we settled on tap and more disdain. It was better than what they’d think if I started drinking.

After we ordered Mara continued, telling me that she and her guy had split because of his mood swings. It was only afterward that he’d begun to drink heavily. “He was never alcoholic, he was self-medicating. He was bipolar.”

Please. How is “self-medicating” because of mental illness different than what people with straight up substance abuse disorders do? What is an alcoholic if not someone who uses booze to make themselves feel better? When people make this delineation, what I hear is that they view mood disorders as something separate from and preferable to substance abuse disorders.

I do get it. No one forced alcohol or drugs into me, and I behaved atrociously when I was using. Nonetheless, addiction—like any mental illness—is rooted in the brain, not its manifestations, despite that it’s mostly described by outward symptoms. But it’s been classified as a primary mental illness in the Diagnostic and Statistical Manual for Mental Disorders since 1980. And substance use disorders often co-occur with other mental illnesses. Bipolar or not, Mara’s friend could still be an addict.

Not that this conversation was the time to bring up my opinion.

“Over the years he pushed everyone away, so he doesn’t have anyone to check up on him. And now he has dementia.” Mara looked up and into my eyes. “All because he was untreated bipolar. But that’s what happens with untreated mental illness.”

My self-righteousness vanished. Untreated bipolar illness could lead to early-onset dementia? What what WHAT?

Having been diagnosed with an array of mental illnesses ranging from bipolar to paranoid schizoaffective, I’d settled on substance abuse disorder. The latter seemed the most optimistic, though it was self-identified. Had settling on this diagnosis put me on a path to dribbling over a bib with no visitors? The exact path I’d feared from the outset?

This is how it is for me, my life changes in small moments as opposed to those Big Days supposedly fraught with meaning — birthdays, anniversaries, even funerals. Not only are such events a smaller portion of my experience, I’m generally prepared for them. But random, everyday moments like a casual comment over pad Thai can drive me to question everything I think I know.

There at the table with Mara, it took every ounce of effort to refrain from pulling out my phone to start Googling. Though aware I was sober, Mara knew nothing of my history with mental hospitals. I didn’t like thinking about it myself.

By now, the waiter had returned with our food. I picked up my fork — who could use chopsticks at a time like this? — and began chewing through the mental evidence, nodding like I was listening to Mara.

Why had I decided I was alcoholic and not mentally ill? Or that I could treat only one of those things?

When I chose addiction as my diagnosis, I was a sophomore in college. My other option was institutionalization, which would’ve been my third in the year and a half since I’d matriculated to Ohio State. At the rate I was going I’d never graduate. It was easy enough to categorize my experiences as addiction. Could my interpretation have been wrong?

Addiction Symptom: Hiding substance use

At Ohio State I had two friend-sets. One was hard-drinking — Vicky with the tuft of blonde bangs falling over one eye, Depeche Mode style (except we were more Black Flag), Andrew, the blond former tennis star (who, yes, wore terrycloth wristbands), and me, queen of thrift store chic (or as my mother described my look at the time, “approaching homeless”).

The other crowd was all about getting high. Alè, tie-dyed and patchouli-scented, was our leader, overseeing a revolving cast of Ultimate Frisbee players. There was no exchange between the two — the Wes Anderson crew was for drinking, while the hacky sack lot was for getting high.

I’d just sold plasma to buy a dime bag of weed. Nothing unusual in that. What was different was how, instead of sharing the stash with Alè, I kept the entire supply. I didn’t sleep, eat, or drink alcohol in the days that followed. All I did was look for dark corners where I could pull out my brass one-hitter.

Memories are scattershot flashes. Colors started speaking: We are all one thing. There is no separation. You’re moving through life in a vacuum tube. Antics at the scholarship house where I lived — blasting X’s Los Angeles album in my shared room, trashing my enormous Chateaux de Chenonçeau poster, spending hours on the house’s communal black rotary phone. Eventually, someone called campus security.

They took me to an office-like room where I was acing their stupid questions — of course Reagan was president and Columbus was the state capital. So I was fuzzy on the date. Who wasn’t? More importantly, I’d discovered all-humanity-was-a-single-cell-divisions-were-futile-and-a-new-messenger-was-coming-to-heal-us. Maybe me?

“Any history of mental illness in your family?”

“Aunt. Schizophrenic.” Finally, an answer that satisfied.

We left the beige chamber, but I didn’t meet with the higher-ups. Instead they locked me in. Over the 20 or so days I was there, I did manage to escape once, only to realize on the sidewalk that I had nowhere to go. I returned to lock-up and stayed until I was officially released.

Diagnosis, manic depressive.

Addiction Symptom: Isolating behavior

I never count my second institutionalization as a psychotic episode. Working, attending classes, and staying high had worn me down. After some extended reminiscing about the closed quarters where I’d been fed, drugged, and free to really be me, I told my shrink I wanted to overdose. I wasn’t really considering suicide, but I knew that saying so was a guaranteed ticket back to that enclosed haven. Based on the research I’d done into my diagnosis, the timing was right for a depression to kick in.

Looking back, I have no idea if I was depressed. Most of my energy went into staying just high enough to feel nothing.

More clear-eyed on my second visit, I recall watching a woman in a housecoat with frazzled gray hair shuffling the halls endlessly. She’d been there on my first visit too.

“What’s her deal?” I asked another patient.

“Electro-shock therapy.”

They still do electric shock therapy? Is that how her hair got that way? Is she my fate?

At the end of my stay, I got the first in what would be a string of increasingly bleak diagnostic upgrades: bipolar disorder.

Addiction Symptoms: Legal/professional/life problems as a result of drinking

Two months after my second institutionalization, a burning pain in my abdomen made it impossible to walk, so I called an ambulance to get to the ER. To my horror, they directed me to a gynecologist. I knew the problem wasn’t my vagina, but the male doctor on call didn’t believe me so I went home.

A day later I returned in agony. They refused to see me until I visited an ob gyn. When the speculum insertion elicited screams, that doctor took one look at my chart and told me to see my psychiatrist. For the third quarter out of the six I’d been in college, I had to drop out of school.

Eventually I was diagnosed with a bleeding ulcer. I switched to pot exclusively in order to maintain a high during the treatment, but I wasn’t sleeping. A return to the locked ward felt inevitable, but I’d lost my enthusiasm for it.

Susan, a friend of my mother’s, offered a different opinion.

“You don’t have the affect of a mentally ill person,” she told me over the phone from Los Angeles. “You’re an alcoholic.”

Susan was neither a medical professional, nor had she clapped eyes on me in years. But I wanted to believe her. If there was one thing that a year and a half of living with mental illness had shown me, it was that I didn’t want to live with this diagnosis. At any moment, I feared my brain might revolt. Sobriety promised mental fortitude. Or so I thought.

Overlapping symptoms

“My treat,” I offered as soon as dinner was over. When Mara insisted on paying I relented too quickly, but I wanted to be alone with my phone. I barely hit the sidewalk before I started Googling.

No doubt a case could be made for mental illness. Mania-fueled risky behaviors, overspending, anxiety and listlessness could describe vast swaths of my life outside my active addiction.

“Hey Siri, can untreated mental illness lead to early dementia?”

Though Mara hadn’t been precisely correct, she wasn’t wrong either. Treated or not, there is a clear link between mental illness and early dementia. Fuck.

Back in 1986, I — like Mara — thought there was a clear line of demarcation between addiction and mental health. Because of stigmas that still exist within recovery circles today, I felt I had to pick one to treat over the other. But thinking I wasn’t sober if I took psych meds contributed to a relapse. It’s nothing short of a goddamn miracle that I regained my sobriety in 1996. I never want to see that happen to another person. But it happens all the time, because this attitude persists.

I looked at my phone wanting to Google more. Hadn’t Carl Jung effectively treated Sabina Spielrein’s schizophrenia through talk therapy? Though many would contend that spirituality is what 12-step meetings offer, in practice, meetings are like talk therapy, which has proven effective for bipolar disorder beyond Jung.

Or maybe I’d outgrown it?

Research also shows that age is a factor in remediating symptoms of bipolar disorder.

As I walked down the dark Manhattan street, my head bent into the blue glow of my phone, I realized there was nothing to do but yield to the ambiguity. No amount of worry would change the life I’d already led. I wanted some guarantee for the future, but all we can have is hope. And what is hope if not belief in the unknown?

So instead more searching, I texted Mara. “Let me know you got home safe.”

Then I called my husband. “How was your night?”

Want to talk about this?

Some conversation starters… 

1. Tell me about something small or random that radically shifted your perspective.

2. Have you ever tried sobriety? How’d it go?

3. Can you relate to ‘picking a diagnosis’?

4. What do you hold out hope for?

Or, AMA!

I love hearing from Ill-Behaved readers!

Want more LLK stories? Check out

-The Golden Bachelor Did What?

-The Oppression of Casual Misogyny

-Getting Your Story Unstuck (A video workshop)

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