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The "Rock Bottom" Myth and the Shame It Brings On

It's the mental health field that makes some of our clients worse


There’s a common belief in the addiction field that addicts have to “hit rock bottom” to be ready to accept the changes that they must to turn their lives around. The idea is that pure and utter desperation is necessary to finally see the light and improve. Sometimes that’s true, but most of the time it’s just because we’re late to the game. Drug and alcohol use are the end result of a neglected mental life, a shameful and unbearable existence that got pushed aside for too long. In the end we all want to feel better, to feel like we have peace and joy. When we can’t find it for too long, we’ll do anything to get there, even if it means putting ourselves at risk and hurting those close to us.

When shame takes a beautiful soul to it's rock bottom

MK came from a beautiful, wealthy enclave in Southern California, but didn’t feel like she fit into her elite Ivy League college crowd. It didn’t help that her family was in pieces. She had been fighting with her overbearing mother since the age of five and her father would rage periodically, especially if he was drinking. Her cushy life and upbringing couldn't protect her from feeling "less than" – less pretty, less prepared for life and less loved. She wanted a way to feel good, to keep those voices screaming "shame!" at bay. She found alcohol and marijuana and they worked. When she got high and drunk she felt more comfortable – talked to boys and fooled around with them. Life was exciting and fun when she was partying and things didn’t seem bad anymore.

But then her parents got involved because the drinking and weed were getting out of hand; MK was fighting with her mother all the time again and the leash was getting shorter. Her insecurity had her fumbling for the next step after and Ivy diploma, so she moved back home while she was figuring things out. We all know how much fun it is to live with your parents again, especially when you can’t stop getting at each other’s throats. MK now had to sneak in weed and alcohol just to make it through the days, she didn’t have anywhere else to go and had no more support to deal with the shame and the issues that were swimming in her head. Everyone was doing their best to help but everything was bathed in the horrible shame and dissatisfaction that now surrounded every aspect of her life. It felt like a dead-end, and she was beginning to fear that she would be trapped in hell forever. And that's when she found nitrous oxide – a simple gas that turns off life for a few seconds and makes everything go away. When you’re high on nitrous you can’t think, you don’t hear and a perma-smile sits square on your face as you let reality slip away. THAT felt like relief. Leaving reality behind felt like the real vacation she craved. And she went all in.

When you get caught in the system - shame abounds

By the time she came to see me at IGNTD, MK had the following diagnoses – borderline personality disorder, bipolar disorder, generalized anxiety disorder, marijuana dependence, alcohol dependence and drug dependence not otherwise specified. She had been through 3-4 treatment centers (one of which had actually told me previously they have a 100% success rate) and was persuaded she was doomed to a life of repeated failures and Alcoholics Anonymous meetings. She hated the idea but so many professionals had told her that was it, and she believed them.

I didn’t see her situation the same way – we worked with MK and her family on reshaping the family structure (that took a while) and on helping her deal with early trauma through mindfulness and CBT work. We helped her deal with her impulsivity by an intensive course of biofeedback and neurofeedback. It took many months but this young woman, who came to us confused and defeated was starting to shine through. She started talking about going back to school, even though every conversations led to anxiety and the re-emergence of shame and tears. But we worked through all that, we persevered and kept walking forward through the fire until it got a little cooler. As we did the work, a completely different picture than the one that presented in our office on that first day emerged.

Wipe away shame and you reveal truth and beauty

In the end, MK turned out to be a highly sensitive and fully functional young woman. No longer tethered to mental-health diagnoses, but fully aware of her weak-spots, she thrived. She moved away from her parents home (with trepidation) and tried a few job, finally landing on one she’s hoping will lead to a career. She drinks alcohol moderately and smoked marijuana for a while, neither causing her problems (she recently stopped smoking weed too). She hasn’t touched nitrous oxide in years and doesn’t intend to. She's no longer taking the handful of pharmaceuticals she came to us loaded with. But the most important point is this - she doesn’t want to hide from her own life so much that she can’t bear the thought of living another day. She feels hopeful and happy and THAT is the important goal for us.

Lessons for those of us in the trenches

For those of us in the helping profession, using one-liners and simple labels to describe our clients seems useful. Unfortunately, we often forget to question the validity and the meaning of those labels in place of a real conversation and a real relationship with our clients. If you know anything about experimenter bias or stereotype threat or the Pygmalion effect – when you see your clients as hopeless you make them more hopeless (See my TEDx on this here). If you want to instill hope I them the look inward and start seeing them as better than they are right now. That’s why they’re coming to us - for help, for hope and for guidance.

That’s how MK found her way out, but imagine how much nicer this story would have sounded if she got the help she needed long before the bottom came…

That is the ultimate goal.

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