Episode 147 -- September 9, 2021

Time for a New Road: Mental Illness, Addiction, and That First Step

When we get the substances out of our systems, piecing together what's left of our lives can be scary and challenging. We learn more about ourselves because we don't have any of the noise or distractions that the booze or drugs once provided. What happens next? We might find out that we have co-occurring disorders—that is, a mental health disorder in addition to our substance use disorder—that we need to address at the same time. Facing one without the other really won't get us as far as we need to go. The good news is that we don't have to do it alone.

In her book Sane: Mental Illness, Addiction, and the 12 Steps, Marya Hornbacher shares the wisdom she's gained from facing addiction along with a co-occurring mental health disorder. In the following excerpt, Hornbacher discusses her early experience with the Twelve Step program of Alcoholics Anonymous and her struggle, as someone also managing a mental illness, with Step One's admission of complete powerlessness.

This excerpt has been edited for brevity.

I don't know which was the stranger, more terrifying moment: the moment when a psychiatrist told me I had a mental illness, or the moment I realized I was an alcoholic, through and through. I remember both moments clearly: my stomach dropped, the room seemed cold, and I wanted to run for the door. When it came time for me to face facts, I didn't do it. Not that first time. The fear that accompanied those simple facts—that I have a mental illness, that I am an alcoholic—was so overwhelming that I did what fear told me to do: I hid.

Addicts are good at hiding—for a while. We've turned it into an art form. We hide from our families, our friends, our employers; some of us feel we are hiding from God. We are capable of believing the ridiculous notion that no one can see what's really going on. No one really knows how sad and sick and dependent we are. People with mental illness often share this skill at hiding. The world we live in tells us that mental illness is something to be ashamed of, and heaven knows we feel that shame—and we do all we can to hide our illness from that judging world, from our fellows, and often from ourselves.

Addicts, mentally ill or not, must all come to a turning point where they recognize that there is no future ahead on the road they're walking, and realize that it's time for them to turn down a new road. That moment of realization is rarely a calm one. It often takes hitting the wall pretty hard—often more than once—before we see the futility of trying to live the way we were. From the Twelve Steps and Twelve Traditions: "We perceive that only through utter defeat are we able to take our first steps toward liberation and strength." And that is where we're headed when we set out with Step One: toward liberation and strength.

When I first came into the program, I found the idea of admitting defeat insane. I already felt defeated, by my illness, by my addiction, by my entire life. Why were these people asking me to go one step further and admit complete defeat—admit, in short, that I was wholly and completely powerless? I insisted that I would get sober anyway, whether I admitted powerlessness or not. Couldn't I just hang on to some sense of control over my life? The answer my sponsor gave me was a resounding no.

When I was first faced with the need to admit powerlessness, I told my sponsor she didn't understand mental illness—if she understood the horrible feeling of being literally out of control of one's own mind, she would never try to make me feel even less power than I already did. I believed, at first, that Step One would be impossible for me. I believed my mental illness would make it too painful. I believed it would be too excruciating, too terrifying, to admit total powerlessness over my addiction and over my life when I already felt so terribly helpless. But I have come to see this differently. I have come to see the First Step as one that my mental illness allows me to understand with particular clarity. I began to apply what I know about mental illness to what I was learning about addiction, and I began to listen to what I was being told about how addiction could be overcome.

The Twelve Steps, it is often said, are a program for living. Each Step is important in its own right, but as we work them one by one, we begin to see how they work together to literally change us and offer us a new way of life. They are not just a way of keeping the plug in the jug. And the First Step—admitting we are powerless and that our lives are out of control—is how we begin to work that larger program, how we begin to create that change in ourselves, and how we embark on that new way of living.

It's important to remember that the First Step isn't taken for its own sake—we aren't admitting powerlessness as an end in itself. The First Step is not there just to make us feel terrified and out of control. It's there to get us started on our way through the rest of the Steps, to get us started on this journey to a new life. It's there to help us let go of our vise grip on the delusions that keep us sick. Picture Step One as the moment when you open your hands and let all the deceptions, denial, shame, and fear drop to the ground. Then walk away.

The same things that keep us trapped in active addictions prevent us from dealing in a healthy way with our mental illness. We tell ourselves: It isn't that bad. No one can tell. It isn't hurting anyone but me. Everyone's making a big deal out of nothing. Or we tell ourselves: It's hopeless. No one can help me. There's no point in trying. I'm going to die this way. There's no way out. Or we tell ourselves: If I just ignore it, it will go away. If I just pretend this isn't happening, maybe it will stop.

These are delusions, and they are fatal. Until we honestly face our mental illness and do all we can to treat and manage it, we will continue to be limited and harmed by it; until we honestly face our addiction and do all we can to recover from it, we will continue to live in this hell of isolation, smashed dreams, hopelessness, and despair.

The Twelve Steps are a path up and out of that isolated, hopeless, helpless place. They are a series of actions I can take, and I take them in the company of others. Sobriety is not something that can be found alone; we need the help and company of our fellows. This maxim is simple but crucial: don't drink, read the Big Book, and go to meetings. Meetings are enormously important to the maintenance of sobriety and the development of a sober life.

There, we find our way out of isolation by listening to the stories of other sober people who are making a new life for themselves. After years of disaffection and alienation from the world, we find at meetings a true community of people with whom we connect. The people we find at meetings are working the Steps alongside us and have much wisdom and experience to share. They help us see the Steps for what they are: hope when I am hopeless, and help when I think there is no help for me. The Big Book says that these Steps can work "no matter how far down the scale we have gone." Millions of recovering people can testify to the truth of that statement. And so, beginning wherever we are, knowing we are not alone, we take that First Step: we admit that we are powerless, and that admission sets us free.

About the Author:
Marya Hornbacher is an award-winning journalist and the Pulitzer Prize¿nominated author of three books. Her best-selling memoirs Madness: A Bipolar Life and Wasted: A Memoir of Anorexia and Bulimia have become classics in their fields, and her critically acclaimed novel The Center of Winter is taught in universities all over the world. Hornbacher's work has been published in sixteen languages. She lectures regularly on writing, addiction recovery, and mental health.

© 2010 by Marya Hornbacher
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