Were I to have a one on one
conversation about substance use disorder with any individual in this room, I’d
ask, “What is your personal experience?
How has substance abuse affected you and your family?” Unfortunately,
our family is closer to the norm than the anomaly.
There are lots of family stories
out there. More than a few have come our way since we shared ours. More than 2/3 of American families have
been touched by addiction. It is
not inconceivable that 10% of us, the people in this room, as in the population
at large, will have, do have, or have had a personal battle with this substance
abuse. 20% of Americans live with
mental illness.
A recent New Yorker cartoon portrayed a politician being interviewed outside
the Capitol Building. He’s saying,
“I like to think we’re not so much anti-science as pro-myth.” That needn’t be a politician. It could be almost any American citizen.
Before we can talk today about
parity in terms of mental illness and substance use disorder we need to talk
about judgment, fear, shame - the
stigma surrounding these diseases.
We need to confront the myth.
For centuries, indeed most of human
history, we have attempted to name
the unknown, the other, that which terrifies us. An old prayer from the British Isles goes:
From ghoulies and ghosties
And long-leggedy beasties
And things that go bump in the night,
Good Lord, deliver us!
The myth of the changeling is about the offspring of a fairy, troll, elf
– or even a gypsy, being secretly exchanged in the middle of the night for a
human child. The changeling would often grow sick or die. This was a convenient, though not
especially scientific explanation, for infants who die young from unexplained
diseases, or suffer disabling disorders, including mental disorders, over a
longer period of time.
Of course we don’t believe in such mythology in our time, unless you or
someone in your family happens to believe in the Tooth Fairy. A spirit who comes in the night and
makes an exchange for at least part of a child. We don’t pay much attention to such mythology, unless you
happened to see a production of Peter Pan – Peter luring children from the
nursery and taking them to Never Never Land. Old myths change shape and die
hard.
In 1584 an English gentleman, Reginald Scot, attempted to describe witchcraft
as irrational and un-Christian. He
wrote, in part:
“…But in our childhood our mothers
maids have so… fraid us with:
spirits, witches, pans, dwarfes, imps, changelings, Incubus, and other
such bugs, that we are afraid of our owne shadows…
“…right grave writer’s report, that
spirits most often…take the shape of women… and of beasts… of fowles, as
crowes, night owles, and shreeke owles.”
Mr. Scot
changed the minds of few. All
copies of his book were purportedly burned. The fright remains. As Andrew Solomon wrote in his
brilliant 2012 book Far From The Tree,
“We live in xenophobic times, when legislation with majority support abrogates
the rights of women, LBGT people, illegal immigrants, and the poor.” At the end of the parade, behind even
those disenfranchised groups, are the mentally ill…and bringing up the very
rear, people with substance use disorder.
A recent Johns Hopkins research
study indicates only 22 percent of respondents said they would be willing to
work closely on a job with a person with drug addiction compared to 62 percent
who said they would be willing to work with someone with mental illness.
Sixty-four percent said that employers should be able to deny employment to
people with a drug addiction compared to 25 percent with a mental illness.
Forty-three percent were opposed to giving individuals addicted to drugs
equivalent health insurance benefits to those afforded the public at-large,
while only 21 percent were opposed to giving the same benefits to those with
mental illness. Respondents agreed
on one question: Roughly three in 10 believe that recovery from either mental
illness or drug addiction is impossible.
We perpetuate the mythology in the way we speak of the
afflicted. Prejudice, hatred and
stigma marinate in our language.
We freely call the sufferers: lushes, alkies, disturbed, acid freaks, wastoids, boozers,
juicers, scary, tweakers, coke whores, crack heads, winos, tipplers, nuts,
loonies, pill poppers, speed freaks, people with a screw loose, mental inebriates, drunkards, dope fiends,
druggies, junkies, dipsomaniacs, psychonauts, dopers, freaks and retards. We persist in trying to make what we
fear disappear by naming it and shaming it. We prefer the myth of weak morality
to the fact of disease.
Only when we accept that mental
illness and substance use disorder are brain diseases, treatable brain
diseases, best engaged at their earliest manifestation. Only when we realize that 23.5 million
people, 10% of adults, are already “living life in recovery”. Only when we truly believe that the
value of addiction recovery far outweighs the $500 Billion spent each year on
lost productivity, absenteeism, health care, social services and incarceration.
Only then can we truly begin our conversation about parity. Otherwise we continue to live in a dark
past.
When we abandon the ancient,
vestigial mythology; when we confront the myth; when we confront the stigma by
confronting our language; when we
adopt a language of hope and possibility;
when we use the best science has to offer us to treat long stigmatized
conditions, then we can talk of parity.
Parity in our nation, parity in our states, parity in our communities, parity
in the voting booth, parity in our homes.
Parity, like charity, begins at
home.
