Dwight Hurst, CMHC: Welcome back, everyone. This is, of course, a podcast to answer your questions on addiction recovery and mental health by Waismann Method opioid treatment specialists. I’m your co-host Dwight Hurst, joined today by David Livingston and Clare Waismann. We are here to answer your questions and today a very special question. It’s a very delicate question. This question actually is sort of a conglomeration and amalgamation of a lot of questions that we’ve gotten online. Periodically, I’ll go and put out the call for questions that people might have regarding mental health, regarding addiction and dependence. And one of the things that we got as a request for many, many people was the question, “Do people use mental health problems as an excuse for poor behavior?” This is a tough one to get into, especially for those of us that work in the field of mental health and psychological treatment. Because when you see a lot of this out there and I think particularly when it pertains to addiction, there’s sort of a reputation that addiction treatment has that if someone is caught a celebrity has a scandal, they go into therapy. Somebody has a problem. They go into therapy as people who work in therapy. We’re not opposed to that. But is it ever used as an excuse and probably more importantly, by people in general other than people in great positions of power or notoriety? So we’re going to dig into that and want everyone to kind of go with this on this because we want to be very, very compassionate and also very, very aware of the delicacy of then. I think you’ll see that in our in our talk today. So let’s get into that right now.
Dwight Hurst, CMHC: The question we’re really looking at is, is mental health ever used as an excuse for poor behavior? And I think that’s a broad question that I mean, the short thing is, well, yeah, but then we’re going to break that down more than just, yeah, obviously. And to say what that means, it’s got a couple of different wrinkles to it. But what’s the initial reaction to that idea of do people use their mental health as an excuse for behavior?
David Livingston, LMFT: So I would say this because a lot of what we talk about has to do with substance use that not always, but very often if you talk to people and in part they understand that substance use is not good for them and they want to give it up, especially by the time know they’re coming to see us and they’re getting detoxed. There’s, you know, they’re here because of that. Very often, not always, but very often there is some ambivalence, right, that they want to go back to if there’s something about it they’d like, there is, you know, and you know, and the thing that that I don’t like because I think it prevents. the thing I don’t like is the idea that it’s a disease, the reason I don’t like it is because it prevents the treatment of it, like if it’s just a disease that you’re stuck with and how do you treat it? Right. So like any disease, you have to understand what it is and how it operates. So in some ways it does operate like a disease. So meaning that feeling would you drive most of life, OK? Tensions, anxiety, sadness, loneliness, happiness, fear, anger. Everything is, is more automatic than it is a choice. We don’t really choose what we feel as much as we discover it.
David Livingston, LMFT: So that is more of an automatic mechanism and it’s going to drive thoughts and feelings and it’s going to drive thinking as well. So and then thinking has a similar component to it. Ok, so what happens is as it comes back to this subject, my long way of getting there is that. And you have to understand that there is ambivalence towards most things in life, no matter what we do, we’re going to have some ambivalence. Most people will have ambivalence about going to work. Part of them wants to go, needs to go. Hopefully, you like it enough that you you get some enjoyment about it. But because there is ambivalence, even ambivalence in giving up a substance that’s been destructive, there’s still ambivalence. So part of what really growing up and becoming a mature adult is how we manage our ambivalence because it’s a given, it’s a given in even the best marriages, even the best relationships. How you manage that ambivalence has a lot to do with it. And if you feel like you don’t have to do that, then you can make excuses for bad behavior and sorted to bring it back to kind of the topic. You can just say, “Well, I’m anxious and I don’t want to do it well.” You know, while anxiety exists on a continuum and sometimes anxiety can be a debilitating part of what you have to develop and learn to manage step by step to grow and be a stronger human being.
David Livingston, LMFT: And I think as a culture we have we have begun to not like, like I was saying before that dynamic I see happening culturally and politically and in so many other ways is so secure attachment versus sort of authenticity. So people will not say anything that goes against the dominant narrative, even within the field of psychology. And the idea is that empathy is always the thing that is going to help people and be the best thing. Empathy includes growing and getting stronger. It doesn’t just mean that what you do is you allow yourself to regress. Sometimes regressing can be benign, like, OK, you know, like, I need a break and then I can get going again. That’s fine. Everybody needs that. But you have to sort of pass that against the type of regression that has to do with a failure and a desire not to take on the challenges of life. To me, that’s where this whole idea of bad behavior exists. A lot of what therapy should, from my perspective, be about step by step, slowly, slowly at a pace that’s manageable. Be about sort of working towards making more resilient, more capable people. And I and honestly, I think it’s the most compassionate thing.
Dwight Hurst, CMHC: There’s a certain amount of identity or self-labeling, or maybe not even self-labeling. It seems like you’re talking about the negative side of awareness, which is you can adopt a label on your side. And I guess even getting back to the idea of what is or is not a disease. Is a disease something that I work with? Is a disease, something I’m struggling with? Or does it become a label or an identity? I know we talk a lot in this show about the identity of addiction that can soak into people’s. They view that as though here’s a deep character trait of mine. We’ve talked a lot about some of the problematic use of the label addict, where people will just adopt that as an identity and that can interfere with their ability to believe that they can recover. And I think it sounds a lot like what you’re talking about now.
Clare Waismann, RAS/SUDCC: I think, um, also, um, there is a that’s where the difference between condition and disease comes in. When you call it a disease, I think it has, you know, a stigma with it. I think it has a length, you know, undetermined length with it. And when you call condition, it is almost like, you know, the moment you’re in, not who you are. And I think there’s a huge difference right now. And I, I think especially for young adults, is really, really important for them to understand. And so as parents and teachers, the difference between, um, you know, judging somebody from the moment they’re in, uh, from who they are, there’s a big difference. And you can be anxious at a moment, but that doesn’t mean you have an anxiety issue, doesn’t mean you have a disease. So is what David was saying to us. Part of the process is learning how to be resilient. Is learning how to overcome feelings that stops us from progressing emotionally and physically and socially. So I think we right now in society, I’m very, very happy that we are discussing about mental health. I think we have to be, um, very careful with the diagnosis made so fast because diagnosis will label people and with label come stigma and with stigma come several factors that can stop people from progressing in their lives. So it’s um, you know, I think the mental health condition cannot be inflated to justify a number of different behaviors and at the same time has to be taken very seriously to understand so many serious behaviors that affect our society.
Dwight Hurst, CMHC: There’s a real connection between mental health and judgment and mental health and accountability and trying to look at what is that? It’s one of these things where it’s not a clear cut either, or it’s not like, Well, my mental health doesn’t influence my choices at all. On the other hand, as you’re saying, it’s not like all my mental health is responsible for my choices, either. And to that point of diagnosis, like you’re saying of actually trying to figure out what a problem is and what is going into that problem, it’s much more nuanced than kind of one or the other. Does that make some sense? I guess that’s the question of what is our relationship between our mental health status and our own judgment and accountability and an ability to make choices.
David Livingston, LMFT: Well, that’s that makes perfect sense, I mean, so. What I mean is that the whole process of the treatment is you pull these things apart. Right? So if somebody is anxious and they sit, you know, and that’s a cause of of of problems in their life, you have to understand what is causing the anxiety – is it’s situational? Is it more biologically driven? Is it emotions that have been repressed and need to be titrated and understood and felt in order for them to become fluid again and actually be felt and become emotions rather than anxiety? So those are the causes primarily of anxiety. And as you get into this with people, you pull these things apart. What you find is what is been a label. I have anxiety. Now listen, you understand and you pull apart, what is the anxiety? What is it? And once somebody begins to see it operate in why it’s operating that way, you have a whole different way of participating and then you begin to know what to do well. You don’t sleep well, so you haven’t slept well in years. Go get a sleep study. You’re going to be anxious. If you sleep two hours a night, I would be. And you’re not going to feel good. Oh, and by the way, you’re not going to want to exercise also, which brings anxiety down. So bad behavior is a way or often means that people just don’t know what to do. Most of the time when I’m talking to someone, they’ll say, Yeah, I’ve been diagnosed with anxiety, and I’ll ask, Do you know what the anxiety is or what causes it? Ninety-nine percent of the time they say “No. What do you mean?” There’s been a diagnosis of anxiety, generalized anxiety disorder, panic disorder. They have no idea of what’s causing it.
Dwight Hurst, CMHC: But I’ve met many people who have a copy of a document that’s a huge diagnostic evaluation. And when they’ll say, OK, let’s look at the results and what do you think this means? A lot of times they’ll say, Oh, you know, no one’s ever talked to me about that before. Now this is something that maybe took them two or three days of going in and taking tests and then took another month while they waited for someone to type up the report. And that is just handed to them. Yeah, I think that’s an area of education.
David Livingston, LMFT: We’re 10 times 100 times better at diagnosis than we are treating. Therein lies where the gap is. If you ask me, is it is that the art of the process of treatment? And really sort of getting in and pulling apart all these things and understanding what it takes to help someone become an alive human being who can manage and knows what to do when they’re sad or they’re lonely or they’re afraid or they’re struggling at work or in a room or in a marriage or whatever it is that you know and has an ability to tolerate that aspect of life, knows what to do, can seek help when they need it can. And. And that’s no small thing. But, but ultimately, otherwise people regress. And we’re kind of beginning to say that’s when you get a lot of bad behavior. It’s that’s kind of a giving up.
Clare Waismann, RAS/SUDCC: I mean, everybody should feel and should be able to talk about it. But we have to be careful not to overinflate these feelings where we paralyze the person you know it absorb the person to a point where they are not able to tolerate that feeling anymore. Some kids feel anxious, so they should do their tests at home. I mean, we are really removing from this society coming in every ability to tolerate any uncomfortable feelings. So what’s going to happen is what we see. They end up self-medicating with drugs because they can’t stand and they can’t handle how they feel. Um, you know, I was speaking to a parent yesterday, and she described this 26-year-old kid that, you know, graduated college that is able to be a productive member of society as somebody that will never be able to live a normal life. And that’s her view,
Dwight Hurst, CMHC: And then that becomes a limiting it just once again, it’s labeling. Right?
Clare Waismann, RAS/SUDCC: Of course, of course. And I think that’s where a lot of these kids are overwhelmed by their feelings because they don’t know what to do with them. Because I think the level of, you know, what’s acceptable and what’s not acceptable has, you know, the lines have been crossed. So again, what is, uh, having a mental health issue? What is a mental health condition? You know, uh, how broad is the spectrum? I don’t I don’t want by any means to undermine those that really have debilitating issues. I’m scared that we are causing not being able to tolerate an uncomfortable feeling; doesn’t even need to be a stressful feeling, just not being comfortable and we received the best rewards are those that are more difficult to achieve.
Dwight Hurst, CMHC: One of the things that we’re kind of bumping into is a term of over-pathologizing to right. It’s kind of interesting as we have learned more about diagnosis. And in one way the intention is to be able to understand where we’re all coming from and why we think the way we do. But sometimes we then over pathologize and you know, it’s interesting to me that, you know, for example, if you’re someone who has is diagnosable with OCD, even if you’re in a healthy range, you probably might have a little bit more of a compulsive nature. And so it’s trying to return not to a person who doesn’t have any trait of anxiety or compulsion, but trying to put that within a normal healthy range because we all have compulsions. It’s just that they don’t dominate our lives. And so if one person is on a spectrum of maybe being more anxious, or maybe I’m a person who thinks of things you know differently than other people do. Maybe I’m in a healthy range, and when I’m in an unhealthy range is when I need treatment. I don’t need to always be labeled as someone who is always OCD or always an anxious person. If that makes any sense, I think that over pathologizing, sometimes we want to chuck everything that’s an eccentricity or a personality trait and put it into the diagnosis that a person has.
Clare Waismann, RAS/SUDCC: I think there’s a huge emphasis in society, especially right now, on what it’s what is lacking in a person and not on their strengths. I think we’re concentrating on, you know, how to justify and in a way help except not achieving. Instead of finding ways to empower this person to achieve everything they can. And not because of society wants you to achieve, because those are the things that makes us feel self-sufficient. Those are the things that brings us to, you know, uh, self-esteem. Um, you know, strength. So um, I think we are, uh, really? Um, removing this from this new generation, the ability to be proud of themselves.
David Livingston, LMFT: So, so, so just to ramp this up to even a higher level, okay. I mean, you’ve just to like I mean, okay, so so. The core conflict, the core conflict in OCD is repressed sadistic wishes. Ok, so if you say that to somebody with OCD, you will terrify that, OK? Because first of all, the word sadistic terrifies most people. Ok, but just to use just to bring this around in terms of literally how you would treat someone, what it actually means in making somebody healthy. So let’s say I’m right. Okay? And this is a system. My idea, this is what started within psychoanalytic thinking. And I’ve treated many, many people with OCD, and you’ll find it. Ok, so here’s what it actually means to go into treatment. The great thing is, they’re terrified of the part of them that that humor is based on sadistic wishes. You needle people, right? That’s all great humor is based on that. And if you want to be successful and as a tennis player in sports, you have to have a killer instinct, enjoy to some degree, within the bounds of good sportsmanship beating the other person. Right. And so so what happens is the treatment of it is actually you get to help somebody feel like the part of them that is overly concerned about that part of themselves is absolutely human. Fine. And part of what is going to help them laugh more, be more playful, be more, you know, needle people and tease people, you know, everything’s within a range, right? And I’m not talking about bullying people or destructiveness or violence.
David Livingston, LMFT: I’m not talking about anything like that, but it’s about the light, you know? And what happens is, and it’s no wonder I see an increase in this because everybody’s terrified of any of those thoughts and feelings now. So anxieties running through the roof, especially in the early generations. So the great thing is it’s this is part of what it means to be a fully alive human being. And so once you begin to understand it, from that perspective, you’re just making people more alive. And by the way, if you don’t do that, that whatever is human in terms of our sadistic wishes will come out in unconscious ways towards ourselves, meaning that what happens is people with with OCD as a container for those feelings will end up spending time doing whatever the activity is that contains that part of themselves. Or it will come out in an unconscious way, which will then maybe be more than they wanted it to be and then terrify them and they’ll have more of the symptoms. So the idea is that we’re trying to make people identify dynamic, alive, human being conscious, like conscious of it. It is fun. I played tennis last night with some people and happened to win and quite enjoyed it, right? And so there’s and you don’t do it. And two weeks ago, I lost to the same people. And they quite enjoyed it. And it’s just like that.
Dwight Hurst, CMHC: So if there’s a mental health advocate who does… Her name is Sharon Gilady. She was the health minister for Manitoba Canada for many years now. She writes and presents and teaches, and one of the things that she often talks about is the concept of saying how if you want to look at it as if you were looking at a comic book, you know you’re looking at a superhero, right? And you look and say the superpower and the weakness of that character and now pretend those are the same thing. Our weaknesses are also our superpowers in a way, right? So like, just like what you’re saying? Right? We have that. Is there something inside me that gets into an unhealthy range? That’s my weakness. But when I returned to a healthy range, I might still have certain characteristics that could be misidentified, right? It’s like saying, Yeah, you know, an anxious person, you do research on this. And people who tend to score high in anxiety also score very high in traditional IQ. Right? And because if you think about it, anxiety has to utilize memory ability to think through things. You know, if I’m going to worry about something that is very, very advanced and I’m going to need a lot of smarts to be able to do that is the idea. So to look at it and say, you know, getting within a healthy range is the goal not to change who the person is.
David Livingston, LMFT: Well, or to remind them of the totality, exactly what you’re saying, it’s a balance. But within that, we all lose track of parts of ourselves and we need mirrors. We need someone to say, “Oh, no, no, that’s fine.” Right? “That’s that’s OK.” Or “You know, maybe that’s a little strong in this situation.” Like you’re saying. And we need mirrors for that.
Clare Waismann, RAS/SUDCC: Yeah, I think a good title for this podcast should be, you know, how to get comfortable being uncomfortable.
David Livingston, LMFT: All right.
Dwight Hurst, CMHC: That’s an interesting thought, what can we say a little more about that, Clair, if you would.
Clare Waismann, RAS/SUDCC: It’s that simple. It’s learning to be comfortable when you’re feeling uncomfortable when you’re feeling a little uncomfortable feelings that you’re not at ease is learning that that is momentary and how to get over it, how to see the bigger picture and not just concentrate on that feeling. Know how not to internalize and actually identify with that feeling that, you know, I might destroy your paths. So it’s really putting things at the right proportions, I think, right, David, being able to keep your negative feeling at a certain base level. And I think concentrating on the positive and not so much on the negative and using it as a justification is probably your best bet. And I think that’s part of society right now.
David Livingston, LMFT: You, you and I may disagree on this one thing I, I, I never use. I don’t like the word positive and negative because I think it splits the world into, you know, I just, yeah, I just when I look at it, I’m just like, because I could give you an example of everything having the potential of being positive and negative. Yeah, exactly right. So what word you know, like, like you were saying to white, it’s just finding the range. Right. And so what? You know what we’re all doing, you know, in talking to each other and in dialog and stuff, this is hopefully we’re learning right? And so. So you know that. But yes, it’s like, yes, that’s it.
Clare Waismann, RAS/SUDCC: That was good. That’s it.
David Livingston, LMFT: He said it all.
Clare Waismann, RAS/SUDCC: Now, right?
David Livingston, LMFT: You know, the way my brain works, it’s like it gets on a tilt and then that’s it.
Clare Waismann, RAS/SUDCC: I think if I can’t say something that nobody expects anybody to completely avoid certain feelings, but I think we can learn to soothe them when needed. And to make our life just easier to live contract, concentrate more on our strengths. And as you said, don’t the things that we fear the most might be the ones that will provide us the biggest strength to keep on going.
Dwight Hurst, CMHC: We’re going to leave that there. Thank you so much for being here to listen. Just by listening, you are participating in the discussion and helping the cause that we’re trying to push for and also helping us to share the word. One way that you can help is go on to your podcatcher of choice if you’re on Apple Podcast, if you’re on Spotify, if you’re on wherever you’re on, check and see how many of them have a rating feature. If you’re able to give us a high rating, four or five stars on Apple or wherever you are, it does help the show to get shared with other people. You can also directly share the show with people, and that helps quite a bit as well. One of the things we need is we need your involvement, we need your questions, and we’re very excited to get those when we get them. You can tweet those questions at us at opiates, or you can email info at opiates.com This podcast is, of course, a production of Waismann Method opioid treatment specialists. You can learn more about us at opiates.com. This show is a production of Popped Collar Productions, helping you to launch your own podcast and get your message out there. Our music is Medical by Clean Mind sounds. For Clare Waismann and David Livingston. I’m Dwight Hurst. Please join us next episode where we’ll be digging deeper into your questions. And always remember to keep asking questions. If you can ask questions, then you can find answers, and whenever you find answers, you can find help.