Following up on our conversation on the condition known as dual diagnosis and co-occurring disorder, Anonymous writes:

I had my first drink at 10 years old. I felt such relief. There was childhood abuse, neglect, abandonment, so when I discovered alcohol it gave me the strength to escape the troubles at home. ...

Anonymous was responding to my post from last week, The Cruel Double Whammy: Bipolar and Alcohol or Drug Abuse. Alcohol and drug abuse is the major complicating feature of bipolar, turning a challenging but manageable condition into an impossible hell.

Anonymous experienced a very troubled teen-hood that included run-ins with the law and an attempt at suicide. She (I’m making at educated guess at gender) left home at 14 and quit school at 16. She was put into her first treatment program at age 18, but it was just about the alcohol. No one mentioned other issues.

At age 35, she was jailed for a year as a result of her fourth DUI. Part of her sentence was a treatment program, which she says was excellent, but again there was no mention of any other issues. She did manage to successfully remain sober for the next nine years, but something wasn’t right: a roller-coaster of three jobs, three moves, and three relationships. 

Over the course of her life, with alcohol in the mix, she has been through 33 jobs, 22 moves, and 12 relationships, not to mention busted friendships and all the rest.

Eight months ago, she experienced a deep depression and sought help. The “other issues” finally came up, and she was diagnosed with bipolar, PTSD, and ADHD. At last, after all these years, she knows what she is up against. She is prepared to rise to the challenge, but a lingering question remains. “Why,” she asks, “was none of this looked at?”

All the signs were there at age 18, as with other programs she has been through over the years. Why, then, did no one even suggest to her that alcohol could be just one of many reasons why her life was not going right? Granted, she acknowledges, she may have not been ready do deal with all her issues at age 18, but eight years ago on release from jail - surely, by then, she says, she was ready to begin her exploration.

Anonymous, I have no ready answer to your extremely poignant and profound question, one that I can restate in one word: Why?

But I do have a theory, if you will permit me to explain: You are age 44, which means you had the misfortune to grow up in the age of biological psychiatry. The age started off with great promise. After years of Freud and other silliness, the recognition dawned that mental illness had a biological component to it. It wasn’t just all in our heads. We couldn’t just snap out of it. Once we identified the biological causes and effects, we could come up with effective treatments equivalent to insulin for diabetes and antibiotics for infectious diseases.