With the exception of Mad Men, Shameless, and Nurse Jackie, I rarely ever learn anything new from television about the addictive mindset or the nuance of being an addict in recovery. I can now add the new USA drama series, Mr. Robot, to the list of shows that showcase addiction and mental illness in a unique way. The show deftly deals with addiction and mental illness, two issues that can often walk hand-in-hand, and the showrunner and writers do it well.
A little back story: I have been the copy editor on The Fix staff for nearly a year. While I have never had to deal with substance abuse myself, I have seen its effect on too many people in my life. On a daily basis, I read copious amounts of addiction and recovery information and this information has now become a part of my life. I find myself slipping addiction statistics into friendly conversations or wanting to illuminate friends on the growing heroin epidemic that is quickly infiltrating our society. I am no longer shocked that "regular" people are unaware of prescription painkiller abuse, or the reality of living with alcoholism, or the fact that naloxone is a game-changing medicine that can save lives. It's not like they're covering this information on the local news. The effects of the War on Drugs is only recently starting to trend in the news cycle with Obama granting clemency to a record amount of non-violent offenders but the coverage is microscopic compared to that of a celebrity's impending divorce or a popular wrestler's alleged racist tirade.
Addiction is not glamorous and is rarely discussed without stereotypes in the mainstream so I don't look at people any differently for lacking addiction awareness. But my veil has been lifted and I can see my daily work is quite ubiquitous. Addiction is everywhere, including the entertainment I love. It can be found in the books I read and throughout the plots of the TV shows I watch. The addict trope is often portrayed in a derivative manner with the same set of familiar outcomes—the characters walk away nice and clean or eventually something terribly permanent happens. Mr. Robot has arrived to challenge the tired tropes with a different take on addiction and mental illness.
Sometimes I dream of saving the world. Saving everyone from the invisible hand. One that brands us with an employee badge. The one that forces us to work for them. The one that controls us everyday without us knowing it...
The psychological thriller centers around a young computer programmer named Elliot (Rami Malek) who works in cyber security. The audience is introduced to Elliot while he is riding the subway and in the middle of a possible schizophrenic paranoiac episode. Elliot informs us via voiceover that he has developed a relationship with the voice inside his head, whom he affectionally calls "friend." He internally wonders if he should name the voice but decides against it. He then begins to tell his "friend" of a top secret conspiracy about a powerful group of people that are secretly running the world.
"What I'm about to tell you is top secret. A conspiracy bigger than all of us. There's a powerful group of people out there that are secretly running the world. I'm talking about the guys no one knows about. The guys that are invisible. The top 1% of the top 1%. The guys that play God without permission...and now I think they're following me."
As Elliot sits uneasily in a moving subway car wearing his signature black hoodie, he sneaks a glance at two men in suits whom he believes are tailing him, though they never actually make contact. Elliot is an unreliable narrator and this device serves two purposes: To make us distrust what we see on screen and to allow us inside the head of an introverted, socially anxious paranoid schizophrenic.
Paranoid schizophrenia is one of the most common types of schizophrenia in the world, but it is not the only type of schizophrenia, there are a handful of subtypes including: catatonic, disorganized, residual, and undifferentiated. There is no uniformity within the illness; Half of all people with the illness have not received any treatment; and between one-third and one-half of all homeless adults have schizophrenia. The suicide rates of schizophrenics is very high with 10% of adult male sufferers dying by suicide. According to NIMH, people with schizophrenia "are much more likely to have a substance or alcohol abuse problem than the general population."
People who suffer from this illness are usually relatively stable, though they experience auditory hallucinations, delusions of persecution, or of having a "special mission," among other symptoms. Though he regularly sees a psychiatrist, Elliot has not been clinically diagnosed, as he makes rigorous attempts to hide his symptoms from the people around him. As the show progresses, we start to see examples of a larger conspiracy brewing in Elliot's workplace, which eventually leads him to take on a "special mission" with an anarchist hacker collective called Fsociety, which is lead by the enigmatical Mr. Robot (Christian Slater). Every decision and person that arrives into the story seems to fit a perfect piece of the conspiratorial puzzle. As a viewer, there is an ominous feeling of distrust because you get the feeling that this entire call to arms exists only in Elliot's head.
While the show has definite Fight Club undertones (which is one of the reasons I love it), it does manage to depict a more realistic version of a paranoid schizophrenic than the 1999 cult classic. In Fight Club, the character with schizophrenia is depicted as an aggressor, when in real life, schizophrenia can have an almost dulling effect on the individual. The documentary, Living with Schizophrenia: A Call for Hope and Recovery features firsthand schizophrenic accounts that illustrate the debilitating nature of schizophrenia and the stigma attached to the illness. These accounts sound similar to Elliot's journey, which also includes substance use disorder.
"If it weren't for QWERTY, I'd be completely empty."
Elliot is a drug addict. He uses morphine to stave off his loneliness. Like many drug users, he has a code. "The key to doing morphine without turning into a junkie is to limit yourself to 30mgs a day. Anything more just builds up your tolerance. I check every pill I get for purity. I have 8mgs Suboxone for maintenance in case I go through withdrawals."
This is the first TV show I've ever watched that has mentioned Suboxone, the medication used to treat narcotic opiate addiction. The drug is quite controversial though it has helped many users manage their opiate addiction when taken properly. I was absolutely thrilled to see it showcased and explained on a major cable network show because the more people that know about Suboxone, the better. The drug has the potential to save lives and sometimes it takes bringing things to the mainstream to promote awareness and make necessary change.
Elliot explains that Suboxone is difficult to get a prescription for so he is left no choice but to get it illegally. This is an all-too-familiar tale for users of Suboxone. Elliot gets his Suboxone from his neighborhood dealer Shayla (Frankie Shaw) but when her supply goes dry, he is forced to break his own code and retreat into the arms of morphine to get through his day. Elliot's morphine addiction reaches peak levels just as he is forced with the decision to either digitally snitch on Shayla's abusive supplier or shut his mouth and maintain his morphine addiction. He chooses the former and proceeds to go into heavy withdrawal.
We watch Elliot attempt to follow through with a major hacking scheme despite being in the early stages of withdrawal and he fails miserably. The hacker collective and Mr. Robot check into a motel and babysit him while he goes through a brutal few days of morphine withdrawal's greatest hits—sweats, nausea, tremors, and nightmarish visual hallucinations. Elliot makes it out the other side, but just barely. The few days post-withdrawal prove to be more difficult than he expects.
Mr. Robot is a tense, entertaining, thriller that manages to address mental health and addiction in a nuanced way. There isn't another dramatic show on air that handles the chaotic balance of mental illness and drug addiction with such attention to detail. What I love the most about it is the unpredictability. I don't know if Elliot will remain sober; I don't know if/when his schizophrenic episodes will progress and I don't know if Mr. Robot and Fsociety are real or just figments of Elliot's imagination. I applaud showrunner Sam Esmail and his team of writers for being fearless enough to break the stereotypes involved with addiction and mental illness, and for creating such a layered character in what could have been a flat one-dimensional portrayal in lesser hands.
Desiree Bowie is a copy editor for The Fix and a freelance writer.
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Although there is some controversy about the effectiveness of interventions, there are undoubtedly situations where, lacking intervention, an individual’s downward spiral would likely continue. In these situations, a skilled interventionist can prove the catalyst that begins the journey to lasting recovery for the patient while also uniting family and friends behind a chosen treatment plan. Rickard Elmore, an experienced addiction and mental health interventionist, recalls a case in which multiple challenging variables were overcome in order to help a man begin treatment and attain early recovery...Richard Juman.
Intervention is a craft. It calls for a well-trained clinician with real-life experience to identify the various components of a situation and then direct it into complete solution. Inviting an unqualified interventionist into a volatile situation could potentially exacerbate the problem. But an interventionist who incorporates strategy, patience, and compassion can help someone to begin the journey of recovery and alter the whole direction of their lives. As an experienced interventionist, I’ve found that a lot of the work I do is more about treatment strategy than anything else. Not everyone is going to make a lifetime commitment to abstinence in the beginning. Even so, we have successfully entered people into long-term recovery by allowing them the opportunity to get some help before making such a daunting decision.
Most of the time it just makes sense to start off with abstinence. If a person has been consumed with toxins and their behavioral patterns or emotional condition have caused them to continue to make decisions that create great conflict and turmoil in their lives, they will often admit that they need to take some time to get better. Eventually, they gain insight, as do their treatment providers, about what might be the best lifetime solution for them. Although intervention techniques can be taught, not everyone has the experience and diversity to be able to handle the complex situations that often occur without warning.
“Dan” was a retired 53-year old professional man who had been consuming 20 to 30 ounces of vodka a day for the last five years. His significant other had finally convinced him to seek treatment. During his intake assessment at the treatment center, he said he thought of killing himself every day and that he slept with a gun beneath his pillow. The treatment facility followed protocol and dialed 911. The client was arrested as a possible danger to himself and others, and transferred to a hospital for a 72-hour evaluation.
That is when I received the call.
At this point, he had begun to exhibit signs of delirium. The hospital staff diagnosed him and proceeded to give him medication (not for detox of alcohol). You see, detox from alcohol can cause a person to be in a great state of confusion about time and place and have a decrease in short memory recall as well as disorganized thinking. These same symptoms exist in many other mental health disorders. Even for trained professionals (in this case, the staff members of a hospital), it can be difficult to discern what is really going on.
An experienced interventionist will be able to ascertain a potential client’s level of substance misuse and to determine the extent to which a psychiatric disorder is impacting the presenting problems. It is critical to recognize a traumatic behavioral episode in the client’s history and understand the underlying issues being presented. Those issues need to be assessed before further diagnosis can commence.
Now, what happened next may seem shocking but it is not an isolated incident in the world of addiction treatment and behavioral healthcare. While the client was sleeping, the nurse decided to wash his body. When she got too close to his private areas, he reached out and attacked her. He was then restrained to the bed and charged with assault. Fourteen hours later, he was discharged to police custody. Not a good place for him to be in his condition; or at all for that matter!
I’ve found that it takes a great capacity for patience to help people find their road to recovery. All too often, medical professionals and treatment providers alike try to determine the cause and the nature of a person’s problem without the knowledge or expertise that’s necessary, and long before a diagnosis can be considered conclusive. This has unfortunately led to many faulty diagnoses.
If a person who has a true mental health condition is consuming a substance to “self-medicate,” does that mean that they have the “disease of addiction”? An accurate diagnosis can not be determined until further analysis has been completed. True diagnosis can only be determined over time. To facilitate emotional, psychological, biological and behavioral stability in a patient, one must allow the journey to unfold.
Unfortunately for Dan, he was looking for help but instead of being admitted into a treatment facility, he found himself in police custody. His road was turning out to be rougher than anyone expected.
After hiring a bail bondsman and getting an attorney on retainer, I found out that my client had been transferred downtown under a false name that he had given to the authorities in his continued delirium after his questionable release from the hospital into police custody. We were told that, once cleared, he would be transferred back to the main jail and released. Instead, they discharged him on his own with someone else’s clothes on!
After a full-on manhunt with family, investigators, and a contracted security team, we found Dan. By this point, I was in communication with a number of different friends and family members. Each one had a different account of what was going on and what needed to be done, but they all hoped that I would be able to help their father, brother, son, ex-husband, father-in-law, son-in-law, or boyfriend. I explained to his family that I could orchestrate things such that Dan would agree to go to treatment as long as we all agreed to be on the same team. They agreed, reluctantly. You see they, too, felt betrayed by the system.
Clearly, an interventionist must hold space not only for the individual in treatment, but also for the family and friends of that individual. An experienced interventionist will be able to educate and support the families and loved ones of those who are suffering. That education will, in turn, allow them to support their loved one without sacrificing their own peace of mind.
Once we were all on the same page and the family understood that I was there for them as well as for their loved one, we began the intervention. The tension in the room was palpable. My client was in the middle of negotiating another drink before going to treatment when I asked his daughter to get the soda I had in the refrigerator. I told my client that for the last 36 hours I’d been riding around with this in my car, and I held up his favorite non-alcoholic drink: a can of Orange Crush.
With a sparkle in his eye, he thanked me and took the soda. After another 10 minutes of negotiation I said, “Hold on.”
All eyes were on me. But my eyes were on him and there was a big smile on my face. I said, “It seems to me that you have a heart that flows with love and compassion. It’s gotta be hard to hear everyone offering their love and support for you. Not only that—I’m over here watching you drink that soda, and I’m drooling after two days of not cracking the top off that drink myself. Aren’t you even gonna offer me some?!”
The tension in the room deflated. He smiled as he handed me the Orange Crush. “Of course my friend, sorry about that.”
I took a drink, smiled, and handed it back. “No worries, thank you for allowing me to be here.”
With that, I could feel his daughter come around, the one that had the least confidence in me, who reluctantly allowed me to proceed with the intervention and whom I purposefully sat next to me. In that moment, the entire room united in support of Dan’s recovery. Of course, there is more to the story, but my hope is that what I’ve described highlights one of the key elements involved in intervention work. It’s about having the ability to work with what is in front of you without allowing unexpected roadblocks or tension to break your resolve. And it’s about compassion.
We have found that the only true healing for a person’s wounded sense of self comes from love and understanding. If you can start a person on the road of recovery, it can alter the whole direction of their life. It’s a magical opportunity to open the doors of recovery and fulfillment to someone who has been suffering from a seemingly hopeless condition.
The craft of intervention is needed to truly move people from their troubled condition into a place of recovery with kindness and compassion, the same compassion anyone would give to someone who they could see was suffering from a life-threatening condition. The right interventionist will approach your loved one with an abundance of compassion as opposed to bullying them: this is an intrinsic value to having a successful treatment episode.
Dan went to treatment the next morning. The treatment team found out why he attacked the nurse, something that had been causing him harm since childhood. Today, nearly one year later, he is sober.
As an interventionist, I have to say it’s quite a blessing to facilitate sustainable recovery for so many people in need. Times have changed, but life in recovery without shame or regret is the clear winner. As a lifetime participant in recovery myself, I have found that there is no need to rest on yesterday’s accomplishments. There are constantly new developments in treatment and recovery that a well-versed interventionist will be informed about. In case you haven’t noticed, tomorrow is the place where hope lives.
Rickard Elmore has been in the field addiction and mental health for over 20 years, and is one of the few interventionists who specializes in mental health interventions. He is the founder of Rickard Elmore Intervention.
Johann Hari, a journalist and presenter of the June 2015 TED Talk, “Everything You Know About Addiction is Wrong,” has popped up on many a recovering addict’s social media feeds in recent weeks. Hari challenges the carceral model of dealing with addiction, making him another welcome opponent of the War on Drugs. But for those who know addiction from the inside, his title is condescending, especially as Hari has no training on the topic, is not himself an addict, and is infamous for a high-profile plagiarism scandal which cost him his job at The Independent newspaper in 2011.
More troubling, some of Hari’s arguments fly in the face of both common sense and the lived experience of addicts. Here are a few of the things Johann Hari may not know about addiction.
1. Addiction Has a Real Physical Component
Hari spends much of the talk exploring the so-called “Rat Park” study, a late 1970s experiment by psychologists at Simon Fraser University in British Columbia. The experiment sought to correct shortcomings in previous addiction studies in which rats—deeply social creatures—were isolated in tiny cages where they proceeded to kill themselves with overdoses of opium water. The Canadian scientists—led by Bruce K. Alexander—built instead a “rat park” which created an inviting, socially-rich environment for the rats. The researchers found that rats there did not typically become addicted to opium or overdose. The implication is that “the real cause of addiction” is social isolation, not any physically compelling nature to the drugs themselves.
“Professor Alexander began to think there might be a different story about addiction … What if addiction isn't about your chemical hooks? What if addiction is about your cage?” Hari says. “Human beings have a natural and innate need to bond, and when we're happy and healthy, we'll bond and connect with each other, but if you can't do that, because you're traumatized or isolated or beaten down by life, you will bond with something that will give you some sense of relief.”
Such as drugs or alcohol.
While 12-step movements have claimed for decades that addiction is rooted in a “spiritual malady” much like what Hari describes, it is obviously wrong to deny that addiction has a very real physical component on top of its socio-spiritual roots. Hari is right to object to the scare-mongering, drug war-justifying notion that drugs themselves have “hooks” which can make everyone who uses them a hopeless addict. At the same time, certain people—it seems—have a physical predisposition to addiction, and if they use certain substances it can trigger an addictive cycle regardless of how “connected” they may be.
This should be obvious to everyone familiar with one of the world’s most addictive drugs: nicotine. Most people smoke a cigarette or two at some point in their lives, and many people smoke somewhat regularly for at least a little while. The vast majority of these people do not become addicted to nicotine. Some people, however, do become addicted and cannot quit without tremendous effort. Some others continue smoking even after it gives them a fatal illness, and even when it exacerbates painful symptoms.
Does Hari think that only the socially or psychologically isolated become addictive smokers? What about caffeine? The same facts exist for this, even more socially acceptable addiction—clearly the people who can’t function without coffee throughout the day are acting out a physical condition, and not merely a yearning for lovingkindness that only a latte can fill.
Nobody who has been addicted to narcotics or alcohol would ever deny that loneliness is maybe the most important feature of our malady. There are many lonely people, however, who use for a time and give it up easily, and there are many otherwise well-adjusted people who develop serious drug and alcohol problems. The determining factor is almost certainly physical and/or genetic. Hari oversimplifies this situation.
2. Enabling is a Real Threat to Addicts
Hari decries, at one point, the television program Intervention and addiction interventions generally.
“So what they do is they take the connection to the addict, and they threaten it, they make it contingent on the addict behaving the way they want,” Hari said. “And I began to think, I began to see why that approach doesn't work, and I began to think that's almost like the importing of the logic of the Drug War into our private lives.”
Hari adds that he encourages the addicts in his own life to reach out to him for companionship. “And what I've tried to do now… is to say to the addicts in my life that I want to deepen the connection with them, to say to them, I love you whether you're using or you're not. I love you, whatever state you're in, and if you need me, I'll come and sit with you because I love you and I don't want you to be alone or to feel alone.”
This is a powerful, beautiful statement, and it is right. There is also ample room for debate on the value of traditional interventions, but Hari misrepresents the logic behind them. While he is correct in noting that interventions threaten addicts and, in effect, punish them into treatment, this is not their true purpose. Their logic is one that recognizes that for all of the isolation associated with addiction, it is a disease which spreads from addicts to their families and friends, and can only persist through enabling, which itself becomes a compulsion for those who get trapped in it. Interventions are supposed to give the addict’s enablers the opportunity to collectively, publicly establish the healthy boundaries which have been missing in their relationships.
It is also irresponsible for Hari to speak to a general audience—more than 1,000,000 views online already—about the need to deepen their relationships with the addicts in their lives without an accompanying warning about addicts’ tendencies to blow through boundaries and take advantage of the people who seek to help them. Maybe Hari assumes that people already know this, but the tens of millions of people enabling the millions of addicts in our society indicates that the word hasn’t gotten out. If Hari had asked me to call him on my worst days, I would have tried to manipulate him for money or other resources until he said no, or until I had borrowed too much to ever pay back. Then I would have been the one cutting him off.
3. Sobriety IS Connection
This brings us to another important point where Hari is not so much incorrect as he is incomplete. Hari’s final line is this: “The opposite of addiction is not sobriety; the opposite of addiction is connection.” What this line packs in rhetorical power, it lacks in real value.
The point is that the most important, most indispensable tool used by the recovery community is connection itself, and that often the only place that a low-bottom addict can find connection is in the community of sober addicts. Working with others is a fundamental principle of every 12-step program, and the traditional response to a particularly unhealthy share from an addict in a meeting is not “you need to leave,” but rather “keep coming back.” To set off connection and sobriety as opposing or separate concepts is to demonstrate a profound ignorance of sobriety and the connections it provides.
Here’s a story to prove the point. My friend Frank died this week. Frank was in his 60s, a transplant to Texas from New York, and he went into cardiac arrest on a city bus last weekend. When he got to the hospital, his wristband said John Doe, and it turned out that Frank had no family left—he had no next of kin to make the crucial end-of-life calls. Frank was an addict and alcoholic, and many of us die isolated, alone, our families gone, unremembered by anybody, totally unmourned. Frank, on the other hand, had so many visitors during his final coma that the hospital staff was almost overwhelmed. Frank’s affairs have been attended to by sober alcoholics, and his memorial service will be full of people who consider him a dear friend. Most of us didn’t even know Frank’s last name until he passed. But we knew his story, and in his sobriety, he found real connection, and we found it in him. Frank died clean and sober, with just over 10 years when he passed.
4. What Hari Knows About Honesty is Wrong
In the end, it turns out that Hari’s plagiarism scandal matters more than he might like in this attempted comeback. The connection and bonding that can produce authentic sobriety like Frank’s can only be reached in a spirit of what 12-step types call “rigorous honesty.” All that boundary busting we did in our active addiction means we’ll need to practice some powerful contrition if we ever want that level of truthfulness; it means taking responsibility for our wrongdoing in an unflinching way. The fellowship of other recovered addicts both demands and makes possible such humility.
Hari, on the other hand, responded to his own serious wrongdoing with excuse-making, minimization, and dishonesty. Hari’s plagiarism was unique—when his interview subjects did not say what he wanted them to, he lifted quotes of theirs from other publications without attribution. He was also caught creating a fake online identity in order to make slanderous changes to his critics’ Wikipedia pages, and accused of making up an atrocity he reported on in the Central African Republic. Hari admitted to all but the last charge, was fired from the Independent—one of the UK’s largest newspapers—and stripped of a major journalism prize.
These are serious wrongdoings by Hari, major violations of the trust the public is supposed to put in journalists. Hari’s “apology,” however, was riddled with excuses and half-hearted “humblebrags”—his career had taken off far too quickly without proper journalism training; it was really all his interview subjects’ fault for not speaking more clearly; he was the victim of a witch-hunt from powerful interests he’d targeted in his reporting, and on and on. Frankly, if a friend of mine in recovery proposed amends of the sort Hari has made, I would think that their sobriety was at risk for lack of honesty.
Recovered addicts believe in forgiveness, but Hari still seems to be selling others’ ideas as his own. He believes he’s saying something innovative by suggesting that addiction is rooted in isolation, but every addict knows this in a way Hari will hopefully never comprehend. We also know things he appears to be ignorant about, like that opening up to an addict without clear boundaries is an invitation to disaster. And for millions of us, we know that the opposite of addiction is a sobriety gained through connection, acceptance, grace, and love, all of which are rooted in radical honesty.
At best, Hari’s TED Talk patronizes recovered addicts, and at worst, he is seeking a return to journalism on the backs of people too marginalized to protect themselves. We may be powerless over our addictions, but nobody should deny us what we’ve learned about our disease; these truths are the most important facts of our lives today. They are, in the end, the real ideas worth sharing.
Andrew Dobbs is a writer, activist and recovering addict based in Austin, Texas. Follow him on Twitter at @AndrewDobbsTX.
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