By David Joel Miller.
How would you know if you have hit bottom, and does it matter?
The idea that you have to hit bottom before you can start back up comes from the early days of the 12 step movement largely by way of Jellinek’s research on people who recovered in A.A. It is not often applied to mental health but the two are just too similar in their disease and recovery processes to not take a look at the significance of the idea of hitting bottom and whether it applies to something other than addiction.
The hitting bottom expression referred to the point of accepting that the way you have been doing things was not working and it was time to try something different. You can think of this as “admitting complete defeat” but you can also think of this as “radical acceptance”, take your pick.
Most people will continue to struggle long after they should have changed directions. Who wants to admit they are an alcoholic? Who wants to say they have Bipolar Disorder or any other form of mental illness. I do not remember Alcoholic or Schizophrenic being included in the list of future careers when I was back in high school. It can be reassuring to tell yourself that you are not that bad. But some of us got there anyway.
So if there is some sort of bottom, lower than where you are, it can give you the false sense that you are not as bad as someone else. People fool themselves for a long time because they can believe that alcoholics are homeless bums. The truth is more than 90% of alcoholics have full-time jobs. People with Bipolar Disorder fool themselves by thinking they are more productive, creative or have more energy than others until they crash.
So hitting bottom is different for different people. For one person the realization they have the disease of alcoholism will come after the first DUI or the first unpleasant incident with the family. Other people will continue to try to control their drinking, complete with recurrent episodes of out of control drinking until they have been sentenced to a fifth or tenth program, or have done more years in prison than on the street.
But it is not just alcoholics that try to deny their disease. People may try suicide multiple times, have repeated psychiatric hospitalization and still believe that they just need to move somewhere else, that it is someone else’s fault, anything to avoid the fact that they have a mental health problem that needs treatment.
Many of us want to pretend we don’t have a disease. If you just ignore it then this problem will go away. Don’t give in to depression is their mantra. A few relatively minor conditions do go away without treatment. Colds and flu may remit without treatment. But serious conditions, Cancer, tuberculosis and heart disease get worse if ignored. Alcoholism, addiction, and mental illness also can worsen if not treated. Pretending is not treatment.
The founders of A.A. concluded that sometimes we need to “raise the bottom” till it hits people. Why do people need to totally destroy their life, spend time in prison, or psych hospitals before they can accept that they have a condition that will respond to treatment?
Education can help sometimes. But the people who need the education the most avoid it. What person who is manic, drunk or on drugs wants to sit and listen to others talk about how they were unable to control their disease until they became willing to accept help?
Lots of people with addictions and mental illnesses will isolate, they will avoid others and shrink from treatment. Their bottoms most often come when the losses and the pain become unbearable.
So you don’t need to wait for you or a loved one to “hit bottom” before you seek help. You do not reach bottom until you put the shovel down and quit digging. There is help available the moment you realize that you can’t dig your way out of a hole. Accepting that you have a problem, condition, illness or defect of character that requires a new way of thinking and behaving can be your bottom. You don’t have to get any lower before you start your journey back.
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For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books