Decades of Pain
Becca’s step-sister Mindy left home when Becca was just 8 years old. Despite Mindy’s annual appearances and promises to get sober, she always left again. Now, Becca is in her early 20’s and isn’t sure what to do about her anger towards Mindy. Another listener, Katie, had a parent that enabled her brother’s substance use for over 40 years. Now that her parent has passed, Katie is left wondering how to move forward with her brother and let go of her anger towards her codependent parent. This episode Nzinga talks about how we can still hold space for those in our lives who’s addiction’s have caused pain, resentment, and hurt.
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[00:41] Dr. Nzinga Harrison: Hello, everybody, this is Nzinga, and you are listening to In Recovery. This week, we are going to be talking about how to move past decades of pain spent in a relationship with someone with addiction. But before we jump into that, in case you’re new to this show, thank you for listening for the first time. This is a question and answer show about all things addiction. And I’m your host because I’ve been practicing addiction medicine and psychiatry, taking care of people with addiction for over the last 15 years. This is my life’s work, so much that I co-founded a company called Eleanor Health, where I’m the chief medical officer, where we strive to take the best evidence-based compassionate care of the people who choose to join our community. So like I mentioned, this is a question and answer show. So we need your questions. You can submit your questions by calling us: 833-453-6662. Or you can also fill out our contact form at bit.ly/InRecoveryquestions. So with that, Claire, should we jump in to the show?
[01:48] Claire Jones: Yes. Let’s jump into the show. So we received this question through our submissions form from a listener named Katie. But I’m going to change some of the names in her story just to protect anonymity and give you a little bit of background. Katie’s question is about her brother, Lawrence, who’s dealing with substance use, and they’re codependent parent Morgan, who enabled his use. It started off in high school, and Lawrence started smoking weed, and Morgan didn’t really allow family members, teachers or friends to call out Lawrence on his marijuana use. And then when Lawrence went to college, his use just escalated. Years later, when a couple of partners came out and accused Lawrence of domestic abuse, Morgan hired lawyers to cover up these allegations. And that’s sort of how Morgan operated with Lawrence for decades. Whether Lawrence was using drugs or was accused of violence or even stealing, Morgan always protected him. And that brings us to the present. Morgan has passed away from Alzheimer’s leaving Katie wondering how she can handle her brother, who spent a lifetime getting bailed out by his co-dependent parent.
[02:57] Dr. Nzinga Harrison: Yeah, first of all, Katie, thank you for sending in your experience. This is like so painful to be going through. Almost sounds like your entire life with your brother Lawrence and your parent Morgan, who I’m sorry to hear passed on, but a lot of people will see themselves in your experience figuring out how to “deal” with Lawrence. I would say the first step is recognizing that your relationship is and has to be completely separate from the relationship that Lawrence and Morgan had. And so kind of the way, Katie, that you asked your question, kind of was like, and now I’ve inherited this relationship. I presume reading in here, you and Lawrence already have your own relationship, which is also not healthy or functional. And so that’s what you’re trying to figure out, is how to move towards healthy and functional. The first step has to be completely drawing a new definition that does not include that relationship that Morgan had with Lawrence.
[04:06] Claire Jones: So it sounds like Katie is still dwelling on some of the details of this story. So how does somebody like her come to terms with all of the harm that’s come from the past in a way that allows her to not be totally buried in resentment for both Lawrence and Morgan?
[04:24] Dr. Nzinga Harrison: So if you’re going to embark on this journey, this is too many years of pain between the two of you for you to navigate on yourself. Because what Katie has to do is go through all of these pain points that she’s been through with her brother and re-conceptualize them. Oh, that’s a symptom of the illness. Oh, that’s a symptom of the illness. And start trying to redirect the pain and the anger and the feeling of being betrayed and the hurt and the devastation, redirect that to the substance use disorder away from her brother. And that is not easy work. I’m telling you, you need support to be able to do that. Once you’ve been able to do some of that work, which will create compassion for her brother, then it is the family work, which is creating the safety of radical transparency. And if he’s still using, that’s being able to say, I’m still using, and that is for Katie to be able to say, and these are the healthy boundaries that I’m drawing if he’s not ready to take that step with her. Still, you can tell from this message that she sent into us that hurt and pain and resentment are eating her. And so still, even if he’s not ready to take that step to be a unified front against the illness, individual therapy will still help her, because we can’t have those extremely painful experiences and emotions festering inside. You have to be able to get them out for you.
[06:02] Claire Jones: How does that work with her relationship with Morgan, who passed away? So how do you deal with resentment towards people who are no longer here, or who you maybe can’t do this work with in the same way that she can do it with Lawrence?
[06:17] Dr. Nzinga Harrison: I think people think it’s harder to lose a loved one that you are very close to, that you had a very nourishing relationship with, because the grief and the feeling of the loss of that loving, nurturing, positive relationship is so heavy. But it’s often as difficult, if not more difficult, to lose a loved one that you had serious conflict and pain in that relationship. Because the mix of emotions that you have, like the loss, the grief, but also some relief, and then because you have some relief, some guilt. But then also this feeling, it’s not just losing the relationship, but it’s also losing the opportunity to deal with everything that was going on in the relationship, which is your question. And so it can be done. It is a specialized type of grief counseling that helps people move through the grief of relationships that were very painful. Emotional healing is just like physical healing. So when you first get stabbed in the stomach by somebody you love unexpectedly, the physical pain is because like your skin is cut open and your bowels are hanging out and you’re hemorrhaging. It is like acutely a horrible physical pain. The emotional pain lays on top of that, because you were living your life. And things were good. And now your sense of safety has been ripped and you feel betrayed. And all of that emotional context lays on top of the physical pain and makes it excruciating.
[08:05] Dr. Nzinga Harrison: Over time, that acute slice begins to heal and the pain gets less. But at some point you have stitches, or you have a scab. And when you brush up against that unexpectedly, like you’re minding your own business and then you accidentally run into the corner of the table, and the pain is almost as great as when you first got the injury. But when you first got the injury, like the pain was that great all the time because your bowels were hanging out and you were hemorrhaging. Now that you’re in the scar phase, or the stitches phase, is not that painful all the time. But if you knock up against that the wrong way, it is just as painful as it was. And then more time passes and eventually you have a scar. And you can touch that scar and you can rub your hand over that scar. And it might feel a little different than the skin around it, but it doesn’t cause pain. You look at that scar and you remember what the pain was like, but you don’t actually feel that pain. And so that physical healing process is the same as the emotional healing process. And so just like when you first took that slice to the belly, you couldn’t heal that on your own. You had to go see a surgeon and the surgeon had to stitch you up. And then you had home health care and a whole support system. And people came by and brought you food and checked on you to make sure you were OK. And then you got to the stitches and you had to be very careful not to bump into tables. Actually, other people around you are careful to help you not bump into it until you get into the scar phase. And so exact same thing, even though Morgan is no longer in Katie’s life, you need your surgeon to help you stitch up those wounds. And you need your support system to bring you food and help you not bump into those stitches. And you need time to get those stitches out so that can turn into a scar so you can look back at it, and remember, it was painful. There was also beauty, but you can feel the beauty and not have to feel the pain.
[14:11] Claire Jones: So I have a few follow-up questions based on Katie’s story. In her words, she feels like her family was destroyed by her codependent parent, and holds onto more harm from that than from her brother’s substance use. And last week, you talked about romantic codependent relationships. But what exactly does that dynamic look like among family members?
[14:31] Dr. Nzinga Harrison: We do think about romantic relationships, that’s kind of the knee-jerk when you hear the word codependent. But if you think about the relationship where you’re most compelled to prevent someone from any negative consequences or any harm, that’s a parental relationship. Like from the minute that child springs from the loins, then it’s like there’s literally a biological drive to protect that child from everything. And it sounds like Morgan, the parent in this story, probably has some internal dynamic, and that’s probably based on whatever Morgan’s experiences were as a child. With adults and with parental relationships, a lot of times what we’ll see is that people who grow up without nourishing, compassionate, healthy, boundary-setting unconditional love, a lot of times when people grow up without those types of parental-ish relationships, then their pendulum swings to the other side. Like, I have to protect this child from all bad things at all costs. And whereas that comes from a noble and genuine and compassionate place, when we start removing the negative consequences of behaviors that are dangerous to our kids, we’re not doing them a favor. We don’t want the negative consequences to be the basic building blocks of what we need to survive. So food, water, safe housing. We want to try, as much as we can, support our children in this case in having those basic needs for survival in place. But then as painful as it is, we do have to let our kids experience negative consequences.
[16:37] Claire Jones: Therapy and counseling and a full psychiatric evaluation are things that we talk about and suggest a lot, and we are planning on diving into that a little bit deeper in an episode coming up, because it’s easy to say therapy, but also not easy to find therapy. We’ll get into that at some point. But something I am curious — because you are, in fact, a psychiatrist. When talking about stories like this — and we’re about to get to another one that has a long history and a sort of a story that spans over 20 years — what are the important details for you to know? Like what is the kind of information that you’re looking for when you are talking to people who have experienced decades of damage?
[17:24] Dr. Nzinga Harrison: It depends on what our goals are. But when I’m talking to that individual person right in front of me, I want to try to know the ins and outs so we can find root causes. Because the fact is, every relationship we’re in, we’re contributing to that space. And every relationship we’re in, we only — ooh, now I’m quoting my own couples therapist. We are in every relationship we are in. So I am a part of that relationship. I am contributing to the dynamic in that relationship. And here’s the light bulb: I only have control over my actions. I don’t have control over the other person’s actions. And so much of the pain and grief that we bring ourselves is like trying to make that other person do something, and thinking that that other person is the entire dynamic, when part of that dynamic is my own self. And so when I’m doing a comprehensive psychiatric evaluation, if it has to do with relationships, I’m looking for root causes. So I’m looking at not just this relationship, other relationships from the beginning of time. So for codependence, say I have a couple and I’m doing the individual psychiatric evaluation for one person in that couple. And one of the difficulties is codependence. I’m looking in your other relationships. So growing up, what was your relationship with your parents? What were your relationship with your siblings? What other adults were there? What other friendships did you have?
[18:57] Dr. Nzinga Harrison: Like where are the commonalities? Because what is common from every relationship is you. And so if we see a common dynamic in every relationship, then we can start looking at what are the root causes coming from you that we now have the power to see what they are and start consciously making a difference. So biologically, anybody else in your family: depression, anxiety or other psychiatric illnesses, other physical illnesses? Because if yes, biologically, there’s increased chance you have it. I need to fine-tooth comb look for it. Psychologically, what were your experiences growing up? So like I said with Morgan, if Morgan grew up with parents who didn’t notice when he was in pain, and that he felt like did it protect him when he should have been protected, then you can see how the dynamic develops for him to be codependent in that relationship with Lawrence. And so what I’m looking for for Katie is that Katie has a relationship with her brother, but the way she sent her message in nests that relationship inside that relationship with Morgan. And so my question is, why is your single relationship with your brother conceptualized through the lens of your parent? Let’s look at that relationship just between the two of you as little kids in elementary school, because it is root cause, root cause, root cause. I’m basically looking for what rock can we lift up that I can shine a light on that says, oh, we have something we can do about this that’ll make things a little easier, or walk in the direction we’re trying to walk.
[20:43] Dr. Nzinga Harrison: OK. In a nutshell, what is absolutely crucial and always at the top of the priority list is safety — emotional safety and physical safety. So we’re going to address anything that affects those two first, period, point blank. Biological, psychological, social, cultural support system factors from the beginning of time. I’m looking for root causes, and I’m looking for patterns. And if you think about how we do a psychiatric evaluation, we do it in the same order every time. It follows the same format for any medical evaluation, just with a focus on mental health and relationships. But one is the chief complaint. So you come into me and you tell me why you’re here. And then from the moment you give me that chief complaint, I have formulated an entire set of hypotheses about what might be going on. So you come into your doctor, you say, I have a sore throat. Automatically, I’m thinking, is it strep throat? Is it viral? Is it allergies? Like I’ve already built what we call a differential diagnosis in my mind. And then I’m trying to collect information that helps me mark things off the list. So you come in and you say, for Katie, I’m full of resentment as a chief complaint. I’m looking like, is this just in the relationship with whoever this other person is? Is there an underlying depression I need to see here? Is there an underlying anxiety I need to see here? Is there a substance use disorder I need to see here? Is there any other psychiatric illness? Is there any physical illness that could be contributing to stress and anxiety and resentment? What losses have there been? What support system is there? I’m building this entire set of possibilities. And then the questions I’m asking you from the beginning of time are helping me mark things off the list, and prioritize what I think is exerting the biggest effect on what brought you into me today, which is your chief complaint.
[23:22] Claire Jones: OK. Our next question is from a caller named Becca about her stepsister, Mindy, who is 10 years older than her. And again, these names have been changed. Becca and Mindy share a mom and were raised by Becca’s dad. When they were kids, they were pretty close. But by the time that Mindy was in high school, she was drinking heavily, and eventually she dropped out, started using drugs and left home. Becca, the younger one, constantly wrote to Mindy asking her to come back and get sober. Mindy would show up once a year, apologize profusely, say she wanted to change, and then she would leave again, oftentimes stealing cash, credit cards or one time even a car. And that’s the abbreviated version of the backstory. Here’s Becca’s question.
[24:08] Caller: What should I do? If I should do anything? Is there anything — I don’t think that there’s much I can do to help, but I don’t know. Is there a point where you do give up on someone? Is that OK? How do I not hate her? How do I understand her addiction? You know, like, I don’t want to spend time with her. I don’t speak to her. I don’t know if that’s OK.
[24:38] Dr. Nzinga Harrison: Thank you, Becca, for sending this in. I’m so sorry, because what your story really points out is that substance use disorder is a lifelong chronic medical condition that just can repeatedly be so painful and just ravish our loved ones and steal them from us. So I think to your question, how can I not hate her? I would say if you can try to start reconceptualizing the behaviors that you’re seeing and the decisions that she’s making as the symptoms of her illness. I often talk about the brain as a strategy for this. And we think about the nerves in the brain that kind of like connect our decisions and our behaviors to our emotions and to our impulses. We have the deep part of our brain which we share with all animals. And the bigger part of our brain, which is our cortex. And right under your forehead is that prefrontal cortex. It’s the biggest in humans and is where our impulse control and our thinking and our planning is. And so part of what’s happening with your sister is that that deeper part of her brain, to use AA’s words, has been hijacked by the drugs. And so everything that her prefrontal cortex is receiving from the part of her brain that tells you how to survive, how to stay alive is that drugs, drugs, drugs, drugs, drugs are the answer.
[26:13] Dr. Nzinga Harrison: And so literally, the decision-making part of her brain is just under a constant barrage that says, I know this is going to hurt your family, but you need this to survive. I know this might make you go back to prison, but you need this to survive. I know that you don’t have a stable place to stay, but you need this to survive. I know you don’t want to steal from your sister, but you need this to survive. And so when she has these behaviors, if you can remind yourself that she’s sick, her brain is sick, her brain is not functioning in a healthy way. Because it really is true that your sister can love you and not want to steal from you and make complete and utter promises and commitment to you and herself that she will “be different,” and her illness won’t allow that to happen. Those two things can be simultaneously true. And so when you say, is it OK to give up on someone? You know, I don’t believe in giving up on people. But I do believe in staying safe emotionally and setting healthy boundaries that can help you do that. And so how do you not hate her is by separating the symptoms of the illness from the person. How do you understand her addiction is by listening to In Recovery podcast, but also reading the diagnostic criteria. Like, when we go through the diagnostic criteria, people don’t come into us and say, “because of this heroin, I’m failing to fulfill my major role obligations,” which is how the diagnostic criteria is written. What happens is that somebody comes in and says, “my sister keeps begging me back in her life. But as soon as I get back in her life, she steals something.” You can see that in the diagnostic criteria for the substance use disorder, just as a way to reinforce for yourself that she’s not doing this because she doesn’t care about you. She’s doing this because she’s sick. And let that create some compassion. The other thing, though, is there is autonomy involved in seeking treatment for any illness. So there are definitely people with cancer whose loved ones are going crazy because they’re choosing not to do chemo. And it’s hurtful and they can’t believe it. And they’re like, “you don’t care about me or else you would go get chemo. Your decision making is awful.” And yet it’s that person’s decision not to get chemo. And so part of what’s really difficult about the substance use disorder is because our decision making is coming from our brain, and the substance use disorder is making the brain not work.
[29:10] Dr. Nzinga Harrison: Every single time a person attempts to get a substance use disorder in remission, they get closer to actually getting that substance use disorder and remission. So I have people who have come to me who have been to rehab 20 times, 25 times, 30 times over 15 years, 16 years, 17 years. And they come to me and they say, “why would it work this time? Because it’s never worked before.” And I say, because every single one of those times planted a seed in this field. We can’t ever refuse to water the field, because what if one of those seeds just needs a little bit of water right now? And so I want you always to have your bucket of water ready to pour on your sister’s seeds when she says this time will be different, this time will be different, this time will be different. But there’s a fine balance in protecting yourself emotionally, which you also have to do, and you find that balance in individual therapy for your own recovery path.
[30:18] Claire Jones: I like that seed and water analogy.
[30:35] Dr. Nzinga Harrison: Well, I mean, it’s 18 years of really trying to be a partner for people that have addiction and to really trying to be a partner to the support system who is also going through, like, excruciating pain because of this illness. And so I just keep trying different ways, different ways, different ways, different ways. And some land, some don’t land. It’s a similar kind of thing — just just make sure your sister knows you love her. And that’s not to mean you’re not extremely angry and devastated and disappointed and feeling betrayed. All of those emotions can exist at the same time. But just make sure she knows I have to set these boundaries to keep myself safe because your illness is out of control. And that creates danger for me emotionally. But just know, I see you separately from that illness. And I love you. Doesn’t mean I don’t have to protect myself from that illness.
[31:39] Claire Jones: It’s a cognitive dissonance. Those emotions of I love you, and also I have to set boundaries for myself from your illness because it also makes me feel angry and guilty and all these other things. All of those emotions are OK to feel at the same time.
[32:03] Dr. Nzinga Harrison: That’s right. For both of these listeners, thank you for sharing yourselves with us, please. I would love both of you to go to WeTheVillage.co. I got some feedback from a colleague who was listening to the alcohol episode and she said, I went to the We the Village website, and he gave me my whole entire life immediately. It’s what I’ve been needing. So thank you so much for this resource. And then, of course, you know, I always point to the Eleanor Health website. So we are just trying to put a lot of supportive content and education and blogs up. So if you go to the blog page, there’s a search bar and you can put in “family” and it’ll pull up some education and support for you there, too.
[32:57] Claire Jones: Anything else that you want to add? Any words of wisdom?
[33:01] Dr. Nzinga Harrison: Oh, words of wisdom. These words of wisdom I’m actually going to bring forward from my own experiences for the last several weeks. So you’ve been hearing me talk about my neck pain and my back pain and how it’s out of control, because sitting all day because of COVID. What you haven’t been hearing me talk about is how I wasn’t doing any of the things that I know make my neck pain and my back pain better. So like running, I know that’s part of my formula. Don’t get too excited for those of you who are real runners. I’m not literally, like, just three-quarters of a mile just to line up my spine. Yoga, stretching my hamstrings, doing my shoulder stretches. I had a pretty good formula and I haven’t been doing it, even though I was literally having so much physical pain. And even though I was literally saying to everybody, pain, pain, pain, pain, pain. And even though literally making Joel massage my neck every single night, I wasn’t doing what I knew could make me feel better. And so I tell that story because I want us to have grace. That is not even pouring on the chemical hijack that drugs take over the brain.
[34:37] Dr. Nzinga Harrison: I have my full brain power and capacity and still it is just part of being human for me to try to make Joel fix it, for me to try to make the massage therapist fix it, for me to buy a new desk. But I know a formula that can make it better. And it took me easily seven or eight weeks to get back into my formula. And so my words of wisdom are just grace.
[35:13] Claire Jones: Like, why does that happen?
[35:15] Dr. Nzinga Harrison: Because humans!
[35:20] Claire Jones: I have paid to go to physical therapy — again, like this is sort of similar in the realm of pain. Paid to go to physical therapy, my exercises take max three minutes, and I just do not do them. And it’s just because we’re human?
[35:33] Dr. Nzinga Harrison: Just because we’re human. And so pour on top of that having a hijacked brain. And I hope that just helps develop some compassion, because I always say we’re breaking down us and them. It’s just us. We are all having these same kind of behaviors in some realm in our lives. Whereas, like, if I would just make a different set of decisions, things could be better. But for some reason — and it’s always a confluence, you know, it’s always a bunch of things. I have been emotionally overburdened. And so I was like ain’t nobody going for a run because I’m tired. I’m getting in this bed. And then getting in this bed made my neck pain worse. And then I was like, oh, I can’t believe my neck pain is so bad. You know what I’m gonna do? Take a nap. I mean, it makes no sense! But it’s human. So those are my words of wisdom. Grace for yourselves, for ourselves, for the people we love: grace. But people we can’t stand: grace.
[36:59] Dr. Nzinga Harrison: In Recovery is a Lemonada Media original. The show is produced by Claire Jones and edited by Ivan Kuraev. Music is by Dan Molad. Jessica Cordova Kramer and Stephanie Wittels Wachs are our executive producers. Rate and review us and say nice things. And follow us @LemonadaMedia across all social platforms, or find me on Twitter @naharrisonmd. If you’ve learned from us, share the show with your others. Let’s help destigmatize addiction together.