SPECIAL SERIES: COMORBIDITY ACROSS THE COUNTRY
This review is the fourth in a series of five issues of the BASIS featuring research and perspectives on comorbidity among psychiatric and addictive disorders. In the past three weeks, The WAGER, The DRAM, and ASHES have discussed findings from the National Epidemiological Survey on Alcohol and Related Disorders (NESARC) and the National Comorbidity Survey (NCS) and its replication (NCS-R) about psychiatric and personality disorders comorbid with pathological gambling, alcohol use disorders, and smoking. This week, Addiction and the Humanities discusses issues of comorbidity in James Frey’s memoir, A Million Little Pieces.
Frey Picks up the Pieces with Oprah
“I have never felt as if I were worth the diseased space I occupy,” James Frey reveals in his memoir, A Million Little Pieces (Frey, 2003). Frey, who recovered from addictions to alcohol and cocaine, wrote about his experiences at a treatment program: the people he met, a past he wasn’t ready to deal with, and his constant battle to stay sober. During a recent interview with Oprah Winfrey, Frey asserted that addictions are hardly about the substances themselves, “…ultimately, I think addiction in any form is about emotions, you know”. He further elaborated, “… We feel anger or sadness…find something that, if we take it, it makes those feelings go away for a while.” Frey, both in his book and in the interview, expresses the complexity of addiction and offers insight into comorbidity, the cooccurrence of several psychiatric disorders.
In the book, Frey describes facing emotionally vulnerable situations with “Fury,” which resulted in self-destruction and/or harming others. Oprah asked him about “Fury” and how he controlled it. He described the feeling as “…extreme rage and sadness and confusion and loneliness that sort of mixed together.”
Frey turned to drugs and alcohol because of his inability to cope with these agonizing feelings and his desire “to make those feelings go away.” He was raging, as Oprah termed it, and needed to “release” and “get rid of it,” whether through his drug use, vandalizing property, or assaulting people. These painful emotions became the basis of his addiction. As a result, whenever Frey’s emotional pain intensified, so did his drug use and disturbing behavior. Frey’s “Fury” was clinically diagnosed as depression accompanied by low self-esteem, anger, aggressiveness, and confrontation leading to violence (Frey, 2003).
Frey’s use of drugs to escape from his depression and “Fury” corresponds to the self-medication theory of addiction. This theory suggests that people use a psychoactive substance or activity to relieve underlying distress (Khantzian, 2003). Khantzian (2003) proposes that individuals suffering with painful emotions will develop an addiction to a specific substance that can help them cope with their suffering.
Though drug and alcohol use dulled his emotional pain in the moment, Frey’s depression and other emotions ultimately were exacerbated by his growing addiction to alcohol and other psychoactive drugs. Frustrated and unable to deal with that inner pain, Frey exhibited more and more externalizing behaviors – the “raging” described earlier. Both Frey’s substance abuse and his “raging” might qualify psychiatrically as externalizing disorders – psychiatric problems that are expressed through acting out. However, Frey’s emotional suffering, depression, and self-hatred would qualify as internalizing disorders – psychiatric problems that are characterized by internal suffering. It is important to recognize that though internalizing and externalizing disorders are clinically differentiated, they can cooccur and influence each other, as in Frey’s case.
Driven by his emotional suffering, Frey contemplated suicide many times: “I have lived alone, I have fought alone, I have dealt with pain alone. I will die alone.” (Frey, 2003). To recover, Frey forced himself to face the complex issues surrounding his addiction: “Fury”, his relationship with his family, and emotional vulnerability. Frey revealed to Oprah that he is alive today because he wanted to stay alive, “When I went into that facility and I was told that I would die soon if I didn’t stop…it was the first time….my head had been cleared of alcohol and drugs in many years, and it just sank in.” For Frey, holding on until the negative feelings passed helped him recover. Frey further describes his discovery, “There are moments where you want chemicals so badly that you don’t think you can keep going…no matter how awful you feel…you just hold on, and it’ll get better.”
Though, Frey recovered successfully, several of his acquaintances and close friends continued to have problems with addiction. Like Frey, many of them suffered from comorbid illnesses. For example, one friend was sexually molested by his father when he was younger, an experience that influenced his addictive behavior, but his treatment did not effectively address his abuse. Thus, treating people for addiction without also recognizing and treating comorbid disorders can stunt recovery. We noted earlier Frey’s suggestion that drug addiction is not only about the object of addiction, but also includes the underlying emotional problem(s). Frey’s memoir demonstrates the importance of addressing comorbidity during recovery. Though treating the full extent of problems might be more challenging, in the long term it is worthwhile and might be necessary for people to achieve a lasting recovery.
Though it is debatable whether James Frey’s “A Million Little Pieces” is an “addictive” read, as Oprah claims, the book’s grit and raw richness makes it difficult to put down. His honesty and humility help make this memoir compelling and heartbreaking. There are few works like “A Million Little Pieces” that resonate and force readers to reevaluate their beliefs and perceptions about addiction.
What do you think? Comments can be addressed to Sarbani Hazra.
Image from The Oprah Winfrey Show. TM & Copyright 2005 Harpo Productions, Inc. All Rights Reserved.
References
Frey, James. (2003). A Million Little Pieces. New York: Anchor Books.
Gilliom, M, & Shaw, D.S. (2004). Codevelopment of externalizing and internalizing problems in early childhood. Development and Psychopathology, 16, 313-333.
Khantzian, E.J. (2003). The Self-Medication hypothesis revisited: The dually diagnosed patient. Primary Psychiatry, 10 (9), 47-54.
Oprah Winfrey Show. (2005). Meet the author: one-on-one with James Frey. Retrieved November 10, 2005, from the World Wide Web: http://www.oprah.com/obc_classic/featbook/mlp/author/author_interview.jhtml.