Last week, on the second anniversary of my mother's death, I took some time to think about the special bond we shared. I have often said that, somewhere along the way, we switched roles. Last summer, I wrote much of the essay that follows, describing the time in our lives where I sort of became the parent and she sort of became the dependent. It is presented here again, in edited form, because I first published it before my blog and social media attracted a wide audience. I believe it remains one of the most meaningful things I have ever written.
I remember the day I became my mother’s keeper.
I was 22, and she was 42. She had just left her fourth husband. She and I decided it made sense for the two of us to share a place for a while, so we rented a little house and moved in together. It was the first time since I left home on my eighteenth birthday that I had the chance to be around her for extended periods of time.
Until that point, I had only a vague idea of the extent of her mental and physical illnesses, and I didn’t realize that her condition was truly debilitating. I knew for most of my life that she would sometimes take pills and often smoked pot, but I never thought of her as an addict. Her recreational drug use had never interfered with her ability to work an endless assortment of shitty dead-end jobs and, after graduating from a technical school, slightly less shitty entry-level office jobs. By the time she moved in with me that summer, she even had a job with health insurance, a first for her.
As her suffering increased, so did her drive to seek drugs to numb the pain. She began complaining more often that none of the drugs her doctor prescribed were helpful in dulling her chronic pain. She often found it hard to work because the pain made it unbearable to sit in an office chair for eight hours a day.
My mother was a follower. I am convinced that her drive to be loved caused her to do things others wanted her to do even if they weren't in her best interest. It happened with the men in her life, her family, and her friends. One evening, just a few weeks after we moved in together, Mom's best friend came to visit, and minutes after she arrived, the two of them locked themselves in the bathroom of the little house we were renting. There was only one thing on my mind in that moment: Meth.
Knowing her friend’s background and lifestyle and having heard rumors recently of her illegal activities, I became certain that she was introducing my mother to a drug that I believed was a death sentence. The drug had just begun its heartbreaking takeover of Appalachia. I had no clue what it looked like or even how it was used, but I knew what it did to people. Mom and I had talked specifically about meth in the days leading up to this. That's why I knew her friend was using and selling it.
I knocked on the bathroom door, and when they yelled at me to go away, I lowered my elbow and pushed through the door with all my weight. When I replay it in my head, I can still hear the sickening crack and snap of the cheap door fame as it yielded to my weight.
My suspicions were confirmed by the small mirror lying on the counter, dirtied with white powder, and the rolled up dollar bill in my mother’s hand. I knew that she had followed her friend down a terrible path, and I knew that the addictive properties of meth likely meant that she would keep following regardless of the consequences. In that moment, the weight of the world settled onto my shoulders. In that instant, I knew that I had become my mother's keeper.
She was angrier at me than I had ever seen her. She told me that what they were doing was none of my business, and that she was a grown-assed woman, and she’d do whatever she wanted. Her friend cursed me and I cursed right back. The two of them stomped out the door in a hurry.
As I sat on the porch in the minutes after her friend’s car left our driveway, my head spun, my mind raced, and I realized that it was up to me to try to save her. There wasn’t anyone else. I suppose I was still young enough and naïve enough to think I could rescue her. I didn’t really know anything about mental illness or addiction, but life was about to hand me an education in both.
I drove to her friend’s house, pulled into the driveway, and blasted the horn until a man I had never met came out and asked what I wanted. I demanded that he tell Libby that it was time to go. He shuffled back in, and in a few minutes, mom walked out and got into the car with me. In my adrenaline-filled rush, I didn't consider how stupid it was to drive up to a house I knew to be filled with drugs and honk the horn and make demands. I didn’t think to be scared for my own safety. I was just worried about my mom.
On the way home, she sobbed and asked me to forgive her. I didn’t admit that I was scared. I was pretending to be a badass without emotions, but I did forgive her. In truth, I could barely keep from shaking from the adrenaline and fear pulsing through my veins. It’s as if the drugs she had taken were having some physiological effect on me, too.
By the time we got home, she was done crying. She started screaming and throwing things and demanded that I drive her back to her friend’s house. I still remember the sound of an ashtray crashing into her dresser mirror, and the feeling of her warm wet tears soaking the right shoulder of my shirt when I grabbed her in a bear hug, told her I loved her, and asked her to calm down. Years later, I would realize that she was exhibiting textbook signs of bipolar disorder that night. At the time, I assumed it was whatever cocktail of drugs she had ingested.
The next day, she left again. She said she’d never speak to me again if I tried to come get her, but she promised to let me know she was safe. She also promised that she wouldn’t touch meth again, but I didn’t believe her. She called every few days, always at unpredictable hours, usually slurring her words, but occasionally hyper and full of big plans.
I decided I would throw myself into my work, because I didn’t know what else to do and I still had bills to pay. She apparently had the opposite notion and left the best job she ever had, either voluntarily or involuntarily. I never got a clear answer, and I’m not sure I want one.
About a month after she left, she stopped calling, then her phone started going straight to voicemail when I dialed her number. Eventually, I got a collect call from the county jail.
Because she had taken up residence at her friend’s house, she was arrested when the police busted down the door one evening and found an assortment of illegal substances. Her friend paid her bail, I paid the lawyer, and a few months later, they dropped the charges against my mother.
She came back home for a while, then reconnected with a man she once knew who would soon become husband number five (and six – long story).
Not long after the events described above, through a series of lucky business opportunities, I bought a business in eastern Kentucky and moved there to run it. Mom decided that she wanted to come, too, so I paid for an apartment for she and number five and paid her a small salary from my business despite her inability to do meaningful work because of her chronic pain.
Just a few months after moving to Kentucky, husband number five decided he had had enough and moved back to North Carolina. I paid for the divorce and we bid him adieu. Mom became emotionally unstable after he left, and one evening after getting a cryptic text message from her, I went to her apartment to find her passed out on her bed, blood dripping from her left wrist. She had tried to take her own life.
At the hospital, she agreed that it would be best if she sought inpatient psychiatric care. In rural Kentucky, however, mental health infrastructure is severely lacking at best and cruel at worst. I’m not sure her week-long stay at the Harlan County ARH Hospital, where the staff treated her like trash, did anything at all to help her. Little did I know at the time that this incident would not be the last time she would attempt suicide or the last time she would spend time in an inpatient psychiatric facility.
Though she never turned back to meth, so far as I know, she managed to find physicians who would give her virtually any kind of pills she wanted, often with little concern for how the drugs would impact her mental health. There was no denying the extent of her physical illnesses. I once paid for an MRI that showed, in stunning detail, the assortment of disintegrated and otherwise destroyed discs in her lower back and in her neck. In an effort to treat her physical problems, she was often prescribed drugs that made her mental health worse.
In particular, the sedative Klonopin caused her to have severe emotional reactions. She was taking this drug at least five of the six times she attempted to take her own life. Each time, she would admit afterward that Klonopin took her to what she described as a “dark place.” She would always flush the remainder of her prescription when she got home from the hospital, but something drove her, time and again, to ask her doctors for new prescriptions for Klonopin. Eventually, I called her doctor and explained the correlation between the drug and her suicide attempts and told him he would be acting irresponsibly if he ever gave it to her again.
The last time she attempted to kill herself, her doctor, despite my previous warning, had just given her a new prescription for Klonopin. After I got mom to the hospital, I called the doctor, and I have never said such horrible words to another human as I said to him. I told him that if my mother died, he would have blood on his hands. She agreed later to never see this doctor again, but he still practices medicine in our hometown.
I first wrote about my mother's life last spring in an essay titled "My Mother Wasn't Trash." Over a million people read that essay in the year after I published it on my blog, and I continue to be amazed by the number of people who read it and reach out to me in response every month. I don't have the words to describe how much I am touched to know that my words and her story have moved so many people. I am now completing a book of the same title, connecting my mother's lived experiences with systematic intergenerational poverty in Appalachia.
Because of the apparent power of vulnerability, and because so many people have found my mother’s story to be helpful in understanding the world around them, I think it is appropriate that I continue to use her story as a lens through which to view Appalachia and the region’s problems.
There are many problems in Appalachia so widespread as to be systematic, and most of them can be examined, in some way, through examining my mother’s life. Two in particular are of urgent importance given what is unfolding in our region now. Addiction and mental health are so deeply intertwined in Appalachian (and, I suppose, in much of America) as to be inseparable, and both have reached crisis level in our region and, indeed, all over the US.
The thing is, we don’t like talking about either. We attach shame and stigma and blame to both mental illness and addiction, and even though almost every family in Appalachia is in some way touched by both, many of us like to go about our lives pretending that our families are safe from the unpleasantness that is rotting our communities.
It’s time we stop lying to ourselves and plastering over reality with rainbows-and-unicorns bullshit and start talking about it, even if it hurts. Actually, especially if it hurts.
When I first wrote about my mother and published it publicly on my blog, I took no pleasure in sharing such intimate details about my life. While I was not embarrassed, I was hesitant to share a story so personal. The harsh criticism I received from some members of my family have strained my relationships with them even more than they were already strained. There are people who will no longer speak to me because I have been honest about my mother's life.
However, The first time I got an email from someone telling me that my mother’s story sounds just like their own, I realized the power of shared experience. I decided that I would continue telling the stories of Appalachian people as a means of speaking truth to power. When those who could bring about change are confronted with the truth – that is, with hard, unvarnished, raw, emotional reality – it is harder for them to ignore us.
My mother was ignored for just about all of her life. Now that she is gone and I’m telling her story, I realize that there’s too much at stake to allow our region to be ignored, or, worse, stereotyped, universalized, and rolled in a simplistic narrative heavy on victim-blaming. I am tired of seeing my neighbors and friends and family members deprived of their humanity, stripped down to nothing but white trash stereotypes, and treated differently because of the conditions into which they were born.
Based both on my personal experiences and my reading of the literature, I realize now that addiction and mental illness, especially for those who suffer from bipolar disorder, are usually cycles. Mom had good days and bad days. The pictures presented with this essay are evidence of that. The top picture was taken a few years before her death when I took her to Gatlinburg, Tennessee for a week of vacation. We spent a week having fun and pretending that her life wasn't falling apart. The second picture was taken around the same time, but on one of her bad days. Both of them came from her Facebook page, so both were photos of herself that she chose to share publicly. For me, these pictures serve as a stark reminder that it is impossible to look at a single snapshot of an individual and know their realities. I realize now that I would often see mom on a good day, or during a good week, and assume that she could simply choose to be like this all the time.
The truth is, even for the first few years after I realized I had become my mother’s keeper, I thought she could fix herself if only she would try hard enough. I bought into the false narrative of “personal responsibility” that is so prevalent in American political dialogue. I believed that those who were poor were poor because they didn’t work hard enough. I thought those who were addicted were addicted because they didn’t want to stop using drugs. I thought that those who suffered from mental health problems, especially depression, should just learn to think differently. I am ashamed that I ever thought this way. I was wrong, and I could have taken better care of my mother had I bothered to stop and listen to her and those like her.
So here we are, in 2018, talking in terms sometimes abstract and sometimes personal, about poverty, addiction, and mental illness. President Trump has at times shown interest in addressing the opioid crisis that is shaking the foundations of rural America. Politicians, some more successfully and seriously than others, are showing interest in addressing the challenges of healthcare access. Few are talking about America’s mental health crisis, though, and this is the key to understanding the first two. We will never begin to solve the opioid epidemic or address healthcare until we come to terms with the way we view mental illness.
Here is the problem, as plainly as I know how to state it: addiction is a mental illness, yet we treat it like a crime or a character flaw. Mental healthcare IS healthcare.
What’s more, those with other mental illnesses, in particular depression, bipolar disorder, and post-traumatic stress disorder, are sometimes more likely to abuse drugs because of their mental health conditions.
The result is that if we have any hope at all of addressing the plague of drug abuse in rural areas in any meaningful way, we MUST invest in mental health infrastructure.
If large swaths of upper-middle-class America were suffering systematically from some sort of physical impairment, all manner of funding would be focused on bringing expertise and resources to those areas to fix the impairment.
In the poorer parts of the US, however, no one is coming. It doesn’t matter if it’s poisoned water in Flint, Michigan or Oxycontin overdoses in Oceana, West Virginia. It seems, at least on the national level, that no one is interested in treating crises in impoverished communities with the same urgency as crises in middle-class America. I have known all my life that poor lives matter less than rich ones. Our approach to solving the opioid crisis is just more piece of evidence.
Many of the proposed solutions coming out of Washington rely on the tried-and-failed “law and order” approach. That is, addicts, and those who support their addictions by selling drugs, are criminals, and therefore increased law enforcement effort is the best way to solve the problem. According to these folks, the proper approach is to clean up the streets, lock the addicts and dealers up so they can’t dirty up our neighborhoods, and push the problem back out of sight. This approach is so wrong as to border on immoral.
When I consider potential solutions, I cannot help but revisit my mother’s story. Chronic pain and a lifetime of mental and physical abuse were likely the two most important factors that led her to abuse drugs. I wholeheartedly believe she was seeking relief from chronic pain, but I also realize that she was seeking relief from chronic heartbreak and mental anguish, too.
People like my mother reach a point where they realize the hopelessness of their situations. As I have written previously, there are many who can make all the least-shitty choices in a life of shitty options and still end up mired in poverty with no means of escaping. When they do all the things society tells them they should – work hard, get an education, work harder, get a second or third job – yet still end up with no path to the middle class, they just give up. For these folks – and my mother was one of them – sometimes the temporary escape provided by drugs or cigarettes or alcohol is the only respite they can find from an unjust world seemingly stacked against them.
I do not know what it is like to have such severe physical pain that I would be tempted to try meth just to make it go away. Neither do I know what it is like to suffer from mental illness that is only made worse by attempts to make the physical pain more bearable. What I do know is that most people who have never experienced these realities firsthand tend to think it must somehow be the fault of those suffering.
To be clear, my mother made the decision to take drugs, both prescribed and illegal. However, she did not make the choice to be poor, or to have her back broken by degrading manual labor for minimum wage. She made plenty of tough choices over the course of her life in response to crises she never asked for. Her choices certainly shaped her life, but not nearly as much as it was shaped by the things in her life that were utterly beyond her control.
I’m not convinced that personal choices end up making a bit of difference for people like my mother. Really, the only truly life-changing decisions they make revolve around how long they are going to try before they give up. Some end up trying until the day they die of natural causes. Some give up by pushing the plunger of an over-loaded needle. Some, like my mother, try over and over, unsuccessfully, to make the pain stop for good. At some point, the date of their death is the only remaining turning point they can control.
As we consider the path forward, we must begin understanding addiction, mental health, hopelessness, and poverty as part of the same broken system. We cannot continue to address these problems piecemeal and expect positive outcomes.
One of the first things we must address is access to quality mental health care. This is particularly problematic in rural areas. Often, addicts end up in the emergency rooms of their local hospitals because drug abuse has threatened their physical health. Once they are medically cleared, they are often sent home. Perhaps, if they are lucky, they leave the ER with a referral to a local mental health provider, but they often lack the money or transportation to go find mental health care.
Rural community mental health practitioners are some of the most caring and giving people I know, but they usually lack appropriate levels funding to provide the evidence-based care that they know will lead to better outcomes for addicts and those with severe mental health issues.
If our current national conversations about the opioid epidemic lead to plans for action, we must first address our lack of willingness to fund mental health treatment. That would, of course, require acknowledging that opioid addiction is, according to the American Psychological Association’s Diagnosis and Statistics Manual, a legitimate mental health diagnosis. I believe wholeheartedly that many Americans are not quite ready to stop blaming addicts for their addiction and start agreeing to use their tax money to pay for solutions.
Addiction touches families both rich and poor, but, like most other mental and physical illnesses, outcomes differ based on socioeconomic situation. Those from wealthy families have the resources to seek out voluntary inpatient addiction treatment. Those from impoverished families rely on whatever piecemeal treatment they can get from outpatient community mental health, and usually, the only treatment available to them is that paid for by Medicaid. In some states, including my own, conservative politicians continue to make access to Medicaid nearly impossible for people suffering from addiction.
Even for those who suffer from mental illness but who are not addicts, access to proper mental health treatment is severely lacking in most parts of Appalachia. Sometimes, local family practitioners offer the only access many patients have to mental health treatment. Faced with no other viable options, it seems, some physicians will prescribe antidepressants as a desperate means of helping their suffering patients. Those patients who do seek inpatient care sometimes end up in situations like my mother, locked up in hellish psychiatric wards in terribly underfunded hospitals that are more like punishment than therapy.
None of the solutions are simple. They require changing hearts and minds, and they rely on political action that comes often in the form of increased funding. When we consider that truly addressing income inequality in the US would do much to address addiction and mental illness, the solutions become even more complicated. However, if we acknowledge that outcomes for those suffering from mental health problems and addiction usually vary based on socioeconomic status (and there’s plenty of peer-reviewed proof of this), it becomes clear that the poor are not given the same opportunities for treatment as the middle class or the wealthy.
In the end, I think we have to ask ourselves a hard question: Do these people matter? Do those who suffer from opioid addiction or bipolar disorder or PTSD or some combination of addiction and other mental illness really matter? If people like my mother do not matter in the grand scheme of American society, then let’s just move on. But if they do matter, then we have to keep asking hard questions and looking for impossible answers.