It’s hard to know what came first for Rachel Watson (Emily Blunt) in the mystery thriller “The Girl on the Train” — alcoholism or depression. What is apparent is that these two issues were inextricably linked and compounded by one another, and helped fuel her downward spiral.
Depression or Alcoholism: The Chicken-Before-the-Egg Phenomenon
Viewers don’t know if Rachel had some of the traditional risk factors that often lurk behind substance abuse and mental health issues, such as a genetic predisposition, childhood trauma and unhealthy early attachment styles. Either way, it’s pretty obvious that her recent life circumstances may have been quite sufficient on their own to create the perfect storm for depression and alcohol abuse: infertility, failed IVF attempts, an abusive and cheating husband, divorce — the list goes on. Did Rachel become depressed about her marriage and inability to have a child and eventually turn to the bottle to numb the sadness? Did she start self-medicating with alcohol from the get-go, and did her brain chemistry change as a result, spawning symptoms of depression? Had she always struggled with depression and trauma, well-positioned for this fate since childhood? We don’t know that part of her story, but it was likely a combination of all of the above. Ultimately, for someone like Rachel to get better, the how’s, when’s and why’s of her condition aren’t critical to beginning the recovery process, and as an addiction and mental health expert tells us, much of this will come out in the journey toward well-being anyway.
The Challenges of Treating Alcoholism and Depression
Malika Burman, MD, has been treating people with mental health and substance use issues since 2003. She has both a professional and personal understanding of addiction, having lost close family members to the disease. A board certified psychiatrist, Dr. Burman blends traditional psychotherapy with Eastern and Western philosophy and medicine to help clients address the behavioral and emotional difficulties that hold them hostage. Dr. Burman says that one of the problems with an alcohol use disorder and depression dual diagnosis is that alcohol compounds the symptoms of depression. “The antidepressants and treatments of our time can have a modest effect on depression, but alcohol is such a powerful depressant that it will override all of these treatments,” she says. Alcohol may provide a brief sense of euphoria and escape from problems. In fact, some research shows that alcohol may temporarily mimic the effects of an antidepressant. The problem is, the relief is just that — temporary, and the next morning, or whenever alcohol begins leaving the system, depressive symptoms come back with a vengeance, much like we see happen in Rachel’s situation. This starts the depression/alcohol-to-medicate cycle all over again. “Anyone using alcohol daily or in binge patterns will magnify their depression,” says Dr. Burman. “The brain shuts down and doesn’t have time to recover. Depression gets worse.”
At the Crossroads of Addiction Treatment: Feeling the Feels
An antidepressant alone isn’t going to cure depression and prevent the urge to self-medicate with alcohol. To truly recover from addiction, it’s important to get to the root causes propelling these behaviors. In the absence of alcohol, which can block the effects of antidepressants, medication can help ease depressive symptoms so that people can concentrate on the therapeutic work needed to get better. “Everyone is different, and we will all turn to different coping tools,” says Dr. Burman. “Those of us who reach for a substance to numb out what we’re feeling don’t really get the chance to fully understand the reason for the depression in the first place.” This can be a roadblock to recovery. Dr. Burman says the key to getting past addiction and managing depression is understanding why you’re shutting down and why your mind is not your friend anymore. She calls this a “calling to consciousness.” This may involve some scary realizations about ourselves, the closest people in our lives, our career paths, and a lot of the things we’ve believed and seen along the way. But getting to the meat of the matter, looking at these parts of ourselves directly, exploring them fully and letting ourselves feel what comes up is how we stop letting them control us. “Everyone comes to this crossroad at some point in recovery, and repeatedly,” says Dr. Burman. “For someone who is prone to alcoholism, it’s very difficult to face these things, feel them, and stay open minded to where it leads.” In the movie, we see the very beginning of this type of work as Rachel begins learning about and facing some of the truths of her relationship with her ex-husband. The hope is that at the point where the movie leaves us, she goes on to get some intensive therapy to help her address and heal from her past.
What Does Dual Diagnosis Recovery Look Like?
Dr. Burman says that a big part of recovery involves lifelong, restorative self-care practices, not temporary fixes. This looks different for everyone and can entail activities and philosophies like yoga, meditation, exercise, volunteer work and different forms of spirituality. Pursuits that nourish the mind, body and spirit and promote acceptance and health rather than numbing and stuffing can be critical to staying sober and managing mental health issues. “The benefits are boundless,” says Dr. Burman. “[These practices] don’t just help the depression and the alcoholism, but they can lead to all kinds of euphoric states that are real and lasting and lifelong. It’s not just a month and you are cured.” Another critical component of recovery is trust and honesty. Dr. Burman says that many people have shame about their drinking so they underreport how much they use alcohol to their therapist. They may attribute pain to situations that are occurring outside of themselves and really believe that drinking is the only relief. This is a form of self-deception that is important to get past. The problem won’t get solved by taking care of the external bits. Healing must begin internally, so we are more resilient and the situations outside of ourselves have less power to destroy us by sending us to the bar or to our coping mechanism of choice. Dr. Burman says a big part of getting better is trusting the therapist and the process and not hiding the parts of ourselves that bring up shame. “[Getting better] is only possible when you can sit with yourself and tolerate a certain amount of discomfort, trusting that you will break through to a much better feeling as long as you are willing to keep an open mind.”