by Carolyn DiPasquale

Who would think that a person with one serious illness could have two or more? It seems cruel, unconscionable that God would allow that. And yet, like other inexplicably painful phenomena, it happens more often than we think. 

The condition of having multiple illness goes by several names: dual diagnosis, co-existing disorder, co-occurring disorder, or co-morbidity. People can have co-occurring mental disorders, mental and intellectual disabilities, or mental and substance use disorders. No matter how you mix or match these, it relates to someone having several illnesses at once. Rachel hit the jackpot: she had co-occurring physical, mental, and substance use disorders. 

Co-occurring disorders are not uncommon. People can receive a medical diagnosis for a physical problem, like cancer, and then develop a mental disorder, such as anxiety or major depression. Or they can receive one mental diagnosis followed by another;[1] for example, major depression co-occurs with anxiety disorders in 50 percent of cases; and with eating disorders, namely anorexia and bulimia, in a whopping 92 percent of cases. [2] Not surprisingly, people with a mental health condition are twice as likely as the general population to acquire a substance use disorder.[3]

Please don’t gloss over these facts. Co-occurring disorders are painful and dangerous. To appreciate a victim’s plight, you’d have to understand how daunting it is to cope with just one serious illness. Diabetes alone requires a person to maintain a constant balancing act between food, exercise, and insulin for healthy blood sugars. Sickness or stress throws everything off. Highs and lows respectively induce searing stomach pains and dizziness. Future health problems constantly loom. You’d have to witness the wild mood swings of someone with bipolar disorder to comprehend how much that one disorder tortures him/her. People with bulimia grapple with chronic freight-train urges to binge and purge; guilt and despair; massive food bills; and frightening physical symptoms. Individuals with substance use disorders, who have struggled for decades with alcoholic or drugs, have their own horror stories to tell. Each disorder comes with its own set of distressing symptoms and risks. Any single major illness is so fierce, so all-consuming that it can overtake a person’s life. And even with treatment, certain disorders require lifelong maintenance. 

Now, if you can imagine how difficult it is to live with one serious illness, multiply that by two or three to get an inkling of the hell people with co-existing disorders live in. It’s no wonder they tend to be less responsive to treatment, have poorer prognoses, and exert a greater demand on health care services than patients with a single illness. People battling multiple illnesses also have more brutal symptoms and poorer quality of life, not to mention suicidal thoughts and higher rates of suicide.[2]

In Reckless Grace, I’ve tried to bring these truths to light. My deepest hope is that my book makes it to the nightstands of people in high positions--doctors and nurses and CEOs of health insurance companies, hospitals, and eating disorder (ED) facilities--moving them to review and improve practices and policies that would give young people with co-existing disorders a fighting chance to improve their health and live long, full lives. 

Carolyn DiPasquale grew up in Franksville, Wisconsin, graduating from UW-Milwaukee with a double major in English and French. In 1983, she moved to Rhode Island where she raised three children while pursuing her Master’s in English at the University of Rhode Island. Over her career, she taught literature and composition at various New England colleges; worked as a technical writer at the Naval Underseas Warfare Center in Newport; and wrote winning grants as a volunteer for Turning Around Ministries, a Newport aftercare program for ex-offenders. She has been an active member of the Newport Round Table, a professional writing group (founded in 1995), since 2013. 

[1] https://www.verywellmind.com/what-is-comorbidity-3024480

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4392551/

[3] National Institute of Mental Health