Mental Illnesses Travel in Packs

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

The Child of Ukraine: Weaving the Threads

Time seems to travel in a circle. Or at least, I remember thinking that when I saw that my book was being bought and read by people after the war in Ukraine started, in February 2022. It’s as if the thread I pulled in 2016, when I began writing this book, was the thread that brought it all together now. Time is funny that way, you only understand how it connects events by looking backwards. "You can't connect the dots looking forward," Steve Jobs famously said. "You can only connect them looking backward.” 

My family is full of threads that are stories woven into a tapestry of who we are: most cultures are like that, but Ukrainians in particular; we are now seen in the world as a country full of storytellers, and fervently stubborn survivors. It was one of these stories, about my maternal grandmother, that catapulted me into finally pursuing a writing career, and I wrote it really for myself, and my own family, but I knew that it would resonate with families the world over. You see, survival and grief and hope are universal themes that we all live with, and the more we talk about them with our parents and grandparents, the more empowered we will be to be transparent in navigating our life on this planet. Or at least, not be ashamed to share that for the most part, we’re figuring it out as we go along. None of us have the answers. 

The Child of Ukraine was one of those stories that flowed out of me like an imperfect fever dream: I saw it play out in my head cinematically, and I wrote it with pure instinct. Was it perfect, even after the 8th draft? No, but no life is, really, and no story is. And once I’d published it, I saw a wave of interest with people not just because it was a story about a mother making impossible choices in her life, but because it prompted people to start asking questions of their own family history, to know where they came from, and to see their living history as full of people that are humans, not just parents and grandparents and aunts and uncles. 

Having published the story in 2020, I noticed that the ebbs and flows of people wanting to read the book was one of those things that I had to accept: people weren’t really aware of Ukraine and Ukrainian stories even as recently as two years ago. Ukraine had always stayed within Russia’s shadow and had always been seen as a poor country full of farmers and cleaners and rent-a-brides. Sadly, this media portrayal was pretty pervasive for a long time. It was only since the war began and Ukraine was front and center in the news on a daily basis, fighting for hope and survival, did the attention on my book (and other Ukrainian translators and authors) kick in. Albeit the circumstances were unfortunate, but the passion for this story was immense. I started seeing a huge investment in not only the media but from readers and agents and activists around the world, reaching out to me and others on how we all feel about writing and creating art during a time of such unrest and grief.

How do I feel? How do we all feel, collectively? Tired, is the first word we can all agree on. But I suspect that every single Ukrainian around the world feels heard, supported, and validated. We have been waiting in the wings for so much of our art and for all of our voices to be amplified, and now we have a moment to extend the narrative past war, past death, and destruction. I feel it is our time now to create a lasting legacy of hope, of creativity, of modernism, of architecture and industry. We are a country with a modern leader who is using social media platforms to create an awareness of Ukrainian culture, our heritage, and our history. And within that history, I’m so pleased that my book, and future books, will connect people not only to Ukraine and its people, but also Ukraine and the countries around it: Poland, Hungary, and even Austria and Germany. 

When my grandmother was dying and I told her about the book that I wrote based on the epic story of her life, she said to me, “little mouse, surely my life isn’t that interesting. So many of us went through much of the same during that time.” Which made me realise that these incredible stories of love, loss, betrayal, and hope is now more important than ever, in an age where time and news stories move so quickly. We, the artists, the voices, are the creators of a new legacy of hope and empathy and change; we are the dreamers, we are the future. Stories like this will create lessons of determination and pride when so much of the world feels like it’s not listening. It is, and we are the ones who will encourage it to, we will connect those threads and create more circles.

Tetyana Denford grew up in a small town in New York, and is a Ukrainian-American author, translator, and freelance writer. She grew up with her Ukrainian heritage at the forefront of her childhood, and it led to her being fascinated with how storytellers in various cultures passed down their lives to future generations; life stories are where we learn about ourselves, each other, and are the things that matter most, in a world where things move so quickly.

Victoria Schade on Researching Veterinary Medicine for Dog Friendly

By Victoria Schade

I’ve always considered my career as a dog trainer to be parallel to the veterinary profession since our goals are aligned: happy, healthy dogs and well-informed pet parents. I thought that I understood the big picture challenges of their job, like difficult diagnoses and heartbreaking goodbyes, but as I dug into my research for Dog Friendly I realized that I had no clue what our friends across the exam table face every day.

I started my research with every writer’s favorite tool: stalking. I found a few web sites for vets that provided first-person accounts of what makes the job so tough and wasn’t surprised to discover that the human end of the leash was at the core of much of it. Sure, the animals can scratch and bite but it turns out that people can do even more damage. I learned about clients who make unreasonable demands, or ignore treatment plans, or berate the front desk staff and techs, or accuse veterinarians of only being in the business for the money. Couple those challenges with crippling student loans and a healthy dose of all too common imposter syndrome and you have a profession in crisis.

But my research wasn’t all gloom and doom. I was lucky enough to connect with two seasoned vets who provided me with stories of resilience and hope. They spoke about the passion that all vets share, and the drive they feel to help the animals in their care reach the best possible outcomes. It’s a job that requires selflessness and a huge heart, and both of my sources agreed that their tenure has toughened them up to some of the challenges that younger vets, like my main character Dr. Morgan Pearce, might find overwhelming.

Another bright spot in my research was learning more about the organization Not One More Vet, whose mission is to “transform the status of mental wellness within the veterinary profession so professionals can survive and thrive through education, resources, and support.” They’re working hard to ensure that “not one more vet” has to face compassion fatigue on their own.

Now that I’ve learned so much about vet life it's embarrassing to admit that I’ve been “that person” in the exam room. While I’ve never been rude I’ve definitely been impatient. And yes, back in the day I might have considered Dr. Google’s advice over the advice from my vet. (Oof, it hurts to admit it!) It wasn’t easy to look inward to realize that I might have caused a headache or two throughout my years as a pet parent. But now I understand how to be a better partner in my dogs’ health, and it’s my hope that readers of Dog Friendly will pick up a few similar tips in between all of the sunshine and swooning on the pages.  

Victoria Schade is a dog trainer and speaker who serves as a dog resource for the media, and has worked both in front of and behind the camera on Animal Planet, as a co-host on the program Faithful Friends and as a trainer and wrangler on the channel’s popular Puppy Bowl specials. She lives in Pennsylvania with her husband, her dogs Millie and Olive, and the occasional foster pup.