Steps For Mental Illness
Step Zero: Knowing Your Mental Illness
Just as in Step Zero, The Doctor’s Opinion, an alcoholic finds out about her/his disease from her/his own experience, so in Step Zero For Mental Illness we find out about our illness from our own experience. This may begin with a reference to our diagnosis and professional information about symptoms, but it is our own experience which we are looking at the most.
Some mornings I just can’t make it out of bed and I lose my job or something else horrific. Or my emotional pain is so bad that I have repeating thoughts about killing myself or someone else? Or the voices of others in my head just pound me to pieces without stop. Or I am so frightened of I don’t know what that I can’t go outside or do something that I want to or have to do. Or I run up $20,000 of credit card debt and just can’t stop spending. Or my thoughts are racing so fast that I can’t think clearly. Or I just can’t stop thinking of some horrible thing that is going to happen to me or my loved ones. Or when I am talking people can’t understand me no matter how hard I try.
All of these experiences, which we are having now or have had in the past, have labels, but it is our experience of them that we wish make clear to ourselves. I experience these things because I have a mental illness.
The illness is progressive; the more I let it go, the worse it gets. The illness can be fatal. I may become dangerous to myself or others.
Step One For Mental Illness
“We admitted we were powerless over our mental
illness –
that our lives have become unmanageable.”
When my thoughts are racing out of control, or I can’t get my butt out of bed, or I can’t stop the emotional pain and suicidal thoughts, or can’t stop the thoughts of horrible things happening or can’t stop the voices in my head, because I have a mental illness, AM I IN CONTROL? Can I make it stop under my own power? Do I have power over them? Or am I powerless?
And the results of my symptoms, of my illness? Is my emotional pain and confusion manageable? Are my thoughts? Are my relationships manageable? Can I get what I want to do done? Or has my life become unmanageable due to my illness?
As with alcoholism, we need to concede to our inner most self that we have a mental illness.
Step Two For Mental Illness
We came to believe that a power greater than ourselves
could restore us to sanity.
With our mental illness what is the most insane thing we can do?
Not take our medications and not work on our mental health everyday.
Like those with diabetes, we need medication, we need a nutritious diet and exercise and we need to work on how to deal with stress. To work on our stress, we need meaning and purpose and we need connection with other people. In life, we can’t eliminate stress. We need support to do these things.
Which brings us to the next part of our second step. What can keep us from doing the most insane thing? What can help us take our medications, or work on our mental health everyday? We are powerless so it needs to be something more than us. We are dealing with Step Two, not with Step Three. Step Two is about a power greater than us, NOT about our Higher Power or the God or our understanding. That is Step Three.
If I stand up on a table in a support meeting and dare everyone, all twenty or thirty to stop me from slugging each of you one at a time, can you all stop me? You could hold me down for quite a while. The group has power and that power is greater than me.
If I go to a support meeting I will not be alone for that hour or hour and a half. So for the next hour of the meeting there is a power greater than me that can restore me to sanity. If I go to several meetings a day for several months, that is a power greater than me. If I have someone to call when I need to, or when I want to or when I feel panic, they will help me not do the most insane thing. If I have someone call me in the morning to remind me to take my medications, it will help.
Who are people you connect to that have power to keep you from doing the most insane thing. For many of us, it is mental health professionals. Some of us have sponsors. Some of us have very supportive families. Some of us have churches. What is it for you? If there is no one, can you find someone?
I need to connect on a daily basis to work on my mental health and not use. Why? Because I am powerless. Alone I can’t control my symptoms or craving and my life will become unmanageable. Why? Because I have an illness that is progressive and fatal. What does that mean? I will get symptomatic or feel restless, irritable and discontent and want to act out in possibly harmful ways. If I don’t take my medications or don’t work on my mental health, my symptoms will get worse.
Step Three For Mental Illness
We “made a decision to turn our will and our life over
to the care of God as we understood Him.”
This step is about a decision, not an experience. We are in this step not to try to experience anything in particular, but just to make a decision.
If there are three frogs on a log and three decide to jump off, how many are left? Click here for answer.
In the Big Book of AA there is a key oft-referred to passage:
The first requirement is that we be convinced that any life run on self-will can hardly be a success. On that basis we are almost always in collision with something or somebody, even though our motives are good. Most people try to live by self-propulsion. Each person is like an actor who wants to run the whole show; is forever trying to arrange the lights, the ballet, the scenery and the rest of the players in his own way. If his arrangements would only stay put, if only people would do as he wished, the show would be great. Everybody, including himself, would be pleased. Life would be wonderful. In trying to make these arrangements our actor may sometimes be quite virtuous. He may be kind, considerate, patient, generous; even modest and self-sacrificing. On the other hand, he may be mean, egotistical, selfish and dishonest. But, as with most humans, he is more likely to have varied traits.
What usually happens? The show doesn’t come off very well. He begins to think life doesn’t treat him right. He decides to exert himself more. He becomes, on the next occasion, still more demanding or gracious, as the case may be. Still the play does not suit him. Admitting he may be somewhat at fault, he is sure that other people are more to blame. He becomes angry, indignant, self-pitying. What is his basic trouble? Is he not really a self-seeker even when trying to be kind? Is he not a victim of the delusion that he can wrest satisfaction and happiness out of this world if he only manages well? Is it not evident to all the rest of the players that these are the things he wants? And do not his actions make each of them wish to retaliate, snatching all they can get out of the show? Is he not, even in his best moments, a producer of confusion rather than harmony?
Our actor is self-centered-ego-centric, as people like to call it nowadays. He is like the retired business man who lolls in the Florida sunshine in the winter complaining of the sad state of the nation; the minister who sighs over the sins of the twentieth century; politicians and reformers who are sure all would be Utopia if the rest of the world would only behave; the outlaw safe cracker who thinks society has wronged him; and the alcoholic who has lost all and is locked up. What ever our protestations, are not most of us concerned with ourselves, our resentments, or our self-pity?
Selfishness—self-centeredness! That, we think, is the root of our troubles. Driven by a hundred forms of fear, self-delusion, self-seeking, and self-pity, we step on the toes of our fellows and they retaliate. Sometimes they hurt us, seemingly without provocation, but we invariably find that at some time in the past we have made decisions based on self which later placed us in a position to be hurt.
So our troubles, we think, are basically of our own making. They arise out of ourselves, and the alcoholic is an extreme example of self-will run riot, though he usually doesn’t think so. Above everything, we alcoholics must be rid of this selfishness. We must, or it kills us! God makes that possible. And there often seems no way of entirely getting rid of self without His aid. Many of us had moral and philosophical convictions galore, but we could not live up to them even though we would have liked to. Neither could we reduce our self-centeredness much by wishing or trying on our own power. We had to have God’s help.
This is the how and why of it. First of all, we had to quit playing God. It didn’t work. Next, we decided that hereafter in this drama of life; God was going to be our Director. He is the Principal; we are His agents. He is the Father, and we are His children. Most good ideas are simple, and this concept was the keystone of the new and triumphant arch through which we passed to freedom.
When we sincerely took such a position, all sorts of remarkable things followed. We had a new Employer. Being all powerful, He provided what we needed, if we kept close to Him and performed His work well. Established on such a footing we became less and less interested in ourselves, our little plans and designs. More and more we became interested in seeing what we could contribute to life. As we felt new power flow in, as we enjoyed peace of mid, as we discovered we could face life successfully, as we became conscious of His presence, we began to lose our fear of today, tomorrow or the hereafter. We were reborn.”
There are four exercises or reflections which come from this passage.
- Take each sentence in the above paragraphs, turn it into a question for yourself and answer it.
The first requirement is that we be convinced that any life run on self-will can hardly be a success. On that basis we are almost always in collision with something or somebody, even though our motives are good. Most people try to live by self-propulsion. Each person is like an actor who wants to run the whole show; is forever trying to arrange the lights, the ballet, the scenery and the rest of the players in his own way.
For example: Am I convinced that a life run on self-will can hardly be successful? Even if my intentions are good am I always colliding with something or someone on the basis of self-will? Do I try to live on self-propulsion? Do I? Am I like an actor who wants to run the whole show; is forever trying to arrange the lights, the ballet, the scenery and the rest of the players in my own way?
- We want to concentrate especially on the following statement. “Driven by a hundred forms of fear, self-delusion, self-seeking, and self-pity, we step on the toes of our fellows and they retaliate. Sometimes they hurt us, seemingly without provocation, but we invariably find that at some time in the past we have made decisions based on self which later placed us in a position to be hurt.”
When have I been driven and acted on fear, self-delusion, self-seeking or self-pity? Remember anger is a reaction to fear and so is trying to control so add these to the list. Self-delusion are ideas about myself that are untrue, for example that I am right all the time. Self-seeking is always trying to get my own way which included greed but is not limited to it. Self-pity is sadness of loss especially of not getting what I want or my own way. List when I have acted in these ways. Have I stepped on toes? Do people retaliate whether consciously or unconsciously? Has someone hurt me seemingly without provocation? If I look into the past is there some action I have done based on fear, anger, control, self-delusion, self-seeking or self pity which is the basis of their hurting us?
This is a key self-exploration as it is in the above ways that we set up poisonous or toxic environments for ourselves. What emerges are major sources of stress for us and since stress sets off symptoms, many times we may get symptomatic over the retaliations we set up by our own actions. How are your symptoms related to retaliation from others due to you acting on fear, anger control, self-delusion, self-seeking or self pity?
- “We had a new Employer.”
Describe your perfect employer. What characteristics does he/she have? When you are done this can serve as a description of the God of your understanding. Begin here, this understanding will grow. This is the just a step toward understanding what God might look like to you. Even if you don’t believe in a God, could you turn yourself over to an Employer who had the perfect qualities you describe? If you don’t believe, turn yourself over to the qualities. They are higher than you. Unless you practice them 100% all the time.
“Most good ideas are simple, and this concept was the keystone of the new and triumphant arch through which we passed to freedom.” What is the keystone? Would we have known that God is the Director had we not tried to be stage director of life ourselves and failed? So what is the keystone? For the answer, click here.
- The final exercise is re-writing in our own words, the prayer
in Step Three and then praying it.
"God, I offer myself to Thee—to build with me and to do with me as Thou wilt./
Relieve me of the bondage of self,/
that I may better do Thy will./
Take away my difficulties,/
that victory over them may bear witness to those I would help/
of Thy Power, Thy Love, and Thy Way of life./
May I do Thy will always!”God will understand it, no matter how we say it. The important thing is that we understand what we are saying.
Step Four for Mental Illness
We “made a searching and fearless moral inventory of ourselves.”
This is like an inventory. As Bill W. says:
“A business which takes no regular inventory usually goes broke. Taking a commercial inventory is a fact-finding and a fact-facing process. It is an effort to discovery the truth about the stock-in-trade. One object is to disclose damaged or unsalable goods, to get rid of them promptly and without regret.”
An inventory is of both undamaged and damaged goods. As Bill points out, “One object is to disclosed damaged or unsalable goods…” Another is to disclose undamaged goods. So we will take an inventory, both positive and negative, of the people, institutions, principles, behaviors, frequent thoughts, typical re-occurring situations, and so on, including ourselves.
In the negative, we will focus on resentments. As Bill says: “Resentment is the “number one” offender. It destroys more alcoholics than anything else.” We will also later focus on fears and on sexual and other relationships.
There are reasons for including the positive besides making our inventory complete. Without the positive we don’t have a balanced view of the person, principle, institution, repetitive thought or situation. Our resentment inventory will be unbalanced and tend to become a “hate” list. Another reason is that a resentment usually has bite in it for us because we also like or in some way are attached to the person (or principle and so on) because of positives we see in them.
Resentments
So first list all the things that we resent.
Then list, for each one, all the positives.
Then list all the reasons for resentment, the exact nature of the wrong.
“We asked ourselves why we were angry.”
For each resentment list the area of self involved: personal or sexual relationships, security (what we need to survive), self-esteem (how we feel about ourselves), pride (how we think others feel about us), money, or ambitions (what we want).
For mental illness, we next look at how our resentments are related to our symptoms. Since resentments are a source of stress, we have discovered that symptoms are triggered by resentments. Which particular symptoms are related to each resentment?
Next, we look at what we looked at in Step Three: Where, before, during or after the wrong, was I fearful (or angry), self-deluded, self-seeking or self-pitying. How did I contribute to this resentment? We need to do this prayerfully. We need to look with the help of our Higher Power, with the God of our understanding. We might add to the above list from Step Three, “was I envious, boastful, arrogant, rude, inconsiderate, irritable, insisting on my own way, dishonest?” What was my role in this matter before during and after? Before the matter occurred, what were my expectations. Expectations are pre-meditated resentments or resentments waiting to happen. What did I do or not do? What were my responsibilities? In what way am I responsible, even if only in a small way, in this wrong? We find freedom insofar as we see we are the creators of our own resentments. For this we need prayer and our Higher Power’s support. “If we were to live, we had to be free of anger. The grouch and the brainstorm were not for us. They may be the dubious luxury of normal men, but for the alcoholic these things are poison.”
Finally, to borrow from the sex inventory, it is good to look at what we might have done instead.
Fear
“This short word somehow touches about every aspect of our lives. It was an evil and corroding thread; the fabric of our existence was shot through with it. It set in motion trains of circumstances which brought us misfortune we felt we didn’t deserve. But did not we, ourselves, set the ball rolling? Sometimes we think fear ought to be classed with stealing. It seems to cause more trouble.”
List all your fears. Start with those from your resentment inventory list, but add any fears not there. Spell out the exact nature of the fear. We ask why we were or are afraid and answer.
List how these fears are related to your symptoms.
“We reviewed our fears thoroughly. We put them on paper, even though we had no resentment in connection with them. We asked ourselves why we had them, wasn’t it because self-reliance had failed us? Self-reliance was good as far as it went, but it didn’t go far enough.”
What is the Solution?
“Just to the extent that we do as we think He would have us, and humbly rely on Him, does He enable us to match calamity with serenity.”
With each fear listed. List what you think your Higher Power would have you do.
Then pray to be reliant on your Higher Power.
When dealing with what we think our Higher Power would have us do, it is important not to trigger symptoms and delusions. It is good to look at what Bill W., the author of the AA Big Book, has to say. At the end of Step Nine, which means that when we have completed Step Nine and done all the steps up to there thoroughly, “We will suddenly realize that God is doing for us what we could not do for ourselves.” Put another way, God will NOT be doing for us what we CAN do for ourselves.” So don’t expect that your mental illness will suddenly disappear and you can throw away your medications. We must diligently make every effort we can to work with the situation before us and how we think and feel about that situation. Taking medications is one of the things we CAN do for ourselves.
On knowing what we think God’s will is, it is particularly easy to become delusional. Many of us have symptoms which tell us we know God’s will and this causes us untold problems. We, after all, don’t know definitely what God’s will is in any particular moment about any particular event. We know in general from sayings like “Love your neighbor as your self” and must work to apply it. Perhaps it would be helpful to quote what Bill W. had to say in the Twelve Steps and Twelve Traditions.
“Of course, it is reasonable and understandable that the question is often asked: “Why can’t we take a specific and troubling dilemma straight to God, and in prayer secure from Him sure and definite answers to our requests?”
This can be done, but it has HAZARDS. We have seen AA’s ask with much earnestness and faith for God’s explicit guidance on matters ranging all the way from a shattering domestic or financial crisis to correcting a minor personal fault, like tardiness. Quite often, however, the thoughts that seem to come from God are not answers at all. They prove to be well-intentioned unconscious rationalizations. The AA, or indeed any man, who tries to run his life rigidly by this kind of prayer, by this self-serving demand of God for replies, is a particularly disconcerting individual. To any questioning or criticism of his actions he instantly proffers his reliance upon prayer for guidance in all matters great or small. He may have forgetten the possibility that his own wishful thinking and the human tendency to rationalize have distorted his so-called guidance. With the best of intentions, he tends to force his own will into all sorts of situations and problems with the comfortable assurance that he is acting under God’s specific direction. Under such an illusion, he can of course create great havoc without in the least intending it.”
So what is God’s will? Above, we mentioned one saying from the Bible. The prayer that Bill W. recommends is from Saint Francis of Assisi. It is in meditating on the meaning of such prayers and sayings that we arrive at insights into actions we might take in any particular situation. But as Bill W. points out we have no definite assurance.
The Simple Prayer of St Francis:
“Lord, make me a channel of thy peace—that where there is hatred, I may bring love—that where there is wrong, I may bring the spirit of forgiveness—that where there is discord, I may bring harmony—that where there is error, I may bring truth—that where there is doubt, I may bring faith—that where there is despair, I may bring hope—that where there is shadows, I may bring light—that where there is sadness, I may bring joy. Lord, grant that I may seek rather to comfort than to be comforted—to understand than to be understood—to love, than to be loved. For it is by self-forgetting that one finds. It is by forgiving that one is forgiven. It is by dying that one awakens to Eternal Life. Amen.”
Sex and Other Relationships
First look at your sexual conduct over the past years.
“Where had we been selfish, dishonest, or inconsiderate? Whom had we hurt? Did we unjustifiably arouse jealousy, suspicion or bitterness? Where were we at fault?
Again, as before, how are our symptoms of mental illness related to our sexual conduct, selfishness, dishonesty, inconsiderateness, our hurting others, our unjustifiable jealousy, suspicion and bitterness.
Finally, “What should we have done instead?”
With this wisdom in hand ask God, “to mold our ideals and help us live up to them.” Our sexual powers are from God. They should be used for good, “neither lightly or selfishly nor to be despised and loathed.”
Now that we have an ideal we must be willing to grow toward it remembering that we expect progress not perfection.
Now list your relationships of most importance over the past years and ask the same questions as in the sexual conduct inventory. And finally formulate an ideal about relationships in the same way with prayer.
Step Five For Mental Illness
Admit to God, to ourselves and another human being
the exact nature of our wrongs.
In the Big Book of Alcoholics Anonymous this chapter is called into action although it took a lot of action in Step 4 to list our symptoms and triggers as they pertain to our diagnoses and to list our resentments, fears, and relationships including sex. This was an opportunity for us to become even more free of fear and distrust.
In Step Four we started to learn about faith by trusting that God was going to take care of us as we started to pull up all the things that have been standing in our way.
In Step 5 we continue to build on our faith that God will take care of us and trust that the person that we choose to hear what we had gotten down on paper in our fourth step will not judge us or criticize us. The reason we tell another person is because it is easy for us to lie to ourselves. We may minimize it or we may embellish it in our own heads but if we choose a person to tell that we trust then that person will be able to help us recognize patterns of our actions. We will start to understand what they were talking about in Step Three, our selfishness and self-centeredness and how we step on the toes of our fellows when we are in fear, self-delusion or self-pity. We start to see how we turned our assets which are God-given into defects of character.
After we have shared our fourth step with God and another human being, we put our fourth step away in a safe place. It is suggested that you sit back and relax for a few minutes realizing that you have just let go of a lot of garbage that you have been carrying around with you for many of years.
Please do not burn or mutilate your fourth step because you will be using it on through Step Nine.
Steps Six Through Twelve For Mental Illness
For Steps Six through Twelve, use the AA Big Book. We will have comments in the future.