Drowning in Shallow Waters: A Star is Born Shines a Light on Co-Dependency and Substance Abuse

With the Oscars just days away, the films that are nominated as the best of the year can illustrate much of the work we face each day as psychiatrists.

Due to its pervasiveness, the leaching landscape of substance abuse provides fertile ground to cultivate the dangerous seeds of co-dependency.  As professionals who chose to dive headfirst into all makes of dysfunction, psychiatrists and other mental health professionals likely encounter this behavioral and emotional phenomenon often. It may present itself as the overly avoidant patient who’s loved ones enable their misanthropic tendencies. Or perhaps you have enough self-awareness to recognize the patterns of co-dependency in your own life? Unfortunately, if we look at one particular subset of the population, it is obvious that the number of people who find themselves in such a dyad, far surpasses the number of mental health professionals there will ever be at one time.  According to the WHO, some 31 million people suffer from some form of substance abuse. Of that 31 million, it is estimated that about 4 million of them suffer from alcohol use disorder. 

As you can imagine the with diversity that exists amongst the millions of people who suffer from the disease, alcoholism can look different depending who you talk to. The illness can run the gamut from fairly inconspicuous to severely debilitating. While the media does not always do a good job at portraying the many facets of the illness, even fewer outlets do so while being honest and disturbingly entertaining. A Star Is Born, a film produced and directed by Bradley Cooper and starring himself and Lady GaGa, manages to do just that. This is the fourth remake of the film, which was first released in 1937 and originally starred Janet Gaynor and Frederic March. The 1954 versions cast Judy Garland opposite James Mason, and a later much acclaimed version starred musical powerhouses Barbra Streisand and Kris Kristofferson in 1976. 

This version, however, feels more befitting for our time. Not only does the film give us a front seat to the wild ride that is a viral rise to fame, but it also poignantly illustrates the mosaic of tenderness and cruelty that sustains co-dependent relationships. Although the term co-dependency is now broadly used to describe any type of unhealthy relationship that people can share with those close to them, it initially was reserved for partners of chemically dependent persons.  Although prior versions of the film touched on the issue of alcoholism, Cooper's film does so whilst acknowledging its place in the broader landscape of substances, specifically pharmaceutical drugs in the form of sedatives, hypnotics, and painkillers. According to the National Institute of Drug Abuse, eight to 12 percent of those who are prescribed an opioid will develop an opioid use disorder. Due to their similarly sedating effects, it is common to find the abuse of alcohol and pharmaceutical drugs in the same users. As the current opioid crisis has unfortunately reminded us, an individual's relationship to substances of abuse often start as a legitimate therapeutic modality. So is the backdrop of Bradley Cooper's character Jackson Maine, a now fading country music star who suffers from the untended emotional scars of generational trauma, and the physical scars of chronic pain and premature hearing loss. Littered throughout the film are a deluge of drug paraphernalia and problematic behaviors. Jackson maintains his limp grasp of fame on a regimen of alcohol, steroid injections, prescription pills, and self-loathing.  

A brief, but memorable moment, was when Bradley's character Jackson Maine used the weathered heel of his cowboy boot to crush an assortment of pills, which he promptly snorted, before sprinkling its remnants into a glass of dark spirit. Whilst the scene had the desired effect, I realized later the shock I felt was misplaced. His behaviors are neither far-fetched or uncommon, and as physicians we try to approach that cognizance without judgment. Similarly common, was a scene where for the first time Ally sees an inebriated Jackson black out drunk. The man who a moment ago was charming and quick witted, became pathetic and sad. It was foreboding. It should have served as a warning for her—every fiber in me wanted to grab Ally and yell RUN!  

But she didn't run. And I can't tell you exactly why. Of course, there are beautiful moments, like when Jackson coaches Ally through the jitters of her first recording studio session, or when he nursed her swollen fist with frozen packs of vegetables. But accompanying the tenderness was also darkness. While there was no instance of physical violence between them in the film, the trauma was there. It took the form of jealousy, self-sabotage, enabling and denial. Like many partners of people suffering from chemical dependency, Ally finds that an integral part of her identity and her happiness, are tied to Jackson. This fact can be lost on physicians, that addiction treatment must not only consider what the addiction does for the addict, but also what it can do for the recurring key players in an addict's life. 

As I said, I could not tell you exactly what Ally was thinking. But I can tell you that whatever she was thinking, it would have helped her to share those thoughts with someone. Psychotherapy, while almost globally recommended for those who suffer from substance use disorders, is often overlooked as a resource to their partners. In an environment where healthcare is not universal, assuring that these resources are affordable and accessible to populations that need them, is nearly impossible. Every effort should be made to offer resources and referrals that are not only clinically appropriate, but also economically feasible. Though we are not treating the family, frequently the notion of family or individualized therapy should be raised for partners and immediate family, as our patients are better served by a network of individuals that are themselves mentally robust and supported. In the film, the music seems to serve as a poor replacement for therapy for both of the main characters, with unfortunate consequences, reminding us that the movies are not always what we want to see in real life.

Using Mindfulness to Heal Ourselves

We spend so much of our lives planning for the future or replaying the past that we miss the only moment we ever have, the present moment. It’s never the past or the future, those are just thoughts in our head; it’s only ever right now. The present moment is the only moment we can ever truly experience real joy or connect deeply with others.

Some of us tend to spend a lot of time going over events that happened in the past. We may replay difficult conversations or interactions that happened in our personal or professional relationships. Or we may ruminate on our perceived failures, whether they be large or small, at home or at school or work.  We can also become preoccupied by how we feel others have failed us or on other hardships we have endured such as divorces, illnesses, and deaths. We begin to feel defined by our pasts and we carry the weight of them with us.   

Many of us also worry about problems that never happen and plan for futures that end up very different from how we had originally planned. The difficult things that do happen in our lives we usually don’t anticipate. When we spend so much of our time worrying and planning our futures, we miss out on what is happening right now. We develop strong habits of compulsively inhabiting hypothetical futures and so when that future comes, we automatically start living for the next future and so on and so forth until our lives pass us by.

Practicing mindfulness brings us back to the present moment where our true power lies.     

One of my favorite sayings is that our mind is a wonderful servant but a poor master. Our minds produce thoughts like our mouths produce saliva. It’s nothing personal or necessarily wrong with us, it’s just what minds do. Practicing mindfulness strengthens our ability to see our thinking for what it is: a powerful tool that we employ when it is helpful and let go of when it is not.  Mindfulness also helps us manage strong emotions as well as physical pain.

The practice of mindfulness is returning, time and time again, to the present moment. We do this in a relaxed, kind, and gentle way, releasing any judgments or analyses of how we are doing or what is happening in the present moment. If there is pain, suffering, shame, anxiety, depression, stress, overwhelm, conflict, or trauma, we simply show up in a kind and loving way.

 We can practice mindfulness informally throughout our day or through formal meditation, which is often sitting meditation but can also be walking or other movement meditations. The informal practice of mindfulness consists of building awareness around when our attention has left the present moment (often to the past or the future) and once we become aware, returning back to now.  

There are numerous anchors to the present moment that we can always return to. One is the sensation of our breath in our bodies, typically where our breath feels the most pleasant. We are not thinking about breathing, we are feeling our breath in our abdomen as it rises and falls, or in our chest as it expands and contracts, or even as the air moves in and out of our nostrils. Other anchors include our other senses perceptions, which only happen in the present moment. You can feel the surfaces you are sitting, standing or lying upon, listen to the sounds around you or feel the wind on your face.   

The formal practice of meditation is often done sitting. Many people like to begin meditating with guided meditations but you don’t need to. Starting a meditation practice can be as simple as setting a timer for five minutes, bringing your attention to the feeling of your breath in your body, noticing when your attention wanders, and returning to your breath. Even though we are sitting, our mind is often in other places and mindful meditation brings our mind back into union with our body. Every time you return to the present moment you strengthen your ability to do so in the future. 

Fully inhabiting the present moment takes practice but ultimately allows us to release what doesn’t serve us and show up for ourselves and others in an honest, powerful, and loving way.