What is recovery? Recovery in mental illnesses can mean living a meaningful and productive life despite a disability. It can also refer to a reduction or complete remission of symptoms and a healing transformation of the self. For most people, it refers to the power of hope in healing disorders that were once thought to be hopeless. As Henry Ford once said, "Whether you think you can, or you think you can't, you're right."

Sunday, September 2, 2012

Crazy Like Us on Madness Radio

Madness Radio is a wonderfully informative and entertaining source of alternative perspectives on mental health, hosted by Will Hall, survivor of a schizophrenia diagnosis. I recently listened to Will's interview with Ethan Watters regarding Watters’ book, Crazy Like Us: The Globalization of the American Psyche.  Watters’ theory is that our own ideas about the nature of mental disorders unconsciously influence their literal manifestation. Based on this theory, he further argues that America globally exports not only its categorization and treatment of mental disorders, but the nature of these disorders themselves. He makes a fascinating case for this, beginning with a description of an explosion in anorexia in Hong Kong following the introduction of Western ideas about it. Watters is not arguing that anorexia did not exist in Hong Kong prior to the importation of American ideas about it, but that it existed in much smaller numbers and with a different clinical picture. He says that the introduction of new ideas about anorexia unconsciously gave people new ways to express their suffering. This is a fascinating interview that I think everyone interested in mental health should hear. I hope to read Watters’ book when I get a chance. 

Watters, E. (2011, January 2). Interview by W. Hall. Exporting Mental Disorders. Madness Radio. [Audio file]. Retrieved from http://www.madnessradio.net/madness-radio-exporting-mental-disorders-ethan-watters

Psychotherapy research and the benefits and limitations of the scientific method

As a little girl I wanted to be a scientist. While pursuing my more recent goal of becoming a psychotherapist, I read with interest the many benefits that the scientific method provides to psychotherapy. Unlike Garb, Lilienfeld, and & Fowler (2012, p. 139), I do not doubt that intuition can hasten scientific knowledge and I know from reading Damasio (1995) many years ago that logic cannot exist without intuition. Because of the many cognitive biases that therapists, like other humans, are prone to, however, I do agree that an over-reliance on intuition can be detrimental to psychotherapy. As an example, one study showed that therapists who treat phobias are much more effective when using empirically supported treatments than when designing their own treatment plans (Stewart & Chambless, 2012, p. 152). However, I observe two limitations of the scientific method that are relevant to psychotherapy research. 

The first regards the observer effect, discovered in physics, in which the act of observation affects the phenomenon being observed. The allegiance effect, in which the treatment favored by the researcher almost always beats out the competition (Lebow, 2010) seems like a form of the observer effect. Our beliefs always affect our outcomes, thus a third “effect,” the placebo, and its twin, the nocebo (which occurs when negative expectations about a treatment lead to negative outcomes). I disagree with Stewart & Chambless’ conclusion that the case of mesmerism, which was revealed to be entirely placebo, “illustrates the dangers of reliance on uncontrolled observations of practitioners and patients” (2012, p. 152). While there are indeed dangers to reliance on uncontrolled observations, mesmerism to me is an example of the extraordinary healing power of the placebo, which by itself is not dangerous. If I had a disorder, and someone cured it by waving a bunch of harmless and ineffective magnets around me, I would happily accept the cure, even knowing it was done by placebo (and research shows it is possible for me to know something is a placebo and still benefit from it, according to Lipton, 2005, p. 140). I would not want to wait around for something empirically supported to cure me, based on the misguided notion that this was more scientific. Research supports the use of the placebo itself, and as Lipton (2005) and others have pointed out, when the placebo itself is so powerful, we ought to study it more, or at least, as we have already done to some extent, study the related “non-specific factors common to all treatments such as hope, expectation of change and a good relationship with the therapist” (Stewart & Chambless, 2012). 

My second reservation regards ethics in research. I was disturbed to see Stewart and Chambless advocate that psychotherapy research strive to achieve the “rigorous testing” of pharmaceuticals required by the Food and Drug Administration (2012, p. 150), since research by Whitaker (2002) has demonstrated that the FDA is not preventing ineffective and harmful psychiatric drugs from getting onto the market due to sneaky tactics on the part of pharmaceutical companies. The Transparency for Clinical Trials Act is designed to close some of the loopholes that allow dangerous drugs to be approved (Drazen, 2012), although should the act be approved, further repairs to the approval process may also be needed. Psychotherapy should be rigorously tested, to avoid treatments that are harmful or ineffective, but if psychopharmacaology research is our current best practice standard, we are in trouble. 

If we keep in mind the effects of beliefs and ethics (or lack thereof) of those involved in all stages of research, the scientific method can contribute much to the field of psychotherapy. We must always keep learning, however, for as Watters (2011) and others have pointed out, disorders can change across time and culture. 


Damasio, A. (1995). Descartes’ error: Emotion, reason and the human brain. New York: HarperCollins. 

Drazen, J. (2012, August 8). Transparency for clinical trials: the TEST Act. New England Journal of Medicine, 367: 863-864. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMe1209433

Garb, H., Lilienfeld, S., & Fowler, K. (2012). Psychological assessment and clinical judgment. In Maddux, J. & Winstead, B. (Eds.), Psychopathology: Foundations for a contemporary understanding (3rd ed.), pp. 121-144). New York: Routledge, Taylor & Francis Group. 

Lebow, J. (2010). Big squeeze: No research, no reimbursement. Retrieved from http://moodle.prescott.edu/mod/resource/view.php?id=82016

Lipton, B. (2005). The biology of belief: Unleashing the power of consciousness, matter & miracles. Santa Rosa, CA: Mountain of Love/Elite Books. 

Stewart, R. & Chambless, D. (2012). Psychotherapy research. In Maddux, J. & Winstead, B. (Eds.), Psychopathology: Foundations for a contemporary understanding (3rd ed.), pp. 145-160). New York: Routledge, Taylor & Francis Group. 

Watters, E. (2011, January 2). Interview by W. Hall. Exporting Mental Disorders. Madness Radio. [Audio file]. Retrieved from http://www.madnessradio.net/madness-radio-exporting-mental-disorders-ethan-watters

Whitaker, R. (2002). Mad in America: Bad science, bad medicine, and the enduring mistreatment of the mentally ill. New York: Basic Books. 

Tuesday, August 28, 2012

Letting go of hubris and learning from clients

Maddux & Winstead (2008) report that clinicians do not show better clinical judgment than a lay judge. Furthermore, although clinicians believe that their clinical experience increases their diagnostic ability, the research shows that this is not true (Maddux and Winstead, 2008). "The relation between clinical experience and judgmental accuracy has been weak in most studies of personality and psychopathology assessment” (Maddux & Winstead, 2008, p. 114).

I have noticed that a disturbing number of mental health professionals believe that their degrees and experience qualify them to diagnose people and determine all kinds of things about them without spending very much time with them or sometimes without even meeting them. Just today I had a counselor tell me that my client obviously does not need disability benefits based on very little information that I provided. I have spent hours interviewing this particular client to determine if she meets Social Security's requirements for said benefits, but this person believes she can determine this based on one sentence! I wish I could say that this is the first clinician whom I've witnessed exhibit such hubris, but that's far from the case.  

I have a theory that there is potential for clinicians to learn from experience if we stop assuming that we know so much from the beginning. As a profession, if we assume less about clients and stop trying to figure them out with increasing speed, and instead keep an open mind and listen, we can indeed learn from experience. This experience however, should never cause us to reach the point where we believe we cannot learn more from our clients. I am reminded of a quote: "Knowledge speaks. Wisdom listens."

Maddux, J.E., & Winstead, B.A. (2008). Psychopathology: Foundations for a contemporary understanding (2nd ed.)New York, NY: Taylor and Francis Group. 

James Holmes: an example of why we need diagnosis?

Someone recently suggested to me that diagnosis is necessary because of violent individuals like James Holmes, perpetrator of the recent shooting in Aurora, CO. This person said, "We must be able to define abnormal behavior which monumentally affects the individual and poses a threat to society... [James Holmes] clearly is mentally ill and probably has an identifiable psychological disorder." This person is making the assumption that (1) James Holmes was not diagnosed and did not receive treatment prior to the shooting and (2) if only he had been diagnosed, he would have received treatment that (a) helped him and (b) would have prevented the shooting. The person is also conflating mental illness and violence. While I agree that it is part of the role of mental health counselors to address and prevent violence, I think we are treading on dangerous territory and promoting stigma when we are not careful to differentiate mental illness from violence. See my earlier post, America's Gun Problem is Not About Mental Illness. 

James Holmes saw at least three mental health professionals before his crime. Unfortunately, the right steps were not taken to help this man or prevent his crimes. I do not know whether he was taking psychiatric medications, but there is also the issue of akathisia, a side effect of some psychiatric medications that has been linked to violence and suicide by a number of professionals, including psychiatrist Peter Breggin, author of (among other things) Medication madness: The role of psychiatric drugs in cases of violence, suicide and crime. James Holmes told a classmate four months in advance that he wanted to kill people. I do not know what, if any, label James Holmes received from the mental health professionals he saw, but for me his case is not a question of his diagnosis. My question is, how can we educate society so that people such as his classmate, who knew of Holmes' plans months in advance, know what to do with such information? And much more importantly, how could the mental health system have better engaged Holmes when he was at the door, finding ways to heal him so that he could feel at peace, for his own good and that of all the lives later lost in Aurora? I don't know the answer, but I do know that it does not lie in the DSM. 

Apples and disorders

Can we define psychological disorders? Should we try?

We can never really truly define what constitutes a psychological disorder, but this hasn’t stopped us from trying. I think the trend away from categories and toward dimensions will further our understanding, but it doesn’t and cannot eliminate all barriers to clarity because a psychological disorder can never be as easily pinpointed as say, an apple. This is in part because there is not as much at stake in the definition of an apple. As David Patrick concluded, “the concept of mental disorder is of dubious scientific value but it has substantial political utility for several groups who are sane by mutual consent” (qtd. in Maddux & Winstead, 2012, p. 15). Every single person on the DSM-IV workgroups responsible for the definition of mood and psychotic disorders received funding from pharmaceutical companies (Maddux & Winstead, 2012). Although most of those people may truly believe that psychological disorders are caused by (yet to be discovered) chemical or genetic imbalances that can only be corrected with medication, this, too, is a problem, because disorders are being defined based on the limited views of one profession, with less consideration to the views and experiences of counselors, psychologists, and particularly consumers. This is by design, because “the purpose of DSM-III... was to allow psychiatry a means of marking out its professional territory” (Maddux & Winstead, 2012, p. 15). When people define disorders so that they can get in or remain in power and/or profit, our understanding remains clouded. Other obstacles to definition include vast differences in disorders between different cultures and individuals. Yet we can do our best to define psychological disorders by continuing to revisit the issue and looking at various perspectives, rather than remaining frozen in one viewpoint. We need more thinking, for example, about why third world countries have much higher rates of recovery from schizophrenia than first world countries. What can we learn that will help us better define psychotic disorders and improve worldwide rates of recovery? The Psychodynamic Diagnostic Manual (PDM Task Force, 2006) is another step toward a deeper understanding, offering a complementary (or alternative) perspective to the DSM.

A related question tugs at my mind. While we are defining disorders, why are we choosing to define them as disorders? Why must we see people with mental health challenges as broken? I see people with mental illnesses as coping as best they can with psychological, social, spiritual and biological challenges. Evidence of post-traumatic growth (Woodward & Joseph, 2010) and post-psychotic growth (Williams, 2012) indicates that what we view as disorders are often healing in and of themselves. The mere idea of disorders assumes a mechanistic rather than naturalistic viewpoint. I see therapists not as mechanics but as guides and supporters along a challenging path of healing. 

Maddux, J. & Winstead, B. (2012). Psychopathology: Foundations for a contemporary understanding (3rd ed.). New York: Routledge, Taylor & Francis Group. 

PDM Task Force. (2006). Psychodynamic diagnostic manual. Silver Spring, MD: Alliance of Psychoanalytic Organizations. 

Williams, P. (2012). Rethinking madness: Towards a paradigm shift in our understanding and treatment of psychosis. San Rafael, CA: Sky’s Edge Publishing. 

Woodward, C. & Joseph, S. (2003, September). Positive changes and post-traumatic growth in people who have experienced childhood abuse: Understanding vehicles of change. Psychology and Psychotherapy: Theory, Research and Practice, 76(3): 267-283. doi: 10.1348/147608303322362497. Abstract retrieved from http://onlinelibrary.wiley.com

Diagnosis: Helpful yet destructive

     I am inclined to agree with therapist Daniel Mackler, who wrote, “The diagnostic categories we presently use are so often arbitrary, misleading, stigmatizing, or just downright wrong (and at times all of these) that they end up doing far more harm than good” (2011, Abandon Diagnosis and the DSM section, para. 2). Because our society would have to change much more drastically than can be expected in the near future, however, I think Mackler’s call for an abandonment of diagnosis is premature. Diagnosis plays a small, valid role in psychotherapy, but it must be “applied properly and its limitations... understood” (Frances, 2010, Afterword, para. 1).
  Diagnosis can lead to discrimination by society, the justice system, the insurance industry, and even the mental health system. (If you don’t believe the latter, ask anyone with borderline personality disorder.) 
  Mackler argues that there are three groups who benefit from DSM diagnosis: (1) the pharmaceutical industry, (2) psychiatry, and (3) some consumers. As Frances points out, “biological psychiatry has failed to produce quick, convincing explanations for any of the mental disorders” (2010, The Epistemological Game section, para. 4), yet most people believe that behind each and every disorder is a meticulous biological explanation that will direct them to a quick pharmaceutical solution. Far too much weight is placed on diagnosis and the related drug treatment. Diagnosis can also provide some relief for consumers, but in my experience this relief often seems more like resignation. Mackler articulates a similar experience: 

...the saddest group to benefit from diagnosis is a not insignificant subset of consumers themselves:  those who are so broken, both by the traumas of their childhood and the traumas they’ve suffered at the hands of psychiatry, that they have lost hope. Diagnosis gives them an excuse not to have to struggle anymore.  It tells them that their brains are hopelessly broken and that they can never recover.  And far too many find a tragic comfort in that.

  Diagnosis does not need to be associated with the myth that recovery is impossible, however. It can serve a limited, positive role that allows therapists and researchers to share a common language, points in a very general direction to treatment options, and allows people to obtain needed disability benefits and treatment. Yet far more important than the label we fix to each person is their individual story. If we can remember this,  make sure our clients understand it, and most of all listen carefully, we may be able to use diagnosis for good rather than evil. 


Mackler, D. (2011). Ten ways to revamp the mental health system. Retrieved from http://www.iraresoul.com/RevampMH.html

Frances, A. (2010). DSM in philosophyland: Curiouser and curiouser. Bulletin of the Association for the Advancement of Philosophy & Psychiatry , 17(10).

Thursday, July 26, 2012

America's gun problem is not about mental illness

I'm getting aggravated listening to everyone talk about how we could solve all our country's gun problems if we just took guns out of the hands of people with mental illness. Statistically, people with mental illness do not commit more crimes than the average person, unless they also abuse substances. They are, however, more likely to be victims of crimes. Keeping guns away from people with mental illness would only work if we (a) redefined mental illness so that it actually meant propensity to shoot people, which is does not, and (b) obtained an all-knowing crystal ball that will tell us ahead of time who is going to develop mental illness, or for that matter, become a criminal.

- Posted using BlogPress from my iPad

Monday, January 30, 2012

Hope in Therapy

The following is an excerpt from a homework assignment about truth in psychotherapy:

I have met many clinicians who believe that people with certain disorders are untreatable and have little or no hope for recovery. They push this “truth” upon their clients, honestly thinking they are sparing them later disappointment, when they are actually hurting them by squelching hope. I can no longer locate the exact source, but psychiatrist Daniel Fisher, himself completely recovered from schizophrenia for decades, has argued that the only thing worse than false hope is false hopelessness. McWilliams (2004) writes:

Frieda Fromm-Reichmann used to try to assign the most “hopeless, untreatable” psychotic patients to the least experienced therapists at Chestnut Lodge, because those therapists did not know they were hopeless and untreatable and consequently succeeded in helping them (p. 47).
Did the less experienced therapists not know the “truth” that these clients were “hopeless and untreatable”? Or were the more experienced therapists, due to burnout and discouragement from failure in the past, unaware of the truth that these clients were treatable and worthy of feeling hopeful? Even when it is true that we do not yet know how to help certain people, it is also true that we continue to learn and find new ways of helping others. 
McWilliams, N. (2004) Psychoanalytic psychotherapy: A practitioner’s guide. New York: Guilford Press.

Wednesday, January 4, 2012

Love: A Key to Recovery

Your experience may be different, but for me, love was absolutely key to recovery. Some of you may be groaning at what at first blush may seem to be my sappiness. But without love for someone or something (by no means does it need to be the romantic kind!), there seems to be no reason to live. During my years of depression I did not realize that my primary problem was a lack of self-love. As I descended into psychosis at age 25, this lack escalated into off-the-charts self-loathing. Way, way off the charts. The voices that I heard at the time, rather than reflecting a chemical imbalance (although one may have existed), were mainly mirroring a deep disgust for everything that was me at the time. When I thought my problem was [insert reason to hate myself], my problem was really the hatred itself. For many years, it didn't really occur to me that there was any other possible reaction, but of course there always was. After attempting to kill myself because I believed God wanted me to do so, my true higher power led me the book A Return to Love by Marianne Williamson. In reading it, I was inspired to believe that maybe- just maybe- it was possible to love myself and forgive myself for my perceived transgressions. One night, I lay awake at 3 am, mentally calling out to forces I wasn't sure existed and asking them for some sign that it was true that I was lovable.  Immediately Abby, our beloved (since passed) family cat bounded into the room and onto my bed, purring and rubbing against me lovingly, a seeming answer to my prayers. Yet the idea of self-love at first perplexed me, since I mistakenly thought that love was something that happened to people, rather than a choice you can make at any moment. It occurred to me visualize love as an energy coming out of my heart and surrounding me. It worked! I "relapsed" into self-hatred a few times, because I believed I had wronged others and therefore didn't deserve the love I was giving myself. I quickly learned that a reduction in self-love led to a reduced ability to love others. Even though I did not "deserve" this love, I thought, I knew that family and friends deserved the love that I would be able to give them as a result, and so I kept moving forward with my self-love efforts. Eventually I learned to love myself for who I am. I am pretty awesome! Yet I could never have accomplished these self-love goals, and thus, my recovery, without those around me who loved me deeply even when I gave them back nothing but ugliness and living nightmares. It was my family and friends who gave me a reason to recover and to keep on living when life otherwise seemed like an endless hell due to my illness. How has love helped, or not helped, you? What or whom do you love that makes your life worthwhile?

Monday, January 2, 2012

Interesting thought

This comes from a retired colleague whom I admire:
A person can be involuntarily committed, having their right to freedom taken away, if they are considered a danger to themselves or others because of a mental illness, but not if they are a danger to themselves or others for any other reason. 

Provocative Ideas from Daniel Mackler

Ten Ways to Revamp the Mental Health System

Among other things, #4, Clients have a right to commit suicide, and no one has a right to stop them, is sure to provoke some strong reactions. What do you think? Is he right that this would actually reduce suicide?

Medication does not equal Recovery

Medication is a tool that many people use for recovery from mental illness that they may find helpful or even life-saving. I respect their choice to do so yet maintain that recovery and "taking your meds" are not the same thing, even though they are often promoted as equivalent. Here are fourteen reasons why. 

1. For most people in recovery, it is so much more important that you show them kindness and compassion and believe in them than it is that you find the right cocktail of chemicals for their brains. 
2. Our overemphasis on medication, as well as our general idea that professionals know best and sick people need to "comply" with their recommendations, encourages the ideas that there is nothing anyone can do on their own to help themselves to recover, that they are at the mercy of themselves and their professionals, and that it is okay to spend months or years waiting to "find the right meds" without doing anything toward one's recovery because it isn't believed there is anything one can do. This encourages hopelessness, and leaves the locus of control externally instead of internally. Others have pointed out that medication numbs problems needing to be solved, leaving them inaccessible, like removing the warning light on one's car rather than fixing it. A refusal to rely on only one path to recovery opens people up to a world of recovery possibilities.
3. Decades of trying has never proven the chemical imbalance theory. To the contrary, it has been shown that there is absolutely no specific chemical imbalance that correlates with any disorder, except after the person starts taking medication. Somehow we're still sold on the theory anyway. Pharmaceutical company marketing has quite a bit to do with that.
4. Meanwhile, the focus of much cutting edge mental illness research has switched to genetics (and drugs that might alter genes), although many genetic theories of the past have been disproven time and time again. The amazing field of epigenetics shows that our genes can be turned on and off by our environment and even, as suggested by Bruce Lipton in The Biology of Belief, by our own choice of thoughts. So whatever links may be found in the future between genes and mental illness will not prove that people can never recover.
5. Psychiatric medication was not invented to ease the symptoms of mental illness. It was invented to quiet the patient, originally advertised as a "chemical lobotomy." This is part of a long history of mental health "treatments" that have focused quite narrowly on whether the patient is outwardly quiet and agreeable while completely denying and ignoring their inner experience. 
6. Scientists are hired by pharmaceutical companies and paid exorbitant amounts of money to "prove" that their pharmaceuticals work. 99% of these studies are withdrawal studies, which means that study subjects are given a medication until they are dependent on it, and then half the subjects are rapidly withdrawn to see how they do. The fact that they deteriorate is used as evidence that the medication "works," even though logic tells us that a real study would show that medication made sick people better. Pharmaceutical companies only have to show a very low number of these "good" (mostly withdrawal) studies to have their drug approved by the FDA, and are allowed to sweep an absolutely unlimited number of "bad" studies under the rug and never publish them.
7. Yes, you can have withdrawal effects from psychiatric medication, even though most of them are not addictive in the same way that addictive drugs are. There is such a thing as a rebound psychosis, and many other mental health problems that are not caused by, or related to, a person's original disorder, but are used as "evidence" that the person needs to stay on medication for the rest of their lives. People are told that they can only stop using their medication with the help of a doctor. This is good advice in one sense because if not done slowly and carefully, withdrawal can cause severe side effects and, in the case of clozaril, even kill you. Yet there is an extremely low number of psychiatrists who will actually help you with this. Most of us who have gone off previously prescribed psychiatric medication have been forced to do so without a doctor's assistance, in some cases secretly pretending to to continue to take the medication, in order to avoid forced hospitalization and other punishments. It doesn’t have to be this way.
8. Medications that act on the brain come with a much higher rate of side effects than any other class of medication. These side effects include (among a ridiculous number of other things) permanent brain damage, and an increased risk of violent of suicidal tendencies along with otherwise often causing the very problems they purport to solve. Yet if problems happen when the person is on medication, this is considered evidence that the person needs more or a different medication. If it happens when the person is not on medication, this is also taken as evidence that they need to be on medication. The psychiatrist Peter Breggin has written extensively on the dangers of medication. 
9. There's been a recent focus on trauma-informed care as we've rediscovered what many already knew- that childhood trauma can play a primary role in mental illness as well as in addiction and many physical illnesses. An insistence on compliance, forced treatment, and other ways we deny respect to people with mental illness can re-traumatize people and trigger old traumas, so that overly zealous attempts to help often leave people feeling worse, not better. An estimated 90% of people in the mental health system have experienced childhood trauma. Instead of asking, what's wrong with you (and therefore, what drugs can we give you), we need to be asking, what happened to you?
10. People with mental illness die 25 years earlier than people without. Some of this is likely the physical illnesses that are correlated with trauma, which again, is correlated with mental illness. Some of it is bad habits such as the high rate of smoking among persons with mental illness, or poverty and/or lack of education that may lead people to eat poorly. And some of it is the many horrendous effects that are caused by psychiatric medication.
11. People can recover completely from mental illness. It is not always (or even usually) a lifelong process. People in other countries and time periods and in alternative treatment systems have far higher rates of recovery than we do in America's modern mental health system. Journalist Robert Whitaker points to studies that indicate that medication can turn what might otherwise be a temporary illness into a chronic illness, by altering the chemistry of the brain. Researcher Courtenay Harding argues that there may be only a tiny percentage of people with very severe illness who need medication indefinitely. 
12. Recovering without medication doesn't imply that you were less sick than others, or that you were misdiagnosed. Not recovering, or not recovering to the extent that you or others might like, doesn't imply you are less than. Taking (or not taking) medication doesn’t mean you are less than.
13. Keys to recovery include hope, love, mindfulness, and self-determination (often the opposite of compliance). Everyone has to- or rather, gets to- find their own path to recovery. There is no one solution to everyone's illness, and there absolutely never will be. Medication is just one tool that some people find works for them. That doesn't mean it works for everyone. No one's path to recovery will work for everyone. 
14. You can recover, too. Maybe it means “full” recovery, maybe it doesn't. Just don't let anyone else take your hope or your dreams away. What, if any, dreams have you let go of because you were told you would be sick forever? 
Primary Sources

Robert Whitaker and personal experience

Further Reading