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."

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