Monday, October 1, 2012

Recovery - From What?

Recovery is the individual lived experience of moving through and then beyond the limitations imposed by the disorder, by the world around us, and even by the treatment itself.

Huh?

Okay, the deal is, unless you know where you are going, it's tough to get there.

Recovery Defined as Escape from the Symptom Silo

The docs know where they want to go.  They want to get rid of your symptoms.  Your illness is defined by a list of symptoms, found in the DSM and measured by survey instruments, and when you score in the normal range, then you have recovered.

Which is sort of like saying that if you don't have chest pain or shortness of breath, then you have recovered from heart disease.  Cardiologists don't think that way.  They want to know the condition of your heart, not just your symptoms.


But that is the state of psychiatric medicine.  Psychiatrists do know where they are going, and what kind of response they want out of you, and they will keep feeding you more and more powerful medications, until they get the measures they want, which is, how you report your symptoms, the ones on their list, anyway.

People with mental illness have a different goal.

Recovery Defined as a Lived Experience

We have to live with this stuff.  Even when our scores improve, our illness doesn't go away.  It might be less noticeable.  But it is our constant companion, in ways that the symptom silos never contain.

Recovery from the Disorder Itself

Symptoms are one part of it, the first layer.  We try to ignore them, shake them off, not let them get us down, just get over it.  But one day, the coping mechanisms fall apart.  The descending darkness, an energy we cannot contain, psychosis, suicidal behavior, paralyzing anxiety, voices that will not be silenced -- they take over.

We hide this layer from ourselves and others as long as we can, because the consequences are really, really shitty.  We can't work.  We lose our jobs.  We flunk out of school.  We make terrible financial decisions.  We wind up in jail or divorce court or the hospital.

It works a lot better if we manage to ask for help, and have permission to do so before the really shitty stuff happens, and if we have resources to get help once we do ask.

The bad news is, this is where we crash.

The good news is, this is where Recovery begins.  More on that to come.

Recovery from Prejudice

The symptom silos that define mental illnesses in the DSM do not contain what we experience in the world on account of our illness.  But these experiences are an intimate part of our illnesses, and we need to recover from these, too.  When people find out about our illness, then we have to bear the full load of all their ignorance and fear and projections and self-centeredness and stinginess of spirit and narrowness of soul and hostility and stupidity and hypocrisy and the list goes on.  Even if they don't find out about us, what they say about others seeps into our souls.

I won't call it stigma anymore.  Stigma is the way they transfer their problem onto our backs.  Prejudice is the problem.  Our backs will continue to break until they deal with their problem, their prejudice.

Meanwhile, we have to live with and recover from, not only our symptoms, but also their problem.  They are afraid of us.  They turn us into a label.  In any conflict, they feel no need to hear our complaint or examine their behavior.  When we are upset, it is because we have a mental illness, never because they did something outrageous, unjust, stupid or cruel.

Let's be clear about this.  The problem is prejudice.  Pills will not take it away, because it is not in us.  We have to learn how to live with being on the receiving end.  That doesn't mean we have to accept it.  But we have to live in a world in which it comes at us.

Doctors and other providers are just as likely to dump it on us as anybody else.  They are not a safe haven.  Their prejudice is more subtly expressed, more difficult to recognize, confront or dispel.  -- See the sentence above about when we are upset.

Recovery from Treatment

Now this is the part that doctors and other care providers never seem to get, that we have to recover from what they do to us.

The cure can kill you.  People with mental illness die 15-25 years sooner than people who do not have a mental illness.  Suicide accounts for a fraction of that mortality rate.  The biggest part is cardiac and metabolic disease.  Those meds cause ballooning weight gain.  Doctors wave around a few words about exercise and healthy eating habits at us.  But they haven't a clue what portion of a disability check remains after rent to buy those fresh vegetables and lean cuts of meat and taxis to the other side of town where there are groceries stores that sell them or even safe places to walk.  And they haven't taken medicines that mess with your appetite.  They have not paid the price.  They do not know what the price is.

In addition, most of us ended up with a mental illness because we spent our childhood on Trauma Lane.  Even if we managed to escape for a few years, we moved back to Trama Lane when we entered The Mental Health System.  Once again we are treated as children, our concerns dismissed, our lives devalued, our identities ignored.  What's a little weight gain or liver damage or memory loss or agitation or crawling skin or dry mouth or loss of sex life or inability to carry out activities of daily living like drive a car or go to work or get out of bed, compared to the doctor's heroic quest to eliminate the particular symptoms that the doctor measures?  What is wrong with us that we don't follow such good advice as the wise doctor gives us?

And God help those who end up in hospitals where they experience or observe restraints and seclusion.  I mean, what kind of genius does it take to figure out that when you take a person who once was raped and now is hysterical and strap him/her into a spread eagle position, that person will kick, scream, bite, scratch, anything within his/her strength to resist?  What kind of genius does it take to figure out that people leave such experiences worse than when they entered?

The most dangerous week in a person's life, the week one is most likely to jump off the bridge is the week following release from a psych ward.

Recovery - You Have to Know Where You Are Going

No, I am not telling you not to get treatment.  I am telling you there is more to recover from than the list of symptoms the doctor ticked off before writing the prescription.  Your troubles will not disappear when you pop the pill.

Recovery is the individual lived experience of moving through and beyond the limitations imposed by the disorder, by the world around us and by treatment itself.

Having said all that, there is a path, a way through and beyond all of the above.  All of it.  Each person travels his/her own path.  The path itself is called Recovery.  There are steps to take and progress to measure.  Those of us with mental illness have changed the goal, redefined progress, and found the steps that will take us there.

And we can tell you, it gets better.

It really does get better.

Coming up, the Stages of Recovery.


Note added on 01/02/13 -- Links to other posts in this series are below:

Is Recovery Possible? - Kayla Harrison Continued August 25, 2012 -- The judo champ's story introduces the concept of recovery.
Seventeen Keys to Recovery August 30, 2012 -- Guest blogger Margalea Warner describes her journey in recovery in schizophrenia.
Recovery - The Medical Model September 7, 2012 -- Introduces the doctor's agenda, covers the first half of the story.
Recovery - The Medical Model Continued September 14, 2012 -- It was a great idea.  If only it worked.
Recovery Redefined September 21, 2012 -- People with a mental illness have our own definition of recovery.
Stages of Recovery - AKA Hope October 5, 2012 -- We recover in stages, and need different tools for each stage.
Neuroscience of Meaningful Work October 10, 2012 -- Oh goodie!  Here come the dendrites!
Hope for a Cure? Or Not? October 18, 2012 -- We finish the series with questions left unanswered, like, What is a cure worth?


images of grades from microsoft.com
flair from  facebook.com

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