Friday, October 5, 2012

Stages of Recovery - AKA Hope

It gets better.  It really does.

People who get tired of the Chemistry Experiment go off their meds.  Why?  Because the meds don't work.  Or they make us sick.  And the doctor doesn't hear us, because the doctor has one tool in his/her toolbox.  [Hint: It's not an ear.]  And he/she thinks that the solution to our problem is compliance, because there isn't time for listening and problem solving.

When you walk into a hammer store, they will try to sell you a hammer.  Fair enough.  If you are trying to rebuild the life that your illness took from you, chances are you will need a hammer.  Chances are you will need some other tools, as well.

The doctor doesn't have those other tools.  But they are out there.  And so is the map.

You are angry that the meds promised what they could not deliver.  Get over it.  Pull out the map.  Or the toolbox.  Mixed metaphor.  Whatever.  Get over it.  Get to work on your recovery.

The Recovery Map

Here is the map.  Recovery comes in stages.  It is not the end of the journey, the successful elimination of your symptoms.  Recovery is the rest of your life -- which does not have to be as shitty as it seems at Stage One/Crisis.  Parts of this map are wondrous.  All of it is hard work.

The bottom rungs are how you got into this fine mess.  Well, there's a little (huge) piece missing -- life.

Genes Plus Something More

But it started with a genetic predisposition, just like a bad back or heart disease does.  Everybody has some spot where the DNA chain is just a little weaker than other spots.  And when life gets to be too much, that's where it goes wrong.  It could be cancer.  It could be a bad back.  It could be bipolar.

Generally, you need that life gets to be too much thing, whatever it is, for the genetic predisposition to kick in.

Neuropathology

So it did for me.  Life gets to be too much didn't hit my immune system.  I didn't get cancer.  It was my brain that took the hit.  It wasn't pretty.

Crisis

Nobody noticed what was going on inside our poor pitiful brains until the symptoms erupted.  Symptoms don't erupt into the open until the brain has been deteriorating for a while, usually decades.

You know what?  That depression, spending spree, word salad, inability to leave the house, conviction that your best friend is stabbing you in the back, the hole you punched in the wall -- it's not the end of the world.  It's the beginning of Recovery.  It's when you finally have no choice but to get help.  Which you need, like the mountain climber who fell off the cliff.

At the Crisis Stage, we discover our lives are never going to be the same.  This first stage is exhausting, physically, emotionally, mentally, spiritually exhausting.

So what do we need?  What are the recovery tools that work at this stage of the journey?

Well, for some of us it starts with a big shot of whatever the doc has, and fast.  For some of us it's safety.  For all of us, it's what anybody else with any other major illness needs, rest, time off, nutritious food, somebody to do the laundry.

I have covered these issues in the past. Click on bdnf (brain-derived neurotrophic factor), neuroplasticity and sleep in the labels section on the right, or catch the basics at this link plus this review of Terry Wahls' Minding My Mitochondria.

Sleep, nutritious food, recuperation are Stage One Recovery tools.  They help your brain heal itself.  If we don't use these tools, then it doesn't matter how long we spend in the hospital and how many meds we try.  We will be cycling back to crisis over and over, fixing our identity in our providers', family members' and our own minds as the mental patient.

Decision/Rebuilding

On the other hand, if people will provide these basics when we are unable to care for ourselves, like how people pull together to support the person who is in chemo, then, when we are ready, we want to move on, to rebuild our lives.  Sometimes we need some encouragement to take the risk.  But really, who wants to live like a zombie for the rest of their lives?

At the second stage of recovery, we need to rebuild our sense of self, by telling our story to people who are willing to hear our pain.  We need people who believe in us.  If family and friends can't/don't provide these things, (it is what it is), then we need to go find people who will.


Stage Two Recovery tools include: support from peers, people who have been there before, to whom we can say the things we can't say to anybody else; therapy; learning about our illness and how to manage it; gaining new skills, relearning old ones; encouragement and practical help to regain independence, perhaps move to a less restrictive living arrangement.

I expect I'll be writing future posts on the neuroscience of these interventions.  Did you know that therapy changes the brain? Even brain cells themselves?

Awakening/Discovery

We do not get our lives back.  Nor do we remain the mental patient.  Passing through the fire, we are transformed.  We dream again about who we could be.


The third stage, Discovery is about self-acceptance, confidence, assertiveness, helpfulness to others.  Once we thought we were independent.  Then the illness made us dependent.  Now we discover inter-dependence.

It’s time for the full keyboard of emotions again, even those feelings that made us and others uncomfortable before.  It’s time for anger at injustice, and action, to advocate for ourselves and others.  We want intimacy, somebody to love, to be appreciated.  We want to belong and to make a difference.

That may be where I go next in this series, with more on the neuroscience of Awakening/Discovery.

It's all about rewiring the brain.  And all sorts of things will get the job done.

Matching the Intervention to the Stage

The trick is to pull out the right tool for the right job, the one that meets your needs at the moment.  Sleeping eleven hours a day when it's time to go find a job will not work.  Joining the protest when you need to be in the hospital won't work either.

Here you go:


Now draw an arrow from the stage you are in this week to the box directly to the right of it.  Then pull something out of that box.  Use it to build your foundation for the next stage up.  For best results, use every single tool in that box on the right.

When you slip, and most of us do, try to catch yourself before you slide all the way down.  Or at least, try to catch yourself before somebody else has to do it for you.  Or at least, catch yourself as soon as you can, however you can.  Then figure out where you are again, draw an arrow from the stage you are in to the box directly to the right of it, and begin again.

Rest when you need rest.  But step up when you can step up!  Because if you stall, you will slip back.  The human brain is designed to heal.  You have to mess with it to keep from getting better.

Or as they say on the Red/Green Show -- good gosh, now a hockey metaphor!

-- Keep your stick on the ice.  We're all in this together.


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.
Recovery - From What? October 1, 2012 -- You have to know where you are going if you want to get there.
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?


flair from facebook.com
photo of toolbox by Per Erik Strandberg, used under the Creative Commons license
recovery graphic by author
graphic of brain derived neurotrophic factor by Jawahar Swaminathan, used under the Creative Commons license
peer to peer graphic from nami.org
Phoenix detail from the Aberdeen Bestiary, 12th c., in public domain

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