Thursday, June 18, 2015

On Recovery

Do you get scared to feel so much?
To let somebody touch you?
So hot, so cold, so far so out of control
Hard to come by, and harder to hold
Some people get by
With a little understanding
Some people get by
With a whole lot more
-- The Sisters of Mercy
So there are mental health challenges that are debilitating and frightening but once the right meds/treatment are found and taken as prescribed, recovery is absolutely possible. I have met people that this has happened to and have heard their stories. It is awesome that there are happy endings to their challenges which often lead to a renewed lust for meaningful and productive lives.

I also know a few people whose challenges are not only treatment-resistant but, I would argue, recovery-defying. I am one of those people. We are a relatively small slice of the mental health pie -- somewhere around a few percent to 30% depending on which definition of "treatment-resistant depression" is used. I am not the poster child for the group by any means but based on the stories I know about, there are a few patterns. We often hate how misunderstood mental health challenges are -- how often media, both fiction and "news", paint us with a broad brush which perpetuates ridiculous stereotypes. And how often this sets the stage for others offering platitudes, ad nauseam, about holding onto hope, about things happening for a reason, and about curing depression because it was easy for their Aunt Gertrude after she tried a detox cleanse advertized on late-night tv.

One of the most empathetic mental health professionals I know believes, and has told me, that people continue to do something, no matter how harmful or counter-therapeutic, only if we get something out of it. Psych 101 and Evolution 101 teach us that is true in a strict sense: we are pleasure-seeking, pain avoiding critters, but that lacks nuance to explain all behaviors. When faced with the suggestion that I am somehow responsible for my depression by continuing to engage in a behavior that worsens symptoms, I have looked at myself honestly and as best as I can figure, I do not do so by choice. Granted I do not, for example, exercise as much as is recommended even though I know full well that being relatively sedentary is contributing to my symptoms. I accept that the recommendations to exercise are correct and increased physical activity would help my mind/mood so it is not a matter of denial. There are probably hundreds of exercises I could do so it is not a matter of ability. I want my symptoms to be lessened or more manageable so it is not a matter of desire.

It is a matter of motivation. Again I cannot speak for anyone else but I seem to have maxed out my motivation. Or at least increasing my motivation has significant diminishing returns.

Furthermore my motivation is like a limited resource. I spend some getting out of bed, some interacting with others (more when I really do not like the people), some taking care of everyday tasks, and on some days I do not have enough for even these simple "motivation sinks". Then I am supposed to eat right, exercise, and generally be productive? In my dreams.

I went to an event that had a panel discussion focused on recovery from bipolar disorder. I attended to support those with a bipolar diagnosis and for an outside chance that I gain insight that may help me. I did not learn much but I am going to start asking the following question to groups that organize events for awareness of disorders related to anxiety, psychoses, personality, impulsivity, addictions, identity, bipolar depression, or unipolar depression: could we please have more attention paid to treatment-resistant depression?

Those of us struggling with TRD have often been in pain longer and willing to accept help for longer than most. This does not make us more worthy or anything like that but who really knows the status of their recovery? All it takes is for one small change: an antidepressant or other medication regimen could stop working; a trauma could happen; a "switch" could flip in the brain. At the risk of being a fear monger, one's recovery journey could change drastically so it makes sense to me to study, educate, support, and advocate for people with even the most difficult mental health challenges, even when the unknowns outnumber the knowns.

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