Do You Ever Actually ‘Recover’ From a Mental Illness?

When someone says their cancer is in remission, we understand it’s not cured. But we tend to lack that grasp of nuance when the disease is psychological. To push back on stigma and cut through the confusion, Which mental illnesses can I ‘recover’ from and which ones will pretty much be with me for life?

One of the ways mental illnesses are less understood by the public than physical ones is that we aren’t told much about how the former turn out. People know high cholesterol can be lowered and low blood sugar can be raised; lots of viruses are preventable with vaccines, and that HIV is chronic but treatable. When someone says their cancer is in remission, we understand that that’s not the same as saying it’s cured. But we tend to lack that grasp of nuance when the disease is psychological.

Most people’s experiences with mental illness are actually likely to be short-term. But when we think of ongoing conditions, eating disorders are what we most seem to perceive as disorders we can put in the past. We talk about them with language like “overcame,” “survived,” and “recovered from.” These phrases communicate an ongoing process of vigilance and awareness of one’s own triggers—work that’s manageable but also never finished, sort of like how alcoholics can stop drinking and still consider themselves alcoholics for life.

Some do recover and when they do and it’s useful for them to think of themselves as someone ‘in recovery,’ but it still could be latent.

Of the two eating disorders people are most likely to know—anorexia and bulimia—bulimia is the more treatable. This could be because it often manifests as a response to stress—which, conceptually at least, means it does actually resemble substance-abuse disorders like alcoholism. It can be overcome with time; if someone’s learned to do something as a response to stress, then the possibility exists that they can learn other responses to replace it.

Like bulimia, borderline personality disorder is often responsive to dialectical behavioral therapy and some antidepressants, even if they weren’t designed for it, and it often goes away as the patient gets older. The good news regarding BPD is that a significant number of patients who have been carefully followed in longitudinal studies eventually no longer meet the criteria—even without any treatment.

So you could consider that one [as] something people can quote-unquote ‘grow out of. Though we’re still not clear on why.

Anorexia can be looked at as a compulsive habit, but borne of a seemingly different mechanism than obsessive-compulsive disorder, though both are notoriously treatment-resistant. One of the aspects of OCD researchers find most compelling is that it’s thought to be on some level more biological, and not solely psychological. OCD is chronic but can be mitigated with intensive treatment. The Diagnostic and Statistical Manual of Mental Disorders classified OCD as an anxiety disorder up until 2013, when the DSM V dropped and declared that obsessive/compulsive symptoms merited their own chapter.

When someone’s anxiety centers on a specific phobia, doctors can desensitize them through exposure therapy. For example, people whose OCD revolves around germs are frequently treated via safe, structured exposure to icky environments. But conditions like generalized anxiety disorder—the country’s most common anxiety disorder, affecting more than 3 million adults— present no such entry point for treatment. Illnesses like that can actually persist longer than disorders of mood or personality.

Anxiety disorders are not as responsive to treatment as people seem to think they are. The escalation in use of the term ‘anxiety’ has been just explosive…and the popular conception is that it comes and goes and people can overcome it easily. The truth is it can actually be quite chronic.

As an umbrella term, anxiety is the mental illness afflicting the most Americans and Australians today. The runner-up category is, of course, depression—all kinds of which can be exacerbated by risk factors like having a lot of comorbidities or life adversity.

Regardless of the root cause, the majority of depressive patients will show at least some improvement if they just get some kind of treatment, whether it’s psychopharmacological, therapeutic, or even through diet and exercise. But there are always those who are prone to being treatment-resistant. We don’t know why that is but we do know it means their lifetime risk for relapse is higher. The principle is a little like that of bipolar disorder, in which each manic episode increases your risk of future episodes. If you have Complex PTSD, PTSD or other trauma related condition triggers are always a risk of causing a relapse.

“Bipolar is considered one of those where once you have that first episode that qualifies you as needing medication, the standard is you should be on medication from then on, even when you’re [not exhibiting symptoms, It’s not considered something that dissipates eventually the way some other disorders might.

Schizophrenia and other psychotic conditions are in the same vein. People understand how to think about someone’s mental illness when they’re visibly ill, but they’re usually less clear on what it means for them to be “well.” You should have all the facts no matter what your diagnosis, but if your illness is primarily characterised by acute, sudden-onset episodes of something— psychosis, mania, depression, and in some cases panic—it’s important to know that it’s very possible for months, even years, to pass between those episodes; that doesn’t mean the illness is gone. It’s kind of like herpes—if you have it, you have it forever, with or without flare-ups.

So never bail on your treatment plan just because it feels like you’ve gotten better. And embrace the fact that you might need treatment, in some form or other, for the rest of your life. But also know that regardless of whether your illness is chronic, there is an ever-expanding arsenal of tools to help you manage it.The prognosis for people with chronic disorders isn’t nearly as negative as it once was, and that more people are now able to achieve enough symptom reduction that they’re not impaired in their daily lives.

The notion of whether or not something is treatable is really dependent on new discoveries and new research. We used to just apply a hammer to every nail, and some wouldn’t respond. Now, there are more and more treatments coming out that are more specific, that are more tailored to [each] illness. People do get better.

2 comments

  1. Thank you for such a well written piece explaining the lifelong struggle with mental illness. We know how harmful it is to keep horrible secrets of sexual abuse, so we encourage talking about it. We also know how bad it is to have victims blame themself for the abuse, so telling them it isn’t their fault is one of the first things you hear.

    I don’t think anyone cares, though, that when we live with the knowledge that the perpetrators avoided justice (or that we were not believed in the first place) it consistently works negatively on one’s psyche and sense of well-being. It can lead a sufferer to be hypervigilant 24-7 with an inability to sleep soundly, or maybe just leave the victim with a shattered soul that can never truly trust, love, or THRIVE.

    The victims of child sexual abuse need to stand together and demand a change in laws for children. As it is now the government cares more about punishing sports players, TV stars, and anyone with a dollar that can be taken away. Society focuses more on things such as labeling and trans-gender issues. Meanwhile millions of homes across America live in poverty, and the statistics show higher rates of child and/or sexual abuse happening in poverty-stricken homes.

    I have only been writing about my own incest/sexual abuse for about 2 years now, talking about it for about 5. I hope that by the time I leave this earth I can be as positive as you and report that it gets better, but all I can say for now is it got more manageable. I was fortunate enough to study psychology (and the reward of teacher comments and good grades) for several years, so I have installed coping mechanisms that do in fact help me deal with the after-effects such as suicidality and intrusive imagery, but I am afraid the fear, loathing, sadness, and even hate – will never go away.

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    • Thank you so much for writing such a considered response to my article. I agree with everything you say. It is stil a hidden silence in society. It is great that you are writing about your experience. I can guarantee you will find it helpful and a worthwhile effort helping you enormously in processing everything you have been through. I have some artciles on Journaling and writing on the site which might help you. If you ever want to publish anything on the blog as a Guest blogger just send it through to me at erinfado@gmail. It could be beneficial to you as a start. You could do it under a pseudonym if you don’t wish to use your real name. It’s a very cleansing start. Great to hear from you and good luck for your future. You’re very brave. Erin

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