There is a famous quote by Patricia Deegan differentiating between healing, recovery, and being ‘cured.’ That recovery is a stance, it is no cure from the illness. Misunderstanding the difference can, in some cases, can be damaging.
In the mental health system, you either get help when you are in crisis or at the onset of a significant incident or diagnosis. There are no emergent needs in between as far as the system is concerned. It is people in clinical-case management grey areas that are in the most need of our help and whose situation should signal the real crisis in mental health.
I use the words ‘mental health’, ‘mental illness/disorder’ all interchangeably because I like speaking to a wide range of beliefs regarding what it is we are dealing with here. I need to stop. When I was first admitted to a psychiatric unit way back in high school my brother gave the book I am Not Sick I dont Need Help by Xavier Amador to my parents to read. Until a week ago, I avoided reading the book. I’m not a person who avoids anything but the idea of reading it reminded me of the first admission.
The irony is, the image of myself frozen in time I just set up is what Amador argues is the reason people with severe and pervasive insight have an image of themselves before they got sick. This is why people that are extremely impaired have such disjointed beliefs about what they can and can’t do and insight into their impairments or limitations.
We all have our limitations. People will call this deficit-based. Others use the term ‘weakness’ with quotations to gesture to the pejorative shade of likening anything part of the human experience to something negative or overly challenging. The fact of the matter is some parts of our existence stink. These parts may inform and brighten other areas of our life and exist to show us how great other avenues can be when we look closely at the bright lights, far away from the darkness and shame that comes from actual disability.
I am talking about the brokenness in each of us. Amador explains the brokenness very clearly. For people with severe and pervasive insight loss, parts of their brains are just broken. This makes sense to me on an organic level. It also makes sense on a chemical level. It makes sense.
The broken parts of our existence are visible to us living with a mental health disorder and for those practitioners who observe their patients closely. The hurt caused by the brokenness, that is more covert and hidden away from the public. Regardless, there is a vast, deep, and complex internal struggle we battle every day for many of us. As a therapist, I can listen to other practitioners talk about their patients. In doing so, we therapists toss around ideas and consult with each other to help our patients in their treatment.
Sometimes my head spins from the ideas circulating the practitioner table when discussing disability. I suppose because the conversation usually dips into fear of teaching our clients learned helplessness and dependency because of their condition. Well, the conversation doesn’t have to move in that direction, folks, for us to appreciate the complex and broken aspects of the lives we treat as therapists and helpers in human services.
In the context of supporting people in their healing with ‘functional’ impairments, we need to attend to the fundamentally broken aspects of people’s lives that won’t heal over and are out of reach when it comes to recovery. Sometimes, people don’t rally back as far as we need to reach our life goals and dreams, the day-to-day important mundane stuff like avoiding incontinence and making it to the toilet without soiling ourselves.
Let’s break it down further. I suspect that depending on the type or nature of the functional impairment we should probably create categories and levels of brokenness. These levels, theoretically, maybe:
- Goals are attainable with minimal assistance from others. Health is firmly intact.
- Goal attainment is still reachable but challenging (without assistance from external collateral involvement or help from others). Health is intact.
- Goal attainment is unreachable. Health is generally intact, medically, and psychiatrically stable.
- Goals are unreachable. Health is unstable, medically, and psychiatrically in flux.
- Health is volatile, a danger to self and others.
These are basic levels of self-survival and self–management that I generally understand from my recovery and working with other folks who have similar, chronic, and long-lasting medical and psychiatric co-morbid situations. These are by no means indicative of someone’s quality of life or happiness. Though, I doubt anyone would be truly secure in their life and stable if they can’t reach their goals and are a danger to themselves. These people, these outliers, exist out there, but we won’t focus on them right now as they defer the message I am trying to get across.
That message or point is that our self-driven capacity to direct the world around us and move us closer to our dreams and goals requires that we maintain and support a standard or quality of life we deem appropriate and that will allow us to see our goals through to their end. Practitioners love to put together treatment plans to address the interfering symptoms that get in the way of people reaching their goals.
I am suggesting that, depending on the individual’s goals, the interfering symptoms should not be the focus of treatment of people carrying a diagnosis. Here is where the limit of symptom management truly lies when driving treatment forward that is attentive to the quality of life rather than simply disease management. Practitioners need to strengthen the actual, broken, weak points in a person’s functioning regardless of the interfering symptom. Why? Because treating the symptom is like putting out a house fire without rebuilding the home or cleaning it up enough to be livable. To this end, we attend to create pathways for a person to maintain their desired quality of living.
Therapists can treat interfering or unresolved symptoms, but it certainly should not be the focus of treatment. Some people never experience relief from their symptoms. Either due to extreme chronicity or impairments which are untreatable, sometimes people don’t experience comfort. Not every sign is rooted in a diagnosis, either. Sometimes, flaws in our personalities govern the expression of our limitations. We need to refocus treatment to target and identify the weak points in a person’s functioning regardless of the symptom blocking and creating impairments. I have seen clinicians and peers dwelling on unresolved and chronic symptoms as if strengthening a person’s weaknesses in functioning wouldn’t help them move in their healing.
Let’s be completely honest about healing. We can address our impairments, but sometimes the wounds or scars don’t close. They need daily ongoing care. Like the emphysema patient on oxygen, sometimes daily maintenance and care is the only way to keep moving on in your healing and recovery. Being honest with yourself about your mental and physical status will go a lot further than waiting for the miracle cure or, even worse, ignoring the problem because it’s unmanageable.
If good health means healing, then feeling better will require us to have better self-management skills moving forward. It isn’t the problem that is the crucial thing to always focus on resolving. It’s the solution. Accepting the explanation for what it’s worth will require you to sharpen your self-management skills to live the quality of life you want and choose for yourself.
An earlier version of this articles was published on the Mental Health Affairs.
Maxwell Guttman, LCSW teaches social work at Fordham University. He is also a mental health correspondent for Psychreg.
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