Not so long ago I had an interesting conversation with my uncle, now 84, who practiced medicine all his life and has also been frequently depressive and knows a lot about psychiatry, both often as a patient and always as a medical professional. I mentioned that I am feeling better in various ways due to ever-improved “self-management” (all this jargon is due an overhaul!) including yoga and, of all things, oatmeal porridge. He commented that he thought I had “burn-out” and then explained that over time he had seen many people with so-called “serious and enduring” mental illnesses go into remission due to the illness “burning out”, especially as they got older.
This encouraged me enormously. I did some research and although, predictably, the so-called advice, evidence and discursive material about “illness”, bipolar disorder, is heavily prejudiced in favor of received psychiatric wisdom, there are a few outposts of conviction and lived experience persevering with the message that “severe” mental illness need not be a life sentence. I’m beginning to see that half the struggle of recovery is getting beyond the idea even that there is anything to recover from. This is not denial, but merely a way of reconditioning oneself. Like it or not, mental illness and its treatment can be a ghetto. Is it time for us to begin to throw off all our assumptions?
What is the basis for the current and growing obsession by society with mental illness? As someone apparently – hypothetically? – “recovering” from a “severe and enduring mental illness” you would think this opening to mental illness would to me represent a breakthrough and relief and even a kind of opportunity. Indeed, at various times it has been one or more of those. Yet now I wonder how much I want to live in what I call a “Supersick me” society where it seems everybody is due a diagnosis or seeking one.
What are the causes of this mental illness awareness, if that is what it is? Perhaps “Its time has come”; it is now safe to be open about it. Is it fashion: it is now “fashionable” to be mentally ill? Is it just that society is just sicker of itself and from itself?
Furthermore, what is the basis for my being sick of the whole subject of mental illness? Firstly, I don’t see myself as mentally ill. I am medicated, but that doesn’t mean I am mentally ill. It’s possible – call me deluded – that I have been misdiagnosed (many are) or that my medication has itself necessitated further medication (possibly true in my case) so that half my illness is due to its treatment. Given all of this, and that some people can grasp and act on the subtleties of their situation as service users, is it automatically a negative if the idea of “recovery” might include an overcoming and eventual rejection of the idea and belief that I am “mentally ill” and need to “recover”?
I have at one time or another since my diagnosis bought into and believed and usually experienced most of the issues and ideas attributed to someone in my situation including, notably, that – as it so glibly said – bipolar disorder is a “disease” (there is no biological proof that it exists, much less that it is a “disease”) and a lifelong, incurable “illness”.
Let’s leave out of this discussion for now questions such as, If there is no hard biological (and genetic) evidence that my “disease” or “illness” exists how can it be incurable? I may be wrong, it may be incurable, but forgive me for not wanting all my life to see myself as some kind of tolerable leper. Grant me real hope.
Assuming I am ill then I feel there is room for what I call an “aware denial”, a way to a new way, beyond “recovery”, that involves an aware denial of illness. By this I mean that as an aid to recovery I do not involve myself more than I need to in any aspect of “mental illness”. Clearly, medication has to be continued, though if possible reduced en route (I am in the process of reducing mine at last) but meanwhile I can maintain an aware avoidance of and denial of anything to do with mental illness. No support group dependencies, no reading of or as much as possible discussion of mental illness, never thinking of or describing oneself as mentally ill. Doing this I feed myself the most positive message that I can: Getting better is not just maintenance, it’s deliverance.
I had an interesting experience last autumn when I was interviewed for a documentary on a musician I worked with who has since passed on. For ninety minutes I gave forth on my musical pursuits and so forth and never once mentioned mental illness, being bipolar or anything else of the kind, and I left feeling wonderful, free, myself, and I suppose genuinely recovered. It made me realise how polluted I had let myself become with the idea that I am “ill”. I experienced myself as I was before diagnosis, with all my liabilities and issues but wholly myself and not half a creature of somebody else’s description and invention. I remembered who and what I am, the least of which is “ill”.
This is not about “pretending” one is or may not be mentally ill; it is about rising above it as a self-description. There also must ideally be no acknowledgement that one is “recovering”, because that means there is something to recover from.
It’s all about taking stereotypes such as “all in your head” and making them work for you: now that mental illness has been legitimized we have to talk and think and feel and be our way back out of it. It’s important for those branding themselves mentally ill to – if possible and it may not be easy – spend as little time as possible with people with “mental illnesses”. Accepted wisdom is that people with mental illnesses should be a lot of the time with those like themselves, but what does this really accomplish?
There could be many causes for what might be my “burn-out”. Given long enough perhaps many experience this phenomenon but it is little remarked upon or documented not because of some conspiracy of silence but simply because life beyond diagnosis and self-conscious recovery overtakes more ephemeral concerns. I’m still medicated and frequently considering myself “mentally ill”. I see, however, that all kinds of tantalizing possibilities lie in store if I can just stop telling myself there is something wrong with me.
When you begin to embrace idea that there is “nothing wrong” with you, you realise that ideas can become facts, and that a lot of what you thought was wrong with you was an idea…the fact is that you are fine.
Polypharmacy/Bipolar illness
A. Bipolar Illness Before the Psychopharmacology Era
Prior to 1955, bipolar illness was a rare disorder. There were only 12,750 people hospitalized with that disorder in 1955. In addition, there were only about 2,400 “first admissions” for bipolar illness yearly in the country’s mental hospitals.
Outcomes were relatively good too. Seventy-five percent or so of the first-admission patients would recover within 12 months. Over the long-term, only about 15% of all first-admission patients would become chronically ill, and 70% to 85% of the patients would have good outcomes, which meant they worked and had active social lives.
B. Gateways to a Bipolar Diagnosis
Today, bipolar illness is said to affect one in every 40 adults in the United States. A rare disorder has become a very common diagnosis. There are several reasons for this. First, many drugs–both illicit and legal–can stir manic episodes, and thus usage of those drugs leads many to a bipolar diagnosis. Second, the diagnostic boundaries of bipolar illness have been greatly broadened.
Lastly:
In a review of 87,290 patients diagnosed with depression or anxiety between 1997 and 2001, those treated with antidepressants converted to bipolar illness at the rate of 7.7% per year, which was three times the rate for those not exposed to the drugs. click here for links to numerous studies.
