🎧 Are Mental Disorders Chronic? | Chapter 2

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My life changes with one word: Google.

I sit in my new psychiatrist’s office with its floor-to-ceiling windows looking out on Michigan Avenue. Dr. R wears his usual crisp, white button-down shirt. His suit pants have a sheen.

We talk about getting me off lithium. Doing so will reduce my pill load from five to three: the SSRI I’ve been on for nearly a decade, the other mood stabilizer, and Klonopin.

Our appointments are all-business. Med checks, basically. He never asks about my life—how teaching or writing is going. I’m not sure he knows I teach and write. Or that I have a sister or chose not to marry and never wanted kids. Or that I live in a dank, dark studio apartment so small my bed is practically in the kitchen, an apartment that looks out onto a brick wall.

He knows I received six different psychiatric diagnoses during the twenty-five years I spent in the mental health system, and he’s masterful at adjusting my meds. Almost witchy—two dashes more of this, a tad less of that. And we’re easing me off the “mess of meds,” as he put it, I was on when I came to him a couple of months ago.

I’m lucky to have the money to see a clinician like Dr. R. The young man I passed on Michigan Avenue on the way here, the one often sitting outside the Ralph Lauren store, the one not wearing a hat and holding a sign that reads please help and sobbing—full, heaving sobs—seemingly all day long—the one so in need of care and not getting it, reminds me.

Apropos of nothing, Dr. R says, “I had a client. Worst diagnosis you can have—schizoaffective disorder. I mean, bipolar topped with schizophrenia? Can’t get worse. She was from a family of litigators—famous litigators. Not what a psychiatrist wants. I told her family what we needed to do. Her family informed me what they thought we needed to do. As far as I knew, they didn’t have a medical degree among them. But I said, ‘Fine, take her to Mass General, best in the country for this sort of thing, and get a second opinion.’ They flew her out to Boston on their private plane. The docs at Mass General disagreed with me. Fine. Six weeks after her treatment started at Mass General, she was worse. The family came back to me. We did what I said. It took time, but she got better. She’s now an executive at Google. Off all meds.”

I nod though not in agreement. No one heals from schizoaffective disorder or any other disorder. And even if they did, they wouldn’t become an executive at Google. Come on. Everyone knows that.

It makes sense that we don’t believe recovery from mental illness is possible. The public conversation revolves around getting a diagnosis and treatment (both necessary for most people) and ends there. We rarely see and hear from people who’ve recovered.

Stereotypes and similes help perpetuate the myth of chronicity. Many people associate mental illness with “lunatic” asylums, where the insane were locked away, never to re-enter the community. Mental illness calls to mind the guy on the street, muttering to himself or talking loudly to someone next to him who isn’t there, the one we see on that corner day after day: hopeless, untreatable.

Many of us are told or led to believe that psychiatric disorders are permanent. They’re called by different names—schizophrenia, social anxiety disorder, anorexia, bulimia, binge eating disorder, major depressive disorder, generalized anxiety disorder, obsessive-compulsive disorder, attention deficit hyperactivity disorder, bipolar disorder, etc. Whatever we call them, the premise is that the best we can hope for is to “manage our symptoms.” The American Psychiatric Association (APA) likens major depressive disorder, anxiety disorders, ADHD, OCD, bipolar disorder, and other diagnoses to heart disease or diabetes, implying they’re chronic.

Our prognoses are often grave: we’ll never hold a full-time job or have a long-term relationship and will likely die ten years earlier. If we think we’ve healed, we haven’t. Whatever is wrong with us will always return and break us again.

Mental health professionals who don’t believe in recovery are said to suffer from the clinician’s illusion. They practice under the illusion that no one heals because everyone they see is sick; many who’ve recovered leave the mental health system. As Martin Harrow, a psychologist at the University of Illinois, writes of mental health professionals who’ve succumbed to the clinician’s illusion: “We get our experience from seeing those who leave us and then come back because they relapse. We don’t see the ones who don’t relapse. They don’t come back. They are quite happy.” I’m not sure about “happy,” but it’s often true that seeing a therapist or psychologist becomes a question of choice, not need.

It turns out very little encouragement is needed to create the conditions for recovery. A 2018 study conducted by Stanford psychology professor Alia Crum and her colleagues showed how a few comforting words from a physician can speed healing. In the study, participants who were told that their allergic reaction would “start to diminish” and their symptoms would “go away” experienced relief and less itchiness than those participants the doctor didn’t speak to. Reassurance induces the placebo effect, in which a person’s mindset influences recovery outcomes. A lack of support can produce a “nocebo” effect, in which a negative outlook on an illness leads to deterioration.

Some people might say that encouraging those with mental illnesses to recover is misleading and cruel. No, cruel is denying us agency and the chance—just the chance—to heal.

*

I let the whole psychiatric-patient-turns-Google-executive thing drop and leave Dr. R’s office. That night I stare out my apartment window at the brick wall that is my view. Then I do what anyone would do: I google to see if Dr. R is right. As I type on my computer, one search after another tells me he’s wrong. Schizoaffective disorder is lifelong. The VeryWell Mind website says so—as do others, many others.

The internet says that other diagnoses are forever. The patient advocacy group Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) tells me that ADHD is lifelong. According to the Mental Health America website, some people may find “relief” from generalized anxiety disorder, but many don’t. Psychology Today calls depression “a lifetime battle.”

Still, something in me—something small and quiet—wants Dr. R to be right.

The next day, my partial-hospitalization-program friend Julia comes over. Partial-hospitalization friends are a particular kind of social connection. They’re immediate and intense—like camp friends but with psychic despair instead of smores. Hospital friends seem like the only people who exist because the outside world doesn’t really exist. But those friendships rarely translate to “real life” and typically fade.

Julia sits on the floor of my apartment. She smells of cigarettes. Her face is pale. She tells me she isn’t sleeping well.

In the PHP, we bonded over having the same diagnosis, as if that might make us compatible. I want to tell her about the Google executive, but it seems like a betrayal. We committed to our diagnoses and our diagnoses brought us together. Our conversations revolve around a life of diagnosis.

We put on our coats and boots and bundle in scarves and hats and gloves and go for a walk. Ice covers parts of the sidewalks. We tread carefully so as not to slip. She talks about wanting to move to Michigan; I listen.

It isn’t until we’ve looped around the zoo and are a few blocks from my building that I ask, “Did you know it’s possible to recover from schizoaffective disorder?” My cheeks are stiff with cold, and my words come out slurred. 

She looks at me sidelong as if to gauge if I’m joking.

“Seriously,” I say. “Did you know that?”

Her face squinches as if she’s smelled something bad.

I tell her about the Google executive.

She shakes her head. “She probably wasn’t ever sick.”

“Why would you say that?” I ask.

“Because you don’t just get better.”

We walk to my building in silence. I ask if she wants to come in. She says no. Neither of us mentions getting together again. I step back. She smiles faintly and walks away.

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» Continue to Chapter 3.

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