🎧 Listen to Sarah read this installment of Cured.
Outside my window, the trees have started to bloom though I can’t see them from my apartment. My view is of a brick wall.
I’m reading Robert Whitaker’s Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs and the Astonishing Rise of Mental Illness. One evening, I sit at my desk and slowly turn the pages, not wanting to read what comes next. It scares me to think that so many people do, in fact, recover, even from bipolar disorder, my most recent diagnosis. It’s scary because although I may have already recovered, it’s still so foreign. Really? Recovery? For others too?
Whitaker cites studies showing stirring rates of recovery. Though many mistakenly believe that depression is biological, chronic, and lifelong, at least a century-and-a-half of studies have shown otherwise, citing recovery rates from 49 to 76 percent. In a meta-analysis, Samuel Guze and Eli Robins at Washington University Medical School, who actually inspired the biomedical model, found that 50 percent of people hospitalized for depression had no recurrence and only one in ten people were chronically ill. In the 1960s and 1970s, before the Prozac-biomedical-model era, the official line from the National Institute of Mental Health (NIMH) was that depression tended to resolve itself. One NIMH official wrote, “Depression is, on the whole, one of the psychiatric conditions with the best prognosis for eventual recovery with or without treatment. Most depressions are self-limited.” But with the biomedical model that took hold in the 1980s and 1990s, the NIMH spread the misinformation that depression was common and should be commonly treated with antidepressants.
He traces similar evidence of recovery from schizophrenia, a diagnosis often treated as deteriorating and hopeless. One NIMH study saw 73 percent of patients discharged after just one year and remaining in the community three years after discharge. Another study found that 85 percent of patients discharged within five years successfully lived in the community more than six years later. An additional study determined that of nearly half of the patients discharged in 1950, more than half never relapsed over the next four years. Overall, Whitaker found that these studies indicated that during this pre-pharma era, only 20 percent of patients with schizophrenia needed to be continuously hospitalized.
How—how—can clinicians not offer patients and their families these recovery rates? How can physicians and therapists and social workers not grant us this optimism and confidence?
It’s not that having recovered, I don’t experience depression and anxiety and panic and very mild mania anymore. Today, my body aches. It’s the kind of bone-ache that comes with depression, along with hollowness and irritability.
No, I say. No. Bracing against it makes it worse.
Sarah, I say to myself, you’ve got this. Nothing has gone wrong. You’re okay. Speaking to it doesn’t make it disappear, but it lessens and, most importantly, makes me feel less alone. I’m with me.
Five years from now I’ll discover this skill’s name: self-talk. It’s what it sounds like: positive statements we intentionally say to ourselves, often amidst a sea of irrational, negative unintentional thoughts.
Negative self-talk is automatic. Also known as our internal narrator, our inner monologue, or internal speech, it may arise when we’re under pressure. It’s a coping strategy to deal with tension, stress, and mental and emotional pain, but it acts like an inner enemy. As the former Nightline anchor turned bestselling author and award-winning podcaster Dan Harris put it: “The voice inside my head is an asshole.”
Supposedly, most negative self-talk stems from a single, universal fear: not being good enough. It occurs in the first person: I’m bipolar and will never be well. My self-insults are of the kind only a really mean fifth-grade girl might dish out: I’m so fat (an oldie but goodie from my teenage years), I’m a loser (sad, but it does come), I’m a failure, etc.
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