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🎧You Want to Heal Too Quickly
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Within a week, hobbling in the boot has become familiar but no less tedious. I’m able to click along at a fairly good pace. This, of course, goes against the very point of the boot. The boot is meant to immobilize so my broken foot can heal.
I enter the waiting room of the osteopath I was assigned in Immediate Care. After checking in, I sit amidst the other patients. Some are in casts, others in braces, and others in splints. Some show no sign of having been injured.
According to Dr. Patel’s profile on the hospital website, he’s certified by the American Osteopathic Board of Orthopedic Surgery. Foot and ankle fractures are his specialties. He has eight hundred and twenty-three ratings which average 4.8 stars.
I never thought to find reviews of any of the psychiatrists I saw. One psychiatrist is connected to this same hospital. I look him up. His profile shows he’s certified by the American Board of Psychiatry and Neurology. His profile has no star ratings.
Another of my psychiatrist’s profiles is tied only to the private practice he’s associated with. It links to his CV, which is replete with licensures, certifications, trainings, honors, and awards. No star ratings there either.
My current psychiatrist, Dr. R, is also affiliated with this hospital. His profile doesn’t even have his photo. No bio, just where he got his Ph.D. and M.D. His profile lists his publications, the titles of which are so scientifically specific they’re like gobbledygook: DNA/RNA-binding protein, chick aggrecan, ubiquitin-mediated degradation. If I’d gone by his profile, would I have chosen him? Probably not, but he’s the best I’ve seen.
The nurse calls my name. I limp assertively behind her. She walks slowly to accommodate me. I want to tell her I’m fine. I’m healing. We can go faster.
She shows me to the examination room. Eventually, Dr. Patel comes in with a resident in tow. The resident looks so young he could be fresh out of college. Dr. Patel is handsome, confident but not arrogant, caring but brusque. The clock on our appointment time is clearly ticking. He clicks the keyboard, and soon the x-ray of my broken ankle is on screen. The two of them consult.
Dr. Patel helps me out of the boot, touches various spots, and asks me if it hurts. It does, but I don’t want to say so. I want out of the boot. I want to be healed.
“You don’t need surgery,” Dr. Patel says. “Six more weeks and we’ll see how you’re doing.”
Panic rises in my chest. “Six weeks in the boot?”
Dr. Patel explains his reasoning at length. I’ve torn ligaments too, and those take longer to heal. I look to the resident as if for help, but he just smiles.
Dr. Patel says I can get a second opinion. He says this easily and without malice.
A second opinion? In a couple of months, I’ll read advice from Dr. Allen Frances, one of the most powerful figures in psychiatry. In his book Saving Normal, he’ll stress the importance of getting a second opinion whenever you see a psychiatrist. I’d never thought of it. No one recommended I do. This is, of course, a luxury, especially in our overcrowded mental health system, but I wish I would have thought that way.
I shake my head. I trust Dr. Patel. It’s a feeling.
“You’ll be out of that boot soon enough,” he says.
As I hobble to the elevator, my foot seems to hurt more than it did when I came in. Six weeks. But it will heal. Dr. Patel said as much. You’ll be out of that boot soon enough. He’ll track my progress as my ankle goes from broken to healed.
What if one of my psychiatrists or therapists had spoken to me that way? You could be out of this depressive episode soon enough. You’re experiencing an intense bout of anxiety, but it is possible to heal. People have healed from bipolar disorder—not that it’s easy. ADHD can be resolved. Anorexia isn’t necessarily lifelong. No promises. Lots of could’s and can be’s and necessarily’s. Conditionals but also possibility.
During the twenty-five years I was in the mental health system, not one clinician gave me the recovery statistics of the diagnoses I received or explained the stages of recovery.
One recovery model, taken from the Transtheoretical Model of the Stages of Change, traces recovery as a nonlinear process in which a person moves from seeing themselves as a diagnosis whose life is limited to someone believing, committing to, and taking action to create the life they want. (Some people dislike this model because it’s so focused on taking action, which is both Puritan and capitalist, but there are other models.) This model has five stages:
Stage 1—Impact of illness: the person is defined by stigma and the symptoms they experience and sees themselves as the diagnosis, which may or may not be helpful
Stage 2—Life is limited: the person glimpses but doesn’t think change is possible because they can’t imagine an identity outside of their diagnosis
Stage 3—Change is possible: the person has hope yet still isn’t willing to take the risk
Stage 4—Committed to change: the person starts to take steps toward recovery
Stage 5—Action taken: the person no longer sees life as limited and trusts in themselves
These stages aren’t prescriptive; each person determines what each stage will entail and what the end goal will be.
But recovery wasn’t mentioned on Web MD. Or on the National Alliance for Mental Illness (NAMI) website. (NAMI wouldn’t have a webpage dedicated to it until 2021—though it’s excellent.) No media outlet—not The New York Times or the Washington Post—covered it. BP Hope, the bipolar magazine I depended on, said that bipolar disorder was physiological like heart disease and “can be managed but never goes away.”
Soon, I’ll learn that most of the time I spent in the mental health system, the U.S. government had embraced the recovery model over the biomedical model, which emphasizes that mental illness is biological and can only be managed. Beginning in 1999, the government had called upon the psychiatric community to make the recovery model the core of our mental health system. Recovery as a concept had gained traction with the passage of the 1990 Americans with Disabilities Act, which recognized serious mental illnesses as disabilities. Surgeon General David Satcher’s 1999 report on mental health was the first official policy to include the term recovery: “All services…should be consumer-oriented and focused on promoting recovery.… [T]he goal of services must not be limited to symptom reduction but should strive for restoration of a meaningful and productive life.”
News that a full recovery from mental illness was possible seemed to take hold with politicians at the turn of the twenty-first century. The President’s New Freedom Commission on Mental Health in 2003 called for a “profound change” on the federal level that would shift the focus of treatment toward recovery and protect the rights of adults with serious mental illness. Its Executive Summary led with these words: “We envision a future when everyone with a mental illness will recover, a future when mental illnesses can be prevented or cured…” It promised a transformation “not at the margins of a system, but at its very core.”
The restaurant is crowded. Every table and every seat at the counter is full. My father and I stare down at the laminated menus. We’re at a four-top, so I can prop my foot on the extra chair. Condensation beads down our water glasses, forming rings on the table.
My broken foot and being in the boot are hampering my determination to recover from mental illness. I’ve lost the ability to go for the long walks that used to help calm and soothe me and make me feel like I was making strides toward recovering my mental health.
Even now, a hum pulses in my chest. The pit in my stomach is so heavy and black that it’s my whole being. The clank of plates being put in bus bins sounds as if it’s inside my head. The table next to us is too close. The two couples drink mimosas. Their voices are too loud though I can’t make out what they’re saying.
The server comes, and we order. Out the window, the sunlight faintly lights the street. She brings my coffee, which I pour milk into and sip. The pulsing in my chest intensifies. I keep sipping.
Eventually, our food arrives. The skillet the server places in front of my father still sizzles. The omelet she puts in front of me is the size of my forearm. My father puts hot sauce on his eggs. I pick at my omelet.
He says, “I’m really sorry this happened to you, hon.” He means my ankle.
No one knows I’m trying to recover from mental illness. It’s being done in secret to prevent anyone from discouraging me. I tell him I’m going to get better, referring to my mental illness.
“Of course you are,” he says. “Just wear that boot.”
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