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Q1. How can recovery be accomplished in mental illness?
Recovery in mental illness can be accomplished in two different ways. The first is the one which is widely researched into by mainstream psychiatry, the Drug Dependent Recovery in which that people are said to recover by taking suitable medications. If they can arrive at an optimal dose of medicines, with pharmaceutical support they can live their life in a relatively ‘balanced’ manner, without the day-to-day chaos that a mental illness can bring. This is pharma-led recovery, in which people consume their medicines throughout their life, and seek other interventions to accomplish daily tasks.
The second definition of recovery comes from those who have quit taking psychiatric medication and taken recourse to alternatives- either partially, completely or not at all. This is a Drug Free Recovery. In many instances such people identify themselves as ‘survivors of psychiatry’. They reject psychiatric labeling and diagnostic categories, defining their lives in their own ways, with support systems duly identified and worked out.
Q2. Is recovery possible in schizophrenia and bipolar disorder as well?
Recovery is fully possible in schizophrenia and bipolar. There are scores of people who go off psychiatric medications for the rest of their lives. They live active professional, domestic, social and community lives with families around them, including spouse, children and community. They take up jobs, create businesses or become homemakers- everything is possible.
John Nash the famous mathematician (of ‘A Beautiful Mind’ film fame) who won a Nobel Prize gave up his medication for 25 years.
Q3. Is recovery equally possible in OCD, social anxiety, other disorders?
A. Yes recovery is possible in all other mental illness conditions as well. The level of recovery may be different for different people, but by and large everyone can accomplish a significant level of social, occupational and emotional wellbeing. A vast majority can engage in trades and professions and become financially independent as well.
Q4. In what manner is recovery accomplished if someone is taking their medicines regularly?
Taking medicine regularly is only a small part of a bigger responsibility. Everyone needs to understand why they are having such problems that they require medicines. One has to be responsible and make suitable changes in their life and try to understand the causes of their suffering. Taking medicine can reduce the symptoms, it does not eradicate the underlying reasons that produce suffering. To understand those reasons we need to examine them, and usually such examination cannot be done by ourselves alone- this is where counseling comes in.
Medicines help with symptoms, whereas counseling helps people to unlock the sources of distress and suffering.
Q5. Is counseling effective?
A Counseling can be equally as effective as medicines in a majority of cases. Instead of referring someone to a psychiatrist first, they can easily be referred to a psychologist, counselor or therapist. Many times matters resolve simply by talking about them and no further action is needed.
Q6. Why don’t more people seek counseling?
A People prefer to take medicines because they think counseling is ‘mere talk’ and ‘simply talking’ cannot help. They prefer something which is more ‘tangible’; where they can see something happening. Putting a pill in the mouth is certainly tangible/concrete.
Q7. Is that the only reason?
A There are many more reasons. Some are as follows. This list is not exhaustive.
Dealing with the (unpleasant) truth– By talking it out you will have to deal with certain unpleasant realities about yourself and your family. A lot of times people prefer to remain silent, or look the other way, rather than talk openly, even if they are alone. For example, if a young man’s anxiety is coming from a family where his father is constantly berating him/others, how easy is it for him to deal with his father? It is far easier for him to pop in a pill!
Lack of family support in counseling– In a number of cases people who seek counseling help come alone to talk about their issues. So even if they understand their problem, until their families also understand and support them things cannot move in a progressive manner. Therefore it is important that families be counseled together. But in a vast majority of cases not every person in the family is willing to communicate with a stranger or pay heed to their insights. Counseling in such a scenario becomes difficult, especially if those individuals are dominant in the family milieu.
Change is uncomfortable– When you seek counseling support, you should be ready to change certain things about yourself or your situation. For instance if it is necessary for you to do some physical work, you should be ready for it, and not say that you have domestic help that can manage all the work. If you need to train for a marathon, you have to learn to get up early in the morning, isn’t it? Renewing a life from psychiatric illness is like running a marathon- you build your capacity slowly and challenge your comfort zones. Living in the comfort zone is very unthreatening, but there is no growth happening there either. If you want comfort or you want growth- you have to make the choice, you have to take the call.
Lack of continuity– Sometimes people do not understand the significance of regular counseling. They come in for counseling only when they have a crisis to deal with- which may be once a year or even once in a few years. If counseling is to be effective and long lasting, the relationship with a counselor is a major support system in someone’s life. By going into counseling regularly, which can be anything between once in three weeks to once a month/two months, a trust is built up. Working in a trusted relationship is more beneficial than working anew every few months/years. Fire-fighting of this sort also does not let the counselor help you understand your problem areas, if they can identify them, or help you deal with them successfully.
Q8. Does it mean I would need counseling for the rest of my life?
A As a matter of fact, that should not happen. The purpose of counseling, unlike medication, is not life-long dependence at all. Over time you would build your reserves, sensibilities and resources enough to understand a lot better about your life and situations, and accordingly you would deal with them with greater strength and certainty. The need for counseling will keep diminishing in your life as your maturity, resilience and responsibility towards yourself increases.
Q9. Is recovery oriented counseling different from other forms of counseling offered by clinical psychologists, psychiatrists or other individuals with university degrees/diplomae?
A Recovery orientation itself is a new concept which is first being embraced by psychiatry. They are also counseling clients these days- but their emphasis is on drug-led recovery largely. They do not have the time, or tools to listen to patient stories and dissect their family situations.
Even in case of other counseling ‘professionals’ since their knowledge base comes from psychiatric diagnostic categories, they do not have ideas about how to deal with the complex dynamics of people’s families, social, economic, spiritual and financial dilemmas. A major part of their counseling is to ensure compliance for psychiatric medication, and some behavioural changes. This is also the goal of cognitive behavior therapy (CBT) and a host of other ‘therapies’. Patient recovery is usually not among their goals.
Q10. Who can benefit most from recovery oriented counseling?
A To benefit from recovery oriented counseling following criteria are recommended-
1. Readiness– You should be ready for recovery- with or without medication, but recovery for sure.
2. No short cuts. Do not expect that recovery can happen overnight or in a few weeks/months. People’s minds take a long time to reach a stage of crisis which is given a mental illness diagnosis. Recovery is a long term goal and a pathway has to be created first. Counseling is one aspect, which will help you immeasurably- but the rest also has to be done, whatever it be.
3. Regularity – If you do not come into counseling, you do not stop progressing. But if you come into counseling with regularity you learn to reflect on yourself and situations faster. You will certainly recover, if that is your goal. But seeking help cuts down the time taken for recovery.
4. Leave the comfort zone– If you are not willing to be more proactive and do new things, you cannot break your old patterns. In comfort zones we are resting, whereas recovery is about building afresh- so invest fresh energy and enthusiasm. You are rebuilding your own life.