Schizophrenia.com

Is striving for recovery always a good thing?

Or does there come a point when one needs to accept that anything resembling recovery is unlikely to happen.
For me recovery is an illusion. Other people’s mileage may vary.

^ After 42 years(longer than many posters here have been alive) I have given up on any chance of recovery. Perhaps if there had been a more holistic approach that wasn’t almost exclusively confined to administering medication and narrowly focusing on textbook ICD symptoms it might have been different.
Therapy,short as it was,was an abusive farce. Two trained therapists who preferred to pass moral judgement rather than help to cope better with negative experiences. An untrained in therapy member of the resource centre who suddenly announced she was part of a small religious sect, and pulled out when I inadvertently upset her religious sensibilities.
I am well past the acute stage of my illness and the chronic and enduring issue is social.
A problem that has as much or more to do with undiagnosed and untreated aspergic traits/ non verbal learning disorder. Phrases like “has very poor social skills” are bandied about but no actual help is offered.
The difficulties that made social interaction as a child/teenager difficult and resulted in that bullying still very much intact. The paranoia and social anxiety being a product of that bullying and social rejection.
There was a chance to acknowledge the difficulties that likely fall into the category of aspergers/NVLD very early on during first psychiatric admission but instead a pdoc chose to brand me an awkward and troublesome teenager. Cue years of not feeling able to really talk about problems and the negativity of that pdoc being passed down to other pdocs. Once you get a reputation however wrong and abusive it is it sticks.
Forward a couple of decades and gradually find the strength to open and seek more help only to be met with claims of being awkward,demanding and troublesome. Phrases like “very dependent narcissist” abounding. Result total breakdown in the psychiatrist/psychiatric team- patient relationship. A change of dx from schizoaffective mixed type to personality disorder (diagnoses are often changed to this when a pdoc has an antipathy towards a patient and wishes to lay all the blame for a breakdown in the pdoc-patient relationship at the feet of the patient).
Nowadays the relationship is better only as much as it is one of indifference rather than open hostility. I keep most stuff to myself rather than risk a repeat of the abuse and nastiness I was previously subjected to.
I have no friends, am socially isolated and have never worked due to my problems but in the eyes of my psychiatric team I’m doing better because I am docile(more astute people might call it apathetic).
I live independently but in a very restricted way. Having said that I guess I do as well as the mismanagement of my problems allows. I can not hope for anything better.

I stop short of calling for the abolition of psychiatry but can we,in all honesty,say it is fit for purpose? Often it seems to be more about blaming the sufferer than acknowledging the very real effects of environmental,psychological and social factors on a person’s life.

My brother has had sz symptoms for 37 years, and today he is well on the road to recovery. He has had all the social issues you mentioned, and CBT helped substantially with the emotional and psychological fallout from it. It didn’t cure him of his sz, but considering the emotional and psychological trauma of having sz, it was necessary for him to have CBT to help him through the fallout. He also regularly needs psychological support as he recovers from sz.

I can’t buy into CBT. Perhaps if it acknowledged the effect of negative experiences more and didn’t tend to dismiss them as just ‘faulty thinking’ I could get into more.
For me it’s too much about saying X wasn’t a bad experience it’s just that your thinking is faulty.

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I like this more modern definition of recovery:

"In mental health, recovery does not always refer to the process of complete recovery from a mental health problem in the way that we may recover from a physical health problem.
"For many people, the concept of recovery is about staying in control of their life despite experiencing a mental health problem. Professionals in the mental health sector often refer to the '€˜recovery model’€™ to describe this way of thinking.
"Putting recovery into action means focusing care on supporting recovery and building the resilience of people with mental health problems, not just on treating or managing their symptoms.
“There is no single definition of the concept of recovery for people with mental health problems, but the guiding principle is hope -€“ the belief that it is possible for someone to regain a meaningful life, despite serious mental illness.”

@firemonkey, I agree with you that many people with mental illness and other differences are encountering unprofessional providers. It’s not as if those of us who, already different, spent our childhood years being abused and bullied and our adult years not fitting in because we have no clue about how human interaction works will suddenly understand subtle social cues, unspoken social expectations, and facial expressions. I think untrained professionals react as if we do it on purpose because they simply cannot imagine not being capable of appropriate social responses and reading of non-verbal cues. It is second nature and automatic for many people.

The last counselor who fired me kept telling me I had emotional dysregulation as if I had spinach in my teeth and I could simply correct it. I still don’t really understand what emotions we are supposed to feel or not feel and how anyone could possibly “regulate” them. That was not explained. Okay, whatever. I have absolutely no idea what is going on around me most of the time and am more and more isolated. No one ever showed me a bunch of pictures of people’s faces and explained what the expressions mean. No one tried to help me adjust socially as a child, just arbitrarily punished me for a vast range of behaviors without explaining why and never told me what TO do. The adult world is just a more systematic, more harshly punitive version of this as far as I can tell (like I said, I don’t know what is going on).

I have found a counselor who understands my dx and the effects of a traumatic early life on someone with a brain like mine. Even then I want to stop because I am afraid of being judged, but he is helping me and not blaming me for things I had no control over. Plus I blamed myself for so long that I may have been projecting that blaming onto other people; combined with the lack of ability to understand emotions and social cues, this is really possible for me.

There are good professionals who can be trusted. Recovery is whatever your meaningful life means to you, not how anyone else defines it.

CBT and every other treatment are tools. They can be used effectively or they can bash holes in walls. While there might be consequences, you don’t have to do anything you don’t want to do. Define recovery on your own terms and if you don’t want to “strive”, don’t. Your life is yours.

My personal preference would be for my way of being to be okay in the world, but it’s not. I have to figure some stuff out because I want to live in a temperate shelter, eat food, sleep safely, and be somewhat clean along with hopefully getting medical treatment when needed (this last one may not be possible as I live in the US). If I don’t figure it out, I am going to suffer more, so I want to try. Admittedly, my striving does not look like I am doing much, but I am.

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I feel ya.
Sorry you have had the wind taken out your sails.
Wished this wasn’t the truth that psychiatry couldn’t fit me into a proper working frame,but as in my case, once I got trapped into the quagmire of psychiatry, I have never improved to their liking. As I was last told by my pdoc, my psych records had continued into a 4th volume, each volume about 5" thick…winning the biggest they know.
They were glad when I got dropped due to divorce.

Seems that when others aren’t aware of my Dx and treat me the same as everyone else, I do ok. Maybe a little 'left of center’
but accepted none the less,
and when accepted “as is,” with flaws and all…
Then I’m free to seek out and discover,
that, which helps me,
and, that which hurts,
and hopefully,
do more of only that which helps.

This, ultimately, gives me the life (or the hope, that this (life) of mine-will not always suck something awful.
so, that become the direction to seek, to gain, to improve .

Without hope, there is no chance that things will ever get better.

To me, that is the perfect description of those often elusive, yet plenty, entities commonly referred to as
"Normal."

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I don’t think recovery involves abolishing all symptoms. I think it involves getting to a level of coping with the illness where one can function in daily life.

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I don’t think I know how to interact properly with people, due to being a social outcast from the start of grade school to pretty much the end of it. So I use it to try to make people laugh on purpose.

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I beleive the concept of recovery in sz/sza is extremelly important. It’s important because we need something that takes us out of the hopeless category in terms of disabled people. It’s important because we can accomplish much more than what we think we can, and need to strive for it. It’s not like we need to get a job and contribute to society, but we can actually chose what’s best for us based on things that others don’t even value, like mental health for example.

I’m sorry you had a rough time @firemonkey but not all of us experience it the same. And even with bad therapists and pdocs, we can accomplish things and live close-to-normal-lives.

I, personally, refuse to fall in the hopeless category.

@Hereandhere The thing is I have never had help with those social interaction/social skills difficulties. As you say it comes naturally to many but for some of us it isn’t the case. Sure I’ve had it said I have very poor social skills ,have problems with body language, had the word autistic mentioned in relation to the way I am ,but that’s where it stops. There’ s a superficial acknowledgement of difficulties but an attitude of " but not that there’s much we can do" .
The very same issues that got me bullied as a teenager are still largely there and help combating them thin on the ground. I don’t have much contact with others and keep myself to myself a lot, but if I was to try and interact more with others those issues would result in a lot of social rejection.

I just wanted to note that I’ve found myself confused and a little frustrated at the way you conceptualize personality disorders, @firemonkey. It seemed disproportionately self-blaming and stigmatizing and not at all consistent with the way I’m used to seeing them handled in a clinical setting.

So I did a little research on the attitude, and the very first google result I got for “are personality disorders mental illnesses?” was a paper on how British doctors in particular don’t view them as such and are somewhat negligent and patient-blaming in treating them. Many US doctors, on the contrary, see little point in separating Axis I from Axis II disorders, as many of them have common etiologies and exist on a spectrum with one another.

I guess this is just to say that I suspect the treatment you’ve gotten has been substandard, at least from a US perspective, and I understand better now why your diagnosis change felt (and may have been) punitive, and why you seem so pessimistic about the whole enterprise.

Also, that maybe looking at this from the US perspective - personality disorders are pervasive, debilitating illnesses caused by factors outside if the patient’s control - might help you? In any case, the judgment you’re perceiving is by no means universal.

And finally, about CBT. In the US, too, they aren’t very concerned with what caused the unhealthy thought patterns addressed by CBT. The cause is more in the realm of talk therapy. But they don’t blame you for the thought patterns. They just focus on fixing them.

I don’t know. Our perspectives are so different. I just wonder if it would help you to appreciate the view from over here.

Good luck, you.

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A personality disorder is treatable, or at least people are able to find good coping mechanisms for them. If they are willing to. It’s definitely not the same. My 2 cents on that question.

The problem a lot of clinicians have with personality disorders is that the prognosis is poor - they’re less treatable. It’s why, in the UK in particular, psychiatric doctors don’t want to be bothered with them.

Which is exactly the problem @firemonkey is encountering - the attitude that there is no point bothering with him, that if he wanted to get better (if he were a “good” person) he’d solve his problems on his own. It’s a patient-blaming and stigmatizing attitude.

The belief that personality disorders are treatable comes from the fact that a relatively small portion of people who have them respond to therapy. Most don’t. Sz, bipolar and depression are much more likely to respond to medication.

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I getcha now.

That doens’t mean the recovery route, even on its own isn’t a good thing.

It can be frustrating to try to get better rellying on a system that doesn’t seem to want to help.

But I bet someone does, and that a lot of people get that help.

Here in Portugal there’s a lot of competition between psychologists and psychiatrists, to the point when my old pdoc said I wouldn’t benefit from therapy, I am benefiting from it, but I also have to adjust to the procedures and need to overcome my own issues with being better.

I don’t think it’s putting the blame on the patient asking for responsibility from the patient to his/hers own mental health.

That’s harder with sz/bp/depression, not so hard with personality disorders.

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Yes, I agree. I think the recovery route is absolutely the way to go. I just now have a much better understanding of why @firemonkey is so discouraged by it. I wonder if maybe looking at it from a different perspective might make him think it’s worth another try.

The articles that I read (this http://bjp.rcpsych.org/content/180/2/110 was the main one) angered me. What I had assumed was a particularly pessimistic attitude on @firemonkey’s part is apparently a very accurate accounting of the situation where he is. I think it would make recovery tough, and that sucks. You shouldn’t have to fight your own doctors in order to recover.

That article talks about psychopathy not being a mental illness, which I agree in totality.

I’m a bit skeptical because I had an argument with @firemonkey yesterday about the benifits of CBT, he says it’s bullcrap I say it’s not. I wish my government gave me free CBT sessions, like in the UK happens.

And also, aside from the issue that personality disorders are not mental illnesses, they’re still mental issues, and I stand by what I said before: there are bad therapists and bad patients.

I also think @firemonkey has been unlucky from what he describes, but I also have to admit I don’t actually know what happens in his sessions and that he might be a difficult patient to help, knowing for how hard it is to argue with him on something here :smile:

Sorry, but I don’t think things are black and white like that.

Free health care is extremely important, and of course it’s underpayed so the doctors prefer to have private offices.

I know I’m priviledged to have a good pdoc, but that changed, my former pdoc wasn’t that good. I also have a good CBT therapist but I have to pay for him 60€ a session, and that’s not cheap. It’s 120€ a month, and if I was on disability or working I couldn’t afford him, so I consider myself lucky and priviledged.

I actually can see myself fitting traits of certain PDs ie avoidant,borderline and schizotypal. I think my main issue is when and how the complete switch over to a PD dx occurred, ie at a point when the patient/doctor relationship was poor.
It may not be true of the US but it is not unusual for UK pdocs to label patients as personality disordered that the pdoc has a subjective dislike for.
I still very much question the complete switch of diagnosis rather than personality disorder being added on as an additional rather than standalone dx.
I think the problem for me and for a lot of people is that we are more complex with regards to symptoms than is allowed for in the rather simplistic diagnostic systems . I don’t fit neatly into any specific dx . I tend to see myself currently (it may have been different at other times) as someone with primary anxiety, secondary mood and thought symptoms and aspergic traits/dyspraxia/non verbal learning disorder. I am certainly a lot more than just personality disordered. If there was a psychotic spectrum classification stretching from mild/intermittent psychosis to the severe psychosis of much schizophrenia I would fit somewhere at the milder end of it.

It is true that therapy is the main approach to PDs but in my case I am on a depot antipsychotic and receive nothing in the way of therapy . For the things antipsychotics are designed to work for it works well in some respects and less well in others, ie it’s better for weird thinking and paranoia than it is for more negative symptoms like poor drive and motivation.

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I think striving recovery is in itself a good thing up to a point but also there is a point when realism needs to kick in. In terms of likelihood of recovery the chances diminish over time.
This of course points to the window of opportunity being widest early on in the illness and the importance of timely and appropriate treatment especially when first ill.

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It uses psychopathy in a broad sense, not solely in an antisocial sense. It goes on to talk about schizotypal and borderline in specific, for example. It’s about personality disorders in general.

I wish we got free CBT, too. And I agree that it’s not all black and white. I honestly think therapy is minimally effective unless you go in with an attitude of, These are my issues, and I’d like help in resolving them. You have to actively work at it.

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Then that article is generalizing too much, it can’t be the same basket for all those eggs.

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