Sunday, August 28, 2011

Day 47, 100 mgs: Treating Mental Illness Like An Illness

I've mentioned before that I'm taking a class in mindfulness-based cognitive therapy (MCBT) for depression.  We're taught various meditation techniques, which teaches us mindfulness skills, which allows us to be aware of our thoughts, which in turn allows us to recognize thoughts that are depressive, and finally, allows us to release those thoughts.

Last week we talked about caring for ourselves if we relapse.  The hope is that the meditative practice will help to prevent this, but also that it will allow us to notice a relapse before it gets too bad.   It's important to be mindful of the physical and mental symptoms that herald a depressive episode.  Depression, the facilitators explained, tends to follow a pattern in a given individual.  Our homework for the week is to write down what these symptoms are and write up a plan in the event that depression strikes.

This was slightly depressing to me, because in my case, the "usual symptoms" have changed.  Wah!

But a more interesting thought occurred to me: in all my years and years of therapy, none of my mental health care providers ever thought of doing this.  WTF?

I've had some pretty good therapists.   They've used CBT to help me to recognize my depressive thoughts and cognitive distortions.  They've taught me how to be mindful, so that I know what I'm feeling as well as what I'm thinking.  They've taught me to recognize when I'm flooded, and how to tell whether my reaction to a stressful event is actually a triggered response to a past trauma.

And yet, none of them have thought to treat my mood disorder as an illness, with identifiable symptoms and warning signs, let alone have a plan in place for what to do if my mood worsened.  What.  The.  Hell.

This seems like an enormous oversight.  I don't know if it's because my therapists just haven't thought of it, or if they were seeing me once a week and figured they'd notice if my mood and thoughts seemed worse, or what.  But it seems that with such a serious illness, one that can go downhill pretty quickly, that maybe, just maybe, you would want the patient herself to develop a a crisis plan.

I wonder how much of this is the bias of therapists toward conceiving of mood disorders as "mental" as opposed to physiological.  Most therapists aren't MDs, and most pdocs these days don't do much therapy. Besides, when we're in therapy, we see our practitioner for the "mental" stuff.  We talk about our problems.  By talking about our problems we learn coping skills.  Over time, hopefully, our moods improve.

Which is great.  But it doesn't change the fact that mood disorders are physiological as well as "mental" illnesses.  I'm living proof of the fact that a person can learn excellent coping skills and still get blindsided by her illness.  Since my depressive "warning signs" have changed, I did not have the advance warning I would have liked before my psychotic episode, but it might have been a good thing if I'd at least had a crisis plan.


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