Mental illness & preventive medicine

Preventive medicine is pretty much 100% accepted nowadays; we (mostly) vaccinate, we take precautions when in the sun, we screen high risk people for whatever they’re at risk for, and so much else. Lots of us take extra vitamins to try to boost our immune systems, or live off oranges when we feel a cold coming on. We accept that ‘prevention is better than cure,’ because…well…it is!

So please explain to me why the idea that you don’t need therapy, or medication, or any other mental health support, unless you are in crisis, still pervades our society.

As someone with a long history of mental illness, I can tell you that my being OK now means essentially nothing. Yes, I’m glad, relieved, that I’m doing well at the moment, but I’m also waiting for the next crisis. I’m not waiting for it because I’m a pessimist, or because I want it to happen, or because my identity is invested in being mentally ill. I’m waiting for it because I’ve been here before, more times than I can count, for so many reasons, and for no reason at all, and I still have no practical way to deal with it when it comes.

I have depression, but I am not depressed all day, every day. That does not mean I do not have depression, it means I am in, for want of a better word, remission.
I have BPD, but there are days, weeks, when I can manage it well enough that it isn’t a massive, all consuming, issue. That does not mean I do not have BPD, it means that hard work on myself and dumb luck have combined to make life manageable for a bit.
I have anxiety, but when I say my anxiety is fine right now, it does not mean it is at the accepted level for ‘normal,’ it means it is normal for me & therefore I am used to it.

Well managed mental illness is not the same as not having a mental illness

I’m not denying that I have come a long way since my diagnosis. I have so much more insight into my issues and triggers, and I can manage many parts of my illnesses much better now, but they have not gone away. And when you assume that, because I’m OK right now, I must be cured, that hurts. That assumption minimises the amount of work I put in every single day just to try to stay in some sort of control, and it ignores the times that, despite that work, I will find myself struggling, however briefly, even when I’m ‘OK.’

But back to prevention! For me, therapy has been amazing, and it has boosted the work I have done on my own. But let me tell you, therapy is hard. HARD. And it is so much harder when I am in crisis already. Therapy while in crisis is essentially, or has been for me, a damage limitation exercise. The aim of it is to get you through that crisis with as little damage as possible, and yes, that’s important work, but it does nothing to deal with underlying issues which may prevent, or shorten, a crisis in the future.

It’s also important to note that many medications do not work instantly. Most (as I understand it) anti-depressants take around 6 weeks to actually kick in, so starting them during a depressive episode isn’t going to result in waking up a few days later feeling fine. We do not have magic pills for mental illness, you can’t knock back some meds and feel fine in 20 minutes like you can with painkillers.

I think the importance of preventive medicine (and by that I mean all forms of treatment) is encapsulated in this quote:

I’m drowning and you’re standing three feet away screaming “learn how to swim”

We need to be teaching people living with mental illness, people like me, to swim in the moments they are not already drowning. We need therapy outside of times of crisis, for people to address the issues that are causing, or worsening, their crises. We need therapy when people are doing OK to prepare them for if/when they are not, and give them the skills to manage it.

We need to not tell people that it’s important they aim to get off their medication, as if that is some measure of worth, or strength. We need to accept that being well right now does not mean the illness is gone, it means the medication is helping.
If you have found a medication, or combination of medications, that eases your symptoms and that you are happy with, take them. Keep taking them.

Sure, maybe this time it’ll be fine. Maybe this time my mood wont crash again, and I wont find myself so lost in emotion that I can’t see a way out, and I wont feel suicidal, and I wont lose control of my anxiety. Maybe this time it’s not a period of remission, but my new normal, but I doubt it. And I partly doubt it because, even during this current period of stability, I have found myself fighting self harm urges, crying so much I felt nauseous which triggered more anxiety because I can’t breathe when I’m being sick, crying out for support from friends on Twitter, and emailing the Samaritans.

It was a very brief ‘blip,’ if you will, but it was also a hefty reminder of how easy it is for me to fall off that cliff edge, and how absolutely terrifying and all consuming it is when I do.

So maybe stop trying to save me when I’m drowning, and teach me to swim instead.

One thought on “Mental illness & preventive medicine

  1. I love your last statement, sums it up perfectly.

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