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Aug 10

Recovery from Disability

disabilitySometimes we are privileged to help someone who is disabled due to bipolar or depression to recover and resume a full and happy life.

In the beginning we face many questions about the process.

Family members may have become very skeptical about the value of treatment. Or they may wonder if the disabled person is exaggerating his or her symptoms or impairment.

Many people who find themselves in this dead end become very discouraged themselves. They go from having a sense of confidence and optimism about the future – working towards a career and a happy life – to a sense of deep doubt and despair.

Life is lived day by day. The goal is to avoid the next catastrophe, which is always lurking right around the corner.

The trouble is that the pervasive pessimism and mistrust (of the disabled person, of treatment, of the disorder) and the focus on making through the next few days without disaster are antithetical to recovery.

Our experience of this process teaches us a few things –

  1. Someone has to have a sense that there may be hope – other than the therapist or psychiatrist. It may be unrealistic to expect the disabled person to have that hope, since they have suffered the most from depression. Although getting so sick and tired of suffering that the disabled person decides to act as if they hope for recovery may be enough to get things going.
  2. The process of recovery involves several stages and often (or usually) takes between 18 months and 2 years. First is “crisis stabilization” – getting safe housing, stabilizing mood enough that thoughts of suicide no longer dominate the person’s mental life, curbing dangerous substance use, etcetera. This often takes 2 or 3 months. Then there is a process of building longer and longer periods of reasonable security, and beginning to hope for real that recovery might be possible. This might take a year or so, since there is almost inevitably one or two setbacks that make the person doubt that he or she is really getting better. Finally there is a shorter (six months or so) process of putting in place the kind of supports and structure (friends, family, school, work, etcetera) that will ensure a long term mood stability.
  3. Recovery is hard work. There is never one quick answer (or “miracle drug”). The way out involves putting together a treatment program that includes several medication trials (often combining two or three medications that worked partially), cognitive retraining to counteract the negative self-talk and sense of helplessness that can otherwise derail recovery, coaching about appropriate life choices (starting with a volunteer job and then working up to a part-time job, being realistic about one’s abilities, and making appropriate relationship choices), and support for getting physically stronger (getting necessary healthcare, exercising, eating a healthier diet, having a healthy sleep / wake cycle).
  4. Recovery is often expensive. There are (sadly) very, very few publicly funded programs that support this process. Most community mental health treatment is focused on minimizing hospitalizations rather than maximizing recovery.
  5. In medicine there is hardly anything that comes close to the improvement in health and functioning that completing this process can create.

Here are a couple of books that may be worth reading that talk about this process –

 

Please also consider attending a local National Alliance for the Mentally Ill (NAMI) meeting.

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