I read a blog post today written by a therapist. I’ve been following this blog for a while, and mostly it’s decent. But today, I just want to throw things.
This therapist is talking about how people with mental illness give up on treatment. Apparently, according to this guy, 80% of people with depression get better after a year of therapy, but we just give up and won’t put in the effort. He says, “Most mental health issues, for example, can be much better managed with a modicum of effort. Most people still do not put in the time.”
I don’t even know where to start with this.
First of all, where is this 80% statistic coming from? He doesn’t cite any sources, and I don’t know if I believe it. I know too many people who struggle with unremitting or recurring depression despite years of therapy, myself included. I know my anecdotal experiences don’t disprove statistics, but I’m not just blindly going to accept numbers thrown around on the internet without any sources cited.
Second, how are we defining “getting better” in this statistic? Are we using the HRSD? BDI? CES-D? Goldberg? Wakefield? What score indicates “better”? And over what interval of time? For instance, counting someone as “better” 3 months after a depressive episode might be accurate then, but if they later relapse, are they still counted in the 80%?
Third, define “good counseling.” Every single therapist I’ve ever seen claimed to be good, but some of them weren’t. Some of them were probably good therapists for other people, but they weren’t good therapists for me. So when I terminated therapy with them, was I giving up and refusing to put in the effort? Was I being one of those patients? What about the therapists who have fired me? Who said I was too difficult, too sick, too complex? I guess I should’ve been a better patient so they wouldn’t have given up on me.
It’s bullshit, blaming people for not being able to do therapy. There are a million reasons why someone couldn’t. I, for instance, am mobility-impaired, don’t have a car, and can’t access public transit easily. I cannot easily get to a therapist’s office. I also can’t have a therapist whose office requires me to climb more than a few stairs, which is a major barrier in the area where I live. This is not because I’m not willing to put in the effort. I’ve pushed myself to the brink of physical collapse to try to get therapy, but my body just can’t handle it anymore. It’s not okay to blame me for not getting better.
I have a Deaf friend who lives in a small town. She can’t find a therapist who is fluent in ASL, so how is she supposed to access therapy? That’s not for lack of trying either.
Or my friend who’s working two jobs. She can’t just take off work from her low-wage jobs to go to therapy when the therapists are working. She works from 6:00 in the morning until 10:00 or 11:00 at night. She wants therapy, but there’s no one near her who can accommodate her schedule. She doesn’t get sick time, and it she asks for time off regularly, she could easily be fired. That’s not because she’s too lazy to put in the effort in therapy.
And what about the people who do get therapy, lots of therapy, for years, who work their asses off to heal…but don’t get better? Yes, we’re statistically a minority, but we exist. And to say that most people with mental illnesses won’t put in the “modicum of effort” to manage their symptoms is misleading and hurtful. Most people don’t want to suffer. We don’t want to be miserable and alone. Most of us are doing the best we damn well can, and most of the time we’re doing it with far too few resources and far too little support.
It’s easy to sit in the therapist chair and judge us for what you perceive to be a lack of effort. It’s easy to say, “Why won’t you just _____?” And I think it’s especially easy to judge of you’ve recovered–you think if you can get better, why can’t/won’t everybody else? But it’s not that simple. Your illness is not everyone else’s illness; your pain is not everyone else’s pain; and your solutions are not everyone else’s solutions. You may not see progress, but that doesn’t mean we’re not trying.