It’s not that we don’t try.

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 meSo 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.

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11 Comments

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11 responses to “It’s not that we don’t try.

  1. 80% isn’t a real number. The sentence begins with “suppose”. It’s just a theoretical construct. Thanks for pointing out the confusion. I italicized “suppose’.

    • Italicizing suppose doesn’t change the issues there. First off, you suppose that, but even then proceed to assume how we’d respond based on (frankly ignorant) ideas about mental health.

      You blame people for giving up because they think that nothing will change and get better, when that is a symptom of many mental illnesses. Your classification of a modicum of effort fails to acknowledge that your idea of effort is based on a “well” mind.

      You talk about how you just stopped, and treat it like it’s something that will happen to others, if only they try, failing to realize that most likely your depressive episode ended. Which they can do, on their own.

      While yes, treatment and such can help push through that, and yes, certain behaviors can make things worse, it’s not a guarantee and it certainly doesn’t mean that people can just stop feeling that way in order to get better. They stopped feeling that way because they got better.

      See, my depression is recurrent. And I allowed myself to believe, every time an episode ended, that my solution — abusing myself into action — worked.

      Until one day, it didn’t. For years. I couldn’t shake it and I did everything I did before. Instead, I was getting worse. My therapist sort of looked on in horror as I explained my previous coping mechanisms and complained about them not working anymore.

      And here I am now, relearning how to treat myself, and even when I do everything right, like clockwork, episodes return. I kept thinking how much of a failure I was, every single time. Blamed myself every single time. My therapist was the one who pointed out the patterns. And also that it’s more important to recognize what is going on, than to blame myself every time it happens. To acknowledge the biochemical component, instead of vilifying myself over it.

      Posts like the one you made, really don’t encourage me to get better. They reinforce the shame that made it difficult for me to seek treatment in the first place.

  2. mandy

    Hope, I just read that post. It’s easy to get pissed off and feel like he’s standing in judgement of those who don’t get better, but I think you have to look at–what if you’re one of those in that other 20%? I think there are some that can’t get better because therapy isn’t what works for them. I’m one of those. I’ve gotten better by blogging. It’s the first thing that’s ever started turning things around. For some like me, therapists are overrated. I know they work for many, but I haven’t been so lucky. I spent so much energy going from one to the other, then feeling like I was “unfixable.” I basically had to come to the place of deciding if I was going to get better I would have to figure it out without them. It’s been freeing. But I also know that some can’t get help because of the broken system and other obstacles. I understand your frustration. You do have definite obstacles! ❤

    • I’m glad you’ve found something that works for you.

      I think I’ve come to the point (for now, anyway) where I’ve accepted that this is just what my life is. I have a chronic mental illness. Just like my physical illness, it’s treatable but not curable. I’m not going to spend all my time and energy fighting something that’s not going away. I do the best I can to manage every day, and to a lot of people that looks like giving up.

      I have managed better when I had good therapy, but it never cured me. So yeah, I resent it when professionals judge people with mental illness from their Therapist Chairs of Privilege. I know I’m over-personalizing it, but that’s just where I’m at.

      • mandy

        I don’t know anyone who tries harder than you Hope. And I know when you are feeling better you appreciate it so much and are filled w/hope that things will improve. I’m always hoping the right therapist or medical help will show up for you. You deserve it.

  3. I think I fit into the category of people who have tried for years, I’ve tried everything it seems and I don’t get better. Other people do so it makes me think I’m failing at it or too sick or not even sick in the first place or all the weird thoughts that go through my head. But I haven’t given up I’ve been in treatment for 2 decades!

  4. You made some excellent points. I agree with you. I guess its a dont go believing everything on the internet, as we all know, the internet has lots of lies specially amongst all the info thats out there. XX

  5. Gabrielle

    I can’t tell if the help I’m seeking is the problem or if it’s me and my “issues”. I have chronic pain and I can’t work or go to school any more and I have trouble getting places. I keep trying because I don’t know what else to do. But if I still feel depressed, angry, anxious, sometimes suicidally destrought and frustrated that nothing seems to help. A lot of times I can’t do the “mindfulness” exercises or the “self-soothing” because my emotions take over my life. It’s been almost 3 years since I hit a horrible rock bottom and went to emergency at the hospital because I was self-harming. What really hurts is that even professionals minimize my pain and suffering like it’s not real.

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