Being neither psychologist nor psychiatrist, I see all the components for fundamental advances in mental health, but often a lack of glue to hold critical parts together. Psychiatrists, under pressure to see more patients more efficiently, tend to drop any form of psychology from their practices (http://www.nytimes.com/2011/03/06/health/policy/06doctors.html?_r=2). They become more focused on drug therapy and medical procedure; behavioral modification is a time-consuming loss center, not reimbursed at psychiatrists' rates. I would not be here today but for the intervention and good advice of my psychiatrist. He helped me get well, but my exit plan from the hospital required me to make the necessary connections to stay well. There is no halfway house for the mentally ill.
Psychologists, so sold on behavior modification, often discount the progress made with medicine or electroconvulsive therapy. Few, in my opinion, talk enough about the importance of exercise and nutrition. Ironically, people like me, who probably have a genetic predisposition for mental imbalance, must craft their own balanced plan for mental health. No wonder relapse rates are so high. The mentally topsy-turvy must set their own clear path. We ought to be able to create a best practices list so each one of us can avoid reinventing the mental health wheel.
I came up with my own plan and have talked about my Struck by Living Top Six (http://www.youtube.com/struckbyliving#p/a/u/1/5Qay6Skv7Go) as I've traveled around the country. I've recently discovered a book by Sarah Russell, A Lifelong Journey: Staying Well with Manic Depression/Bipolar Disorder, that gives the history of a number bipolar patients who have successfully maintained health for more than three years. The "Stay Well" techniques quoted from various people in this book are remarkably similar to my Top Six. And guess what? These are the same stay well techniques for almost any illness: take medication (if you need it), get plenty of sleep, eat well, exercise, manage stress and develop strong support systems.
Stress management is where individualism shines. Some people meditate, others write, some garden, others turn to music, older mentors or laughter. There is a higher level of focus on sleep with mental illness than with other diseases, but other than that the solution sounds identical to the common cold. I can almost hear my mother reciting her list: Get your rest. Take your vitamins. Say your prayers.
Can it really be that easy? In theory, yes; but in practice, no. Clinical depression makes simple tasks mental Everests. With each omission, the mountain gets bigger. Yet at the same time, the only long-lasting chance for health depends on setting new patterns of behavior that avoid the pitfalls of mental illness. In order to get better, the patient must own her problem, learn to monitor herself and change behaviors that reignite a negative pattern.
I can feel someone wince as she reads that last sentence. The mentally ill are disadvantaged, I often hear, incapable of making their own decisions. I would agree. And as Goethe says, "Treat a man as he is and he will remain as he is. Treat a man as he can and should be, and he will become as he can and should be." Psychologists never like that "should" word. However, without envisioning a better result, we flounder in the present. Dare to imagine wellness. Our mental health system would serve us better if geared to that result.
The mentally well take ownership. As a person with a genetic disposition for depression, I might slip and fall more than most, but the moment I release the wheel because I'm destined to crash, I'm toast. The disease wins. Instead, I define the pieces of my wellness plan (with help, of course) and apply the glue. The slightly funky result is my life, but it works.
For more information on Julie Hersh or Struck by Living, please visit her website: www.struckbyliving.com.