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"I have learned to hurry slowly."

Recovery through trial and error

So said a woman with a prolonged history of psychosis when asked by an interviewer what, in particular, she had found useful in managing her condition. By the time of the interview, she had come quite a long way toward reclaiming her life from out of the ravages of the illness and, for her, this phrase captured well a significant aspect of her struggle. I was struck, in reading the transcript of the interview, both by the emphasis she had placed on this phrase and by the phrase itself. She was expressing something that had been, and remained, important to her, and so something from which I might learn some valuable lessons as well. But how does one "hurry slowly"?

Thirty years ago, such an oxymoron might have been taken to be a sign of the formal thought disorder that was considered to be at the heart of the psychotic disorder from which she suffered. There was nothing at all in her interview, though, to suggest such a disorder in her thinking or in her speech. Rather than assuming that my difficulty in understanding her reflected the nature of her illness-as Rumke had considered his "praecox feeling," or failure of empathy, to indicate the presence of schizophrenia in his patient-it seemed to me that it would be worth putting in the effort it might require to tease this intriguing, even poetic, phrase apart. And then, in happening to read a book by the novelist Milan Kundera a while later, I learned that "hurrying slowly," or, in the original Latin, festina lente, was a popular phrase in the Middle Ages. Originally attributed to Erasmus, the phrase was later adopted as a motto by Aldus Manutius, the Venetian who is credited with inventing the art of publishing. It was a phrase that continued to be in common use in Italy through the earlier part of the 20th Century, and a phrase the use of which apparently reflected this woman's upbringing more so than her illness.

So, how does one hurry slowly? For both Erasmus and Manutius, as well as for our woman with psychosis, "hurrying slowly" was a way of conveying the simultaneous need to act with urgency (hurrying) while also taking the time (slowly) to be deliberate, thoughtful, and reflective. The phrase is most relevant to those times when it is necessary to act rather than to wait until one has all the facts, has considered all the options, or is sure of one's decision, and yet when it is equally important to remain open to learning from one's mistakes, making mid-course corrections, and adjusting to new realities and contingencies that simply could not have been anticipated, no matter how long the eventual decisions were delayed. In this sense, it becomes an especially well-chosen phrase that captures one of the major challenges facing people who are working hard at recovering from a serious mental illness. Indeed, given the devastation, not to mention potential lethality, of the illness, it is incumbent upon people with these disorders to hurry, but nonetheless to do so slowly and with caution.

This is, at least in part, due to the fact that we know so little about the nature of the illness and of recovery. How, for example, do we currently help someone with a psychotic disorder to live with this condition? We offer medications that help some people with some of the symptoms of the disorder, we offer to help arrange for housing, income, and maybe some meaningful activities to "pass the time," and we suggest that people avoid stress. This is the kind of approach we might have had for diabetes or epilepsy before we understood more about the nature of these illnesses. But it is no longer the best that we can do to tell people with diabetes to take their insulin and avoid stress. If they are to have a life in addition to diabetes, they will need to learn how to gauge their food intake with their level of exertion, monitor and adjust their glucose level on an ongoing basis, learn how to play soccer and drive a car, and attend to other effects and side effects of the illness, such as foot care and the possible loss of their vision. We are still a long way off from learning how to be similarly responsive to the specificities of a psychotic disorder. And thus the need to hurry slowly.

Will our woman with psychosis, for example, be able to return to school, or go to work? There is no way for her to know ahead of time, nor is there a way for anyone else to either. Will watching television make her hallucinations worse, or perhaps better? Will riding the bus increase her level of anxiety, cause her to feel claustrophobic, or instead give her a sense of pride and accomplishment? Or will it perhaps do all three of these things at the same time? There is no way for her to know ahead of time, at least not yet-no glucometer to assess risk for disorganization or delusions. And so she is left, largely up to her own devices, to struggle through an extended process of trial and error; a process for which, however, the stakes can be extremely high. No wonder so many people with psychotic disorders give up or give in from time and time, or at least try to resign themselves to living less of a life than what they would like to hope for. What is more remarkable is the number of people who, despite these odds, manage to get back up again no matter how many times they fall, or are pushed, down. For them, hurrying slowly is not as much a matter of privilege as it is of survival. Like Ginger Rogers, they are having to learn how to dance not only backwards but also in high heels.