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Avoiding Relapse (pdf leaflet 79k)

What To Expect If You Are Treated for Mental Illness

The first step to getting treated is recognising that you could be helped. This is often the most difficult step, because many of us in our hearts can't admit that we need help.

The biggest reason to deny that we might need help is the current stigma of mental illness. This stigma tends to make us assume that "people with mental illness are unsuitable candidates for the presidency" or that "mental illness means you virtually a write off as far as any achievements might go". (Hence we need more role models - Dick Cheney's wife was treated for depression, Churchill was a depressive).

Another very common reason for rejecting treatment is having read some of the truly appalling "anti-psychiatry" diatribes that exist. These are very biased and ill-informed books although some disguise their ignorance with a facade of quotations and apparent scientific basis. Some of them are so bad that people end up thinking they would be better off committing suicide than seeking treatment - RD Laing is particularly guilty in this regard, although ECT was grossly misused in his day

Some common things that might make you realise that you could have a treatable illness include the following (although many are normal at one time or another):

• Feeling suicidal or that nothing is worthwhile
• Unusual, atypical or more extreme, thoughts
• Extreme loss of appetite
• Bizarre or atypical, and often unhelpful, behaviors

If you are lucky, a friend or someone else who knows you might mention that, possibly, you could be helped. The natural reaction to this is to reject out of hand any such thought. However, if you have exceptional strength of character and knowledge, you might take their advice and talk to a professional.

People you might approach could include:

• your doctor (GP)
• a psychologist - often seen as less threatening but possibly less helpful
• a counsellor
• college nurse
• a priest or other figure perceived to be wise

You might even refer yourself to a psychiatrist. Obviously all of these people are subject to human failings, so the individual you choose could be quite important. Also, you might (for some of the reasons given above) go to see a person who is likely to give you the answer you want to hear. If that is the wrong answer you are likely to be in for a more difficult time than if you got more helpful advice.

Assuming that you are still interested in getting your problem treated: in a lot of cases professionals will adopt a "wait and see" approach if your symptoms are not too severe. On the other hand, if your symptoms merit treatment, you might be referred to a psychiatrist, given counselling, or prescribed medication. If your symptoms are very, very dire you might even be admitted to an "in-patient facility" or mental-health facility. They are generally not that great, but are often better than they are said to be.

Your chances of recovery are best if your problems are treated. However some people do recover without treatment. They then sometimes go on to reject the whole of the mental health system. Which is a shame because actually a lot more people would recover if they had treatment.

For this reason many psychiatrists are reluctant to assign a diagnosis of schizophrenia or other severe mental illness during a first episode. It might be dismissed as psychosis, post-traumatic stress, or another related illness. If the patient is one of the lucky 25 per cent who recover without treatment, or receives medication and responds, they might then go on to recover, become "lost to follow-up" and dismiss their illness as "a temporary breakdown" with nothing so nasty and stigmatising as a diagnosis of severe mental illness.

In the case of people diagnosed with schizophrenia, the figures are roughly as follows: 25 per cent might recover without any help; 50 per cent might be greatly helped by medical treatment (no ECT!) and recover fully; and the last 25 per cent remain severely affected by their illness and need ongoing help (EF Torrey). In Victorian times, someone admitted to mental hospital had a 50 per cent chance of staying for the rest of their life - today the probability is exceedingly low.

To sum up: It takes a lot of courage and insight to admit that one needs help. Help can be of variable quality and a small proportion might recover without help. However, modern medical or psychological treatment can help a much greater proportion of people to get back to fully "normal" lives. Most people who suffer mental illness recover fully and blend back into the community - it is only a small minority who are so disabled by their illness that they need ongoing care.

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