By David Joel Miller
Do people with depression, anxiety or emotional problems relapse?
The term “Relapse” is increasingly being applied to mental illnesses and for good reasons. Many people are familiar with the idea that people with a substance use disorder, alcoholics and drug addicts can relapse. The idea that people with a mental illness can relapse is becoming a recognized part of the mental (or behavioral) health field.
Wellness and recovery.
We know more now than ever before about mental and emotional illness. Professional’s no longer think of the mentally ill as somehow different from others. We now know that them is us. In their lifetime half of all Americans will experience the occurrence of an emotional or mental health problem that meets the criteria for a mental illness.
Looking at mental health issues as chronic conditions rather than once and forever problems has helped us to understand how someone with a mental health issue can “relapse.”
Mental health and illness lie on a continuum.
There are not two discrete groups, the well and the ill. People who appear to be emotionally and mentally well may gradually develop symptoms. Disorders can come on suddenly or slowly. People with mental health issues can and do recover. They get better.
Along this continuum people can move from unwell (ill) to less unwell to well. Others can move from well to unwell. Across your lifespan you will probably make many trips back and forth on the continuum. You get sad and depressed or anxious and then you get better.
People can have a mental illness and then get better.
For professional treatment we have set the point at which people get diagnosed as mentally ill very far over on the continuum. Your condition needs to interfere with school or work, prevent you from having good relationships, upset you or impair some important part of your life for it to be diagnosed as a mental illness.
Plenty of people get life problems that almost, but not quite reach the point of being mental illnesses. These people benefit from counseling also if they are able to get some. For milder issues (subclinical) self-help books, blogs like this one, religious and social activities and so on can help them maintain their mental health.
Mental illnesses are often chronic conditions.
Mental and emotional issues are a lot like being overweight and developing type two diabetes. Once you have been diagnosed as a diabetic it is unlikely that this will come off your medical file. You may take medications, exercise and watch your diet. All those things may get your blood sugar back under control.
With chronic conditions, and mental and emotional disorders fit this pattern well, even once you recover there will be things that you need to do to keep your condition under control.
Our understanding of the need to do things to maintain mental health recovery is informed by the stages of change model. See Stages of Change for a list of all the posts on this process.
In that model we discovered that when someone recovers from a condition, excess weight, substance use, depression or just the normal problems of life, there are things that they will need to do to maintain those changes. We call that recovery the “Maintenance steps or Maintenance Stage of Change.”
People with mental illnesses do relapse.
By relapse I mean a return to symptoms or an increase in symptoms that were previously under control. Sometimes that relapse is a result of new life events. Someone with PTSD or complex trauma may experience another trauma or something that reminds them of past trauma.
Someone with depression or anxiety may have an experience that is sad or makes them anxious. As these levels of emotion rise the person may become overwhelmed. If their support system is not being supportive or their coping skills are overwhelmed then the person moves to being less well, less able to cope and they may experience another episode of whatever we chose to call their mental or emotional issue.
This continuum of wellness and the possibility of recovery is easier to see when we talk about relatively well know conditions. Anxiety, the most common of all mental illness, and depression, that cousin of sadness, are good examples of how the journey from wellness to illness and back may occur.
We have all experienced some anxiety and can see how it may get better or worse. Depression is understandable. Sometimes in life we get sad, if we get too sad or stuck there to long that might turn into Major Depressive Disorder.
What about really serious mental illnesses, the ones were it is harder to understand the symptoms. Do people with Borderline Personality Disorder, Schizophrenia or Dissociative Identify Disorder ever recover?
There sure do. There are treatments for all those conditions. Most of these treatments are skills based. Someone who hears voices all the time, they can learn to listen to the police officers voice and not the one in their head. This is not easy, it takes lots of skill development and practice, but many people with even the most serious of emotional issues do recover.
Do you get the picture that I and other mental health professions are coming to be strong believers in wellness and recovery? Recovery happens. If recovery happens, sometimes there may be a return of symptoms. When that happens we expect a return to doing the things that helped the first time to help them recover even faster than the first time.
If there are other skills they need to learn, well during a relapse is a really great time to try out new skills and find a way to create your happy life, however you define it.
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For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books