Arguably the way to resolve a problem is to see what is holding back the problem from finding a solution. If mental suffering and its associated “illness” be seen as a problem then possibly there has to be a way out. Does the way come via psychiatric medication or does it come via some other pathway(s)?

When I recovered from bipolar disorder and stayed “sane” for long periods of time, one of the first acts I performed was try unearthing why or how I had recovered. But when others, predominantly caregivers of other similar “patients”, started calling me an exception it became a challenge for me to understand if I could recover, why were others not doing so. I got this opportunity via doctoral research in 2016. I took the challenge up to not rebuild my life, but find a way out for others! (no wonder the “mad” are called so!).

Entering the psychiatric maze in 1992, by the time I quit the patient role it was 2010. I spent another dozen years understanding (1) my own recovery (2) recovery from psychosis (schizophrenia and bipolar disorder) more generally, all via research done alone at home for years and years.

Finally when my book came out last year three decades had passed. Not the easiest time of my life, a time spent in grief and suffering, thereafter pondering over intractable issues of living, listening to narratives both in research and counseling.

At the end of this span today I can say that nobody’s mental health will get affected if everyone had opportunities and managed to do what they ardently want to. And, significant others who would support and believe in them getting there, instead of imposing their ideas on them, as parents sometimes tend to. The book is a bit of an academic analysis, but for someone interested the publisher offers 50 odd pages to read for free, from this link. There is a button that says “preview PDF” to the top right of the page, if seen on a computer, as I am doing right now. Once you click it it downloads those pages into your device.

Hope it will interest you to engage with some of these ideas. What is true for psychosis is valid for most mental health issues, as schizophrenia and bipolar disorder are among the more unmanageable of issues, even for psychiatry. If people can recover from these, they can pretty much heal their minds from most other things as well. Provided, they will do what it takes to recover, which itself is not child’s play!

This is a first of what may be a set of posts around the same theme- recovery in mental health or recovery from mental health issues, regaining one’s sense of wellbeing after an emotional/psychological setback.

The past year has gone in a lot of work in this area (also among the reasons I could not write on this blog). So now is the time to talk about the work which has been done away from the public eye.

Let me begin with the book, which comes out later this year, I put to bed a few months ago. Currently the last phase of that is underway- on the production front.

As an aside, a somewhat disconcerting thought which has always been there at the back of my head is that when we say the word ‘recovery’ in the context of mental health it conjures a particular kind of image. Recovery is often mistaken to be the recognition of someone’s suffering as a diagnostic reality. (Oh, but this was not the disconcerting thought I had in mind- it was about my book and how academic it is!)

“Oh, now I know why I was feeling so bad. I have anxiety after all“.

“I got a diagnosis of PTSD and chronic depression. I was also wondering what is going wrong.”

This description of suffering and its reframing into a diagnostic “truth” is what happens all the time in the field of mental health, something that troubles me immensely. But I will not go into that trouble right now. I better share with you what is the problem for me to solve here- the problem of talking about recovery.

I recovered from bipolar disorder. It may sound like something un-relatable, for one is not supposed to. In other words I am an outlier by all standards. This sudden disclosure is not part of my identity politics and I do not use mental health as a means for attention-seeking for I am troubled by it. For me my positioning is an ethical stance which comes with an agenda, largely research driven.

My agenda

My agenda post my own recovery was twosome. First it became to map my own recovery- for how did I recover?

I had no clear cut ways to share with another. I am talking about the year 2011. That was the time I started on recovery research, and a number of articles followed in diverse journals across the globe- Psychological Studies, Canadian Journal of Music Therapy, World Cultural Psychiatry Research Review and others (you are welcome to check them from my linkedin profile, ResearchGate or Academia networks. Oh yes, there is one article which is just a click away in which you can both read my (less academic) writing and hear my (self composed) songs (ghazals to be more precise). A longer piece of writing about the ghazal and its role in my healing is there in the World Cultural Psychiatry Research Review (2015).

My second agenda is/was to see if one person can recover, why are others not able to. Or rather, what is it that does not allow more people to recover- which became my PhD research (2016-2020)

Three decades in the field and five decades of life behind me, I know there was none other than this which was my goal, at least for now- recovery research. So while the research was done as a PhD and barriers to recovery found the next and more befuddling (may I say unenviable) option is how to tell others they can recover as well?

This is what I am doing nowadays- creating those other resources to disseminate the findings from my work, advocacy about recovery from mental health issues and suchlike things.

I am not going to say further in this post except having introduced the context- of who I am, where I come from and why I talk about recovery so much. And yes the resources I am busy creating- resources for recovery, advocacy and helping others recover just as well as me.

The first put to bed was the book of course. I will talk about it closer to the time it publishes (later this year)

The second is DIALOGUES FOR RECOVERY with the support and handholding by Vidya Sagar, Chennai. Here is a sample of that work, though we are not yet adept with this sort of work. Whatever else is unfolding is still firming up and I will share about them in subsequent posts. But I invite you to read the writing I have shared, which are scores of articles about my recovery and where I stand today, or what ideas I propagate via diverse means. The video that follows is a sample. There are at least five others of its siblings you can check from the same link and you get to hear my other ideas too (not mine solely, of course for we all stand on the shoulders of giants after all) …

It may be a common sense assumption that when someone enters the world of treatment for their emotional or mental health issues their intention is to be relieved of their suffering, emerge healed and whole from the treatment. But does it really happen? Is there any way to know how many people actually exit the (mental health) system? Is anything going on in the treatment process that can actually lead to someone’s recovery?

By and large experiences of vast numbers of people are that once they enter into the system they are told by psy-professionals (and other medical professionals) of all hues that they would now have to rely on psychiatric medication for the rest of their lives. This insistence on medication, which is borne out of the agreed upon knowledge which all psy-professions draw from, invalidates the day-to-day suffering of people into a predetermined ‘illness’ category, complete with a diagnosis and prognosis. In 2019, I wrote this article which can be downloaded or read here or here which problematizes this aspect of treatment and questions what the goals of such treatment are.

It may be common sense assumption that when someone enters the world of treatment for their emotional or mental health issues their intention is to be relieved of their suffering, and emerge healed and whole. But does it really happen? Is there any way to know how many people actually exit the (mental health) system? Is there anything going on in the treatment process that can actually lead to someone’s recovery?

Research suggests that recovery is mostly not a goal psy-professionals target when they start treating people for their mental health issues. For most people the starting of treatment itself is ‘recovery’ because according to professionals the fact that people’s suffering has been recognized is itself a great victory over their ignorance: of being a mere suffering, while it is actually a real ‘illness’. However the truth from a ‘patient’s’ perspective is that until people take pharmacological treatments they believe themselves to be ‘ill’ or ‘sick’ and therefore not quite recovered. From the ‘patients’ ‘ position it is the ending of the treatment process and exiting psychiatry that counts as real recovery, not interminable treatments. Whether or not mental illness is a real illness is itself a topic of big discussion and debate, which I postpone for another location as of now.

Knowledge about recovery missing

When there is a gap in the social knowledge about a situation it has consequences; both for individuals, families and society as a whole. For example until penicillin was discovered by Alexander Flemming, a number of people would die for reasons as simple as flu or pneumonia. Antibiotics gave a new lease of life to people around the world and heralded a new era which cumulatively brought newer efforts that prolonged human life expectancy.

In the context of mental health when people are not aware that they can recover and they choose instead of continue taking medication, their lack of information is a knowledge or information gap. Instead of recovery their bodies become sites for testing newer drugs, yet no advancement produces the desired ‘cure’. When drug treatments continue for decades people not only become chronic patients, they also slowly develop  co-morbid conditions such as thyroid malfunctions, liver damage, akathisia (I have written about it here), seizures, lupus and scores of other conditions, not to mention the ‘regular’ issues of hypertension, diabetes etc.

A lack of information about the possibility of recovery, which leads to never ending treatments is the issue  addressed here. This knowledge or the lack of it, also called epistemic ignorance in research, becomes an issue of justice first of all. When people have unequal access to information in society, even though we  live in the information age: the internet having created unprecedented possibilities for diffusion of ideas, only the idea of rising incidence of mental health issues are widely publicized, especially by the media and myriad psy-professionals. Treatments that do not end and progressively disable people, making them socially outcast and confined to their domestic spheres become an issue of justice- for what then are these treatments intended for?    

Why human rights issue

When a patient or their caregiver is told by a psy-professional that their treatment is for life more often than not they do not question it, but accept the ‘diagnosis’ as a truth or fact. Treating people and the inability to produce a healing or cure, or letting them exit psychiatry by supporting drug withdrawal is not common or heard of. Long periods of remaining on these drugs makes people more and more disabled and socially marooned   for they lose the confidence to deal with life, situations and other people.

The information of recovery is a right to knowledge about the idea of recovery. It is a   right of every person who is on drug treatments to know how long their treatments would be and what alternatives exist. Until people do not realize that their interests and rights are being compromised if they continue taking drugs passively it will not help them, while pharma corporations will keep making steady incomes and rising profits. This is a gap of knowledge which can only be filled by people who have taken the path of recovery or who understand the injustice of denying people the knowledge about their mind and body. In one of my future pieces I will write about how the new Mental Healthcare Act of 2017 also does NOT support recovery and ensures people remain ‘patients’ ad infinitum, once they enter into the mental health system (that being the work I did for my doctorate)

Thank you for reading. If there is something more you would like to know about recovery from mental health challenges, or have a personal concern, you are welcome to post a query or comment in the comment box below. Prateeksha would be happy to respond to it, if necessary, even with a new blog post.

This post is a response to a query someone sent. Since it requires some study I thought I would share my findings, which are as follows. Everything that I am citing from others is in purple and my writing remains in black.

Akathisia (Greek “not to sit”) is an extrapyramidal movement disorder consisting of difficulty in staying still and a subjective sense of restlessness. It is a recognised side effect of antipsychotic and antiemetic drugs but may also be caused by other widely prescribed drugs such as antidepressants (Akagi and Kumar, 2002). Citing further research Sharma, Guski et al (2016) note that ‘Akathisia is an extreme form of restlessness, which some patients describe as wanting to “jump out of their skin,” that may increase the risk of suicide and violence’ In plain language Akathisia is a kind of trembling which individuals on antidepressants may experience, which makes them very agitated, restless, and even suicidal (Healy, 2003, p.72), and homicidal.

Antidepressants and their uses

Antidepressants are used to treat several conditions. They include, but are not limited to: depression, generalized anxiety disorder, agitation, obsessive compulsive disorders (OCD), manic-depressive disorders, childhood enuresis (bedwetting), major depressive disorder, diabetic peripheral neuropathic pain, neuropathic pain, social anxiety disorder, posttraumatic stress disorder (PTSD) etc says Ogbru. This of course is a diagnostic view of the matter and does not necessarily talk about whether antidepressants really help someone deal with their depression. So how do we figure this out? For those who have great faith in the efficacy of psychiatric medication some of the following points are noteworthy. It may be pointed out that these is coming from an implausible source- a psychiatrist! People seek out psychiatric treatments as ways out of their suffering hoping medication is going to rid them off their socially produced suffering. How does this come about- how can something which occurs as a response to their social living be dealt with by chemicals? Of course there is a complicated pathway via which people come to believe in the efficacy of drug treatments and is not the subject of this post. Instead I maintain my focus on antidepressants and their side-effects, in particular akathisia.

Another aside, about clinical trials. The average intelligent person is far removed from the world of drugs and pharmaceutical operations. Instead their focus is on accepting their situations as truthful medical diagnoses and attempts at maintaining drug compliance in the faith and hope that science is working in their favour and best interests. Clinical trials or randomized clinical trials (RCTs) are therefore taken as the gold standard for new drug and their development and few have the ability to read beyond the rhetoric of pharma companies. In this context psychiatrist Joanna Moncrieff writes this piece about drugs trials of antidepressants. Here is a brief excerpt- “Whatever the reason, STAR-D suggests that in real life situations (which the STAR-D mimicked better than other trials) people taking antidepressants do not do very well. In fact, given that for the vast majority of people depression is a naturally remitting condition, it is difficult to believe that people treated with antidepressants do any better than people who are offered no treatment at all.” To simplify this language: Moncrieff is saying that depression is not a permanent state and people get well even on their own, by other means. So it becomes difficult to believe that people who are not given any treatment are worse off than those who are treated. In other words taking medication for depression is not necessarily useful. You can also hear this podcast in her voice. which sheds further light on her work, ideas and findings.

Side effects of antidepressants (or SSRIs)

As the title of this post suggests antidepressants, of which SSRIs are one major variant, often have side effects of diverse sorts, and akathisia is only one among them. Antidepressants may cause withdrawal symptoms if abruptly discontinued. Withdrawal symptoms include nausea, vomiting,  dizziness, headache, irritability, sleep disturbance, nightmares, psychosis, and seizures, according to this site. Here I would also like to share another piece I wrote on my own blog sometime ago, which talks about SSRIs and brain damage, which includes a video interview with some doctor that I forget for now. And here again is another article that is not only a bit more technical but also talks about increased suicide risk due to SSRIs.

So the long and short of it is that taking antidepressants may be approached with caution for it is likely to increase the risk of other forms of debility, sexual dysfunction and other side-effects or outcomes which can be difficult to deal with in the long term. I am leaving you with further resources to read : by Robert Whitaker, and the absolutely brilliant blog by psychiatrist David Healy, which has scores of articles about suicide, side effects of different SSRIs, about sexual dysfunction disorder and so forth.

Of all the things one gets to hear about mental health, we often do not hear the word ‘recovery’. This implies that though society encourages people to examine distress-causing issues through the lens of suffering or accessing mental health treatments, the acceptance of people once they enter treatment regimens is markedly changed. Do treatments have to continue for life and if yes, then what is the goal of such treatments? Do we need to talk about recovery at all, for is not the start of treatment the start of recovery itself? The answer to this question is both yes and NO, for it depends upon whose perspective is considered. In other words, depending upon stakeholders the perspective changes!

Introducing the series

This weekly series, much like the writer behind it, is dedicated to the idea of ‘recovery’ . It brings together an experience of engagement with the field for nearly three decades, of which the last decade (2010-2020) is spent exclusively on the idea of researching about ‘recovery’ or whether it is viable for a vast majority of people. This recovery series will principally be a response to the queries the writer, in her role as therapist, receives from diverse platforms, including emails which reflect people’s struggles to reclaim their mental wellness and lives, instead of necessarily looking at them through diagnostic categories.

Why should recovery matter?

When someone accepts the medical diagnosis of a mental health issue, they enter into the stage of becoming a patient. In that role they keep on getting treatment for years and years, and there seems to be no exit; especially when the diagnosis is schizophrenia and bipolar disorder. Not only psychoses, increasingly people are coming under the remit of mental health diagnoses and unable to exit the ‘system’ for a lack of alternatives to reclaim their mental health and a reinforcement received from different ‘professionals’, the social milieu saturated with claims of rising incidence of mental health issues and efforts which are purportedly directed at stigma reduction. In such an environment anyone who gets a diagnosis, and their families, are so overwhelmed by the one sided representation of mental health as an illness claim that to think about recovery is certainly not on anyone’s mind; but only to get themselves/loved one treated and manage the ‘illness’.

A vast majority of people are unaware that mental health issues are not measurable ‘illnesses’ which can be established by any scientific evidence, pathological tests or measurements via any scales etc. What can be called ‘illness’ is dependent largely on the capacity of the person who is observing the disturbed person to pronounce a behaviour as ‘illness’ or an ab-normalcy; which in research is called epistemic privilege (someone’s knowledge given more credibility than another’s). This is NOT to say that a person who is experiencing suffering is faking their suffering or masquerading. This is to acknowledge their suffering as a reality which needs a different handling than a simple classification into a predetermined diagnostic category. This is simply to say that mental health issues are not biological illnesses which are treatable via biochemical means, the way they are made out to be- they are deep emotional disturbances which can also be resolved by talking, discussion and other ways, which we will examine in future articles here.

Recovery matters because the alternative, of lifelong patient-hood, is a painful, debilitating, disabling option for people/families and thereafter for society. It not only makes people dependent and insecure it leads scores of families into a downward spiral of infirmity and poverty. The usual option someone has is to either remain a patient, or having become a patient for a short while, when overwhelmed by suffering, take the path to recovery by slowly building their capacities to deal with life and its vicissitudes- a journey familiar to this writer. From thereon springs this urge to share these ideas/research and findings with fellow human beings and let others comprehend that if one person can recover, so can another- for this is how one lamp kindles another’s wick.

In the forthcoming posts you will read (when the posts are not direct responses to queries)

• Why the idea of recovery is tied to human rights,
• What are the three ways in which people can understand recovery
• Why a majority of people do not believe they can recover
• Stigma in mental health
• Psychosis and recovery