CHOICES: #9 - Medications, Therapy & Functionality
In previous blogs in the Choices Series, I have suggested that there are three milestones in the Journey of Recovery from schizophrenia: Functionality, Wellness, and Fulfillment. I've also suggested that the starting point for this journey is Acceptance of the fact that we have a serious brain disorder. We've also addressed the idea that evaluating an individual's level of functionality has to be determined on a person-by-person basis and in relation to the person's capacity for functionality. [I believe this should apply to everyone in society, not just those of us with mental illness.] And finally, we talked about the fact that society's definition of functionality often differs from ours to the extent that it can place us at a disadvantage. From our perspective as people suffering from schizophrenia, grading can only be done fairly on the curve. One size does not fit all. Society, however, does not grade on the curve, and this makes society a tough task master.
In this blog I will illustrate how in my Journey of Recovery, with medications and cognitive behavioral therapy, I have managed to progress. And because for some, like me, a picture is better than a thousand words, I'm going to use a chart.
Examine this chart and its components, and then I will explain.
This chart is intended to communicate how medications and therapy interact to increase my functionality. Movement from the left side towards the right represents the passage of time, and from bottom to the top represents my improving condition.
The red line [Medications], which looks like stair steps, illustrates how improving medications increased my capacity for functionality. I believe that in my case, the effectiveness of my medications set a cap, or upper limit, on my capacity for functionality. Each time the red line bumps up, (and creates the impression of stairs), it represents a point in time when I changed to a more effective medication. The horizontal portions of the line represent limits on the effectiveness of the medication
The green line [Psychotherapy] represents cognitive behavioral therapy and how it made it possible for me to take advantage of any increases in my capacity for functionality that my medications provided. In a very real sense, this therapy "pulled me up by my boot straps" to make me the best that I could be given the capacity for functionality that my medication provided. When the green line rises above the red line, it indicates the therapy I was being given was too much of a challenge for me to implement given the limitations my medications placed upon me. And when the green line runs below the red line, it indicates that the therapy I'm receiving is falling behind my capacity for functionality and may even become a hinderence to me.
The black line illustrates actual increases in my functionality. You will note that this line never rises above the lower of the red line or the green line, i.e., at any given time my medications or my therapy defines the maximum actual functionality I am capable of achieving. You will note, however, that if I hadn't taken my medications my functionality would have remained flat on the bottom of the chart. And you will also note that even if I had gotten medications, without the cognitive behavioral therapy there would be nothing to "pull me up by my boot straps." I would have remained mired near the bottom without ever realizing the capacity for functionality provided by my medications.
This is how I describe my Journey for Recovery. The validity of this chart was proven for me once again about three years ago when they stopped making the medication that had worked so well for me for forty years. The red line collapsed and in a matter of ten days I was reduced to a level of functionality on the bottom of the chart. Once we found one of the new atypical antipsychotics that worked for me, my functionality jumped straight up to very near what it was before. [I had already internalized all the therapy I needed.]
I should point out that this chart is illustrative. The actual progress in my Journey for Recovery was much more complicated. When I became ill in 1956, there was only one medication available and it didn't work very well for me. [You'll notice that at the very left of the chart my medicine did not increase my functionality.] My doctor and I tried every new medication as it came out. Some of these did not work as well as the medicine I was then taking and actually had the effect of lowering my capacity for functionality. In these cases we would then switch back to my prior medication. In terms of the chart, in my Journey for Recovery, the stair steps representing the capacity for functionality conferred on me by my medications went both up and down over time as illustrated below. You can visualize from this just how complicated the actual process of improving my functionality was.
Next week I'll overlay some of society's expectations with respect to functionality and this will begin to describe what those of us with schizophrenia are faced with in the "real world." From there, we'll talk about the importance of getting the right diagnosis early and then move onto coping skills and to the important issue of stability. All this will describe the process of how we get from the starting line, an Acceptance of our illness, to Functionality, that first milestone on our Journey of Recovery.
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Please remember, this writing reflects my own experience and opinions. If you, or a loved one, are experiencing the symptoms of schizophrenia, or any other mental illness, you should seek professional assistance.