The 10-Year Recovery Model, Year Four: Guarding Your Health

  • The fourth year is a foundation period during which you use your strengths to build a solid recovery.  At this time, you are probably experiencing a sense of stability that grew out of all the work you did in the previous years.

    From 1990 to 1991, I had settled into a routine at my job, found a sunny apartment near the beach, and was more active and social than ever: out in the world in a big way.  I no longer collected disability checks and was cut off from Medicaid.  Those income and benefit sources were replaced with a regular paycheck and employer-sponsored health insurance.  The job even had a 401(k)—my first-ever retirement plan that I could contribute to with pre-tax dollars.
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    In this moment in my recovery, with things going so well, I let down my guard.  I was alone in what I went through, and my only close friend was Margot, who also lived independently while attending college.  From time to time I did see a woman I knew from the residence, but our connection faded and my days in the system, while not a blur, were a time that I aimed to put out of my mind.  They reminded me of my pain.
    Not having any role models, I resisted the idea that I could possibly be sick, because I didn’t know anyone else who had accomplished what I did.  According to all five long-term studies (exceeding 20 years’ duration), approximately 60% of those individuals diagnosed with schizophrenia achieve an outcome of full recovery or significant improvement.  Among the 40% who do less well, good improvement is also possible.  However, I didn’t know this when I first started out, and I hadn’t gotten to the point where such things mattered to me.  I saw only that most people around me who had mental illnesses were lifers in the system.  I never wanted to be defined as a “high-functioning psychotic.”  I had higher expectations for myself, and I desired to become fully integrated in the world.  I didn’t want to be an ex-patient who got out but remained locked inside because other people wouldn’t give her a chance.
    The solution seemed simple: lower my meds from five mgs. to two mgs., and then go on a drug holiday within the year.  I thought I could make it on my own.  Why should I take the meds if there was nothing wrong with me?  I could function; what happened to me was just a fluke.  And according to the DSM-III R, symptoms had to last six months for a diagnosis of schizophrenia to be made.  I got better almost as soon as I was put on the meds.
    In 1991, Dr. Santiago indeed lowered my dose.  I was taking classes at the College of Insurance to obtain my property and casualty broker’s license, and I had been given more responsibility at work.  In the small department I worked in, that meant not only working on the direct mail campaigns, but making cold calls to set up appointments for the brokers to meet potential insurance clients.
    In retrospect, I know that this was a stressful time in my life.  Although fairly decent at it, I dreaded the telemarketing aspect of my job.  No support groups existed then for ex-patients who were working or wanted to do well.  I was alone, utterly alone.
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    At night, after I got home from work, I wrote in my journal in my cramped studio, recording not just the events of my life, but my feelings and thoughts about them.  I had a two-hour commute each way, to and from the City, and I had barely any time for myself except this nightly sliver.
    I call year four “guarding your health” because at this point it’s easy to slip.  I suggest that if you didn’t join a support group when you first got sick, do so now.  You need positive affirmations and encouraging feedback.  I never had that in all of the seven years I worked at the insurance brokerages.  It would’ve made a significant difference, I feel, if I had others to talk with about my illness.
    Instead, I lived with this secret shame, telling no one I’d been in a hospital.  My goal was to become an account executive, making more money by managing client accounts and obtaining insurance for them.
    This pivotal year is when you need to keep up your mental health.  I know you’ll be tempted to go off your medication.  I wouldn’t recommend trying a drug holiday, because most people who go off their meds aren’t successful.  Going on and off your pills could diminish your functionality.  The “kindling effect,” observed primarily in those with bipolar, could take place for someone who has schizophrenia, too.
    As defined in the NAMI Peer-to-Peer education course, “Kindling means that something happens in the brain which increases a person’s vulnerability to mood disorders over time.  In the early stages of illness, episodes are generally related to a precipitating event.  But with each episode, susceptibility increases so that further episodes are set off by less significant stressors.  Eventually, episodes occur spontaneously.  This same process is also thought to occur in the case of repeated psychotic episodes in schizophrenia.”
    Thus, you need to get into treatment early and stay on the medication.  I’ve been in recovery for 19 years, and if I knew then what I know now, perhaps I wouldn’t have internalized the stigma and tried to live medication-free.
    Next up is Year Five: Making Changes.
Published On: March 29, 2007