Recovery is Responsibility

Patient Expert

Within the recovery movement, people tend to talk disparagingly about "the medical model," as if doctors and psychiatrists are somehow inimical to the concept of us getting well and staying well. The medical model theorizes that bipolar disorder and other mental illnesses are biologically-based. In essence, this model implies that bipolar disorder is a no-fault illness. It's not your fault for having it, and it's not your fault if your psychiatrist is an idiot and the meds don't work. Moreover, it's not your fault that your loved one has left you, your friends have abandoned you, your family has disowned you, and employers treat you as radioactive.

Maybe your next prescription will fix everything.

Patients are partly correct in interpreting this model to mean that chemical imbalances of the brain should be countered with prescription chemicals, but it is clear that the medical model does not go far enough. In my book, "Living Well with Depression and Bipolar Disorder," I write:

When I walked into my first support group meeting not long after I was diagnosed, Moe, who ran the group, told me that meds are only one part of the equation. Getting well and staying well, he said, also involves eating right and sleeping right, diet and exercise, as well as a wide range of intangibles, which may include getting out of the house, volunteer work, spiritual practice, developing a support network, and a whole bag of survival tricks one starts to pick up.

To this day, this is the best advice I have ever received.

But eating right and sleeping right and exercise and all the rest involves a lot of hard work. Not long ago, I had the good fortune to interview Frederick Goodwin MD, former head of the NIMH, who many regard as the leading authority on bipolar disorder. Dr Goodwin has an engaging bedside manner, but in our interview he was also blunt. He told me that people with bipolar disorder need to lead more disciplined lives than the general population.

Seriously, I thought, who wants to practice more discipline?

Yes, it's true that mental illness is no-fault, in that you didn't get to choose the genes you were born with. And hardly any of us know what hit us after a first-episode depression or mania or psychosis has hijacked our brains and left us in a hole that will take us years to dig our way out of.

The medical model tells us that mental illness is much like diabetes. Yet while no one tells a diabetic to just snap out of it, doctors and other health experts do tell individuals with diabetes and those at risk of diabetes a lot of the same things they tell us: Proper diet and exercise is a must. Cut down on the drinking and other bad habits.

At-risk individuals invite in trouble by refusing to change their behavior. Those who are already ill - whether physically or mentally - undermine their ability to work toward stability and recovery by failing to implement lifestyle changes.

But there is an added complication to mental illness. Our broken brains conspire to play tricks on us. If we're not over-reacting and over-thinking, we're under-reacting and under-thinking. On one hand, we drive away the very people who can help and support us, on the other we are afraid to seek them out. Either way, we risk finding ourselves alone, isolated.

Then there's that little-understood chemical imbalance of the brain people keep talking about. The neurotransmitter dopamine, among other things, is involved in motivation. So if your dopamine levels happen to be low, there is a good chance you will not be motivated to improve your life. Researchers and clinicians are only just beginning to appreciate the role dopamine may play in helping us get well and stay well. Ironically, antipsychotics - a first option in treating mania, psychosis, and some depressions - block dopamine.

Glutamate is another neurotransmitter that can boost our mood, but too much of a good thing can flip us into mania or psychosis or affect our neurons in a way that may bring on depression. It can be difficult to change one's behavior if one's glutamate is imbalanced.

Glutamate's tag team partner is GABA, a neurotransmitter that works to massage the neurons into a state of ease. Without sufficient GABA, we tend to become fearful and anxious. Try turning your life around while fearful and anxious.

What this tells us is that everything starts with the medical model. In essence, the recovery model embraces the medical model. We can't do it ourselves. Most of us need a chemical assist. Our biology needs to cooperate with us to get motivated, to think things through, to have the courage to change. Our meds are far from perfect, but they help us to help ourselves. Psychiatric meds may not return you to the kind of life you wish to lead, but good meds management can bring your brain back on line. The operating system may not function perfectly, but the hard drive is at least booting up.

At last, we are in a position to take charge, assume responsibility and start to lead disciplined lives.

We are ready to dispense with the excuses, while at the same time acknowledging our shortcomings. After all, Rome wasn't built in just a day. A difficult road filled with heartbreak and frustration may lie just ahead. But now, at least, the recovery can begin.