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Plan B: Relapse and reconstitution  

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The anxiety of a small problem has the potential to eat us alive. Imagine the stress around a significant mental illness and lifelong disorder? Like most thoughts surrounding fear, paranoia, and anxious thinking, they all snowball, combining and multiplying our worst thoughts.

 

Following my self-care plan across the lifespan will mean living a life free of this fear—or at least regulated as best as possible to reduce the likelihood and chances of paranoia and the fear that we will see one day relapse or become sick without warning. This would pose to be quite tricky. With such a connected group of friends, some angry with me, others sitting on the fence, and some with a mouth so big, and any sort of help usually backfired on all of us.

 

My biggest concern was always to position myself the right way. With friends, providers, and co-workers, I learned to do this well. In doing so, I allied with my therapist, treatment team, and close peers with a vested interest in my mental health.

 

I firmly believe in the importance of establishing a deep trust with close personal everyday contacts. In doing so, if my collaterals begin to detect an extreme and toxic abnormality in my health, I felt safe enough to take their advice and concerns seriously. Sure, no clinician or friend can get a perfect read on our health.

 

However, for those of us without a great deal of self-awareness or drive to look after ourselves, there are still options and strategies to stay healthy without relying entirely on your own devices. Such is the case for people like my friend and others I would encounter along my healing path.

 

Indeed, not everyone cares enough about their health to self-monitor all the time. In other cases, the day’s priority will capture our attention—for example, paying the rent, housing, employment, or even just showing up to work on time. If not also addressed in our lives, all of these would disrupt our mental health and even jeopardise our lives regardless of our diagnosis.

 

Staying connected with collaterals to delegate health needs is a great ‘Plan B when your self-care takes a back seat to life’s priorities (which only seem like they come before focusing on maintaining or working toward good mental health). During the first few years out of the hospital, I provided regular, almost weekly reports to my friends regarding my treatment status and medication changes. This served multiple purposes:  (a) kept me firmly treatment focused; (b) communicating my treatment needs to other people; and (c) allowed my friends to get a better idea of where I was at, so they could be as attentive as possible with my needs on a moment-by-moment basis.

 

Avoiding or reducing the risk of relapse does not mean handing out your mental health’s full responsibility to others. Instead, as a prosumer, I recommend you hand part of it to family, friends, and those you trust to keep them looped into your clinical treatment. These natural supports are excellent advice sources even when we may disagree with their reasoning (unless it puts us directly or indirectly at risk of harm).

 

I am suggesting that regardless of how we feel or think about the validity of our friends’ opinions on our mental status, our disorder disrupts our capacity to stay connected to reality. This may take the form of elaborate delusions about our life, which complicate our own interpretive eye’s ability to know what is truly happening with our health.

 

In the end, anyway, people want to manage their mental health is a significant step but do at least that much. Have a plan and have another goal when the original roadmap to better health becomes unworkable. Ultimately, whether you have a chronic condition or an acute diagnosis, relapse is only to be feared when you are not doing what you need to do to work toward better health and healing.

 

Relapsing and experiencing the renewal of old symptoms can still remind you to get back on track with your recovery. Keep going, and do not stop. When you stop taking care of yourself, be prepared for your worst fears not just to haunt you but become the grim reality you feared so vehemently instead of investing the same mental energy in health and healing.

 

In my opinion, as a prosumer, the best part of recovery is gaining access to new responsibilities, materials, information, and all the good things that come with stable living. Given that relapse is an inevitable part of recovery, the loss of materials, access, and resources attributed to relapsing and mental status degradation is the worst part of relapsing, in my opinion.

 

Usually, the biggest loser in a person’s life relapsing is hygiene, and on a broader level, the person’s living environment or home. It may be a matter of neglecting cleaning or not being aware of dirt and disorganisation in the house, or it may go even more profound.

 

I even treated a former psychiatrist in his home, providing him psychotherapy. Sadly, I watched this psychiatrist lose ground weekly on my watch, knowing full well what was happening. He was decompensating rapidly. For this man, this means a growing delusional system and potentially aggressive behaviour, according to his case history. While he was never free of his delusions, earlier on, the distortions were much less fixed and pronounced in what he was reporting to our team in session.

 

According to him, he was set up’ by extra-governmental agents and was in his position because he was the target of a more massive governmental conspiracy. This conspiracy was becoming more problematic for the psychiatrist, and ultimately, he became so agitated in session and adversarial that all treatment failed.

 

When our team returned, we came back with the local police. With the shield’s help, police entered the apartment against the psychiatrist’s will, sitting him down on his couch, handcuffed. On the sofa, he was sitting upright, screaming utter nonsense and profanities and the police. This was hard to watch both as a provider and as a person with lived experience. Someone who knows what it is like to be handcuffed amid a delusional rage.

 

Sadly, I have also witnessed police storming doorways with shields to access a home fortified for the ‘end’ to avoid being evicted. Barricading yourself in the home or something even worse is never the answer. It may even further your risk of relapsing more acutely – if you go against police orders or personnel, it will only exaggerate your problems and complicate your relapse even more deeply. The worst privilege to lose during relapse is the freedom of healthy living. With healthy living comes life circumstances that support wellness and mental hygiene.

 

There is no question that when we lose healthy living practices, we lose the freedom to be useful to our bodies and minds and treat ourselves kindly and with respect at all times. Relapsing means surrendering some of these healthy moments for symptomatic periods of distress in which it is more difficult to live peaceably with the world at large and adjust to our situations accordingly.

 

Relapse ages the body. During my many meals with Caroline, I would just gaze at her face. She looked tired all the time. Sadly, she aged twenty years in a span of ten. She was no stranger to the police and emergency service intervention.

 

‘I climbed into the city fountains wearing all white robes and began cutting myself. The fountains turned red. It was a horrific scene that I thought was directly from the Bible. The end of time,’ my friend would recant.

 

I would try to tell people in similar shoes as my friend about my injection and how much I preferred getting medication administered through my muscle tissue so I would not have to take medication daily, just once a month for the shot. I explained the benefits and tried to seem like an expert. She would consider speaking to her doctor about it. I was an expert, but my friend always knew better yet was still wrong about the following steps to take in her recovery.

 

For people living in a group home or apartment treatment facility, relapse usually brings with it more concrete freedoms that may be stripped away. Sometimes, relapsing means changes in curfew or even may trigger reduced independence in the community; doors to your residence that are usually open for residents to come freely may become restricted.

 

Such is the case of people like my friend. She has to ‘pack’ her medication. Every few days, in front of the agency personal, before transporting her meds back to her apartment in the community, my friend has to provide visible proof she had medication on hand.  In cases like hers, this might also mean increased home visits, if the person is living on their own, or added chores in the community home of a residence if they live in an adult home or community residence.

 

Relapse can mean many things. It can also mean losing mental health housing or moving into a residence with more supervision and more restrictions on your freedoms. In any event, be mindful of what the losses mean for the bigger picture. Ultimately, what matters is your pathway back to health and wellness.

About the Author

J. Peters

Max Guttman '08, MSW '12, is the owner of Recovery Now, a private mental health practice. Through his work as a Licensed Clinical Social Worker, therapist and disability rights advocate, Max fights for those without a voice in various New York City care systems. He received a 2020 Bearcats of the Last Decade 10 Under 10 award from the Binghamton University Alumni Association.

Guttman treats clients with anxiety and depression, but specializes in issues related to psychosis or schizoaffective spectrum disorders. He frequently writes on his lived experiences with schizophrenia.

"I knew my illness was so complex that I’d need a professional understanding of its treatment to gain any real momentum in recovery," Guttman says. "After undergraduate school and the onset of my illness, I evaluated different graduate programs that could serve as a career and mechanism to guide and direct my self-care. After experiencing the helping hand of my social worker and therapist right after my 'break,' I chose social work education because of its robust skill set and foundation of knowledge I needed to heal and help others."

"In a world of increasing tragedy, we should help people learn from our lived experiences. My experience brings humility, authenticity and candidness to my practice. People genuinely appreciate candidness when it comes to their health and recovery. Humility provides space for mistakes and appraisal of progress. I thank my lived experience for contributing to a more egalitarian therapeutic experience for my clients."

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