Why you may never heal from your mental illness

In psychiatry, there is often a lack of well-defined endpoints for treatment, especially in the most severe cases. How long should a therapy be, and when is the patient healthy enough?

It is expected that the patient’s condition will be cured 100%. Is this possible? 

And what is “cured”?

Table of content

Somatic vs mental disorder

 

An exacerbation of a heart condition is treated by stabilizing the temporary exacerbation, and the treatment is considered successful even if the patient should return a few months later with another exacerbation. If a psychiatric patient is treated with the same intensity and still gets a worsening a few months later, the psychiatric treatment will quickly be considered a failure.

You will get help when you need it, but you may never be "fixed"

The health service does its best to prolong life and postpone death. At the same time, work is being done on a so-called zero vision for deaths in psychiatry – and for psychiatric suicides in particular. It has never been a question of whether we should die, but when and by what. Why has it become a stated goal that all of the deaths that constitute suicide can be attributed to a somatic cause? A zero vision for psychiatric deaths is only rational if all psychiatric deaths could de facto have been avoided. Unfortunately, this is not the case.

This is discussed in an article from the Norwegian Medical Journal of the Norwegian Medical Association.

Rarely cure, often relieve, always comfort.

Palliative care has over time become an important and important part of the medical profession, as formulated in the well-known aphorism “rarely cure, often relieve, always comfort”. For psychiatry, on the other hand, there is little tolerance for enough being enough. There is also no offer of psychiatric palliative care. The latter would in fact demand acceptance that mental disorders can also be fatal. In somatics, one seeks to end useless treatment. And termination of life-prolonging treatment with limited benefit and potential for harm is called treatment limitation. On the other hand, when one ends useless or harmful treatment in psychiatry, it is often advertised in the media with headlines of the type “do not get more chances” – as if psychiatry wants to take the lives of its patients.

Rarely cure, often relieve, always comfort.

Expectations for psychiatry

 

When we have a somatic disease, we do not expect a zero vision with regard to chronic condition, zero vision for death from disease or that we oppose palliation. In psychiatry, on the other hand, we expect this. We have a zero vision with a view to death, we have an expectation that one will recover completely from a mental illness and that providing the best possible accommodation if a person dies of a psychiatric illness is taboo.

My neighbor has had surgery on his hip and I often see him walking around on crutches in the neighborhood to train. He also told me about his surgery and the cause of the problems and the expectation of recovery. Had he had a psychiatric illness, I do not think he would have been as open about background, cause and expect recovery. So, unfortunately, the taboos hang low when it comes to mental illness. (As we all know)

Some may think that one must expect to have low ambitions in psychiatry. It’s wrong. Psychiatry can help lift a person out of a deep depression and thus change their whole outlook on life. Psychiatry can help a person out of a psychosis and thus bring this person back to reality. Compared to somatics’ treatment goals, this is almost like hubris – and yet you often succeed. We dare to claim that the treatment of serious mental disorders is one of the most important and beautiful things the health service has to offer.

At the same time, we should be able to have two thoughts in our head at the same time, because realistic expectations are a prerequisite for optimized treatment.

Acceptance of the illness and the result

Accepting that there are people who become so seriously mentally ill that they die of it, and that this can happen without psychiatry having failed, is a wise attitude.

A surgeon who operates on a patient will always aim to cure his patient. In the same way that a psychologist or psychiatrist will have as his overall goal to “cure” his patient.

In the same way that we talk about patients “losing the battle against cancer”, we should be able to say that some patients simply “lost the battle against depression”. We also sense the contours of zero-vision tendencies for coercion in psychiatry (21). An exemplary objection to this was made in a column that argued that we must tolerate some of psychiatry’s “unpleasant truths” better than we do today.

(Partially retrieved from the Norwegian Medical Association’s journal.)

 

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