What a Difference a Year Makes

A funny thing happened at work this spring. It hit me one day that my patients with serious or chronic mental illnesses were doing a whole lot better. Many of them had recovered completely. Others still had a few symptoms which were relatively minor, manageable, and well-controlled. What was responsible for this dramatic and rather sudden improvement? Was it the gorgeous springtime weather? No, this is Miami – the weather here is gorgeous year round. Was it something I was doing differently? No, because I have been using the same evidence-based treatments all along.

And then it hit me. I opened my private practice in March 2009. A number of patients have come and gone since then – mostly those with mild or moderate issues who did very well with just a few months of CBT and were ready to end their treatment. Then there are those with more severe mental illnesses whom I’ve been seeing since last spring – those with anorexia, bulimia, severe depression, and personality disorders. Those longer-term patients are doing exceptionally well now because a full year has passed since they began treatment.

So many ingredients go into a successful recovery from mental illness. My recipe typically includes some combination of the following: psycho-education for patient and family, weekly therapy using evidence-based practice, full and consistent nutrition, restoration of physical health and weight, family support, a stable and low-stress environment, acquisition of healthy coping skills, plenty of sleep and exercise, psychotropic medication, clarification of core values, creating a full and meaningful life, and time.

That last ingredient – time – is often forgotten but absolutely essential for recovery. It takes time for parents to learn how to manage their child’s mental illness. It takes time for a patient and her family to grasp fully what it means to have major depression or borderline personality disorder or anorexia nervosa. It takes time for a patient’s brain to heal, for her neural pathways to re-wire. It takes time for the therapeutic relationship to flourish. It takes time to learn and master new skills and implement them in daily life. It takes time to heal broken relationships and build a life worth living. It takes time for the dedication, persistence, and heroic efforts of the patient and family to translate into psychological health and stability.

We live in a fast-paced world of high-speed internet and instant coffee, of fast food and quicktrim and rapid refills. Patience is a virtue so few of us possess. As burgeoning technology has made so many things quicker and easier, we have become far less tolerant of things that require us to wait and persevere. It can be humbling and frustrating to realize that some things still require considerable time and effort.

Most things that are truly worthwhile in life take time and effort. Earning an advanced degree, mastering a foreign language, writing a novel, learning a new sport or musical instrument. Starting a business, building a strong friendship, nurturing a romantic relationship, creating a family. None of these things happen quickly. Those who struggle with mental illness have an added challenge of expending considerable time and effort to do the things most people take for granted – getting out of bed in the morning, eating a meal, leaving the house without having a panic attack, tolerating emotional pain without self-destructive behavior. These people face the additional burden of shame and stigma, expensive and time-consuming treatment which is typically not covered by their insurance, family and friends who don’t understand, and the absence of that proverbial quick fix. Treatment for mental illness is SO HARD and it takes SO LONG, but it is definitely worth it!

My time in private practice – 15 months now – has been the most rewarding experience of my life so far. I have seen victims become survivors; suicidal students develop a thirst for life; skeletal teens blossom into self-confident young women. Those desperate parents of sullen kids who once curled up in a fetal position on my couch became joyful and optimistic as their child’s bubbly personality reemerged. All of these miracles took time.

There are new patients now – those who cry in despair and lash out in anger, those who would rather not exist than endure another day enslaved to their own minds. There are the terrified, exhausted parents who wonder when this hell will ever end. These brave souls keep me humble, keep me challenged, and most importantly, keep me going. I have faith and hope that by next spring, they will be strong and stable and full of life, that I can say goodbye and trust that they will never have to see me again.

If you are battling a mental illness in yourself or in your loved one, remember this: time heals. Be a tortoise, not a hare. As Winston Churchill famously said, “When you are going through hell, keep going.”