What a Google Exec and the Clinician's Illusion Can Teach Us about Mental Health

What if your mental disorder isn't permanent?

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You can start reading ‘Cured’ anywhere.

My life changes with one word: Google.

I sit in my new psychiatrist’s office with its floor-to-ceiling windows looking out on Michigan Avenue. Dr. R wears his usual crisp, white button-down shirt. His suit pants have a sheen.

We talk about getting me off lithium. Doing so will reduce my pill load from five to three: the SSRI I’ve been on for nearly a decade, the other mood stabilizer, and Klonopin.

Our appointments are all-business. Med checks, basically. He never asks about my life—how teaching or writing is going. I’m not sure he knows I teach and write. Or that I have a sister or chose not to marry and never wanted kids. Or that I live in a dank, dark studio apartment so small my bed is practically in the kitchen, an apartment that looks out onto a brick wall.

He knows I received six different psychiatric diagnoses during the twenty-five years I spent in the mental health system, and he’s masterful at adjusting my meds. Almost witchy—two dashes more of this, a tad less of that. And we’re easing me off the “mess of meds,” as he put it, I was on when I came to him a couple of months ago.

I’m lucky to have the money to see a clinician like Dr. R. The young man I passed on Michigan Avenue on the way here, the one often sitting outside the Ralph Lauren store, the one not wearing a hat and holding a sign that reads please help and sobbing—full, heaving sobs—seemingly all day long—the one so in need of care and not getting it, reminds me.

Apropos of nothing, Dr. R says, “I had a client. Worst diagnosis you can have—schizoaffective disorder. I mean, bipolar topped with schizophrenia? Can’t get worse. She was from a family of litigators—famous litigators. Not what a psychiatrist wants. I told her family what we needed to do. Her family informed me what they thought we needed to do. As far as I knew, they didn’t have a medical degree among them. But I said, ‘Fine, take her to Mass General, best in the country for this sort of thing, and get a second opinion.’ They flew her out to Boston on their private plane. The docs at Mass General disagreed with me. Fine. Six weeks after her treatment started at Mass General, she was worse. The family came back to me. We did what I said. It took time, but she got better. She’s now an executive at Google. Off all meds.”

I nod though not in agreement. No one heals from schizoaffective disorder or any other disorder. And even if they did, they wouldn’t become an executive at Google. Come on. Everyone knows that.

It makes sense that we don’t believe recovery from mental illness is possible. The public conversation revolves around getting a diagnosis and treatment (both necessary for most people) and ends there. We rarely see and hear from people who’ve recovered.

Stereotypes and similes help perpetuate the myth of chronicity. Many people associate mental illness with “lunatic” asylums, where the insane were locked away, never to re-enter the community. Mental illness calls to mind the guy on the street, muttering to himself or talking loudly to someone next to him who isn’t there, the one we see on that corner day after day: hopeless, untreatable.

Many of us are told or led to believe that psychiatric disorders are permanent. They’re called by different names—schizophrenia, social anxiety disorder, anorexia, bulimia, binge eating disorder, major depressive disorder, generalized anxiety disorder, obsessive-compulsive disorder, attention deficit hyperactivity disorder, bipolar disorder, etc. Whatever we call them, the premise is that the best we can hope for is to “manage our symptoms.” The American Psychiatric Association (APA) likens major depressive disorder, anxiety disorders, ADHD, OCD, bipolar disorder, and other diagnoses to heart disease or diabetes, implying they’re chronic.

Our prognoses are often grave: we’ll never hold a full-time job or have a long-term relationship and will likely die ten years earlier. If we think we’ve healed, we haven’t. Whatever is wrong with us will always return and break us again.

Mental health professionals who don’t believe in recovery are said to suffer from the clinician’s illusion. They practice under the illusion that no one heals because everyone they see is sick; many who’ve recovered leave the mental health system. As Martin Harrow, a psychologist at the University of Illinois, writes of mental health professionals who’ve succumbed to the clinician’s illusion: “We get our experience from seeing those who leave us and then come back because they relapse. We don’t see the ones who don’t relapse. They don’t come back. They are quite happy.” I’m not sure about “happy,” but it’s often true that seeing a therapist or psychologist becomes a question of choice, not need.

It turns out very little encouragement is needed to create the conditions for recovery. A 2018 study conducted by Stanford psychology professor Alia Crum and her colleagues showed how a few comforting words from a physician can speed healing. In the study, participants who were told that their allergic reaction would “start to diminish” and their symptoms would “go away” experienced relief and less itchiness than those participants the doctor didn’t speak to. Reassurance induces the placebo effect, in which a person’s mindset influences recovery outcomes. A lack of support can produce a “nocebo” effect, in which a negative outlook on an illness leads to deterioration.

Some people might say that encouraging those with mental illnesses to recover is misleading and cruel. No, cruel is denying us agency and the chance—just the chance—to heal.

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I let the whole psychiatric-patient-turns-Google-executive thing drop and leave Dr. R’s office. That night I stare out my apartment window at the brick wall that is my view. Then I do what anyone would do: I google to see if Dr. R is right. As I type on my computer, one search after another tells me he’s wrong. Schizoaffective disorder is lifelong. The VeryWell Mind website says so—as do others, many others.

The internet says that other diagnoses are forever. The patient advocacy group Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) tells me that ADHD is lifelong. According to the Mental Health America website, some people may find “relief” from generalized anxiety disorder, but many don’t. Psychology Today calls depression “a lifetime battle.”

Still, something in me—something small and quiet—wants Dr. R to be right.

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The next day, my partial-hospitalization-program friend Julia comes over. Partial-hospitalization friends are a particular kind of social connection. They’re immediate and intense—like camp friends but with psychic despair instead of smores. Hospital friends seem like the only people who exist because the outside world doesn’t really exist. But those friendships rarely translate to “real life” and typically fade.

Julia sits on the floor of my apartment. She smells of cigarettes. Her face is pale. She tells me she isn’t sleeping well.

In the PHP, we bonded over having the same diagnosis, as if that might make us compatible. I want to tell her about the Google executive, but it seems like a betrayal. We committed to our diagnoses and our diagnoses brought us together. Our conversations revolve around a life of diagnosis.

We put on our coats and boots and bundle in scarves and hats and gloves and go for a walk. Ice covers parts of the sidewalks. We tread carefully so as not to slip. She talks about wanting to move to Michigan; I listen.

It isn’t until we’ve looped around the zoo and are a few blocks from my building that I ask, “Did you know it’s possible to recover from schizoaffective disorder?” My cheeks are stiff with cold, and my words come out slurred.

She looks at me sidelong as if to gauge if I’m joking.

“Seriously,” I say. “Did you know that?”

Her face squinches as if she’s smelled something bad.

I tell her about the Google executive.

She shakes her head. “She probably wasn’t ever sick.”

“Why would you say that?” I ask.

“Because you don’t just get better.”

We walk to my building in silence. I ask if she wants to come in. She says no. Neither of us mentions getting together again. I step back. She smiles faintly and walks away.

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How you tell your story matters. Anyone with a psychiatric diagnosis has an illness narrative running in their head.

In books and stories about mental illness, that narrative tends to follow a standard plot line: symptoms, diagnosis, treatment, and acceptance of life with the diagnosis. The diagnosis is a pivotal moment in the rising action: Will it bring relief, a way to finally name and legitimize the protagonist’s pain? Often she rejects the diagnosis—at first—because her medication limits her creativity and/or changes her personality and/or leaves her emotionally numb. Eventually, she embraces her diagnosis and treatment and finds relief and strength (hooray!). Then the book ends, and the protagonist is left to live out her illness narrative in perpetuity.

I followed this narrative for twenty-five years. At first, each of the six diagnoses I received seemed to hold the key to my suffering—yes, I am obsessive and compulsive; yes, I am clinically depressed; yes, I am extremely anxious; yes, I do get manic and then depressed; yes, I am easily distracted or hyperfocused and hyperactive; yes, let’s try that type of therapy, that brand of meditation, that yogic breathing technique, that diet, those herbs, that pill; yes, yes, yes. But no diagnosis or treatment fully explained or relieved my suffering. I went from one waiting room and doctor and therapist and alternative treatment to the next. The point of every treatment—traditional or alternative—was to find relief and strength, not become fully well. My narrative was that I was sick—always.

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To appreciate how we’ve come to believe mental illness is a life sentence, it’s important to understand psychiatry’s history.

For the past two hundred years, psychiatric research and treatment haven’t focused on healing. The prevailing notion has been that recovery isn’t possible; the goal has been to find the cause of mental illness, which will someday, they hope, lead to a cure. One cause. One cure. Cure—the noun—a magic bullet, not a process that considers the various factors that cause psychiatric disorders: environment, social support, trauma, physical health, etc.

Psychiatry’s preoccupation with cause and cure has been carried out with the best intentions and has had catastrophic results. It’s meant that patients, particularly those from historically marginalized populations, have been neglected at the expense of research.

Nineteenth-century public asylums were overcrowded and inhumane. Patients were neglected or brutalized. “Care” entailed being chained and abused and not given clothing or food. Treatments focused not on healing but controlling patients. These treatments were untested, inhumane, violent, even fatal: bloodletting, ice baths, insulin comas, early electroshock therapy, injecting patients with malaria, the surgical removal of body parts, neglect, isolation, restraints, physical abuse, incarceration, psychotropic medications with dangerous side effects.

We’ve created a mutually causal situation: The psychiatric condition requires treatment that often exacerbates it, creating new (worse) psychiatric conditions.

The supposed incurability of mental illness has long since been presumed. In Desperate Remedies: Psychiatry’s Turbulent Quest to Cure Mental Illness, sociologist Andrew Scull meticulously documents how America’s asylum system influenced psychiatry’s and the public’s views of mental illness. He writes, “[A] large proportion of the population came to be composed of long-stay patients, and it was this specter of chronicity, this horde of the hopeless, that was to haunt the public imagination…and to dominate late nineteenth- and early-twentieth-century psychiatric theorizing and practice.”

Although during the nineteenth century, a small group of reformers embraced a cult of curability and created environments that fostered healing, they were private institutions available only to those who could afford them.

During the early twentieth century, psychiatry began to see and treat patients not just as hopeless but as degenerates the public needed protection from. Darwinian theory, the eugenics movement, and biological and hereditary explanations for mental illness solidified the idea that mental illness was permanent and that patients needed to be prevented from mixing with society lest they spread the illness. Laws were passed preventing those with mental illnesses from marrying and reproducing.

Other twentieth-century theories of mental disorder may have lent themselves to a more forgiving attitude toward patients—bacterial theory, psychobiology, Freudian psychoanalysis.

But in the 1980s, the dominant strain of psychiatry turned to the biomedical model and the misconception that mental disorders are purely biological. From the most stigmatizing symptoms to the least, people were told that depression and irritability and distractibility and anxiety and obsessions and compulsions and psychosis represent an irreparable brokenness in the brain. Billions of dollars were spent on psychiatric theorizing and research based on the “specter of chronicity” for the “horde of the hopeless.”

The word recovery didn’t appear in a single government policy regarding mental illness until 1999.

I know you don’t want to hear this. It disrupts our mental illness narratives. It sounds like I’m saying mental illness and emotional distress aren’t real (which I’m not). I’m saying we could give recovery a chance. We could consider the ineffectual, traumatizing, and sometimes life-threatening care patients have received and ask how anyone could heal in those conditions.

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Morning sunlight comes in the classroom windows, glinting off the whiteboard. The students move the tables into a U shape, seminar-style. I close the blinds partway. As they lower, it’s as if I’m being lowered too.

Dr. R and I have gone too low on my dosage of the antipsychotic I’ve been on. Panic and dizziness kept me awake most of the past few nights. An itch that’s not an itch makes it feel like bugs are crawling on my skin. Yesterday, I had to duck into an alcove between two buildings to sob—at length—my back to the sidewalk and people passing by. I called Dr. R that morning, and he readjusted my meds, but it will take time for the withdrawal side effects to go away.

My students settle in. For class, they read Adam Haslett’s “Notes to My Biographer.” It’s an oddly funny but heart-wrenching short story. The protagonist, Franklin, suffers from manic depression. He’s nearly destroyed his family because he won’t get treatment and accept his diagnosis. Franklin visits his estranged adult son, Graham. Graham reveals to his father that he has manic depression, too, but he takes his medication.

I’ve taught the story many times, connecting deeply with the pain the disorder has caused the characters, but while re-reading it this time to prepare for class, I didn’t have the same response. Haslett’s story does what great literature can do: the same story or novel or memoir resonates with us differently at different times in our lives. The story has changed because I have.

The story is still heart-wrenching but not for the same reason. What saddens me isn’t their pain or disorders. Franklin and Graham have been given no chance of recovery, only treatment. No wonder Franklin and others reject a diagnosis. There’s no hope, only acceptance. And that seems the worst fate of all.

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When my bestselling memoir Pathological: The True Story of Six Misdiagnoses came out, Dr. R said, “Every medical resident and mental health professional should read your book.”

(Dr. R is still my psychiatrist. More to come on why mental health recovery doesn’t mean we necessarily stop medication or getting support from mental health professionals.)

If you’re a mental health professional or a primary care doctor and want to empower patients with the truth, buy and read Pathological: The True Story of Six Misdiagnoses. It can’t hurt.

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Both a memoir and a work of investigative journalism—Pathological: The True Story of Six Misdiagnoses dives deeper into the ways we pathologize human experiences and ask, Is a psychiatric diagnosis a lifeline or a self-fulfilling prophecy?

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You can also purchase a copy to donate to your local library or used bookstore.

The more we know, the more powerful we are.

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Next: Managing our emotions and relearning relationships