Even though mental health diagnoses can be useful, a teen can build their identity around their diagnosis, leading to a rejection of recovery and a belief that the symptoms they experience will always be their reality. There isn't an easy solution.
I can definitely offer insight on this article versus my admittedly scathing criticism on the last. I'm at least a bit sorry about that. Anyhow, I was diagnosed with panic disorder and agoraphobia when I was 13. By the time I was 15 I had also developed severe depression and began the revolving-door-style trips in and out of inpatient psych wards, sometimes in handcuffs and chauffeured by police, and sometimes with my parents. As an adult I've continued this to some extent though with less frequency.
Last year I did a residential treatment program, a PHP, and an IOP. From the time I was 15 and until now I have tried every SSRI and SNRI, and I recently tried a Parkinson's drug called amantadine which is used off-label for treatment resistant depression. In 2021 I did TMS, and I've been in therapy with few gaps since I was 16. And in September I had my third psychological evaluation and was diagnosed with ADHD and OCD, both of which had been suspected for years now.
I'm turning 27 in a few days, and my symptoms have never gone into any kind of "remission" or "mild" state. It now meets the diagnostic criteria for major, persistent, and treatment resistant depression. I don't really get panic attacks or agoraphobia anymore, but I have high levels of anxiety related to socializing. Isolating due to depression obviously hasn't helped that.
I speak only from my perspective on this, but I stopped wanting to put the work into recovery when I decided it wasn't worth it anymore. This happened extremely early. I have always been very cognizant of current events, politics, disasters around the world, and any type of injustice, to which I am extremely sensitive to.
I grew up on the internet, more or less. I started using Facebook when I was 13 and added on Twitter and Tumblr when they were brand new, as well as Instagram and Snapchat. I met friends online who were in similar situations as me; mentally ill and/or ostracized by their parents due to their sexual orientation, gender identity, or other personality traits deemed unacceptable by society.
A lot of us in these communities had been bullied, myself included, for such things. And I've never met anyone who received proper help from their school about that, again, myself included. I was able to go online and either consume a lot of incredible knowledge and entertainment, or I could also look at the entire world at once and feel a sense of impending doom, like it was all just slowly crumbling around us and nobody in charge was bothering to fix it.
Basically, online, I found solace. But I also learned a lot about the world's unfairness, awfulness, and cruelty. It wasn't long after I got depressed that my thoughts began to twist this perspective into an all-encompassing worldly view. And I was hardly the only one. I definitely experienced more than a few suicides or deaths of young people that were present in these spaces and then suddenly disappeared. In my community, while I was in school, 4 students in various grade levels died by suicide. I wish I could say I want to have hope in the world and humanity or that "deep down" I don't really believe the world is so bad, but I don't. I really don't see a future for myself, at least not one that's worth living. I've been passively suicidal for almost the entire time I've been depressed. I'm heavily monitored by my therapist, with whom I meet with every week.
I'm almost 27 and didn't go to college (rather, I dropped out three separate times in the first semester), I've had around 30 jobs in eight years, and my credit score is starting to drop because I've run out of money to pay back things like student loans and medical debt. And now I've started to have some serious medical issues like pulmonary embolisms and a possible autoimmune disorder or some kind of blood disease.
These are all things about my personal circumstances that can and should be worked around, but every day I wake up and I look at myself (I don't value myself at all) and I look at the world through the screen of my phone (which is a total sh*tshow) and I talk to my friends who are all on some level of burnout or mental illness, and I wonder "Why?"
Why bother working through all of my baggage, why bother pursuing anything if I don't even have the confidence I can brush my teeth more than once a week, why bother hoping for recovery when I've tried so many treatments and nothing has actually worked? Everything these days is met with a resounding why. "We should brush our teeth." "Why?" "It's good for our oral health." "So?" It goes like that with every little thing, it's been this way for a couple years now. I didn't always used to struggle so much with ADLs and that fact alone tells me things have gotten worse.
I want to feel better. Obviously. Everybody wants to feel better when they feel like sh*t. But maybe in this world it's easier to stay feeling like sh*t and that way I can avoid more disappointment, especially because whenever I have a week or two of feeling "okay" I always end up nosediving again. That way I can continue to stare the tragedies in the world head on instead of putting on the blinders as so many therapists and therapeutic strategies in CBT are just dying for us to do.
One thing that really gets me upset is willful ignorance: when people look away from things or choose not to learn about things that will make them feel upset or that contradicts their optimistic beliefs. Well, I refuse to look away. I will not lie to myself in order to treat my depression when many of the reasons I am depressed are things I can't control in society and in the world. Somebody on Reddit said "Recovery from depression feels like being brainwashed." They summed up what I've felt since the beginning of my journey.
I've tried to figure out how to express that this whole issue with young people and mental health isn't just about diagnoses, but about hope and purpose and a general lack of those two things, but I've never been able to figure out how except by explaining my own experiences.
I was going to do some mental health advocacy work with the residential program I did, basically do a video interview and stuff, but I knew I couldn't. I'm no better than I was last fall, and the hospital I went to has a large number of what I refer to as "revolving door patients" i.e., we always end up back there, myself included, so actually is the hospital truly getting people into permanent recovery or are they just creating customers? It's hard to say. Not to mention on certain websites like NAMI or SAMHSA or even in this article you posted, they all talk about the people who get better after a short time and the people who never struggle with their diagnoses again.
But what about all the people who seek out these resources and they've already had their illnesses and been suffering for five, ten, twenty, fifty years? I think we feel a little forgotten and left out of the data. But I get it. We're not good examples. Placing something like "some people never get better or suffer for decades" on a mental health website is hardly a beacon of hope. So I think the people who don't get better are purposely left out for that reason. We're just kind of existing, and trying to stay alive for some arbitrary reasons, like not hurting those who love us or for our pets or something like that.
If you ever want to seek out the perspectives of people who feel similarly to me, there are subreddits on Reddit called r/depression and r/SuicideWatch. Even I try not to consume the content there in large amounts because it's very, well, depressing, but sometimes people say really honest and profound things that tend to get us punished if we say them in real life, or chastised by a well meaning therapist.
I'm also sorry this is so freaking long, but I guess that's what you get for telling me to check out part 2 of this topic 😅
Wow. You've blown my mind. First, I'm so sorry again for all you've been through. As I said before, you're very strong and smart. You're also a really good writer. (Ever considered doing that? If so, we should talk.) You explained your perspective so clearly and so well.
You raise many good points--about people turning away and how the world is so messed up and how that must feel to young people. What you said about willful ignorance is particularly striking: "when people look away from things or choose not to learn about things that will make them feel upset or that contradicts their optimistic beliefs." Well said.
In this, I understand how you wouldn't want to work toward recovery--because it is hard work. It also requires service, serving others in some way.
To be clear, I'm one of those "treatment-resistant," twenty-five-years-in-the-system, beyond-help, not-good-examples people, and I recovered. But recovery isn't what I thought it was.
It's completely individual to each person and the most subversive thing you can do. It actually goes against all of society's standards and ideas of how we "should" be.
But we aren't taught it. Right now, most treatment (inpatient, PHP, IOP, CBT, DBT, ACT, therapy) revolves around a biomedical/maintenance model that says something is permanently wrong with us and the most we can hope for is a reduction of symptoms. It creates, as you said, a revolving door of patients. As someone I know who survived the foster care system and years of homelessness and somehow recovered said, "There is no graduating from the mental health system." But that's changing. Many, many people, including SAMHSA's brand new Office of Recovery, are trying to move the mental health system away from the biomedical model and (finally--they've been trying since 1999) to a recovery model. A recovery model demands patient autonomy, self-determination, and (you may not like this word) hope. (Hope isn't all happy, smiley optimism. Hope is hard and hardcore.)
That's why there are very few beacons of hope online for recovery. NAMI's first page on recovery (its first!) didn't appear until last year (2021! two decades after the Surgeon General first called for us to move to a recovery model). NAMI's new recovery page is written by the great Larry Davidson, a recovery movement icon.
This is all to say that the treatments we have now aren't geared toward recovery; they're (primarily) designed for maintenance only. The "reduction of symptoms." That's not recovery. Recovery is much deeper than that.
Not everyone will recover. That's true of any illness. But right now, those with psychiatric illness, aren't even being given the chance.
It sounds like you have a therapist you trust (yes? or just a therapist?). Some clinicians do work in the recovery model, i.e., give their patients an equal say in their treatment and help them design what recovery will look like for them, but that's not the norm. I hope you have that.
Thank you for the Reddit recommendations. I'm not online or on social media very much at all. If I were, I'm pretty sure I would never have recovered. It can be great, and it can be not-so-great for some people. I serve people as a Certified Mental Health Peer Recovery Specialist, so I'm not turning away either.
Please keep reading and commenting. I love hearing your perspective.
Hi Sarah, so sorry for the delayed response. The past couple of weeks I've been "in the trenches," so to speak. I am a writer, though only for fun and not as a profession. If there's something writing-based you want to discuss, I'm happy to indulge. I do have a therapist and next week I will start seeing her twice a week instead of once.
She's really wonderful, and I've gained a lot of insight as to why recovery hasn't been working for me. Within the last few years, I knew that this was no longer an issue of medication, and was very aware of all the psychological things I need to work through. I've been opposed to recovery as it's been introduced to me time and time again. I view it as a cookie-cutter process that will force me through a "machine" in which I will pop out the other side, squeaky clean of mental illness and a totally different person, only sad or angry when it's justified to be.
Growing up, I was bullied and outcast from the rest of my peers, save for a couple of wonderful friends with whom I grew completely apart from once I became depressed in high school. The earliest I remember feeling depressed is age 9 and I was 5 when I began to feel alienated from everybody else. I identified with being shy, quiet, intelligent, analytical, and innovative. These are also the types of things that got me bullied, and so I held onto them tighter.
Anxiety and depression are almost siblings of these traits by consequence. Social anxiety is often attributed to shyness and introversion by the public, and staying in my room to read, write, and watch videos was always how I escaped from the harshness of reality. And in being someone who loves to learn, I became rapidly disillusioned to all the cruelties that happened all over the globe every single day due to growing up online.
Since mental illness swallowed most of my adolescence and along with it, precious time and opportunity to develop my brain and a sense of identity, my mental illnesses became my identity. So every coping skill I've learned thus far I am vehemently opposed to utilizing because they feel so invalidating and threatening to my identity, or at least a vital part of who I am.
It shouldn't have turned out this way, but it's an issue that I don't think professionals look out for or aren't aware of. Your take on all this has a lot of good points, and as you can see, I felt threatened by those because in my mind, you want me to change who I am or at least hide it all away. Now I know that this wasn't what you were saying, and I reacted emotionally.
Right now, I'm trying to pick all this apart with my therapist, as well as explore with her what recovery actually looks like for me and not what I think society thinks I should be. I have struggled most the past two or three years with the "whys" of it all. I have a few reasons not to kill myself, but I don't have a reason to recover, so I've just been stuck under this crushing weight of emotional pain with no out. The question of "Why?" permeates every part of my day to the point I am not currently able to keep up with basic hygiene or meals; luckily, I am living with my parents who are taking care of me.
I'm so glad you have a good therapist and the support of your family. You make a good point about recovery seeming to be cookie-cutter. I don't know how it's been presented to you, but I'm impressed it has been. I wonder if it's been presented as something you determine because that's what it is. Regardless, I understand being resistant to recovery and losing a diagnosis that's become one's identity. I felt the same.
As for writing, I feel like you could be the voice of your generation. It seems that many young people feel the same way you do. We're all trying to understand, so we can help.
I can definitely offer insight on this article versus my admittedly scathing criticism on the last. I'm at least a bit sorry about that. Anyhow, I was diagnosed with panic disorder and agoraphobia when I was 13. By the time I was 15 I had also developed severe depression and began the revolving-door-style trips in and out of inpatient psych wards, sometimes in handcuffs and chauffeured by police, and sometimes with my parents. As an adult I've continued this to some extent though with less frequency.
Last year I did a residential treatment program, a PHP, and an IOP. From the time I was 15 and until now I have tried every SSRI and SNRI, and I recently tried a Parkinson's drug called amantadine which is used off-label for treatment resistant depression. In 2021 I did TMS, and I've been in therapy with few gaps since I was 16. And in September I had my third psychological evaluation and was diagnosed with ADHD and OCD, both of which had been suspected for years now.
I'm turning 27 in a few days, and my symptoms have never gone into any kind of "remission" or "mild" state. It now meets the diagnostic criteria for major, persistent, and treatment resistant depression. I don't really get panic attacks or agoraphobia anymore, but I have high levels of anxiety related to socializing. Isolating due to depression obviously hasn't helped that.
I speak only from my perspective on this, but I stopped wanting to put the work into recovery when I decided it wasn't worth it anymore. This happened extremely early. I have always been very cognizant of current events, politics, disasters around the world, and any type of injustice, to which I am extremely sensitive to.
I grew up on the internet, more or less. I started using Facebook when I was 13 and added on Twitter and Tumblr when they were brand new, as well as Instagram and Snapchat. I met friends online who were in similar situations as me; mentally ill and/or ostracized by their parents due to their sexual orientation, gender identity, or other personality traits deemed unacceptable by society.
A lot of us in these communities had been bullied, myself included, for such things. And I've never met anyone who received proper help from their school about that, again, myself included. I was able to go online and either consume a lot of incredible knowledge and entertainment, or I could also look at the entire world at once and feel a sense of impending doom, like it was all just slowly crumbling around us and nobody in charge was bothering to fix it.
Basically, online, I found solace. But I also learned a lot about the world's unfairness, awfulness, and cruelty. It wasn't long after I got depressed that my thoughts began to twist this perspective into an all-encompassing worldly view. And I was hardly the only one. I definitely experienced more than a few suicides or deaths of young people that were present in these spaces and then suddenly disappeared. In my community, while I was in school, 4 students in various grade levels died by suicide. I wish I could say I want to have hope in the world and humanity or that "deep down" I don't really believe the world is so bad, but I don't. I really don't see a future for myself, at least not one that's worth living. I've been passively suicidal for almost the entire time I've been depressed. I'm heavily monitored by my therapist, with whom I meet with every week.
I'm almost 27 and didn't go to college (rather, I dropped out three separate times in the first semester), I've had around 30 jobs in eight years, and my credit score is starting to drop because I've run out of money to pay back things like student loans and medical debt. And now I've started to have some serious medical issues like pulmonary embolisms and a possible autoimmune disorder or some kind of blood disease.
These are all things about my personal circumstances that can and should be worked around, but every day I wake up and I look at myself (I don't value myself at all) and I look at the world through the screen of my phone (which is a total sh*tshow) and I talk to my friends who are all on some level of burnout or mental illness, and I wonder "Why?"
Why bother working through all of my baggage, why bother pursuing anything if I don't even have the confidence I can brush my teeth more than once a week, why bother hoping for recovery when I've tried so many treatments and nothing has actually worked? Everything these days is met with a resounding why. "We should brush our teeth." "Why?" "It's good for our oral health." "So?" It goes like that with every little thing, it's been this way for a couple years now. I didn't always used to struggle so much with ADLs and that fact alone tells me things have gotten worse.
I want to feel better. Obviously. Everybody wants to feel better when they feel like sh*t. But maybe in this world it's easier to stay feeling like sh*t and that way I can avoid more disappointment, especially because whenever I have a week or two of feeling "okay" I always end up nosediving again. That way I can continue to stare the tragedies in the world head on instead of putting on the blinders as so many therapists and therapeutic strategies in CBT are just dying for us to do.
One thing that really gets me upset is willful ignorance: when people look away from things or choose not to learn about things that will make them feel upset or that contradicts their optimistic beliefs. Well, I refuse to look away. I will not lie to myself in order to treat my depression when many of the reasons I am depressed are things I can't control in society and in the world. Somebody on Reddit said "Recovery from depression feels like being brainwashed." They summed up what I've felt since the beginning of my journey.
I've tried to figure out how to express that this whole issue with young people and mental health isn't just about diagnoses, but about hope and purpose and a general lack of those two things, but I've never been able to figure out how except by explaining my own experiences.
I was going to do some mental health advocacy work with the residential program I did, basically do a video interview and stuff, but I knew I couldn't. I'm no better than I was last fall, and the hospital I went to has a large number of what I refer to as "revolving door patients" i.e., we always end up back there, myself included, so actually is the hospital truly getting people into permanent recovery or are they just creating customers? It's hard to say. Not to mention on certain websites like NAMI or SAMHSA or even in this article you posted, they all talk about the people who get better after a short time and the people who never struggle with their diagnoses again.
But what about all the people who seek out these resources and they've already had their illnesses and been suffering for five, ten, twenty, fifty years? I think we feel a little forgotten and left out of the data. But I get it. We're not good examples. Placing something like "some people never get better or suffer for decades" on a mental health website is hardly a beacon of hope. So I think the people who don't get better are purposely left out for that reason. We're just kind of existing, and trying to stay alive for some arbitrary reasons, like not hurting those who love us or for our pets or something like that.
If you ever want to seek out the perspectives of people who feel similarly to me, there are subreddits on Reddit called r/depression and r/SuicideWatch. Even I try not to consume the content there in large amounts because it's very, well, depressing, but sometimes people say really honest and profound things that tend to get us punished if we say them in real life, or chastised by a well meaning therapist.
I'm also sorry this is so freaking long, but I guess that's what you get for telling me to check out part 2 of this topic 😅
Wow. You've blown my mind. First, I'm so sorry again for all you've been through. As I said before, you're very strong and smart. You're also a really good writer. (Ever considered doing that? If so, we should talk.) You explained your perspective so clearly and so well.
You raise many good points--about people turning away and how the world is so messed up and how that must feel to young people. What you said about willful ignorance is particularly striking: "when people look away from things or choose not to learn about things that will make them feel upset or that contradicts their optimistic beliefs." Well said.
In this, I understand how you wouldn't want to work toward recovery--because it is hard work. It also requires service, serving others in some way.
To be clear, I'm one of those "treatment-resistant," twenty-five-years-in-the-system, beyond-help, not-good-examples people, and I recovered. But recovery isn't what I thought it was.
It's completely individual to each person and the most subversive thing you can do. It actually goes against all of society's standards and ideas of how we "should" be.
But we aren't taught it. Right now, most treatment (inpatient, PHP, IOP, CBT, DBT, ACT, therapy) revolves around a biomedical/maintenance model that says something is permanently wrong with us and the most we can hope for is a reduction of symptoms. It creates, as you said, a revolving door of patients. As someone I know who survived the foster care system and years of homelessness and somehow recovered said, "There is no graduating from the mental health system." But that's changing. Many, many people, including SAMHSA's brand new Office of Recovery, are trying to move the mental health system away from the biomedical model and (finally--they've been trying since 1999) to a recovery model. A recovery model demands patient autonomy, self-determination, and (you may not like this word) hope. (Hope isn't all happy, smiley optimism. Hope is hard and hardcore.)
That's why there are very few beacons of hope online for recovery. NAMI's first page on recovery (its first!) didn't appear until last year (2021! two decades after the Surgeon General first called for us to move to a recovery model). NAMI's new recovery page is written by the great Larry Davidson, a recovery movement icon.
This is all to say that the treatments we have now aren't geared toward recovery; they're (primarily) designed for maintenance only. The "reduction of symptoms." That's not recovery. Recovery is much deeper than that.
Not everyone will recover. That's true of any illness. But right now, those with psychiatric illness, aren't even being given the chance.
It sounds like you have a therapist you trust (yes? or just a therapist?). Some clinicians do work in the recovery model, i.e., give their patients an equal say in their treatment and help them design what recovery will look like for them, but that's not the norm. I hope you have that.
Thank you for the Reddit recommendations. I'm not online or on social media very much at all. If I were, I'm pretty sure I would never have recovered. It can be great, and it can be not-so-great for some people. I serve people as a Certified Mental Health Peer Recovery Specialist, so I'm not turning away either.
Please keep reading and commenting. I love hearing your perspective.
Hi Sarah, so sorry for the delayed response. The past couple of weeks I've been "in the trenches," so to speak. I am a writer, though only for fun and not as a profession. If there's something writing-based you want to discuss, I'm happy to indulge. I do have a therapist and next week I will start seeing her twice a week instead of once.
She's really wonderful, and I've gained a lot of insight as to why recovery hasn't been working for me. Within the last few years, I knew that this was no longer an issue of medication, and was very aware of all the psychological things I need to work through. I've been opposed to recovery as it's been introduced to me time and time again. I view it as a cookie-cutter process that will force me through a "machine" in which I will pop out the other side, squeaky clean of mental illness and a totally different person, only sad or angry when it's justified to be.
Growing up, I was bullied and outcast from the rest of my peers, save for a couple of wonderful friends with whom I grew completely apart from once I became depressed in high school. The earliest I remember feeling depressed is age 9 and I was 5 when I began to feel alienated from everybody else. I identified with being shy, quiet, intelligent, analytical, and innovative. These are also the types of things that got me bullied, and so I held onto them tighter.
Anxiety and depression are almost siblings of these traits by consequence. Social anxiety is often attributed to shyness and introversion by the public, and staying in my room to read, write, and watch videos was always how I escaped from the harshness of reality. And in being someone who loves to learn, I became rapidly disillusioned to all the cruelties that happened all over the globe every single day due to growing up online.
Since mental illness swallowed most of my adolescence and along with it, precious time and opportunity to develop my brain and a sense of identity, my mental illnesses became my identity. So every coping skill I've learned thus far I am vehemently opposed to utilizing because they feel so invalidating and threatening to my identity, or at least a vital part of who I am.
It shouldn't have turned out this way, but it's an issue that I don't think professionals look out for or aren't aware of. Your take on all this has a lot of good points, and as you can see, I felt threatened by those because in my mind, you want me to change who I am or at least hide it all away. Now I know that this wasn't what you were saying, and I reacted emotionally.
Right now, I'm trying to pick all this apart with my therapist, as well as explore with her what recovery actually looks like for me and not what I think society thinks I should be. I have struggled most the past two or three years with the "whys" of it all. I have a few reasons not to kill myself, but I don't have a reason to recover, so I've just been stuck under this crushing weight of emotional pain with no out. The question of "Why?" permeates every part of my day to the point I am not currently able to keep up with basic hygiene or meals; luckily, I am living with my parents who are taking care of me.
I'm so glad you have a good therapist and the support of your family. You make a good point about recovery seeming to be cookie-cutter. I don't know how it's been presented to you, but I'm impressed it has been. I wonder if it's been presented as something you determine because that's what it is. Regardless, I understand being resistant to recovery and losing a diagnosis that's become one's identity. I felt the same.
As for writing, I feel like you could be the voice of your generation. It seems that many young people feel the same way you do. We're all trying to understand, so we can help.