🎧 You Still Hide Sometimes | Chapter 41

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At our annual appointment, Dr. R asks how I’m doing. I went from weekly visits to monthly to bi-monthly to every few months, then every six months. I’ve since graduated to once a year.

I’m not sure what to say: I’m okay. Teaching is going well. I love my apartment. My family’s all healthy. I got a cat. Oh, and I totally healed from mental illness without telling you. And I wrote a book exposing the flaws in the Diagnostic and Statistical Manual of Mental Illness (DSM), psychiatry’s bible, and psychiatric diagnoses, and you’re in it. How are you?

Instead, I tell him I’m doing really well.

He bobs his head the encouraging way he does. “Good. Good.”

Gingerly, I tell him about getting an agent and selling the book. Even more gingerly, I explain that it’s about my years in the mental health system. More gingerly still, I mention my research on the DSM. “But I’m not anti-psychiatry. Not at all.”

He bobs his head knowingly. “Oh, yeah. The DSM? It’s just a mess. I tell my residents at the hospital, Don’t even go there. Stay in the real world. It’s a guide. Stay with your patient. I’m a biologist. I believe in science, but that’s not science.”

We talk for some time. I ask him questions about his experience with it and how he uses it.

“Well, it’s easy for me,” he says. “I don’t take insurance, so I don’t need to tell my patients they have the worst disorder so I can get reimbursed.”

His response to my book and honesty about the DSM fill me with trust—again.

He says, “Every medical resident should read your book, so they know what it’s like to be on the other end of the DSM.”

I want to tell him about my recovery. Instead, I stare out the window and become increasingly self-conscious. How am I “presenting”? How do I seem to him? What diagnosis do I embody? Would someone who’s recovered from mental illness stare out the window? Maybe she would. Maybe she just did.

We sit without speaking. How can I prove I’ve recovered? I don’t have any data marking how well I’m “managing” my symptoms. Anxiety is still an abiding part of my existence. Sometimes, it’s debilitating. Whirling dervishes of depression and darkness take hold. The sodden pit still comes. There’s no avoiding them.

Emotions and thoughts aren’t easy to manage. I wish there were an “atlas” of emotions, but it’s taken learning my bodily sensations and understanding which thoughts cause those sensations, and even then, I’m often puzzled because emotions don’t simply arise due to external events. There’s affect and mood, the ways that physical health and equilibrium—hunger, tiredness, blood sugar level, level of caffeine and other stimulants, etc.—create emotional responses. Our evolutionarily driven thoughts trigger them too.

As evidence of my recovery, could I present the way my self-talk isn’t cruel anymore? What about how strong I feel because I paved my path to recovery? Or how I wake each morning with a sense of purpose because I know my book will someday help improve the mental health system by giving patients the information they need about diagnoses? Or how when I’m at home, I still occasionally stop mid-kitchen or mid-living room or out on the balcony, amazed that I live in such a beautiful apartment with a view?

Could I use as proof my lunches with my father and phone calls with my mother and visits with my sister and brother-in-law every Saturday at 4 pm to walk Augie? What about how incredible it felt to hear my nephew introduce me as his aunt and realize, Yes, I’m an aunt, not a diagnosis?

Could I describe my love for my cat Sweets, who is so set in his ways? At night I lie in bed, and he lies ten feet away on the floor. It’s a kind of cuddling. The closets and under the bed are his territory. When he stretches out, exposes his belly, and gives me a haughty look, the likeness to Henry VIII (not the Buddha) is unmistakable.

Would my gratitude practice count toward my recovery?

What if I told Dr. R I’ve recovered, and he disagreed?

Maybe he already knows.

*

Later, I’ll learn that in the recovery community, symptoms aren’t important. Our symptoms are part of what it means to be human—maybe not for everyone but for us. Psychiatric disorders are extreme occurrences of basic thoughts, emotions, and behaviors. Intense anxiety. Punishing depression. Dangerous risk-taking and grandiosity. Severe distractibility. Excessive rumination and compulsive behaviors. Even hearing voices seems to organically occur. Ever had a song stuck in your head?

As Allen Frances, once named the most powerful psychiatrist in America, said in a 2018 interview, “We’re taking everyday experiences that are part of the human condition and we’re overdiagnosing them as mental disorders, and way too often providing a pill when there’s not really a pill solution for every problem in life.”

For many in the recovery community, the absence or even lessening of symptoms is neither possible nor the goal. The goal is to build resilience and then a life with what some call “symptoms.”

Clinicians see it differently. They take the presence of any “symptom” (i.e., depression, anxiety, ruminations, obsessions, manic energy, hallucinations, and paranoia) as proof of illness. They categorize us as asymptomatic (within the normal or clinically acceptable range and consistent with the absence of disorder), fully symptomatic (indicating full syndromal expression of the disease), and partially symptomatic (everything else). We’re then viewed in terms of severity, duration, and functional impairment and placed on a scale of acute, maintenance, or continuation with no hope of escape.

The biomedical model trains clinicians to view remission and recovery as uniform and determined by the complete absence of symptoms. A landmark 1991 paper, published during biopsychiatry’s brain-disease heyday, set the parameters for the operational criteria for remission and recovery. The patient must experience x number of symptoms in y number of weeks. For those diagnosed with major depressive disorder, to be asymptomatic we must have fewer than x symptoms present and receive a score of less than seven on the Hamilton Rating Scale for Depression and less than eight on the Beck Depression Inventory.

Recovery, for the traditional bio-psychiatrist, is a linear process. Each day brings improvement. The patient strives for and achieves partial remission (critical symptoms abate and treatment must continue) and then full remission (asymptomatic and no increase in treatment are required). It’s as if they’ve never spoken to someone who’s recovered, who could easily explain that recovery is nonlinear and redolent with instability and inconsistency.

Based on the amount of time spent without symptoms, remission is declared if the clinician sees fit. If a patient is christened recovered, there are two options: discontinue or continue treatment. (And what if we want to recover and continue treatment? Many of us will remain on medication indefinitely.) But neither entails fully graduating from the mental health system. The inevitable next episode still looms.

*

My father stares pensively at his phone. We’re at our usual table in Starbucks. A water for me, ginger tea for him. I showed him how to download an app. He’s trying to do it. (He and my stepmother only recently agreed to get a cellphone.) He taps the screen and bites his lower lip.

My love for him encompasses me.

He taps his phone, his forehead pinching in concentration.

To the sound of the barista calling out a double skinny iced something, the gravity of what I’ve done hits me: I’ve actually healed from mental illness—serious mental illness.

He looks up, defeated. “I can’t do this. Apple must only hire young people who hate their grandparents.”

I take the phone from him, feeling the smile on my face. We laugh together, not loudly but in a way we haven’t done in a very long time.

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