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When Mental Health Professionals Overlook the Difficulties of Choosing Recovery

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So many health professionals overlook the simple fact that some of the patients they see with mental health difficulties may feel ambivalent about certain aspects of their recovery.

I recall vividly one such consultation when I had just begun weight restoration during the years when my anorexia was its most severe. The GP (general practitioner) paused his typing and said, “You’re clearly doing well, I can see you are starting to fill out a little,” and smiled a broad grin at me. I left the room in floods of tears and hardly ate anything for the next two weeks, exercising obsessively, horrified that I felt this doctor had just called me “fat.”

This is a particularly obvious example of such insensitivity, but it isn’t the only one. The GP was clearly aiming at being encouraging by reinforcing that my efforts to stick to my meal plan were having the desired effect. The crucial oversight, however, was that weight gain, although a goal of anorexia recovery, is also an anorexics worst fear confronted. The doctor had much to celebrate feeling that his patient was recovering and moving out of the “danger zone” in terms of their low weight, but as the patient, I didn’t share his joy in something that terrified me more than I have the words to say.

Another example is when I visit the practice nurses for dressings. They smile at me over their armful of bandages and saline and say my self-harm “wounds are healing well.” If I were a patient whose wounds weren’t self-inflicted, then I feel this statement would be far more appropriate. While the nurses are again trying to encourage me in managing to restrain from further self-harm, their statement instantly fills me with a striking fear and terrible grief. On the one hand, I want my wounds to heal because they need to heal and I need to heal and move on. On the other hand however, as my wounds leave me it feels like losing friends, losing the very things that I’ve made for myself when I felt utterly alone with nobody to turn to. The nurses are deliriously pleased, while I am overcome with an all-consuming panic and urge to inflict further damage upon myself so I am not left alone without them.

I have several friends who struggle with bipolar disorder, who, when their doctors become enthused about their “mania” coming down and their mood leveling off, can’t connect to the same sense of progress and triumph because a part of them misses their incredible “high.” Why, when you felt so invincible, would a physician assume that losing that feeling would be so unequivocally celebrated?

Inherent to so many mental heath difficulties are the double-edged swords that keep those whose mind they capture so ensnared. I don’t think it’s so simple as to say the individual filled with such conflicts wants to remain unwell. It totally overlooks the fact that many of the difficulties those struggling face have come about because these somewhat self-destructive and “maladaptive” behaviors have actually been what has ensured survival at one point. These troublesome problems may make life difficult in many ways, but they can also be helpful for coping when life becomes too overwhelming.

I think treatment falls down so often when physicians expect their patients to always be happy about “progress” made. Such assertions can leave “patients” feeling alienated and lead to us not attending appointments, skipping out on programs, not taking prescribed medication or being open with those who are supposed to help.

In order to help me, you need to understand that while I desperately want to be well, there is a part of me that is trying to destroy myself. It isn’t a part of me that I like or want anymore, but it is a very real part. When you celebrate the things I can only just muster the courage to withstand, you demonstrate to me that you don’t know what it feels like. I feel conflicted and I need the professionals around me to understand this conflict rather than to not detect it, or worse, label and dismiss it.

Recovery and wellness are indeed something to be celebrated, but on the journey toward those things, if a physician or professional is too busy celebrating their own sense of success at helping their patient obtain outwardly quantifiable recovery milestones, then you may find not only are you celebrating alone, but that your cause to celebrate may be short-lived.

If you or someone you know needs help, visit our suicide prevention resources page.

If you struggle with self-harm and you need support right now, call the crisis hotline at 1-800-273-8255 or text “START” to 741-741. For a list of ways to cope with self-harm urges, click here.

Or if you or someone you know is struggling with an eating disorder, you can call the National Eating Disorders Association Helpline at 1-800-931-2237.

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Unsplash photo via Ben Blennerhasset

Originally published: October 17, 2017
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