Healing a Troubled Mind Takes More Than a Pill

Davidson's contention is supported by the provocative finding by a number of researchers that schizophrenia outcomes are better in developing countries, where, generally speaking, patients get more support from family and society, and where ill people are less likely to be excised from their natural communities.

Another thing patients will tell you is that recovery exists, or can exist, within the context of illness. In other words, recovery doesn't mean cure. It means living with the illness, managing it and getting better within certain limitations. "I define recovery as the development of new meaning and purpose as one grows beyond the catastrophe of mental illness," says William Anthony, director of Boston University's Center for Psychiatric Rehabilitation. "My feeling is you can have episodic symptoms and still believe and feel you're recovering. It is a matter of moving beyond the debilitating phases of the illness."

The idea that recovery doesn't usually mean the removal of all symptoms is a novel and distinctly un-American way of looking at psychiatric illness, and illness in general. The fact remains, however, that most major psychiatric illnesses are episodic but chronic. Recovery involves both coming to terms with symptoms -- one hopes in the context of their gradual moderation, but that's not always the case -- and finding a meaningful life in their midst.

For many patients, this is a decades-long process of acceptance and resolve. At the end, some patients can actually say they're glad -- within reason -- that they've experienced an illness, because it has greatly enriched their lives and their appreciation of things. We do have to be careful not to romanticize suffering, but this is nonetheless something you commonly hear from those who have found the elusive meaning in the presence of sickness.

This leads us to the final lesson I've learned: Treatment is most effective when the patient is in charge and the ultimate expert in his or her own recovery. There is evidence that when patients feel in control, the results of treatment are better. Treatment works best when the doctor or therapist acts as a kind of expert consultant. As Home Depot puts it: "You can do it, we can help."

That's what I found in my own process. That my journey was a self-directed path, one in which I saw myself as the author of my recovery rather than as a passive recipient of a pill, made all the difference. Ultimately I no longer saw myself as a patient but as a writer, father and husband. Ultimately I found ways to use my obsessive ways adaptively. A little like Monk, the television detective who uses his OCD to solve crimes, I repurposed or redefined my illness to write and research with extra drive.

But these complex lessons about the arduous realities of attaining emotional health, as told not by doctors or companies but by patients, have received little traction in mainstream health care and the mainstream media. The negative reception isn't surprising. Listening to patients cuts against the establishment grain. We live in an age of experts, in which we like to cede control of our bodies and our being to others. Different parts of our bodies go to different experts. The ultimate expert, perhaps, is the pill. Our fervent and simple-minded belief is that the experts, and the pills, will take care of things for us.

The simultaneously inspiring and terrifying reality is that getting better -- the winding, agonizing road to stability -- is a little messier (and a lot more interesting) than we would like it to be.

charles.barber@yale.edu

Charles Barber is a lecturer in psychiatry at the Yale University School of Medicine and the author of the just-published "Comfortably Numb: How Psychiatry Is Medicating a Nation."