What is most important to get better from mental illness?

Sometimes people ask me what I think is the most important “thing” that can help the patient to recover from mental illness. Many would guess it is the patient’s compliance to treatment, support and love from family members, getting help from the right person/place etc. Yes these are all quite important.

But no, I think it’s the patient’s insight to his/her problems, that’s the most important factor.

First you need to be able to recognise that you have a problem. And then you seek help, and then you comply to the treatment, and then maybe your family support you throughout, and then you learn about your illness and how to prevent relapses. Without insight, none of this is possible.

Yes I have mentioned before that for some patients with no insights to their problems, sometimes family members can put medicine into their food/drink. But do you think family member can consistently and successfully put the medicine each and every time? Do you think they can fully recover after a period of time?  Do you think next time they have a relapse the patient can spot the early warning signs themselves? Do you think family members can be there all the time? Do you think about the consequences if and when the patient finds out?

Many people don’t recognise their problem as a problem, and allow it to worsen. It’s a bit like liver cancer, you don’t feel pain, you don’t see any symptoms, by the time it’s discovered, the cancer could have spreaded quite badly. But what we are talking about here is worse than liver cancer, some people with clinical depression don’t recognise it even until the time they jump down from the building and end their lives – they still think it’s their problems that they can’t cope, can’t face and manage adversity in life. They didn’t see that it could be their hormones, their brain circuits, and that maybe they need help (not on adversity in life), on their mood disorder (and perhaps learning some coping skills and become more resilient), and then they can face all the challenges by themselves again.

One’s insight to their problem affects all stages of treatment. Recognising symptoms of hearing voices as mental illness, recognising the need to seek help, recognising the need to be compliant to treatment, recognising how the illness functions, recognising how to prevent relapses, recognising when to see doctor whenever needed.

So sometimes I’ll tell people, it’s good enough that you recognise it as a problem and that you need help. Quite often this is to people with bipolar disorder (don’t recognise the manic phase as problem, as they enjoy it!), morbid jealousy (insist that it’s the partner that’s unfaithful, not their excessive jealousy and suspicion as the problems), schizophrenia (thinking the voices are real, they are not problems to them), depression (genuinely believing that they are useless, they can’t cope, they are stupid etc instead of seeing those as just negative automated thoughts) etc. Don’t worry too much once you have got the insights, there will be people trying to help you along the way. All you need to do first of all, is to reach out, really.

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