You may have to change your expectations, but living well is not an empty dream.

by John McManamy


YOU ARE no longer bouncing off walls or chained to your bed. The meds are kicking in. Your worst symptoms have receded. You have your brain back.

But something isn’t right. “You” has not returned. And the side effects of the meds are making you feel worse in many ways. Is this it? you wonder. Is this my fate? Is this what each day of the rest of my life will be like?

Those who champion “recovery” tend to talk disparagingly about “the medical model,” as if medical practice has nothing to do with us getting well and staying well. A more apt distinction is between “stability” and “recovery.”

Psychiatry tends to focus on "treating" a patient into stability. In this context, a treatment "success" is one where you are displaying few, if any, of the symptoms that you experienced in an emergency or crisis situation. But you are not well. Unfortunately, stability is where the therapeutic relationship tends to fall apart. Many clinicians lose interest in your concerns once stability is achieved. Rightly or wrongly, they abdicate authority to you.

“Full functioning” is where virtually all of us want to be. We feel “well.” We are able to have satisfying careers. We are able to have friends and loving relationships. We are able to enjoy our lives. We feel good within ourselves.

Recovery is the current buzzword, a cause taken up by patients demanding better outcomes than mere stability. In 2006, SAMHSA came up with a ten-point consensus statement, which I will compassionately not include here. Instead I offer this short but by no means definitive take:

Recovery is a state where one has achieved:

    1. A long-lasting period of zero or low symptoms and impairments, together with very high functioning.
    2. The ability to successfully manage one’s illness.
    3. A level of comfort within one's self.

Even in a state of recovery, it is highly likely you will have to accept certain limitations in your daily life and perhaps even in what you can expect out of life. What is key is that you have reached full acceptance of your situation, and that you are fully comfortable in your ability to lead what you define as a rewarding and productive life.

So, recovery is possible, even if you are unable to return to the life you had before your illness. If this fits your situation, recovery is more likely to be a journey rather than a destination. We are very rarely the same person once we are well along into the journey. Along the way, many of us experience a profound healing, a coming to terms with ourselves, in closer touch with our own humanity and divinity.

In this sense, even living within certain limitations that our illness may impose upon us, recovery may actually translate into a life better than the one we had before, rather than a mere return to where we once were.

In my book, Living Well with Depression and Bipolar Disorder, I write:

When I walked into my first support group meeting not long after I was diagnosed, Moe, who ran the group, told me that meds are only one part of the equation. Getting well and staying well, he said, also involves eating right and sleeping right, diet and exercise, as well as a wide range of intangibles, which may include getting out of the house, volunteer work, spiritual practice, developing a support network, and a whole bag of survival tricks one starts to pick up.

To this day, this is the best advice I have ever received.



Actually, this is the same type of counsel that family physicians dispense to their patients. Eat right and all the rest and chances are we won’t have to schedule by-pass surgery 10 years from now.

But eating right and all the etceteras involves a lot of hard work. In an interview, Frederick Goodwin, co-author of Manic-Depressive Illness and former head of the NIMH, told me that people with bipolar disorder need to lead more disciplined lives than the general population.

Seriously, who wants to practice more discipline?

So is “just snap out of it” valid? Is recovery our responsibility?




It’s a bit more complicated than that. Our broken brains conspire to play tricks on us. If we’re not over-reacting and over-thinking, we’re under-reacting and under-thinking. Think of that hoghly misused term called the  chemical imbalance of the brain. For instance, the neurotransmitter dopamine, among other things, is involved in motivation. So if your dopamine levels happen to be low, there is a good chance you will not be motivated to improve your life. Perversely, many of us are prescribed meds that block dopamine.

Often, it's us against our neurotransmitters. For instance, when thing are working right, glutamate gets our neurons going. But too much of a good thing brings on stress and disordered thinking. Meanwhile, too little of glutamate’s tag team partner, GABA, sets us up for fear and anxiety. Try turning your life around when your thinking is out of whack or you’re feeling fearful and anxious.

In essence, the recovery model embraces the medical model. We can’t do it alone. At some point in our lives, most of us will require a chemical assist. Our biology needs to cooperate with us to get motivated, to think things through, to have the courage to change.

Or at least get us to stable.

Our meds are far from perfect, but they can be used as part of a greater strategy to help us to help ourselves. Psychiatric meds probably will not return you to the kind of life you wish to lead, but good meds management can bring your brain back on line. The operating system may not function perfectly, but the hard drive is at least booting up.

At last, we are in a position to take charge, assume responsibility and start to lead disciplined lives.

Living Well

Following is my own personal “eight-fold path to living well,” which I first came up with in a blog I wrote for HealthCentral. The main points:



  1. Knowledge is Necessity - Studies have found that “expert patients” who put in the effort to learn about their illness and actively manage it have far better outcomes than “passive patients.” The other aspect to this is "knowing thyself."
  2. Mindfulness - In the context of our illness, mindfulness involves being microscopically attuned to subtle shifts in our moods and energy levels and behaviors. We need to pick these up before our clinicians do, or our friends and family.
  3. Avoiding and Managing Stress - The brain in crisis or overload is probably the greatest risk factor for a mood episode. With mindfulness techniques, we can often avoid stress before it eventuates, or manage the stress we can’t avoid.
  4. Good Sleep is Crucial - If you struggle with your sleep, you are certain to be struggling with your illness.
  5. You Are What You Eat - There is no one right diet, but there are millions of wrong ones.
  6. Exercise - Numerous studies have linked exercise to elevated mood and reduction of depression.
  7. Connectedness - This includes being connected with who you are, with other people, and with something greater than yourself (be it God or your own intuition). Without these connections, you are inviting in depression and frustration and anger.
  8. Resilience - We may be a vulnerable population, but we are a lot tougher than we think.

Wrapping Up Recovery

At a critical stage in our journey, the emphasis changes. We are no longer just being “treated.” Our meds aren’t doing all the heavy lifting. Our psychiatrist is no longer making all the calls. We are taking charge. We are working on our recovery. There are no guarantees. Heartbreak and frustration is par for the course. We screw up. Setbacks happen. Wanting to give up is normal. Yet, for some perverse reason, we refuse to listen to reason and keep going.

Call us crazy.

We are not just going to survive with this illness, we tell ourselves. We are going to live well. Take heart. Recovery has begun.

July 9, 2016




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