I’ve been in the system for over seven years. One thing I will say of myself: I am fairly observant.

In all this time, I’ve talked with doctors, therapists, and nurses. I’ve also interacted and observed all kinds of mentally ill people. My experience in the system is supplemented with academia and independent research.

I’m listing several (but by no means all!) potential pitfalls to watch out for. Some of the ideas presented are based on my personal opinion. Other thoughts are more conventional and widely agreed upon.

Something to keep in mind, especially early in recovery, when things are most difficult, is that when needs are high, judgement is low. People are a lot more likely to reach for a quick fix when in pain, to underestimate the eventual harm they’re doing by escaping for what’s honestly a few moments of time that will probably be forgotten.

Hence the first pitfall:

  • Drug abuse (including legal drugs)
    • One doesn’t need a second mental illness
      • Becoming an addict brings another (they call these unfortunate tandems “comorbid”)
    • Medication and therapy will not work if one gets loaded, blasted, hammered, or otherwise euphoric on recreational drugs
    • The instant gratification isn’t worth it
      • Days, weeks, months, years of pain.
      • People go to rehab ten times and can’t get clean.
    • One instance of drug abuse can have permanent effects
      • For instance, 15% of people who become psychotic on stimulants never fully recover
        • There are those on antipyschotics for life because of this

For people who are prescribed benzodiazepines and/or stimulants, a time honored trap…

  • Chasing benzodiazepine-induced euphoria
    • Benzodiazepines have questionable utility
    • People think they should always feel like the first month or so
      • One thinks they need a higher dose
    • Most of Western and Northern Europe ceases treatment after a period of about four weeks of daily use
    • Highly physically dependence-creating in the long-term
      • Thus, taking more than directed by a provider, including buying illegally, sets one up in a terrible position
      • Withdrawal from non-sanctioned doses can be lethal and is very uncomfortable
  • Chasing stimulant-induced euphoria
    • Similar to the case with benzodiazepines
      • Yet stimulants can be much harder on the brain
    • In the beginning, empathy, socialization, euphoria, and a significant push to complete tasks is usually experienced
      • When this period ends, people oftentimes think that the medication dose is too low, a misconception
      • Stimulants continue to work for focus (when one wants to focus) and energy

This is the dark side to stimulant addiction, a true degeneration of self.

Lesson: a neat bottle with directions and a doctor’s name on it does not make a substance harmless, or even necessarily less harmful than illegal drugs. As seen below, Ritalin (methylphenidate) and cocaine work very similarly in the brain.

  • Isolation
    • The first red flag of mental illness is excessive isolation
    • Some alone time is healthy for all, but as a chronic reflex, heath worsens
  • Medication non-compliance
    • Not taking medication because it costs too much
      • This is a common problem, especially given the sorry state of insurance availability and quality and corporate kleptomania (pathological drive for money) that affects our daily lives
        • In this case, please consult your doctor about switching to a medication that’s affordable
      • This pit I fell into after being well-primed from a hospital visit. If only I had agreed to the depot shot…
    • Not taking medication because you don’t think you’re ill
      • This overlaps with trust in family and friends
        • We know ourselves in some ways better than anyone else could, but by the same token, our loved ones have certain perspectives on us that we could never cogitate (think of) without their feedback.
        • This isn’t to say that everyone needs a given medication because a doctor says so.
    • Not taking medication due to adverse side effects
      • Simply because one medication is intolerable, that doesn’t mean they all are.
      • For example, there are roughly fifteen antipsychotics on the market. There are tens of antidepressants available. And at least several mood stabilizers with qualitatively different effects can be tried.
      • Particularly regarding antipsychotics, medication might be intolerable, or near so. In this case, it’s ironic, as people with a psychotic illness are perhaps the most salient demographic within the mental health system to treat.

I, for one, was pretty surprised at the diversity of reasons for people not taking their meds. All of these reasons, though, are not reason enough if a psychiatrist tells you that you really do need medication.

The failure of getting medication to people is not indicative of an idea that one doesn’t need it, it’s simply a failure in the insurance system, which is itself one more industry that has become a for-profit enterprise, at least in the United States.

In many European countries, every health service is paid for in full by the government; unfortunately we haven’t reached that point here in the United States.

And yet, all but one psychiatrist assigned to my case was willing to interact and reason with me, before medications and doses were doled out. The exception even let me go on just one medication, rather than the two he wanted me on.

  • Telling your doctor what you want to take without the doctor first stating that it’s an option
    • A rule of thumb: never be afraid to walk out of the doctor’s office without the prescription you wanted
    • No amount of personal research equals an in-person evaluation by a doctor: roughly a decade of very intensive higher education. Medical school is notoriously difficult.
      • No internet blog, forum, or website should convince you to seek a specific medication
  • Not trusting friends and family
    • It’s easy to be suspicious, irritable, and skeptical when symptomatic. Some of that is even healthy. But putting faith in loved ones usually leads to greater health down the road.
    • Troublesome side effects usually diminish or go away. And if a loved one opines that you seem better, that is reason enough to consider staying on the medication.
    • Here we have a neat series of signpost suggestions. We’re talking mainly about four and five here, keeping in mind how number six can be broken as a result of miscommunication. But number three is important.
    • Finding the ideal balance is a process of trial-and-error.

  •  Excessively looking up and researching your medication
    • For instance, if efficacy usually declines after a period of time, or if there are some adverse side effects, knowing this information increases the likelihood of experiencing this
    • For this reason, I try not to speak of side effects, and please consider this my additional, clear warning, of how things could go wrong if you start researching your meds past the sites listed in the Your Research section. Mayo ClinicWebMD, the National Institute of Mental Health, the National Alliance on Mental Health, and Mental Health America, are fine.
    • Getting too involved in the psychopharmacology (the study of the effects of drugs on the brain) of your medication(s)
      • People tend to latch onto grossly over-simplified, mistaken ideas of what they think is medicinal for them
        • For instance let’s take a hypothetical case study. Ethanol (the alcohol many of us drink) tends to give person X more confidence. When not drinking, person x finds herself mildly, but noticeably, anxious. Person x looks up how alcohol works in the brain. They then research medications that act in roughly the same manner. The next time they see their doctor, they petition to get prescribed Klonopin (clonazepam) solely because it shares an action with alcohol. They didn’t read about the efficacy, cognitive effects, abuse potential, and other negative effects of clonazepam – to say nothing of the horrible withdrawal syndrome. They didn’t read about medications used for mild anxiety. Instead, they tried to take the psychiatric process into their own hands, whereas the truth is that we only know how medications work very generally.
        • Their doctor, if they really cared, would have prescribed an SSRI and recommended a good therapist.
        • Taking benzos for mild anxiety is somewhat akin to taking Adderall (mixed amphetamine salts) for jet lag.
  • The idea that medication solves problems
    • Psychiatric medication doesn’t launch people into a utopia. Recovery isn’t found in a pill, shot, and definitely not in a bottle of booze.
    • Any psychiatric drug that produces a high without any environmental rationale should be well-reconsidered
      • Psychiatric medications are not supposed to cause this effect
      • Please contact your doctor immediately if you experience this
      • An example is feeling euphoric after first taking an SSRI
        • While SSRIs are designed to improve mood, and some people find them effective within a few weeks, they aren’t supposed to work as recreational drugs.
      • As research into fast-acting antidepressants continues, however, this effect may be the desired outcome
    • The illness is partly biological in nature. But it didn’t likely start with someone making a laceration in your brain
    • There are so many other manners for one to forge their recovery
      • The Complimentary Healing page lists other methods that are largely harmless, yet still asking one’s provider is a good idea.

Here’s an interesting little infographic that looks pretty well thought out from my standpoint:

  • Supplement use
    • They may seem inconsequential, but tend to just complicate the picture
    • It’s imperative to tell your doctor if you’re taking any herb, supplement, vitamin, or otherwise another chemical that affects your mind and brain. For example:
      • Zinc
      • Magnesium
      • Fish oil
      • If you’re a smoker
    • Ask your doctor whether or not it could possibly hurt
      • Let them make these kind of big decisions
    • If your doctor recommends stopping use (or anything else), follow their instructions exactly
      • They have a working theory on your condition that likely supersedes your knowledge
    • The truth: no one knows how these supplements interact with psych meds
      • It could be as harmful as blatant drug abuse
      • Take holy basil (also called tulsi).
        • It’s been in use for thousands of years, so it’s safe by itself.
        • A few studies even detail how it could ease anxiety and depression.
        • But there are few, to no, studies on how holy basil interacts with Prozac, which is also used for anxiety and depression.
  • Selling or giving away your medication
    • People with mental illness are already under enough stress without having to worry about the law
    • Furthermore, if you’re caught doing this, you could be…
      • Cut off from helpful medication for life
      • Branded as an addict
      • On the receiving end of a lot of social stigma
      • Never get prescribed a controlled substance again
      • Facing felony charges, even for one, low-dose pill
        • Felonies do not disappear. They will smear your record forever!

  • Lying to whomever is treating you
    • This can be catastrophic
    • It’s true: you know yourself in some ways that others don’t, or can’t
      • Given this, it’s your responsibility to honestly communicate your perspective to your doctor.
      • If you don’t, they simply will be unable to help you. You must let other people in.
  • Putting anything but your health as the main priority
    • Whether it’s work, school, or a relationship, all come after securing your own health.
    • Analogously, we could picture when we are given the short tutorial on a plane ride before taking off.
      • They tell us that, in the event of an emergency, oxygen masks will fall from the ceiling.
      • Importantly, we are told to secure our own mask before attending to others.
      • We have to take care of ourselves before we can meaningfully attend to outside obligations.
  • Relying on things outside of yourself to be at peace, not including medication
    • Again, we are the arbiters of our lives. It’s unrealistic to expect that some outside assistance will catch us if we fall.
    • There’s the hospital to stabilize us, but that’s all it does. It’s up to us to forge the life we need ourselves to experience.
    • The mental health system is somewhat lax and deceptive in that it implicitly promises that it will take care of us. No one but ourselves can take care of ourselves. More than one of my previous psychiatrists ended sessions by telling me to take care of myself. Got it.

  • Waiting to get better
    • Similarly, we can’t wait for life to be good. We have to continually advocate for ourselves and take steps toward a more bright future if we are to be what we want and get what we want.
    • Society will move right past us. It’s our judge to jump on the train of progress, and fight for our right to stay there.
    • Life can tragically pass us by. But we’re doing something about it!
  • Wasting energy on a personal vendetta against anyone or thing
    • Again, mental illness can make people irritable, and in general, combative.
    • Simply the disconnect, perhaps a somewhat truthful (though general) way of explaining how mental illness functions, oftentimes leads to miscommunication, which can mediate hostility.
    • As with drug abuse and spreading your prescription around, it’s simply a waste of energy, a great personal and legal risk, and needlessly complex to make enemies in general, but especially when battling a mental illness.
  • Pushing yourself so far that your quality of health actually degrades
    • This happened to me.
    • I forced myself into situations that I knew weren’t good for me. It’s not always clear what is healthy exposure versus what is detrimental to health.
    • In fact, it’s very important to find these boundaries through introspection and conversation with people whom know you well., and whom are on your side.
  • Too much screen time
    • I should really abide by this rule more so.
    • It’s important to spend a significant amount of time in the real world, facing real-world problems. That said, watching a movie or surfing the internet is a relatively harmless means of temporarily retreating to mend wounds before facing the world again.

  • Not straying outside of one’s comfort zone
    • The comfort zone is an important concept to keep in mind.
    • It can be thought of as functioning roughly analogously to a brain. The brain is muscle that we exercise in our daily lives. Sometimes we go through a period, such as a semester in college, exercising our brain’s intellect a lot. This tends to raise our level of cognition.
    • Similarly, when we exercise our will to leave the comfort zone, it expands. If we never or rarely venture out past the comfort zone, in the same manner as not pushing ourselves to do homework, our comfort zone shrinks.

Sources: Dr. Theodore Papperman, recovering people with mental illness (anonymous), https://image.slidesharecdn.com/medication-adherence-and-compliance-the-pharmacists-role, https://lh3.googleusercontent.com/-WE5CVxg__mo/VpQv1rQN-BI/, http://www.comprehensiverecovery.com/wp-content/uploads/2016/04/Treatment-4-Visual.png