I checked out of the inpatient psychiatric facility facing the world with a bag full of medication and a new label called mental illness. I thought I had gotten through the worst of it. Now that I know what this horrible disorder is, I should be able to ‘outthink it’. I believed I was stronger than my disorder. I believed that the torture and misery was in the past, perhaps just the result of ignorance. I believed that knowing I had Obsessive Compulsive Disorder meant it would no longer affect me.
I was gravely mistaken.
“The meds are great, but I don’t need them anymore. I will just know if I start to feel sick again.” And like clockwork, a couple months after my last dose of the antidepressant, I began to unwind at a rapid pace. The obsessions crept up on me, and like shadows overtaking my mind with the setting sun, everything was dark again. Suicidal thoughts plagued my mind around every corner. I couldn’t escape the anxiety, the depression, and the tormenting obsessions that had been dormant for almost a full year.
The logical explanation was because I stopped my meds, the disorder became unmanageable. But, mental illness isn’t logical. Understanding symptoms in the midst of a relapse does not include rationale. To speak or communicate with someone in a mental relapse expecting logical reason is asinine. It is not a reflection of the human-being; it is a reflection of how the individual perceives the world through the eyes of mental illness.
I have been suffering with OCD and depression for 30 years. You would think that I could quickly point out, understand, and ask for help eagerly when I began to slide into a relapse, right? Wrong. There is still part of me that naively believes I can control OCD anytime, anywhere, and anyhow without outside help. Why? Because I don’t want to believe I am mentally ill. I don’t want to believe with my level of intelligence, I cannot harness power over my brain. It scares me to think that I could be out of control tomorrow. It terrifies me to believe that my perception of the world through my senses can be wrong. It frightens me that my thoughts can be so powerful and convoluted that I may want to die because of them.
But, it is my reality. As scary as it feels, I have to accept it.
The Reality of Relapse
Relapse is a given in most cases of mental illness, no matter how much we will and want to deny it. There is no amount of positive thinking and optimism that can stave off a relapse without vigilance. This can take many years for a sufferer to understand and accept. It is in the phase before this acceptance that the individual is in the most danger.
The element of denial will wreak havoc on one’s life and their loved ones in this phase. If someone believes they are incapable of relapsing, they will be incapable of recognizing when a relapse is occurring. This is not uncommon. The sufferer may recognize symptoms of their illness, but will not want to accept that they are real. This denial can be fueled by many emotions including fear, shame, or guilt.
Fear is the most common denominator when faced with an impending relapse. If one has fallen to rock bottom with their illness, the idea of relapse will associate that individual with the emotions felt at said rock bottom. This feels terrifying. The reality is far different, but fear is a powerful enemy. The sufferer may imagine the relapse as a short freefall back to the lonely and miserable bottom. If unaware how to handle a relapse appropriately, fear may drive a sufferer to embrace denial ultimately expediting the freefall process as a self-fulfilled prophecy.
Shame and guilt inevitably accompany relapse. Most individuals who have hit rock bottom with mental illness understand the pain and suffering they have caused their loved ones. Stigma can riddle an individual on a societal and a personal level as well. Typically before an individual accepts and understands their disorder is life-long and can be managed, it is common to attempt to create distance from it to avoid those negative feelings. When faced with a possible relapse, one may begin to feel the feelings of shame, embarrassment, and guilt they believe they caused their loved ones at one time. The distance from the disorder starts to shrink. Panic can ensue as the feelings create the reality one has tried so hard to distance themselves from. These negative feelings can blanket one’s view of their own life as well as their disorder and exacerbate their symptoms making relapse inevitable.
Another commonality in relapse is individuals may not even realize they are experiencing symptoms. While this may seem bizarre to the average person, it is common for a sufferer. Understanding perception plays a large part in recognizing relapse. If I walk outside and my brain processes the weather as cold, I will put on a coat. If I walk outside and my brain tells me that I should worry about an irrational fear, why would I not believe that? I just put a coat on because it’s cold? Why wouldn’t any of my other thoughts be valid?
When I am symptomatic, I do not only think irrationally, I physically feel things that are not there. Symptoms of anxiety are physical. If my body is reacting to a thought, it absolutely appears real to me. Why would I not believe it? In order to understand my symptoms and my disorder, I have to understand how I perceive things and react to them. I have to figure out the physical sensations accompanied by my thoughts and make an actual decision on whether to perceive them as real or not. This is a very difficult process. It has taken me years to understand, and I still doubt my perception when I am experiencing symptoms. I still need help understanding and convincing me that I am actually experiencing OCD and it is not normal reality. I receive this help from my support system.
How to make a possible relapse easier?
Relapse is never easy. To think one day it will be is setting yourself or your loved one up for failure. A possible relapse should be taken very seriously.
For the sufferer: The best way to preemptively cope with relapse is to understand that relapse is possible and likely. This can eliminate that unwanted fear that it may or may not happen. To understand the likelihood and plan for it puts you ahead of the game.
If and when relapse happens, make a plan on what to do and how to manage it. When relapse does occur, you may be too saturated in your symptoms to know what to do and how to do it. There are many resources you can find to help structure a plan before it happens. (Please see below for recommended sites and plans). Also, educate your support system on what to expect and what to do if you are experiencing a relapse. Often your support system will recognize that something is different about your behavior before you do. Do NOT be afraid to ask for help. Do NOT be afraid to articulate exactly what will or will not help you. Individuals in your support system want you to succeed, so they will want to know how to make things easier for you.
In regards to shame and guilt, understanding that they may be present during a relapse may help lessen their effect. There may not be a possibility of resolving them in the moment, but knowing these feelings are common may ease their impact on your symptoms. It is important to recognize that mental illness relapse and symptoms are NOT your fault. As you progress through recovery and acceptance, it is likely the guilt and shame feelings will diminish. Until then, do not give them power by becoming overtaken by them.
For the Support System: It can feel painful and helpless to watch someone during a mental disorder relapse. But, there are many things you can do during and after to help make the best of it for the sufferer.
Understand that relapse is almost inevitable. If you understand and accept that relapse is part of having a mental illness and expect that it will happen, you are not only preparing yourself, but you are showing immense support to your loved one. This takes the fear out of the potential occurrence. It also gives you an opportunity to plan and prepare your support role when it happens. When you know what to do when a relapse happens, you will feel less panicked and helpless. This will help the sufferer with their feelings of guilt and shame if you are calm and prepared.
As a support, find out how the sufferer wants to be communicated to in regards to symptoms. It is extremely important to know how to talk about symptoms and behaviors with individuals with mental illness. Poor communication can result in exacerbated guilt and embarrassment which may contribute negatively to a relapse. When symptomatic, sufferers may try to shut you out or make you angry. It is important to recognize that their actions and behaviors may be fueled by symptoms as well as fear and stigma. The sufferer feels guilty and ashamed. They may not want you to have to experience the pain. They also may feel as if they have let you down by having the mental illness.
As a support, it is important to practice empathy without verbal validation. If the sufferer is driven by fear, guilt, or shame entering a relapse, it is okay to reassure your understanding of those feelings. It is okay to verbalize these emotions may play a factor. Make it clear that you understand beyond the symptoms the difficulty and suffering relapse can cause. Open communication and acceptance, regardless of the absurd logic will help the sufferer feel less ashamed and validated in their experience.
Most importantly as a support, it is imperative to believe that what the sufferer is experiencing is their perceived reality. To deny what they perceive as real damages trust and may drive them further into the realm of guilt and shame. Even if their symptoms defy all logic and rationale, to them it appears real and sometimes frightening. If they know you believe them, they will be more likely to accept your help and trust your support.
To Sufferers and Supporters Together: Relapse is disappointing and painful, but it can be managed successfully if planned for and executed properly. A few important points to remember about relapse:
- It is important to stay calm and level-headed as a support.
- It is important to remind yourself that you have gotten through an episode before, and you can do it again as a sufferer.
- Just because you have hit rock bottom once, doesn’t mean you will fall that far down again.
- It is difficult to remember what it is like outside a relapse when you are in it. It is also difficult to remember what relapse feels like when you are out of it.
- It feels like things will never be okay again when you are experiencing a relapse. It can. It will. Hang on and follow your relapse plan. You will get through it.
- Your mental illness is NOT your fault. This relapse is NOT your fault. Do NOT blame yourself for this illness.
- Relapsing feels very lonely. You are not alone, though. Reach out to your support system.
- Being hospitalized is not a death sentence. It is a necessary place sometimes to find baseline in a safe and controlled environment. If you need hospitalization, do not feel ashamed or embarrassed.
- Although relapse is oftentimes inevitable, you can be proactive and successful in managing it and avoiding it.
- There is no shame in asking for help. Don’t wait. Do it immediately.
Even though I experienced all of the negative emotions associated with relapsing, I survived my first bout. Afterwards, the possibility of occurrence was embedded within me. It took me a few months to get back on my feet after the first relapse, but it helped me understand the process and plan for the next time.
Since my first relapse, many weeks have been carved off my relapse timeline. The last episode took roughly 3 weeks to get back to baseline. Even though it was painful and I didn’t believe it was a relapse in the moment because of my perception, I went through the motions of my proactive plan. It worked. It will always work as long as I understand that relapse is possible, I accept the fear associated with it, and I don’t allow the shame and guilt to dictate the outcome.
I can choose to live in fear of my illness or I can choose to actively manage it. I can choose to live blanketed with the stigma surrounding mental illness or I can choose to fight it for myself and others. I can choose to deny that relapse is part of my journey, or I can accept and prepare for it.
You can too. Never give up.
If you would like more information on creating a wellness plan for relapse prevention or management, please visit the following websites:
Thank you for taking the time to read,
Mental Health Advocate/Public Speaker; Host ‘Mental Illness Matters Radio’; CBT/ERP Coach Effective OCD Treatment; Peer Support Specialist/Behavioral Healthcare Inc; Crisis Intervention Team Trainer/Denver Police and Sheriff Department