On therapy and life skills

Today I have mostly been marvelling at how much I've learned about coping techniques, mindfulness, and distress tolerance. When they told me therapy would be a long process, I didn't realise that they meant about fifteen years...

I used to be vehemently against therapy. I was totally wedded to a purely biochemical-dysfunction model. In a way, I still am.

Therapy didn't 'cure' my mental health problems. It had absolutely no effect on them at all. Therapy does not fix people, or their mental health problems.

What it does do, however, is teach you how to live *through* your mental illness. It teaches you the skills to live your life, whether or not your mental health ever improves or can be controlled by medication. Distress tolerance, insight, emotional expression, communication skills, all sorts of things like that. Skills that mean you don't need to get *rid* of your illness, problems, differences, idiosyncracies, whatever you want to call them, however you personally see them.

It's also helped a lot in dealing with the progressive disability caused by my physical condition or conditions (still not got a definitive answer). Long term illness and disability is commonly accepted to increase the likelihood of someone experiencing depression. The techniques I've learned for coping with, working around and living through depression work just as well for depression caused by my physical limitations and the disabling barriers imposed on me by society, as for depression caused by a chemical imbalance, crappy childhood, whatever you attribute it to. Whatever the cause, for me at least, as the effects have been the same - so have the methods for dealing with it worked equally well regardless of what caused the depressive episode.

Therapy has been more valuable to me than I ever expected it to be. Especially given I went into it out of sheer desperation, having exhausted other options and deeply wary, cynical and unsure. However, I have to say at this point, that I consider 'therapy' to be distinct from 'positive thinking', 'behavioural modification', 'attitude changes' and all the other bullshit, rubbish, and unscientific victim-blaming crap.

I consider cognitive behavioural therapy and the biopsychosocial model of illness to be the greatest scams in medicine in recent history. The idea that negative expectations and thinking badly about things is the reason that illness - mental or physical - has a negative effect on a person's life is ridiculous. The negative aspects are real, quantifiable problems, with a negative effect on quality of life - they're not just hysterical psychological constructs invented, consciously or unconsciously, to allow someone to avoid being a responsible adult human being.

Teaching someone how to tolerate and deal with distress is helpful. It increases their ability to cope independently, their control and autonomy over their self and their life, and their chance at a decent quality of life.

CBT/BPS on the other hand, just tells the person they are to blame - that they are responsible for the fact that they are defective. They have been so *wrong* that they've made themselves ill. How does that help? It's about as useful for depression as 'snap out of it', in my opinion. It almost *is* 'snap out of it' - it says, you're doing it wrong, just stop doing these stupid things and you'll be fine. I cannot see how that improves someone's quality of life - how it gives them more control, more autonomy, more ability to cope in a way that improves their life.

I am so grateful for the skills I learned in therapy. I lucked out completely - I had a great CPN who referred me to a scarily intelligent, highly qualified clinical psychologist who was amazingly skilled. I will be forever grateful to the CPN and clinical psychologist - I honestly believe I would be long dead by now without their help. It was not easy - hell's bells, sometimes it seemed completely impossible, beyond even imagining, much less achieving. But those two smart, skilled, compassionate women cared enough to kick my arse when necessary for my own good, as well as coddling me when that was what I needed - and to put up with the tantrums and avoidance meant to drive them away as I tried to protect myself.

And, as I said, I found these skills even more useful when my physical health took a nosedive. Again, I think I would have killed myself long before now - especially during the period I was being denied any effective analgesia and accused of malingering, which I've found out since is actually a normal experience for anyone with mental health issues in their records who then develops a physical illness.

I've been severely depressed since I was twelve or so. I made my first suicide attempt - a very poor attempt, but nonetheless - at thirteen. Had my first psychotic episode at about seventeen. Hospitalised for a suicide attempt for the first time at twenty one. Admitted voluntarily to a psych ward at twenty four. It's not a good history, and most people with one like it can be expected to be in and out of depression, psychosis and hospitals for the rest of their life, with limited periods of stability.

I am incredibly lucky, and I know it. I've had a fairly minor episode of depression recently, but before that I had over a year of more or less normal mood - the longest period I've gone in my memory without feeling incredibly awful. I am so grateful for the happiness I've experienced - I've been _able_ to experience - over the last couple of years.

In short: therapy is brutal, gruelling, unpleasant and takes years if not decades to show any results. And it's worth it. Every last painful second.