Barriers to Recovery
In order to recover from a medical condition you need to know/realise what the barrier/s to recovery is/are. With a broken leg for example it’s obviously that if you put weight on the leg or bend it this will prevent healing so you put it in plaster. But what are the barriers to recovery with paranoid schizophrenia?
You can’t tell you’re ill
From my experience most people in an episode of the condition “lose insight” or in other words are not able to discern their delusions and hallucinations are just that. They will look to and find all manner of explanations eg for the fact they have been hospitalised including that it is everyone else not them who are ill. It’s probably the case (though I’m not an expert in psychological
Image copyright Government of Sweden
therapies) that even at this stage of the condition psychological therapies can have an impact even though the effect of the therapy might not be immediately apparent.
The problem of the stigma (really just an antonym for something fashionable) is not just the stigma you experience in other people’s eyes when looking at you but also in your own when thinking about the diagnosis you have been presented with by the psychiatrist. As we all know having a mental illness is generally not regarded as cool. In fact being diagnosed with one is more like having mud, or worse, thrown at oneself. Who’d be pleased to be diagnosed with paranoid schizophrenia? It’s literally much easier to believe as in the first barrier above “it’s everyone else who is crazy!”
Side Effects of Medication
I reckon after my one spell on Chlorpromazine the first 2 barriers got the upper hand even more. Who’d want to believe they had a medical condition the consequences of which were having to take medication for the foreseeable future that, in my case with that drug, put suicide in protest continually on the agenda if I didn’t escape from hospital in order to avoid the forced medication of such a dangerous regime? So that was what I did, I actually escaped from the unit never to be seen at that one again!
Co-morbid Substance Use
Co-morbid substance use is when along with your illness you indulge in “drugs” and alcohol. In particular many studies have linked cannabis use with the development of psychosis. One psychiatrist even maintained my diagnosis was the result of just 1 incidence of the use of a “skunk” that is strong cannabis 10 years before I got ill. Addiction can only make the problem worse for a proportion of people who genetically are more susceptible to the condition.
You Prefer Being Ill or even You Enjoy Being Ill
If the medication you are prescribed for the condition is unpleasant to take for some it won’t be difficult to conclude they preferred being without it particularly if they, and I and a proportion do, enjoy being ill. The flip side of this by the way is some will tolerate quite unpleasant side effects as they did not enjoy being ill even being yes aware, they have, or at least had the condition (once the medication has worked and their insight comes back).
The above are not the only barriers though. Having say a physical disability or another mental health disability in addition to paranoid schizophrenia eg post traumatic stress disorder can add to your burden making recovery more still of a challenge. It is well known that BME males get sectioned more often than their white brothers so it would probably be that they find barriers to recovery their white brothers do not encounter. Then if you are already in a group like they are who get discriminated against eg the LGBTQ community this will require additional work to provide a route around the above barriers to recovery including (stigma again) people not respecting diversity. As explained elsewhere on this site arts therapies are recommended by NICE for the treatment of psychosis; art is a means to be fulfilled and this tells us not being fulfilled is another barrier. Finally, and perhaps no surprise to many patients, your own psychiatrist can be a barrier to recovery! Why? Because he or she sees ill people all the time and forgets the ones who got better (AESOP 10 study). So this tells us psychiatrists need more contact with recovered patients their not doing so being the final barrier I can come up with.