CBT theory asserts that mental illness stems from a simple, rational thing in the mind that can just be fixed — just like that. This is as weird as mental illness itself…
Yesterday in Life, I described the weirdness of mental illness — how its intensity, its severity, its terror and its nearness to death make it difficult to imagine, and how that difficulty of imagination blurs the distinction between mental illness and life’s everyday problems.
CBT theory asserts that the underlying cause of a mental illness is a simple thing that leads to a catastrophic chain reaction in the mind. When the simple thing is fixed, the catastrophic chain reaction just collapses. That’s weird too.
In therapy, a patient and therapist talk about some stuff that’s perhaps painful for the patient, and perhaps seemingly unrelated to the patient’s illness, and then the patient’s symptoms just vanish. It’s sometimes difficult to make sense of. Sometimes, neither therapist nor patient understands the entire chain reaction that made that simple thing cause such mental devastation.
Finding the thing
Finding the thing, of course, is the hard part. That’s what psychotherapists are for, if they’re any good.
There’s also a natural mechanism that operates to fix faulty processes in the mind without any therapist. A therapist is a useful helper in the task of finding the thing, but people do recover from mental illnesses without therapy.
In fact, therapists who don’t practise CBT and who don’t believe in this theory may be helping their patients to find the thing indirectly, without knowing it.
People whose minds find the thing all by themselves, or with the help of a therapist, occasionally try to describe the weirdness of when the catastrophic chain reaction just collapses. Here’s Shelly Guillory, who took part in the documentary, Thin:
As a therapist once told me, (and I laughed at this and totally used this phrase in a mocking tone on more than one occasion)…”it’s simple, but I am not saying it’s easy”
…
I cannot say why I decided to get better, but a few months ago something just “clicked”.
That “click” was when Shelly crossed between mental illness and life. It was when her mind replaced the faulty process, and the catastrophic chain reaction in her mind that was causing her illness just collapsed.
Shelly’s illness was complex, and complex takes time to unravel. Whatever it was that clicked in might click out again on occasions. It’s not always easy or quick, but even so…
A change is happening in me and I welcome it this time instead of pushing it away. This is the first time I have allowed it to hapen. I am slowly finding out who I am, what I like, what I don’t like, who I want to be and so on…although scary, it feel awesome and It feels real.
So I write to tell you it is possible…
Back to life
Coming back to life after a mental illness can be a dramatic change in mental terms, but no change at all in other terms. All the problems you had when you were ill, you still have, with the one exception of the illness itself. And all the secondary problems that being ill caused, you still have too.
For example, Helen (one of the fictitious characters from the previous post) is depressed. She sees a therapist for some CBT. The therapist helps Helen to identify the thought processes that lead to her depression. It turns out that they relate to the time when Helen was a child, her parents were killed in a road accident, and Helen went to live with her eccentric aunt. As Helen and her therapist talk through the feelings from this time, Helen’s depression mysteriously vanishes.
Marvellous!
Or not. Helen is no longer ill, but she still lost her parents when she was a child, and she still has strong feelings of loss and sadness that may haunt her for the rest of her life and affect her relationship with her own children. She still has a crazy aunt to deal with. She still has to overcome the secondary effects of all this on her education, career and relationships. All that’s happened is that she is no longer ill.
Author and blogger Martha M. put it like this, in a warm, wise comment elsewhere:
Just wanted to reassure you that you’ll still be nuts, even when you’re recovered. Please don’t take it wrong — I’m recovered and I’m still nuts. Rather weird, actually.
I have a query regarding CBT that, had you a moment to spare a sentance or 2, I’b be intested to hear your response. I was put on a waiting list for this therapy when suffering from ’severe depression’. Some months later I as diagnosed as being ‘bipolar’ and was immediately taken off the waiting list. Reason they gave – CBT (or any talking therapy for that matter) is of no use to bipolar. I can only assume that these experts were going on the assumption that bipolar is of organic origin rather than a consequence of cognitive malfunctions. In my mind, bipolar disorder can generate cognitive skewing and, so long as it is not ‘adressed’, can continue to generate and complicate that ‘catastrophic chain’. I am not suggesting that CBT would ‘cure’ my disorder but surely it could help mitigate some of the more perverse thought processes that i am inclined towards (and may act upon) during either extreme of mood (and sometimes inbetween).
I have only just began following your blog, by the way, and find it most interesting and informative!
Thanks
Kate.
I agree with you. I would expect CBT to be a useful way for you to deal with thought processes even though it obviously cannot cure an organic condition. Also, the investigative work that you do in CBT is often helpful in establishing early warning signs of extreme mood, so that you can medicate or take other action to limit the effects.
The NICE guideline certainly recommends psychological therapies, including CBT, although the research evidence is not very clear. Here’s the booklet version. (The full version is 600 pages!)
Perhaps your local bureaucrats have separate waiting lists for separate conditions, so that they can meet their targets by switching diagnosis instead of actually providing treatment…but no, surely that couldn’t happen in the NHS.
I wanted to comment on this because it is a very thought provoking post. However, it may have been too thought provoking because I am still thinking….
thankyou for your reply. I have been working myself to identify triggers and while I mostly recognise them i don’t always manage to take the appropriate action each time. I also suffer alot from social anxiety which i believe is a separate issue and could be tackled with CBT. You’re probably right about the bureaucrats. I seem to have been pushed from pillar to post with very little continuity in treatment/advise.
Thanks again