The Imperative of Accountability in Recovery

Recovery does not happen overnight. Nor does it happen with only one person wanting it.

I do not wish to delve into textbook definitions of recovery, but how I, a diagnosed manic-depressive, experienced it.

Mental illness is disruptive: it interrupts daily functioning and sometimes destroys relationships along the way. To recover is to function again and to have well adjusted relationships with family, friends and the community.

However, it takes a confluence of elements to make recovery happen. As one doctor put it, the patient has to want to recover in order for it to take place. Although the family and the treatment team may do their best to help the patient, it is the patient’s willingness to accept his or her condition and do something about it that always spells the difference between being trapped in a destructive cycle, or breaking the pattern and going back to functioning again.

A supportive environment is likewise an important ingredient in recovery. Without a family that understands the condition of the patient and gives appropriate care, recovery would be akin to a mountain that is hard to climb. The family has to be tolerant of lapses, vigilant during crisis periods, understanding, and generous for treatment and medication is often a costly undertaking.

Doctors who are empathetic and caring could also make a difference in the way a patient recovers. Without a medical supervisor who has a genuine interest in the patient’s welfare, recovery may be an obscure spot in the horizon.

As the patient recovers and regains normal mental, emotional and physical functioning, however, they must remember that they begin to take accountability for their actions.

In my years as a volunteer in this psychiatric facility, I have seen fellow patients backslide and slip in their journey to recovery. Often, I have noted, they blame their condition for their actions. For instance, a reckless spending spree or promiscuity is often said to be caused by a manic spell. Or another instance of drug and alcohol abuse is blamed on an adverse environment or family problems.

I do not subscribe to such excuses.  I have been asymptomatic since 2009, with no major breakdowns after that year and I ascribe my recovery to two things: my education about my condition and my sense of accountability for my actions.

While the two are not mutually exclusive, I believe there is a dynamic about how one’s awareness of mental illness, vigilance and accountability interplay to sustain the momentum of recovery. I once heard a trainee complain that his family treats him like a child. I told him: stop acting like one.

Education is important; one has to understand that there is a biopsychosocial element to mental illness and behavioral problems to know that it is a condition that one should not be ashamed of. Education tells us that the aberrations in our functioning are part of a disease, and that disease can be managed and treated, as with any other medical condition.    

Accountability, has been, I believe, my compass through these years as I stayed asymptomatic and functional. I do my best to watch for warning signs of depression or mania, and go to my doctor as soon as I feel a spell coming on. This, I would not have been able to do without self-awareness, which can only come from education.

I am of the belief that my condition is an opportunity to remain humble and be of service to my community. Humble because I recognize that I, as a patient in recovery, need help as much as the people I try to assist with my knowledge and skills.

Without a sense of accountability, I believe I will not be able to perceive my condition as such. Without this, too, I may have relapsed, conveniently ascribing my maladjustment to my illness.

Patients ask not to be discriminated against because of their condition. But equitable treatment is a double edged sword. Yes, we could be treated like the rest of functioning society, but we must also be prepared to be held to moral norms that dictate we control our maladjusted behavior. We cannot, for the rest of our lives, attribute our misbehavior to our environment, our circumstances, our families, but most of all to our illness. 

And while our families may cut us some slack because of our condition, they should not condone destructive behavior, especially if it affects other people.

We want equal treatment; then we should hold ourselves accountable for our actions. A person who has truly recovered is one who contributes to the welfare of the community and its members and holds themselves responsible for their actions. Mental illness should no longer be considered a causal factor for maladjusted behavior; rather it should be motivation to strive for normalcy and functioning.

Knowing When to Get Help

Co-Authored by Dr. Mai Lopez-Roces

One late afternoon in mid-2004, AM, a stockbroker, completed his first major solo trade - that is, trading stocks and portfolios of a major client on his own, based on his perceptions of risks and rewards, and without the coaching or prodding of a senior broker.  The trade signaled that AM was no longer a trainee, but was now part of the ranks of the "elite". A two million peso trade and it felt like he was on fire. The atmosphere was electric, or so AM thought. 

"It was a particularly risky trade, and I had to go in and get out as fast as the system would let me. I knew I was getting a big commission out of it, but the money wasn't really what it was all about.  I felt like no one can touch me. I owned the world! This was a ‘high'," AM related.

He quickly rose through the ranks, getting even bigger clients who were willing to let him play around with their money.  Eventually, AM gained a reputation as somebody who can give his clients higher returns for their investments, his risky  - reckless is more apt - methods notwithstanding. He was rich, happily married and respected in the finance world.

Two years later, AM lost all it all.  But rather than take a step back, he tried to recoup his losses, investing and risking more, as if willing the market to his wishes. Soon, he not only had major losses, but almost brought his company down with him.  Beneath the surface of his reckless confidence, his family noticed changes such as frequent outbursts, sleeping late and waking up early, neglecting his usual routine such as jogging and golf as he focused more and more on trying to prove himself back. 

“He was a passionate and driven man” his wife says, “but this time, he seemed to have excluded us in his goals and had nothing else on his life but work, work, work.  The changes were initially subtle but one day, I just realized, he was not the man I married.  And when I found out that he started to gamble so he can invest more, touching our savings and even selling our cars, I knew we had to get help”

Now, AM's back.  But former colleagues will not recognize this tamer, seemingly guarded version of AM.  Those who do recognize him will not see the swagger and self-assuredness that people used to associate him with. In sharing his experiences, he says. "I'd like people to treat my experiences as a cautionary tale. The main thesis will be on the value of risk aversion. I was never scared of risks. I embraced it.  People expected that from me." he recalled.

What’s almost never talked about was AM's subsequent nervous breakdown and his struggles in therapy. A few days after the unraveling of his risky trades, AM began suffering from mild panic attacks, sudden weeping fits, and an inexplicable feeling and urgent need to do something reckless.  The exact feeling, he says, is a terrible want to get high.  This was when his gambling also started.

Eventually, his family decided to have him admitted to a psychiatric facility. He was diagnosed as suffering from Bipolar disorder and thus left the finance world. As he explained, an associate laughed at his face when he told him at that time that he was seeing a psychiatrist.  People like AM are expected to quietly deal with their illness. But how can one do so when most people will not categorize his struggles as an illness in itself, let alone be able to diagnose it and know when to seek help?

While AM now believes his diagnosis for Bipolar disorder was spot-on, his initial suspicions of it are, rightly or wrongly, characteristic of  attitude towards mental illness, where only truly crazy people deal with psychiatric problems, while drinking, gambling, and vices are encouraged.  The hesitation towards seeking professional help comes mainly from the stigma attached to it. 

There is difficulty in identifying abnormal behavior versus certain prejudices, beliefs and behavior which compounds the problem.  Certain behaviors which may cause distress in one area may in fact be embraced or encouraged in another because that is simply what culture, or in AM’s case, his working environment dictates.

But cultural and institutional prejudices aside, the key is the timeliness of knowing when to seek professional help. AM was fortunate in this regard, as he was prodded by family to do so and at the same time was also willing to seek help.  But the majority  aren’t as lucky.  Moreover, the lack of information and tendency for self-diagnosis, results in one doing nothing… at least not until, crisis happens. 

The behavior exhibited by AM led to such degree that he exercised poor judgment, which made him do unnecessary risks.  Even without the gambling problem setting in, his sleep difficulties, extreme behavior and dysfunctional work and relationships are  blaring RED FLAGS which should’ve signaled that he needed help. 

Overt symptoms may signal need for professional help: excessive sadness or extreme mood swings, recurrent anxiety (especially if with very discomforting symptoms like palpitations, tremors, hyperventilation), suicidal thoughts, psychosis such as auditory hallucinations or delusions, and substance use problems.  However, in cases like AM where functioning is intact to some degree, the lines are more blurry.   More subtle clues that consult is needed will include problems with relationships with friends or family members, difficulties at work or at school, oversleeping, overeating, recklessness, depression, promiscuity, difficulty with emotional expression, delayed physical or mental development, difficulty in concentration or attentiveness.

But the general rule-of-thumb should be this: If one feels or experiences mental health concerns, seek appropriate treatment and care. Most will start by talking to family or friends, or even to work supervisors, pastors, priests or community elders, but this should always lead to a professional. Psychiatric disorders are medical, and as with any medical problem, remember that treatment is always available.

AM is one of the many faces of people whose lives have unnecessarily been complicated should he have sought help earlier.   He adds, “Do I regret having made those risks?  I’m not sure.  Do I regret seeing a shrink for this?  A resounding no.  I know better now.  It came a bit late but I’m still hoping there’s something out there for me. It’s a drag, sure but things could’ve been far more worse.  “  He shudders at the thought. 

• The names/initials and circumstances have been changed to respect AM’s privacy. 
• Dr. Mai Lopez – Roces has been with Roads and Bridges to Recovery as an in-house psychiatrist for three years.