On Mental Illness: How I Prevent a Relapse

By Jack Bragen
Monday May 16, 2011 - 04:53:00 PM

Many people with Schizophrenia or Bipolar illnesses have a relapse of acute symptoms every two or three years. Sometimes, this is triggered by going off medication against medical advice. In other cases, the relapse occurs in spite of the psychiatric consumer taking medication, and doing everything he or she is supposed to do. Stopping medication without a doctor’s approval is sometimes caused by an initial resurgence of symptoms (while still on medication) that clouds the judgment and interferes with the insight that the medication is still needed. The person had already begun the process of getting ill; and then stopping medication accelerated this deterioration. 

In the paragraphs below, I have given a description of how I manage my specific delusional condition. Other people’s experience could dictate doing other things; their diagnosis may not be the same as mine. This description should not be considered a replacement for the advice of a trained physician. My use of these ideas could be a factor in my better than average recovery; I haven’t had a full relapse of psychosis for fifteen years. 

To begin with, I keep my condition “monitored.” This can include what I call “self monitoring.” It also includes asking for other people’s feedback. If a flare-up of symptoms occurs, the progression of the illness can be caught and halted in time before it gets worse and becomes a total relapse. 

I realize that, at first, the concept of “monitoring,” if you are already paranoid, can seem like some oppressive governmental or other authority is controlling one’s thoughts. However, it is important to realize that the people with whom you are dealing do not come out of a George Orwell novel, and our government doesn’t perceive me, or you as a threat. We are dealing with doctors and psychologists, who, while not perfect people, receive a paycheck, at least theoretically, for helping us get well. 

Let’s take a look at the idea of accepting someone else’s feedback. In my past, my illness made me prone to disbelieve a person when that person said I had a delusion. Yet, with enough experience, I have learned to know when I ought to believe another person’s opinion instead of believing my own paranoid thoughts. This does not mean that I mistrust myself and allow other people to control my thoughts: It is applied specifically to the strange thoughts that I have decided are in question. Under different circumstances, I continue to believe myself above believing someone else; such as in the areas where I have some expertise. 

It can be difficult, embarrassing, and otherwise painful to open up to another person and talk about the strange thoughts that I have experienced. Yet, the more I overcome this awkwardness and talk about my thoughts, the more relief I feel, and the healthier I become. 

When you give light and air to your secrets, it prevents them from festering and becoming more of a sickness. Above I have described a type of “reality checking” which relies on the judgment of other people, hopefully people who are not also afflicted with delusions. Another type of this reality checking involves observing facts to see if they match up with one’s beliefs. I use “reality checking” alongside “self-monitoring” to make sure I am not getting ill again. Self-monitoring is done when I am essentially on stable ground, and have not slipped into a partially psychotic mode. It involves engaging large areas of consciousness to evaluate a thought. Not everyone will be able to “self monitor.” On occasion, due to a short-term flare-up of symptoms, I might discover that delusions have sneaked up on me, and I have begun to believe in a “delusional system.” If symptoms have progressed too much, it might be time for me to bring the situation to my doctor. At that point, it might be necessary for me to get a short-term increase in my anti psychotic medication. 

I have attempted to create a “failsafe” internal environment. This means that I have a whole repertoire of skills that I can take off the shelf to prevent a relapse. Using memory, feedback from other people, and the cultivated ability to face and talk about a sometimes unpleasant or embarrassing truth, are all things that go into the system that I use. When times are harder, I try to do things to take better care of myself. In general, I don’t invite more stress into my life than I can handle. I also don’t push myself to work excessively hard. This is because I have seen myself and other people do damage to themselves or become burned out from pushing too hard. If something is causing me a lot of stress, including writing, I back off from it for a while. I also try to get some enjoyment from my life. 

I do not postpone happiness for some projected future when I finally believe I am successful enough. I try to enjoy the things I have now, regardless of where I might or might not be on the “success scale.“ I credit the meditative practices that I have done over the years with allowing me to be gentler and more patient with myself. 

My most recent psychotic episode in which it was necessary for me to be hospitalized took place about fifteen years ago. This is a pretty good length of time to stay out of the hospital for someone who has a severe mental illness. (I have to give some of the credit for this to my wife, who helps keep an eye on me.) To put it in perspective, the County Hospital that I go to for medical care was no more than a structure of steel girders that the welders were working on, that stood next to the psychiatric ward I was in, a ward that today is long torn down and gone. 

I encourage any person with a psychiatric disability to try to expand their awareness through meditation as an addition to medication. Some doctors may believe that schizophrenic people shouldn’t try to meditate because it might open a door to more symptoms. To this I say, “hogwash.” The benefits of real meditation will, in almost all cases, outweigh any drawbacks. Meditation increases a person’s quality of life. 

In the paragraphs above, I have given my view of what works for me to be well. Other people may or may not find this useful. Whatever your beliefs, you’re welcome to take any part of this material that works for you, and to discard the rest. 

Your stories and comments are welcome. I can be reached care of The Planet, or at