On Mental Illness: Relapses, Big and Small, Revisited

By Jack Bragen
Friday November 11, 2011 - 09:13:00 AM

Many people think that the main cause of relapse for a person with mental illness is noncompliance with taking medication. However, much of the time, persons with mental illness are doing everything they’re supposed to do (including taking medication, attending therapy, and being a participant in life) and yet a relapse still takes place. Furthermore, when noncompliance is a major factor in a relapse, it is not always something that happens on a mere whim. Often, the person with mental illness first deteriorated to an extent, and this led to the poor judgment of choosing noncompliance. A very large percentage of people with schizophrenia, possibly more than half, will have a relapse within a year of getting stabilized—and this is despite being medication compliant. 

In my case, stopping medication against medical advice always preceded a major relapse. I was able to stay well for about six years at a time until I finally had a lasting realization that I could not stop the medication. My last total relapse into psychosis was in the spring of 1996. I hope to never have another relapse of this kind. 

The experience of relapsing to psychosis and then coming back to tracking “reality” in a psychiatric hospital is like a chess player being checkmated, getting frustrated and knocking all the chess pieces off the checkered board. And then, another game can be played. (No, I am not under the misconception that that is how “real” chess players behave.) The comparison is like saying that the mind gets scrambled and then reset; the person with mental illness must in many ways start over. 

During my second to last relapse, in 1990, I experienced coming back to reality upon watching a videotape of the movie “Field of Dreams” that was being played in the psychiatric ward. The experience of watching a movie relaxed me and also took me off the delusional track of consciousness in order to follow the story. Staff told me that night that they could start planning for my release. 

I met the woman who would become my wife, Joanna, about a year before I experienced my most recent and hopefully last episode of severe psychosis. 

The relapse that I experienced in 1996 was devastating; I lost a lot of ground in my ability to do things that many people take for granted. Upon being re-medicated, my delusions didn’t clear up nearly as fast. I felt as though my mind was scrambled. The vulnerability made me the dupe of some people’s jokes. In the years since then, I have grown stronger. At the beginning I had to deliberately do a “retraining” to clear up a lot of my mind’s delusions. In the first six months that followed the relapse, I spent several hours per day sitting in the back room of my apartment with pads of paper and pens, a portable radio, and massive amounts of coffee and cigarettes. I did exercises to learn once again how to think. 

I came out of this training with more “marbles” than I originally had prior to the relapse. I don’t recommend the above process to anyone. For one thing, something that worked for me will probably not work for other people. Secondly, I continue to have other problems such as agoraphobia and sensitivity to getting stressed out. Furthermore, I began the retraining with considerable experience under my belt at meditating and at analyzing my own innards. Such a training as this doesn’t eliminate the need for medication. It merely installs “software” which is supported by a medicated and properly working brain. 

Upon middle age, the prospect of going off medication and relapsing becomes a serious threat to physical well-being. There are severe stresses on the body that take place during a psychotic episode; stresses that someone past thirty will not always survive. 

Relapsing and recovering is a huge setback from which it takes years, not months, to recover. However, it also provides an opportunity for relearning. It is not something you would voluntarily choose, any more than you would choose to have a car accident that gave you the near death experience that gave you new insights into life, but that also left you crippled. Relapses are best prevented, and being medication compliant is a part of how to accomplish that.