THE TRICKY MATH OF MENTAL ILLNESS RECOVERY

It helped me to see mental illness as being about how I spent my energy. Regardless of the labels that get stuck on it, mental illnesses involve spending energy on compulsions as a reaction to intrusive thoughts, feelings, urges, voices, etc.

Let’s say there’s a guy that’s struggling with mental illness. He spends 10% of his energy each day on the mental illness. Imagine he has units of energy that he can spend as he does things during the day. 10% of his energy is 10 units. He spends those units on 10 different compulsions throughout his life. We can represent his energy expenditure on compulsions like this:

Now, he decides he wants to recover from the mental illness and start cutting out compulsions, so he stops one of the compulsions. Energy spent on mental illness goes down to 9:

But cutting out a compulsion increases anxiety and intrusive thoughts. His mind is racing and he has panic attacks and he doesn’t want to have those experiences. So he does one of his other compulsions more often because it’s one that’s always helped him feel relief, even if it’s only temporary. Now he’s back to 10:

He did, however, cut out one of his compulsions and he’s happy about that. He wants to keep this recovery moving and eliminate more compulsions. So he stops another one that was causing lots of problems:

But that was a compulsion he’d had in his life for a very long time. There are fears he doesn’t know how to control without that compulsion. That leads to a big increase in uncertainty in his life. There’s massive pressure on him to fall back on other compulsions and what he’s done before. He starts spending more energy on a familiar compulsion. It gives him an opportunity to control something and bring some certainty to the world around him. But he’s back to 10:

Because he’s practicing some of his compulsions more now, like with any practice, he gets better at them. The compulsions get easier, his life and relationships get built around the compulsions, and he does them more. He’s struggling with fewer symptoms but he now spends 11 units of his energy each day on the mental illness:

There’s one compulsion, however, that’s difficult to do because it interferes with work and he can’t do it often in the office or he’ll get fired, so he decides to cut that one out:

However, he takes that stress out at home, doing more compulsions where nobody interferes. His partner is happy to enable him and also wants to avoid the stress and anxiety of stopping compulsions. The amount of energy spent goes up again:

This is creating a feedback loop as he spends more time and energy on specific compulsions–he becomes increasingly proficient at those and he needs the other compulsions less. He mentions to his psychiatrist how amazing it is that some of his fears have simply disappeared on their own. Now he’s up to 12 units of energy spent on the mental illness:

But his attempts to cope with, check on, and control uncertainty and other feelings he doesn’t like diminishes in effectiveness over time, as it would for anybody. He needs to do the compulsions more and more to get the same relief, the same sense of control. To help, his brain gives him even more of the feelings he doesn’t like, at an even greater intensity, which leads to more time spent on compulsions, which pushes him to do compulsions that provide more relief from the feelings he doesn’t like. So he invests more energy in the compulsions that have a bigger pay-off. He goes up to 14 units of energy spent each day:

The compulsions that provide more relief–like avoiding work, dropping out of school, avoiding people, violence, not leaving the home, drowning in substances, etc–involve limiting major aspects of his life. That has a variety of stressful consequences. With an increasingly shrinking life, all of the time and energy that would have gone into other things gets pumped into compulsions to deal with the stress caused by his compulsions:

As his options shrink and the uncertainty is overwhelming, it seems like there’s only one compulsion that really ever gave him a sense of control over his feelings and thoughts and urges. Now he focuses even more energy into only one compulsion:

25% of his energy goes into the mental illness. He’s doing far fewer compulsions and struggling with fewer mental illness symptoms. But that one compulsions takes up more than twice as much energy as the ten different compulsions he started with. As well, the amount of energy invested in that one compulsion interferes more with his life and the lives of those around him. So is that improvement?

Understanding how I spent my energy on mental illness helped me in several ways:

  • I shifted my focus from cutting out compulsions to focusing more on building and creating what I wanted to see in my life.
  • Measuring the amount of time and energy I put into the things I care about in life has been a far more useful gauge of improvement and recovery. If I measured success by getting rid of compulsions or feelings I didn’t like, then I would need to keep those things around so I could keep trying to get rid of them so I could be successful.
  • This approach prevented me from getting caught up in the superficial differences between compulsions. Spending an hour checking door locks and unplugging appliances is the same as spending an hour ruminating about something embarrassing I said yesterday or spending an hour avoiding something that makes me anxious. Those aren’t separate issues. In both cases, I spent an hour on compulsions trying to control feelings. I lost an hour.
  • I couldn’t have “good” compulsions and “bad” compulsions. They all had to go.
  • The reverse of the pattern I illustrated also happens frequently. For example, somebody that is heavily invested in an addiction will notice an explosion of mental illness symptoms when they cut out the specific compulsion related to that addiction. That’s just their brain trying to find new ways to get them to keep investing the same amount of energy in compulsions.
  • It continues to remind me that mental health is a practice. If I want to maintain recovery and keep improving my mental health, I need to keep investing my energy in the things I care about and the practices I want to grow in my life. I can always go back to practicing compulsions but I should only choose that if I want to bring the practice of mental illness back into my life.
[Image reads: How will you spend your energy today?]