I have bipolar 2 disorder. Right now, my psychiatrist and I have finally hit on a combination of medications (several used in tandem) that treat my disorder without unmanageable side effects. Family and friends tell me I look well and seem happy. And I am well and I am happy. But I am not cured. I am okay today, but I might not be okay tomorrow.
Here’s why: mental health disorders are usually chronic. Chronic means they do not “get cured.” They get treated. Right now, my treatment is effective. But the same way cancer can come back, my brain chemistry can warp, twist. It can winnow its way around the drugs that once kept it orderly. What worked yesterday may not work tomorrow. My doses may need to go up. One drug that worked before may stop working. This is normal, and this is normal because I am not cured.
Psychiatric drugs do not cure. Listen to the ads. They don’t say the word “cure.” They use the word “treat.”
If you have anxiety, you may go through many different treatments. Anxiety tends to be a chronic condition. Maybe sometimes guided meditation and yoga works, but at other times, you need Xanax to get you through the day. This, at no point, means you are cured. Getting through the day without side effects means that your anxiety is currently treated.
The same thing can happen with depression. For many of us, depression is a ravenous beast, always lurking. It lies in wait. The depression monster wants us, and for many, pills keep it at bay. We are not cured. We are treated. Because sometimes the pills stop working. We need to switch to a higher dose, a different pill, an extra pill, more exercise, more time outside — the list of depression treatments can seem endless, and figuring out your magic bullet is difficult.
We are not cured. We are never cured because people with chronic mental health disorders like persistent depression, bipolar disorder, and anxiety have fundamentally different brain chemistry than people without it. This altered brain chemistry causes us to think and react differently than other people. We cannot change this chemistry permanently. It cannot be cured. It can only be treated.
The knowledge that I cannot be cured, and will never be cured, enrages me. I will always think differently. I will always be dependent on pills, and those pills will often stop working. Many of us who cannot be cured feel that same sense of helpless rage. We can’t fix ourselves. We cannot outthink it, we cannot outrun it. We are deprived of one of the most fundamental, the most basic of human rights — the ability to think rationally.
It also terrifies me.
If I am not cured, I could spiral at any time. I could lose everything I’ve carefully crafted for myself: my stable family, my career, my own life. Everything. Bipolar disorder, according to Medscape, has an 11% mortality rate — via suicide.
If I am merely treated, my BPD2 can come back at any time and spare nothing, not even me. In an episode of one of my favorite TV shows, a character who’s long struggled with mental health issues dies and goes to the underworld. Quentin immediately asks, “Did I do it?” He means, “Did I die by suicide?” When I saw this episode, I bawled. Like Quentin Coldwater, I know that when I die, this will be my first question. Did I do it?
Because it always, always comes back. One day, the pills will stop working. One day, my brain chemistry will veer off the pathways I’ve carefully carved for it. Those of us who live with mental health conditions know this. Anxiety waxes and wanes, never cured, only treated. Depression ebbs and flows. Bipolar disorder works the same way. We can only keep the wolves from the door.
So, to everyone else, please stop assuming it gets better.
Yes, it can get better. It can also get a hell of a lot worse.
And when it does get better, we are not cured. This is not a permanent fix. You do not go to the psychiatrist and magically, suddenly, no longer have depression. You do not pop a pill and wave away the anxiety. People still have mental health conditions. Those conditions are merely treated. They are not cured.
The rest of the world needs to understand this. You do not pop a round of pills and decide you don’t need them anymore. You do not visit a psychiatrist once and realize everything’s all better. For most of us, mental health treatment is an ongoing process, a maintenance effort, that will take the rest of our lives.
You cannot expect us to get better.
You cannot expect us to be cured.
In turn, we must give ourselves the space and grace not to be cured. We must accept that we might relapse. These relapses will hurt. They will be frightening. We will need a strong support network and plenty of help to get through them. But with the right medical team and the right help, we can make it through them.
I know all of this, so I’ve made plans for what happens if I spiral. I have people around me who know the early warning signs. I have plans for what to do when those signs show up. I have a good doctor who can usually figure out another treatment. If all else fails, I’ll go back into a mental health facility for a little while. If it’s necessary, it’s necessary.
But if we know we can’t be cured, we need to have a plan in place for our continual treatment. We can’t get blindsided. So we work with your diagnosis, rather than against it. We try our best to understand that our brain works differently, and we must make allowances for it.
That is neither good nor bad. It just is.
And we do not deserve any shame for it.