Can my mental illness be cured?

John is at his first visit to the psychologist. He had been experiencing low mood and panic attacks in the past weeks. The psychologist assesses the factors that contributed to the development of his depression and anxiety, and works with John to manage his condition. At the end of the appointment, John poses a question to his psychologist, “Can my depression and anxiety be cured?’.

John is a fictional character, but the question of whether one’s mental health condition can be cured is rather commonly posed to me at the end of first visits. At times, some clients even report that they have been asked by their family members to see a psychologist to "get yourself fixed”.

Although seeing clients with mental health conditions is a major role that I play as a psychologist, the short answer to the question above (and it may come as a shock to some) is: No. Mental illness cannot be cured.

Let me explain further below.

Cure vs treatment

Mental health professionals, such as psychiatrists and clinical psychologists, provide treatments or interventions for mental illnesses to help our clients recover. We seek to relieve our clients of their current suffering and restore their ability to function effectively. For John, I may work on balancing his unhelpful cognitions and address the impact of certain significant events in his life. Research has consistently shown that mental illnesses can be treated and individuals can continue leading meaningful life following their recovery. For example, refer to this article discussing the effectiveness of CBT for anxiety disorders 

However, being cured means that the illness is gone forever. Certain physical illnesses, such as diabetes and arthritis, do not go away. They have to be managed continuously through medications and/or lifestyle changes. The full-blown symptoms may re-emerge if one does not take the necessary precautions. This is the same for mental health illnesses. For example, Barcusa and Iacono (2007) highlighted that there is a 50% probability of relapse after recovering from a first episode of depression, which increases to 70% after a second episode. On the other hand, 27% of patients with panic disorder experienced a relapse after successfully undergoing cognitive behaviour therapy (CBT; Brown & Barlow, 1995).

Why mental illness cannot be cured?

1. Stress is unavoidable

The development of a mental illness can be attributed to the interaction between one’s risk of having the condition and experiencing significant levels of stress. For example, a large-scale study found that participants who reported experiencing higher levels of stress in response to life events experienced significantly higher levels of depression and anxiety (Phillips, Carroll & Der, 2015).

There are multiple sources of stress in our everyday life, making it inevitable that we will experience stress from time to time. A global study conducted by Cigna (2019) found that 92% of working adults in Singapore report experiencing significant levels of stress, compared to the global average of 84%. Of those experiencing significant levels of stress, 13% informed that their stress is ‘unmanageable’.

While we can take precautions to prevent falls after recovering from a fracture, we are unable to do the same for stress. As a result, there would be times when our mental health may be compromised when the stressors faced are overwhelming.

2. Most mental illnesses are dimensional, not categorical in nature

There are two approaches in diagnosis or determining the presence of a condition- categorical or dimensional. In the categorical approach, you either have the condition or you do not. For example, an X-ray can determine if you have a fracture. Another condition is pregnancy- you are either pregnant or you are not.

On the other hand, the dimensional approach takes into consideration the varying degrees of severity. The most prevalent mental illnesses- depression, anxiety and addiction- exist on a continuum of severity. Treatment for these mental illnesses seek to lower the severity of the symptoms to a healthy level, but it is not impossible to totally prevent the occurrence of low mood or elevate anxiety levels in an individual. Even individuals who have not been diagnosed with mental illnesses may experience sadness and anxiety from time to time. Which brings us to the next point….

3. Negative emotions serve a function

Emotions are an important source of information in guiding our behaviour. They signal to us that something is going well, or even if we are in danger. Emotions such as sadness, guilt, anger and fear are often regarded as ‘negative emotions’. They are unpleasant to experience, and may even lead to adverse consequences for our well-being.

Despite being perceived in a bad light, these negative emotions serve important purposes. For example, anxiety plays a part in warning us about possible threats and danger. Without anxiety, you would not put in sufficient effort to prepare for an examination or an important presentation at work. You may even cross the road without checking for oncoming traffic if you are unable to experience anxiety. On the other hand, sadness allows us to realize what or whom is important to us after a loss. The reduced energy that accompanies sadness also prompts us to slow down and consider our next step without being rash.

Thus, eliminating anxiety, low mood or some other negative emotions, is impossible. Spme individuals would attempt to avoid these emotions by suppressing them. However, suppressing these emotions would only cause more harm than good to us.

Importance of continued self-care following treatment

Although there isn’t a cure to mental illnesses, recovery is certainly possible. For those who have recovered from a mental illness, self-care is essential in preventing relapse. Continue to practice the strategies and coping techniques taught by your psychologist. You may monitor your health and stress levels, and return to your therapist if you find that you are having difficulties in handling your stressors.

References.

Brown, T. A., & Barlow, D. H. (1995). Long-term outcome in cognitive-behavioral treatment of panic disorder: Clinical predictors and alternative strategies for assessment. Journal of consulting and clinical Psychology, 63(5), 754.

Burcusa, S. L., & Iacono, W. G. (2007). Risk for recurrence in depression. Clinical psychology review, 27(8), 959-985.

Cigna. (2019). 2019 Cigna 360 Well-being survey well and beyond. Retrieved from https://wellbeing.cigna.com/360Survey_Report.pdf

Phillips, A. C., Carroll, D., & Der, G. (2015). Negative life events and symptoms of depression and anxiety: Stress causation and/or stress generation. Anxiety, Stress, & Coping, 28(4), 357-371.