What do you say when you bless a sick person?

• “I hope you get well soon” or
• “I hope you feel better soon?”

Both, of course, are expressions of love and a sick person probably gets the love, no matter what you say. I wondered, however, why I almost always say, “I hope you feel better soon” just like my mother.  Maybe get well, seems like a demand; while feel better is more tentative, more humble. When I say “I hope you feel better soon,” I think it is flavored with, “I am not sure where this is going. I don’t feel comfortable promising wellness. But I am hopeful.”

The other day some Circle Counseling clinicians got into the subject of getting well and feeling better applied to mental health. We discussed whether mental health was more about eradication (well) or more like remission (better). I had never really thought through the difference. Eradication vs. remission is often the tension cancer patients feel, right? They wonder “Is there a cure or will I have to worry forever?” That kind of tension also applies to mental illness. “Does being well mean I am just like I remember good times in my past — a return to normal? Is it acquiring an idealized future — what I always thought I should be?” Or is mental health feeling, thinking and behaving better, beginning where I am now and moving on?

Need to talk about power

I think eradication was paired with remission in our dialogue because people in the U.S. assume power is at their disposal or should be. Around here, successful treatment for many means eradication of the invading illness. Something like “Vaccinations would have provided a no-fly zone against the virus if people had just gotten one, two, three and now four!”

Like I was asking last week, many Americans see healing as an act of power. Should Jesus followers all be like Jesus and eradicate disease and mental illness with a word, a touch, or a prayer? Or is healing more typically resting at the feet of Jesus, having faith in the storm, and persevering in trust? In a powerful country, psychotherapists might lust for power — the power of my work, my touch, my method. I heard a different take when I talked to a person last week who lives half-time in Ecuador. They said it would be much more likely there to see health in terms of one’s relational context and one’s daily process. People there never expect to have power, so they are more comfortable with unpredictable destinations and more attuned to feeling present in their relationships and circumstances. They do not find suffering sinful.

But here, I think it is good for me to answer the questions. Am I more of a psychological technician, eradicating mental illness and discomfort? Or am I providing space for health to unfold? If the latter, I might be able to promise raising your pain tolerance instead of implying all pain is an anomaly. In a recovery mindset, I might admit I don’t know the meaning of your suffering, or whether some ideal of wellness might really be a trap!

I’m glad I travel with people who ask good questions.  At one point last week, I listened to an Indian psychotherapist (his choice of label) explaining why Native people might not take advantage of the services of the counseling center on the reservation. The elders told him the center’s idea of “wellness” was mostly about becoming individualized (as opposed to tribal) and medicalized. If one is poor or constrained by colonization, “getting well” might mean eradicating who one is to become more “white” and more acceptable to the power structure. One’s setting or one’s relationships might be the cause of mental illness, not only what is happening inside. If a person refused mental health care, that might be the same thing as resisting the indignities of colonization, the end of which would likely improve their mental health!

Eradication/Medical model

I was not sure the interesting binary argument we therapists were making between eradication and remission was reasonable. Aren’t most mutually exclusive labels easily placed on a spectrum that meets somewhere near the middle? But once I started looking, I found a lot of eradication models that feel pretty exclusive, mostly coming from the world of medicine, from which psychotherapy emerged. They looked a bit one-sided, as in this definition: “The biological approach of the medical model focuses on genetics, neurotransmitters, neurophysiology, neuroanatomy, etc. Psychopathology says that disorders have an organic or physical cause. The approach suggests that mental conditions are related to the brain’s physical structure and functioning” (link).

I usually love science. It is unintentionally miraculous. But I don’t love it when it dominates us. So I have mixed feelings about some relatively-recent approaches from the medical end of the spectrum that propose and sometimes promise eradication of mental health issues. Here is a collection.

• A TV station gushed: “Repetitive transcranial magnetic stimulation is a depression treatment that is “turning lives around in five days.” By adding imaging technology to the treatment and upping the dose of rTMS, scientists have developed an approach that’s more effective and works more than eight times faster than the current approved treatment for the world’s leading cause of disability.
• The medical terms are Psilocybin and MDMA. The terms you know are ‘shrooms and ecstasy. Psychedelics have resurfaced as a means to treat stubborn disorders. Psilocybin (the essence of mushrooms) has been used for severe depression and MDMA for PTSD. One of my clients ended up in psychotherapy because an uninvited night of ‘shrooms unveiled an inner world he never dreamed he contained.
• Ketamine injections have become a new mental health industry, lately. The anesthesia has been found useful for treating depression, PTSD, social anxiety and OCD. Mindbloom is the company that a new client connected with; the effects were real, but apparently short-lived for them.
• I am not sure I think of EMDR as a “medical model” in essence. But it is another way to short-cut lengthy talk therapy. I’ve done some training myself. It gives a lot of authority to the technician. Brainspotting seems, to me, like a more easy going, user-friendly version of EMDR. Both use bi-lateral stimulation of the brain to allow for entrenched feelings and patterns to be accessed and renegotiated.

Remission/Recovery Model

I hesitate to say the “remission” end of the spectrum is more “right-brained,” but there, I said it. While the medical model gets more specific and tiny all the time, right down to your neurotransmitters, the recovery model allows for a wider range of possibilities and contexts for the state called mental health. The documentary Bedlam is one of the latest critiques of the results of the medical model the recovery model seeks to correct.

The recovery model takes a holistic view of a person’s life. The Substance Abuse and Mental Health Services Administration (SAMHSA) defines recovery from mental disorders and/or substance use disorders as “a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.” SAMHSA outlines four dimensions that support recovery: 1) Choices that support physical and mental well-being, 2) a safe place to live, 3) meaningful occupation and participation in the community, 4) supportive relationships of love, emotional availability, and respect.

The recovery model is in direct response to the unmet promises of the medical model. Rather than focusing on “the elusive state of return to premorbid level of functioning” these are more systemic approaches emphasizing “one’s personal ‘resilience’ and control over problems and life” (NCBI). For instance, the medical model makes many promises to alleviate depression, the leading cause of disability  worldwide (WHO). The recovery model is honest about the shortcut approaches that sometimes prove ineffective and discouraging.

In the case of depression, a sufferer is moving toward recovery when symptoms respond to treatment and diminish, however slowly. Remission is achieving a symptom-free state and returning to normal functioning. After several month s of remission, one enters the recovery stage (more). For many people, looking for remission may be more satisfying than never achieving eradication. Finding a new normal, rather than lamenting the lost one, allows a person to live the life they have.

With what healing do I bless you?

I think I can bless someone with “Be well.” Whatever wellness you have in your present state today, I hope you can have it rather than lusting for what you don’t have and condemning yourself for not being healthier. If you don’t see yourself in the light of the medical industry’s “gaze” and label yourself according to your faults, I think you’ll find amazing tools there to use.

I also think I can bless someone with “I hope you’ll feel better.” Whatever process of development or recovery you are in, there is hope of appreciating it, moving beyond it, or suffering it creatively. You have personal resources – some you know about and some which are yet to be fully realized or even discovered. You are valuable as you are right now and there are likely people who can see that. Even when you feel ill and less capable than you desire, what you bring to the community is worthwhile right now and will likely grow in blessing as you learn to love and share your true self.