I need to clarify something. For my own sake as much as for anyone else. One of the terms I hate most in the psych world is ‘Treatment-Resistant’. I’ll explain why in a moment, but first what was a new term for me. Maybe it’s not new to you, but I wish it didn’t exist at all. I was quietly checking my Twitter feed recently when these two words came flying off the screen at me. “The Untreatables”. Ughhh!
“The Untreatables”? Really? Does anyone else take an immediate dislike to this term? (As an aside if you’re interested, the tweet I read contained a link to this article). ‘The Untreatables’: the people for whom there is no treatment.
If I had skills in the cartoon drawing you would see now a group of ‘Untreatables’ gathering together in what might be some type of 12-step group aimed at recovery from untreatable mental illnesses. But I can’t draw to save myself so I’ve hopefully left the image in your mind.
I think I have gained entry into this group three times. Firstly, I was pretty quickly labelled with the ‘treatment-resistant depression’ label. It only takes two different types of anti-depressants tried unsuccessfully, and you’re there. I don’t remember how it was put to me, that this was how I was now seen but I always thought it was an odd term. I thought it applied to me personally whereas it actually applied to the illness. A small but necessary difference.
There was I thinking”but I’m not resisting my treatment!?!” I had been taking my pills, careful not to miss a dose, and I had been going to my therapy (with a man who seemed decidedly odd. But that’s another post.). How could I be defined as ‘treatment resistant’?
The second time this applied to me was many years later when I was
discharged dumped by the Adult Mental Health Service in my city because I wasn’t responding to their treatment. This time, ‘treatment-resistant’ was being applied to me, the person. A social worker had been working with me using Cognitive Behavioural Therapy (CBT) and I didn’t respond as I should (apparently). Actually, I suspect the term ‘Untreatable’ was used because that’s really what they were saying. There was no treatment for me.
The same thing happened a short while later with the Eating Disorders Service I had been seeing. There I had been in group therapy (using CBT again) and I hadn’t responded as they thought I should. I was
discharged dumped again with my untreatable eating disorder. Fortunately, I had got myself past the Anorexic phase before I even got seen by their Service (sitting on a waiting list for years) otherwise, I suspect I would be dead by now.
My point in sharing what was a very frustrating but also depressing stage in my life is that in each case, mental health professionals were leaving me with a sense that all this was my fault. I was either resisting treatment or I was untreatable because I didn’t respond to CBT.
I accept that in the first case, the psychiatrist involved may well have been clear in saying that my depression (the illness rather than me personally) was treatment-resistant, but in my frame of mind, I took it to be about me. It wasn’t. I wasn’t doing anything wrong. I simply hadn’t responded to the anti-depressants he had chosen. It was actually more about him than about me. It was about choices he had made.
When I saw the tweet that hit me between the eyes, I took exception to that term ‘The Untreatables’. It’s an awful description as well as being an easy way out. Class us as ‘untreatable’ and you can send us on our way.
I take exception too, to the term ‘treatment-resistant’ if it is used to describe a person.
To any mental health professionals who happen to read my blog, please think before you use either term whether it is to the patient or not. How you think about it will determine how you see your patient, regardless of whether you use the terms in front of them.
And to mental health patients, please hear me when I say
You are not treatment-resistant.
Your illness may be treatment-resistant, but not you. And I hope that you are never made to feel ‘Untreatable’. Don’t believe it, and know that it is not your fault.
There are theories that some mental illnesses are untreatable, particularly Personality Disorders. I don’t accept that, but then I’m no professional. I think it comes down to how you understand the term ‘treatment’. The Mental Health Services who chose to
discharge dump me from their services could have chosen a different treatment path. They could have simply listened to me. Instead, they put a distressed and unwell person out of their systems without support. It wasn’t until a few years later when another mental health professional worked out that I had Borderline Personality Disorder (BPD) and not just depression and an eating disorder, and that is perhaps why I hadn’t responded to the earlier interventions.
I am convinced that sometimes it is just about having the time to work beyond the ‘treatment resistant’ or ‘untreatable’ labels.
Thanks for reading