The article was excellent, well-written, and explained thoroughly the differences between the concepts of “cure” and “remission.”

You might have included an analogy often used: diabetes. Persons suffering with diabetes can usually live near-normal lives, but their disease is not cured in any sense. Miss a dose of insulin, or, in milder cases, gain too much weight, and diabetes comes back.

BTW: my own depression, in complete remission for over 5 years now; generalized anxiety disorder, under control via medication, but not in remission (if I stop taking meds, it comes back, 100%–my doc and I have tried stopping meds several times over the years).

John

My daughter is following some DVD/workbook set to work on her social anxiety, and I’ve noticed major improvements in her behavior. I think that by the time you’re my age (54), that sort of cognitive/behavioral programming is far less effective.

My daughter is following some DVD/workbook set to work on her social anxiety, and I’ve noticed major improvements in her behavior. I think that by the time you’re my age (54), that sort of cognitive/behavioral programming is far less effective.
P.S. – Sorry, forgot to tell you great post!

Good god, man, ADHD a “mental illness?” What tripe. Conventionally, it’s considered a disorder, but Ed Hallowell, MD and Peter Jensen, MD, in their latest collaborative effort (Superparenting for ADD)have said it’s a trait. As much as ‘experts’ try to insist, according to the NIH, no pathology exists to identify ADHD. This would strongly uphold the notion that it’s a trait like being left or right handed. One of the greatest limits we place on human beings is the label mentally ill. But ADHD is not a mental illness. That’s total rubbish.

As a PhD myself, and former educator with a child who has the ADHD trait, we’ve used cognitive skill building techniques (Play Attention — http://www.playattention.com) and ADHD Nanny. We modified our parenting techniques as well. Low and behold, we’ve made incredible significant improvement for our son, Alex. Would I call these techniques and strategies ‘cures?’ No. Are they strategies that improve his quality of life? Yes. Is he mentally ill? He was never more mentally ill than someone who was born left handed or with crooked teeth. You don’t cure a trait. You can work with it to make vast improvements. That’s a fact. It’s neuroplasticity. Calling someone with the ADHD trait mentally ill is not only ridiculous (Dr. Hallowell is labeled ADHD — I doubt he considers himself mentally ill), it’s also enervates the person labeled. It’s more than past time to stop this label.

For the last thirty years, there has been a movement of people with psychiatric disabilities that emphasizes the idea of “recovery” from mental illness. Recovery doesn’t mean a 12-step program – although many people with psychiatric disabilities do have co-occurring addictions and find 12-step programs useful – recovery is a holistic notion aimed at self-determination and at living the best life one can as a productive member of a community.

As one who has been able to successfully taper off of what was an original psych med cocktail of 4 down to 1 ( I will be completely off this year or next), I am speechless at this doom and gloom article. Talk about stigma and sentencing someone to life imprisonment with no possibility for parole.

By the way, I have nothing to sell and I am not a scientologist. Anyway, I was one who was essentially given the message I needed to be on meds for life. Hmm, I had other ideas, especially in light of dealing with horrific side effects, including a hearing loss.

I decided I would learn self CBT to deal with the ups and downs of life that everyone deals with. The only difference between me and someone else was I didn’t initially have good coping techniques and thus ended on meds. It wasn’t because I have an incurable mental illness and to imply otherwise is doing a huge disservice.

Think about the implications of your article regarding someone with a label getting a job and health insurance. I am still stunned at what has been written.

There are many people like me who reject this labeling and stigma and we have gone med free. Unfortunately, there will never be any studies because of articles like this and psychiatry’s beliefs, that once diagnosed, never undiagnosed, to quote Philip Dawdy’s psychiatrist, in reference to when he asked about his BP label.

AA

Mr. Glennon,
Do you think they should wait for the pathology before treating alzheimers too? Maybe it too is a trait and not an illness.
I have a mental illness and I accept that and take medication daily. As long as the ignorance exists concerning mental illness, so will the stigma.
Jude the biofeedback program called Wild Divine is fantastic at any age.

Hi John,

so a mention but no link?

Keep in mind I only have 140 characters to work with in Twitter. My initial draft for the tweet was

1. They’re spammers. 2.They’re ignorant, liars or both. You don’t cure #ADHD, you learn to manage it more effectively and turn it into an asset

but there wasn’t enough space, so I cut out the last 6 words.

Given that my blog is called Adult ADD Strengths I thought it wouldn’t be a problem leaving them out.

One of the thing we Adult ADHD coaches do is to teach our clients how to manage some of the negatives of having ADHD so they can focus more on the positives of ADHD. In fact I have a whole category of them on my blog.

Many people with ADHD make their living by identifying and focusing on those strengths. Creativity is impulsivity done right. Hyperactivity channeled correctly gives you extra energy and staying power.

I’ve never heard of anyone with ADHD paying for a course to teach them how to be creative, often the problem is limiting it.

“To Pete Quily’s claim that one does not “cure” ADHD (attention deficit disorder), there are certainly many good treatment options for ADHD that minimize its impact in a person’s life.”

So on one hand you’re saying I’m claiming one does not “cure” ADHD and later you say “how do you cure mental illness? The answer — you don’t”

So are you saying I’m making a claim or a statement of fact?

I agree there are many good treatment options for ADHD, and I most certainly did not imply there weren’t. I make my living doing one of those options, ADHD coaching. One of my most popular posts on my blog is called top ten ways to manage adult ADHD.

The reason I did those 2 tweets is that there are many modern snake oil salespeople on twitter who claim there product/service cure’s ADHD. I encourage people to type in ADHD as a keyword into twitter search and see how many people are trying to take advantage of people with ADHD and scam them. There are a few ADHD coaches and therapists tweeting about ADHD that are offering legitimate useful services for people with ADHD, but often it seems they’re outnumbered by dishonest internet marketers who’ll say anything to push their product/service/ebook etc often using fear based marketing.

Often they demonize ADHD medication as a way of trying to legitimize their snake oil/ 4 step process because it’s “drug free”. They take advantage of people with ADHD many of whom who buy into the stigma against ADHD and ADHD medication to such a degree that they’d almost pay any price and are often fleeced. Leaving them no better at dealing with their ADHD but a lot poorer.

There are some people out there with ADHD who’ve spent a lot of time, money and effort to successfully learn how to manage ADHD and wouldn’t want to cure it even if they could because they’ve been able to structure their life so that they consider having ADHD to be mainly a strength or a gift. There are billionaires who credit having ADHD as being part of their success.

I hope more people with ADHD learn how to manage it more effectively and can move in the direction where it’s more of a strength than a challenge, it’s not easy, but it’s worth the effort.

You cannot cure depression until you psychologically change your mind set through Positive Psychology. I went through a major depression for eleven to thirteen years, in and out of mental hospitals, with analytic, behaviorist, cognitive-behaviorist and humanistic techniques taught to me. It was not until Dr. Doug Caldwell (whom I became a desciple of) taught me Positive Psychology’s short, positive, in the present reaffirmations (“mantras” that I later learned what they were from wisdom traditions), but He taight small individual problems whereas I went the “female” equivalent of global in asking for a change in my mind set and perception of my core being. I am now going after at least a masters in psychology and possibly a doctorate in psychology so that I can teach what I learned and document through experiments its validity. I am in the process of writing a book about my experience to explain my poem about my conversion from major depression to my first level of happiness. I will then write a second book about the different levels of consciousness in relationship to happiness. I also hope to bring back the “classical” definition of psychology as my philosophy professor has challenged me to do. Patti

Thanks for the great article. I like that way that you point out that “cures” are rare when it comes to mental illness.

Dr. Grohol,

You seem to be taking for granted that the medical metaphors of “illness,” “disease,” “cure,” “treatment,” etc. are descriptive of “the way things are,” rather than useful (but limited) ways to understand the complex, multi-dimensional problems we face as human beings.

I’ve said it once, I’ll say it a thousand more times: This disease model of understanding mental “illnesses” is no where near adequate to make sense of human experience and problems of living. Putting “illness” in quotes doesn’t deny the very real suffering people face. Nor does it deny the obvious truth that all subjective experience–of health, balance, normal emotions, or profound dysfunction and pathology–is anchored in the brain and physical organism. But the convention of using medical disease/treatment language to talk about our problems is still just that—a convention. It’s useful in some ways and terribly limiting in other ways.

Maybe trying to find a “cure” for mental “illnesses” is a little like trying to find heaven by building a really big ladder, or trying to mend a broken heart with needle and thread. Maybe psychological problems are “like” diseases is some ways, and thus it can be useful to talk about diagnosis and treatment, but they aren’t actually diseases, in the sense that cancer or small pox are disease. Psychiatric and psychological “treatments” like meds and therapies may help–and of course do often help–, but this doesn’t mean they’re helpful because a presumed disease is being treated. Why is this assumed?

Neuroplasticity, biofeedback, the placebo effect, the efficacy of talk therapy, —all stuff you write about in this blog—can not be contained within the disease model/brain disorder philosophy of mental health. Yet, whenever you get philosophical and talk on a fundamental level about the work that you do, your use of language seems to imply some basic assumptions, assumptions I would love to hear you explicitly articulate one day.

My take is that psychologists and psychiatrists will continue to chase “cures” and other ghosts until they acknowledge and develop integrative theoretical perspectives that take into account the multiple dimensions of human life. Integrative perspectives already exist, but they don’t get a significant “buy in” from either leaders in the field or the general public, for a variety of reasons. Another discussion!

I look forward to your aforementioned “Groholian Philosophy of Psychology” piece…

Bravo. This is an area as a long time urban Mental Health post graduate Social Worker have been struggling with especially with my unwanted foray into the world of the severely mentally ill with several years of extreme symptoms of either Bi Polar of Psychotic Depression. I can’t be cured and will need multiple and sometimes dangerous meds for the rest of my life. My contern that this category of illness falls under chronic diseasse which is so so much better than in the past for all of this dieases that fall into the arena.What I find appalling is the lack of motivation to find a cure. This is difficult, we have cancer efforts galore and still many types are uncurable. Our brains and our metabolism which I think will be the system that will yield a cure for mental illness and other chronic diseases are complex and we still know so little. I also feel the Pharm industry is content with this type of medication treatment. As of yet, there are no carrots hanging in front of them to actively push for a cure. We also are competing with so many other worthwhile medical causes. Maybe we need a human genome like project – a cure for all and not for some.

i believe depression will only return if the root cause was not treated, suppose that a person had poor coping abilities that resulted in depression, after this person is treated another trigger will result in depression because the problem is still in his coping abilities not brain chemicals, if this person understood this fact and worked on it depression will never return back

In response to D McArthur’s statement: “Mr. Glennon,
Do you think they should wait for the pathology before treating alzheimers too? Maybe it too is a trait and not an illness.
I have a mental illness and I accept that and take medication daily. As long as the ignorance exists concerning mental illness, so will the stigma.”

There is pathology to Alzheimers. It can be seen in parts of the brain through fMRI and CAT scans (at least is detrimental effects). It is a true disease.

I’ll maintain that ADHD is most likely a heritable trait past from generation to generation. In some instances, ADHD-like symptoms may have some other etiology like trauma or toxins. So, when is a trait a mental illness? That’s the question. If it deteriorates the brain and causes death (Alzheimers), certainly. If you have diffused attention, NO!

If mental health is considered to be a continuum then any idea of cure doesn’t make sense. Can anyone ever really say they are in a condition of perfect mental health?

check thyroid with bipolar, it is more common than thought, and takes more than the standard tests. The treatment is much better than the anti psychotics, many fewer side effects.

It’s good to see this kind of discussion going on. Reframing the question changes the answers. I’ve long felt that dealing with chronic depression is a craft, much like knitting, that is perfected over time.

There’s a movement to take the stigma away from mental dis-ease (as they characterize it) and lots of big-name folks are behind it, among them founder Joe Pantoliano (from “The Sopranos”). They’ve made a documentary called “No Kidding, Me Too!”

They started doing screenings around the country this winter.

Here’s a link to the web site:

http://nkm2.org

BRIDGES, a course taught by Peer Specialists to others working toward mental wellness, is a recovery-directed program. It is not snake oil. It teaches people how to communicate with their psychiatrists when side effects of medication out-weigh the benefits. It helps with awareness of social skills necessary for finding jobs, and maneuverability through the government support systems that help maintain independence. Each of these issues is a step toward recovery. I prefer, “process of recovery,” to “remission.”
-E. Garner, Peer Specialist, BFA, MFA, Bi-Polar Disorder

Interesting article.
I have always wondered about ADHD in particular and whether it is a diagnosable disease/illness. I know many people who have ADHD and one of whom said the doctor told him he “grew out of it” and it only affected him as a child. So is ADHD a phase? I see it has been described as a trait; so can it be a temporary trait?

You forgot to add that the drug companies really don’t want to cure mental illness. They are making a big profit off the misery and suffering of others. Why cure it? There’s no profit in that.

In response to Dr. Grohol’s comment from May 26th, 2009 – wanting a cure – I think some of us think in terms of wanting science to be more constructive in finding ways to address the causes of depression, rather than merely treating the symptoms (known as the field of psychiatry). I don’t see anything black and white about that and can’t imagine any good reason why we “shouldn’t be” searching for that cure, diverting more resources to curing/finding the causes instead of focusing on treating symptoms. Not that the 2 are mutually exclusive, and research is obviously conducted for both ends, but your comment stated cure is the “wrong” word to use..

I believe it is sort of dismissive to classify seeking “cures” as “wrong”. I perceive strong implications from the language you use to describe how we “should” view mental disorders. Do people dismiss those who want to find an actual cure for cancer, rather than treating symptoms? I think NOT…It can be argued cancer is caused by several factors much like mental disorders-genetics, lifestyle, environment (and yes-even social support, attitude/optimism, etc. have been said to affect the disease progression) How is this fundamentally different from mental disorders? I don’t hear people dismissing those seeking a real cure for cancer in this manner. Maybe cancer will someday be cured by reversing the altering of the metabolism of cells; maybe someday mental disorders will be cured by altering the processes of brain neurotransmitters (no-not like the finding the needle in the haystack approach of today’s meds)…no one knows.

Many of us are initially given drugs to address the symptoms without the physician even searching for a cause such as thyroid and other endocrinological malfunctions, infections/Lyme, etc. This happens more than you think.

Just using the example of thyroid malfunction-if that alone can cause depression-who is to say depression is not all biological? As a non-scientist who only reads the views of scientists, I hold the opinion that it seems to not all be necessarily biological, but I would not state that in confidence because in reality-none of us know.

Maybe perception even in terms of depression-anxiety/how we view the world/relate to others is all biological…just look at autism or synesthesia, among other things. http://en.wikipedia.org/wiki/Synesthesia. I mean if people can see sounds and hear colors, is that much different than psychosis except for the more intermittent nature of psychosis? Again, it seems nobody really knows for sure. Maybe mental disorders are a combination of genetic factors and-or from strutural changes to the brain resulting from childhood trauma, or both, but maybe not.

Of course ‘brain science’ is not simple. But when you said “Virtually every mental disorder is a complex combination of factors”, how do you know that for sure? And, btw, I mostly agree with you as any other human being with an opinion, although I would not state this strongly….I think it’s more appropriate to say, instead, the only thing current research can tell us at this point is that generally mental disorders are thought to be a complex combination of factors….

Main point (not so articulately expressed): It doesn’t sound black and white at all.

AND

I think recognizing what we DON’T know is just as important as knowing what we know!

Your opinion is valid as anyone else’s and I respect it–however, since you brought up black and white thinking, I perceive your opinion to be more black and white than the opinion of some of us who want that “cure”.

I hope we, as a society, can be open minded about this. This reminds me as far back as 9th grade (and this was many years ago) when an astute teacher of my Genetics 101 course once told me that some can argue “all that is possible in the future actually exists today”. What a wise thought.

We have “Fight for a Cure” for breast cancer..why is it NOT wrong to think that way about breast cancer according to societal mores, but you – the owner of a mental health blog and Psych D. – assert it is wrong to think about mental illnesses in a similar manner?

Would you also tell the millions located throughout the country who are passionately running in Komen’s Races for the Cures that their thinking is black and white? That they should not ever think in terms of cures because it is wrong and instead, they should only be thinking in terms of how to manage and cope with cancer?

Much like depression, someone can get breast cancer once and never have a reoccurence, or be in remission only to have a subsequent relapse. Even if cured of breast cancer, one can still get skin cancer, brain cancer, pancreatic cancer…

So we have all the bumper stickers for finding a cure for breast cancer and autism…

And since you said:

“Depression, on the other hand, like most mental illness, knows no boundaries. It will come and go as it pleases in our lives, even if we’ve successfully treated one episode of it. There seems to be little rhyme nor reason to when a mental disorder strikes, who it will strike (outside of genetic predispositions for some of them), and how deep or long the episode will last.”

Umm, sounds just like cancer. In addition, depression also leads to impairments, even death (suicide) – just like cancer.

And you also said:

“But I am a fan of re-thinking our expectations and societal inclinations when it comes to the word “cure.” We shouldn’t always be looking for a “fix” or a “cure” or look at the world in such black and white ways. Virtually every mental disorder is a complex combination of factors, so “cure” is the wrong word to use or think about.”

Why isn’t “cure” the wrong word to think about cancer? Or autism? Are these illness not also a combination of factors?

So when you said:

“Why is that? Why is there such a reluctance to invoke this magical word? I mean, cure literally means, “recovery or relief from a disease,” so if someone has recovered or has found relief from depression, why not say the person has been cured?…I think our reluctance comes from the belief that mental illness is far more recurring than most diseases in many people’s lives.”

My thought was, no way…and especially after reading this article and your comment, it seems more likely “our reluctance” comes from the stigma STILL associated with mental illness – the belief that, despite some awareness of genetic and biological factors, mental illness is still somehow viewed as the result of an individual’s flaws or weaknessnes. People develop maladaptive patterns because they are somehow not as strong and able as others (no you did not say this directly). Those with mental illness are somehow less than others, but those with cancer are the unlucky, the unfortunate.

But how do you know that depression is not the result of the composition of brain structure or cognitive processes we are born with? Why is it NOT ok to seek a cure for mental illness, but it IS ok to seek a cure for cancer and autism?

Think about what you are saying – as the leader of Time’s 50 best websites of 2008 as you proudly display that on the top of the page. Perhaps some stigma lies in your very own unconsciousness. I feel what you have written has very negative connotations for those with mental disorders.

You said: “But I am a fan of re-thinking our expectations and societal inclinations when it comes to the word “cure.”

Yeah, thanks, let’s go backwards….more toward the previous beliefs that the mentally disorded are possessed by demons. Let’s continue to encourage the seeking of cures for cancer, but reverse any trends towards hopes or initiatives to cure mental illnesses. I am so suprised you think we should rethink our expectations for finding a cure and that thinking about cures for mental illnesses are black and white.

While I’m more sure than not it was unintentional, the stigma is so apparent in reading between the lines of what you wrote.

I think your explanation is excellent. However, I do have a question about PTSD or DDNOS, since these are a result of trauma if a person is treated for them can these be considered cureable disorders?

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Thank-you for some straight talk about mental illness. I also hope for the day when there is a “cure” but in order to find a cure they first need to determine why mental illnesses happen. Theories about genetics, chemical imbalances and other “reasons” have not made treatment more successful, it is still time-consuming for many. Also for many patients, finding the quality care that can properly diagnose them is hard and then there are the expenses involved…not to sound hopeless but this is why so many people do not do well. The lack of success in treatment helps to make the stigma against the mentally ill so strong. Thank-you again for your insightful article.