For some people, hearing the words “you have a mental health disorder” can mean instant relief and a sense of validation. As a clinical psychologist, I have also sat opposite a great number of people who have been shocked and griefstricken by their diagnosis. But regardless of whether a person initially accepts or rejects their diagnosis, one question that almost always follows is: “Will I have this for life?”, or “Can I recover from it?”
Diagnosing a mental health disorder follows, more or less, an objective process, but the improvement that follows treatment is much harder to measure. The answer of whether a person can “recover” from a mental health disorder has sparked a level of controversy over the years within the scientific community. There are indeed conflicting views between psychiatrists, clinical psychologists and mental health researchers. Some argue it is entirely possible to recover, while others suggest it is not. Largely, this is due to differing views on the following topics:
- Neurological versus psychological disorders
- Clinical recovery versus personal recovery
Neurological versus psychological disorders
When answering the question of whether someone may have a mental health disorder for life or not, it is helpful to decipher between whether it is a disorder of the mind — “the province of psychiatry”, or a disorder of the brain — “the province of neurology”.
This distinction has historically been applied to the following rule: if a disorder is associated with a recognisable pathology involving malfunction of or damage to the central nervous system (CNS) — the brain, spinal cord and nerves — then it is neurological. Various neurological disorders include Autism Spectrum Disorder (ASD), Attention Deficit Hyperactivity Disorder, intellectual disability, Parkinson’s disease, Huntington’s disease, epilepsy, multiple sclerosis and Alzheimer’s disease. While there remains a debate on the prognosis of neurological disorders, most argue they are inherently not curable and for life, especially neurodegenerative diseases (e.g., Alzheimer’s disease).
However, with some neurodevelopmental disorders such as ADHD and ASD, for example, there is no question some children do remarkably improve or “outgrow” symptoms as they age into adulthood. The likelihood for a child who has been diagnosed with ADHD or ASD to achieve this kind of improvement in functioning is typically related to whether or not they were able to receive early intervention, and the age they first received intervention. Generally, the younger they commence intervention, and the more intensive, the greater chance they will have of achieving improvement in functioning over time as they age.
The hallmark characterisation of psychological disorders, on the other hand, are clinically disturbed cognition, behaviour and emotional state. Included in this group are mental health disorders such as Major Depressive Disorder, Generalised Anxiety Disorder, Eating Disorders, Obsessive Compulsive Disorder, Post Traumatic Stress Disorder (PTSD) and personality disorders such as BPD. With an effective, individualised treatment approach, which may include psychotherapy in isolation or along side pharmacotherapy and other interventions like nutrition, social work and occupational therapy, many people can successfully reach their desired outcomes and essentially be deemed “cured”.
However, it is highly important to remember that just because two people have been given the same diagnostic label (e.g., Major Depressive Disorder or Anorexia Nervosa), this does not guarantee they will both respond to the same therapeutic approach in the same way. For example, consider two 20-yearold individuals who may have been given the same diagnosis of Borderline Personality Disorder (BPD) and may experience extreme emotional dysregulation, impulsivity and have depressive symptomatology. We may perceive them to both respond in similar ways with a manualised therapy such as Dialectical Behaviour Therapy (DBT), however:
Example, Client 1: Born in South Korea, moved to Australia at the age of 6. Has been physically abused on multiple occasions between the ages of four and nine years old by her parents for underperforming academically. Along with this trauma, she has also witnessed a highly traumatic event at the age of 14 years old involving a close cousin, who passed away from it. This left her with extreme grief and depression.
Example, Client 2: Of Aboriginal cultural heritage, born into a warm and loving family home, but severely bullied at high school and still suffers from severe traumatic flashbacks and memories of it that leave her with persistent hypervigilance and, at times, panic attacks. Was also been diagnosed with an eating disorder and is part of the LGBTQI community.
Expecting that both these individuals would respond to one traditional line of therapy in the same way is arguably irrational. While DBT may effectively help both clients with issues such as impulsivity, emotion dysregulation and distress tolerance, it may not adequately help with the other comorbid issues of childhood trauma, eating disorder, or even be perceived the same due to differences in their values and different cultural upbringings.
If we consider the above example and apply it to the question of whether someone will have a mental health disorder for life, the answer is perhaps more apparent when we focus on client individuality rather than the diagnosis itself. For the two clients in the example above, alongside DBT, other lines of therapy may be required to help both of them achieve their treatment goals and ultimately find recovery.
Clinical recovery versus personal recovery
When asking the question of whether someone will have a mental health disorder for life, it is perhaps more appropriate to revise the question to whether someone is capable of recovering. Then we must look at what that recovery looks like and how it is measured.
The definition of recovery in the context of mental health traditionally emerged from professional-led research and practice. Generally speaking, clinical recovery entails an outcome rated by the clinician and is an objective, dichotomous state (meaning a person is either “in recovery” or “not in recovery”). More specifically, this means recovery can be defined, measured and investigated in empirical studies.
A different perspective of recovery has more recently challenged the notion of clinical recovery, encompassing the personal experience and subjection of the person themselves. “Personal recovery” can be conceptualised as a process or a continuum that is:
- “Rated” by the person experiencing the mental health problems and is deemed the expert on their own recovery journey.
- Understood as a representation of when a person believes they are living a meaningful life in the context of their own experience of mental health.
- Recovery is not homogenous and can mean different things to different people due to a range of factors (e.g., individuality, values, beliefs, spirituality, cultural background, upbringing, characteristics and traits).
Personal recovery has a different focus from clinical recovery. It emphasises the centrality of positive adaptation to illness and disability where the individual strives to achieve and maintain self-awareness, self-efficacy and self-empowerment in the face of mental health problems. It holds the view that optimal wellbeing, functioning and personal growth is possible, and involves taking responsibility for one’s recovery, establishing an identity separate from a mental health diagnosis and finding meaning, purpose and hope in one’s life.
My own view of whether a person can recover from a mental health disorder is something of a blend of clinical and personal recovery, but perhaps more weighted on the personal recovery side.
From years in research and from working with so many inspiring individuals as a clinical psychologist, I know firsthand that a diagnosis is not a blanket rule for a measure of life quality or recovery. I have seen countless clients reach their desired outcomes and go on to live, in their own words, a “rich and fulfilling life”.
Some of these clients clinically met criteria for a mental health diagnosis when I first met them, however did not tick off the same level of severity or criteria to warrant a diagnosis at the end of treatment. Hence, using this objective measure, it would be fair to suggest they have indeed overcome the diagnosis and are “cured”.
Other people can go through a course of psychotherapy treatment and report meeting their desired goals, yet they may still meet clinical criterion for a diagnosis.
Recently, I received an email from a former client who I treated in 2020, who has given me permission to share her words. In the email she updates me about her mental wellbeing: “I wanted to share with you that I am still doing really well. I have some days where my BPD symptoms flare up at me, but for the most part, I am very able to reel them back in and feel better pretty quickly. Actually, I am doing bloody amazing, and I just had to share with you what I have been up to. Things I never thought possible.” Further down in her email there were 12 photographs of her travelling through Europe, a letter sighting her acceptance to a university degree, and her hand hosting a big diamond ring (she had found a wonderful man and was engaged).
Underneath her photographs she writes: “At the beginning of therapy when I first met you, you told me I had every chance of recovery, the same as anyone else. That was the first time I had heard that, and for me it was everything I needed to fight for my life. I have found my purpose after all those years of suffering, and ultimately my new identity. I know now that I am not a label — BPD, I am [name], a pretty incredible person that BPD is simply a part of.”
My old client learnt how to live her life alongside the BPD, rather than being consumed by it, proving that the notion of “once diagnosed/ill, always diagnosed/ill” is not only untrue, but can be hugely damaging to people living with a mental disorder. The question of whether a person will have a mental health diagnosis for life is best judged by the person living with the experience.
