Choosing to be well. Thursday, August 12, 2010.

“Although the world is full of suffering, it is also full of the overcoming of it.” - Helen Keller

If you’re sick, whose responsibility is it to make you well?

You might say it depends on what’s ailing you. If you have cancer, maybe the oncologist is responsible. Heart problems? A cardiologist. But if your illness is of the mental variety, most people will put the responsibility on you, more than on your psychologist or psychiatrist.

It’s not that the other illnesses don’t have an element of choice in them. If you’re trying to recover from cancer, you’ll need to quit smoking and be willing to take medications that make you feel very sick. If your heart’s bad, you might need to exercise or do other things to straighten this muscle. And whatever the illness, people will tell you that a positive outlook helps with healing.

But how do you have a positive outlook when you are suffering from clinical depression? Cognitive behavioral therapy can help you look at things in a different light, but depending on the depth of your despair and your life circumstances, you might or might not be able to do this right now. Many people (including me) have testified that medication has helped them, but not everyone agrees, and pills are never a cure-all. They might elevate mood enough to help cognitive behavioral therapy take hold, but they don’t solve problems. Wish they did.

Many people believe those who are clinically depressed are choosing to be sick. I think that’s a false charge, but I do think it’s true that some of us refuse to participate in our own healing. Many members of my Suicide Attempt Survivors group have contacted me again and again, to tell me how miserable they are, and how meaningless their life is. I suggest a toll-free number to call, or a particular book to read, or an activity that might lift their spirits a bit – but so often, they don’t follow my suggestion. And that leaves me powerless to help them.

In the United States, we have an additional impediment to treatment – its cost. It’s all well and good for me to say, “You need to talk to a professional,” but if the individual lives in America and doesn’t have health insurance that covers psychiatric care, he’ll have to come up with $150 an hour for counseling and maybe hundreds of dollars a month for medication. Alternative medicine is almost never covered by insurance and can be prohibitively expensive as well. And even here, doctors are overbooked. I was suicidal, going through a crisis, and my own psychiatrist was booked for five months. After three months, I wound up in that motel room.

Whose responsibility is it to make you well?