On Mental Health Relapses

What to do when you're doing well and then you aren't

Photo by Taylor Deas-Melesh on Unsplash

Whatever your mental health journey¹ may be, it almost certainly will be up and down. Our daily experiences of life, the little indignities we encounter, the stresses and anxieties we face (I did my taxes yesterday. It was terrible.), the biological changes that affect our mental states due to lack of exercise or eating the wrong thing or not eating enough, plus the fact that mental health challenges themselves (depression, anxiety, OCD, take your pick) are mercurial, all add up to the reality that one day you may be feeling quite well and then suddenly a cloud passes, someone sneezes, you see a roller skate, and your mind is off to the races, remembering wrongs, traumas, fears, what ifs, doubts, insecurities, and so on. The world is seemingly filled with opportunities to be invited into your mind and the suffering it has waiting for you.

Maybe your relapses² don’t feel or look like this. Maybe for you it comes in the morning. One day you wake up and everything is gray. And it hangs like that for weeks on end. Months. A curtain hung over everything dear to you. However you experience relapse, the fact of relapse is what I want to focus on here. For all of us, whether we have diagnosed mental health challenges or not, our experience of mental health will not be linear improvement. That would be bizarre and would require us to be born anxious and depressed and die in a state of utter bliss. The reality is that life involves a lot of fluctuation. Periods of suffering followed by periods of great joy. The thesis of On Getting Out of Bed is that everyone experiences those periods of suffering eventually, and we must learn how to cope with them. But those of us with mental health challenges need to learn how to also deal with relapses as we move toward recovery. No matter how well you are doing, or how hard you’re working to recover, at some point you will be challenged by a relapse, because “progress is not linear.” So how do we deal with relapses in hope?³

Don’t Panic

The first step is to avoid panicking. Your impulse will be to worry that you are slipping back into your “old ways” and habits and that you will end up in exactly the same place you were before you sought help. But if you have been working to recover from a mental health challenge⁴ through therapy and/or medication, then you have tools you didn’t have when you began, so you can’t fall back into where you were before. You can’t go back to square one, because you will take your tools with you. And they will help you get back to where you need to be faster and with less trouble. That has certainly been my experience. You are going to be okay. Take a deep breath, take a step back from your thoughts, consider the tools you have learned to manage your symptoms, and see what you can apply in the here and now.

Reach Out For Help

One trap I’ve found with relapses is that you fear relapsing so badly, you fear letting loved ones and friends down, that you don’t communicate your current situation to them. This means they can’t support you or pray for you or advocate for you. So a healthy practice is to reach out to your support system and let them know that you are having a difficult time and you are afraid of relapsing. Then contact your therapist and let them know what’s going on. Don’t try to white-knuckle it. We’re meant to get through this together.

Ignore Feelings of Shame

As I mentioned, a major trap is feeling ashamed for relapsing, feeling like you’ve let everyone down: your loved ones, your therapist, yourself, and God. But there is no shame here. God has grace for you. This is a process of growth, and growth includes some setbacks. But you learn through those setbacks and become stronger through them. Dwelling on feelings of shame and regret will only make it harder for you to get out of your head and move back to a place of recovery.

Take Care of Yourself

Especially because of those feelings of shame, you may be tempted to stop caring for yourself. You may be tempted to think that you are not worthy of eating, drinking water, sleeping, going to work or class, engaging with people, getting sunlight, exercising, showering, wearing nice clothes, praying, reading the Bible, and so on. What Josef Pieper calls “selfless self-preservation.” Failing to care for yourself leads to a cycle of insularity. You begin to fold in on yourself and your emotional state such that all external concerns, even for your own body, fall away, which leads to worsening emotional states, which leads to more absorption in yourself, which leads to worse external conditions, and so on. It’s important to remember this principle of selfless self-preservation: when we care for ourselves, we honor God and love others. And getting back to a position of recovery will begin with you caring for your basic needs and acting healthy even when you feel unwell.

Hope

In my limited, personal experience, the most important response when experiencing a relapse is to practice the virtue of hope. Because despair will be at your door begging to come in. It will whisper to you that you are a failure, that you may not get out this time, that you deserve to stay in this state, that you can’t improve, that this time your fears are real, that you are letting everyone down, and so on. And the point of despair is to keep you locked in that insular state I talked about previously, so that you can’t move toward the healthy space you know you are capable of being in. The key is hope. Hope in God’s promises to make all things new. Hope in God’s promise to never leave you nor forsake you. Hope that you can get better because God loves you and desires your good. Maybe “better” for you will never look like full remission. That is the case for many of us in this life. That’s okay. Paul had his thorn in the flesh, too. But hope in God’s love for us and his desire for our good gives us desire for our good. Because we can hope for recovery, we can desire it and work toward it, using the tools we’ve learned in therapy. As I’ve written about before, desire is the first step in recovery.

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There’s more I could say, but that’s enough for now. I will add that prayer is important, too, but you must be careful not to let your prayers become compulsive or rituals. Pray for God to intercede and bring you back to recovery, but don’t mindlessly repeat it out of desperation. Pray and trust God to be faithful; He will. Recovery is a long process, full of errors, trials, mistakes, and lessons. But God is faithful to preserve us.

1. I can’t finish the first sentence without a footnote, but I hate the use of the word “journey” for every life experience we have. It just makes me think of The Hobbit and adventure and woods and flowers, with a clear destination and stops along the way. My mental health experience has been more like moral duty, like taking the Ring of Power to Mount Doom in the Lord of the Rings. Lots of suffering. Lots of confusion. Lots of trials. Lots of doubts. The only things that carry you are your inner commitment to the goal and your friends (and God).

2. One of the common phrases in mental health circles is that a “lapse is not a relapse.” They make a distinction between a simple lapse and a full-blown relapse. In this piece I’m conflating “lapses” and “relapses” because when you are in the experience of lapsing it feels plausible that it is going to end up being a relapse.

3. The following is a completely non-mental health professional, personal experience opinion. But I think it’s helpful, otherwise I wouldn’t share it.

4. I’m using “challenge” here rather than “illness” or “disorder” at the request of a reader who finds those terms offensive. Personally, I think they are just accurate descriptions of the experience of mental affliction, but I see her point and want to respect that.