Perfect cure

I was interviewed for a newspaper article about the increase in referrals to adolescent psychiatric services. Many feel it is too difficult to get help. But the journalist surprised me by asking if mental disorders actually can be cured. Or does a psychiatric diagnosis in adolescence mean that a life-long struggle and misery is ahead, no matter what we do?

The magic concepts in contemporary discussions are increased awareness, prompt recognition, early intervention and psychotherapy. In only we invested more in these…

But I couldn’t honestly repeat those four magic things. Many mental disorders are long-term and have a natural course of ups and downs, better and worse periods, however early we start whatever therapy. None of the different psychotherapeutic approaches is a proven superior treatment for any specified disorder. Psychotherapy can further not always be given, for example due to the patients’ acute and fulminant symptoms, somatic condition, cognitive challenges or lack of insight and motivation. Medications are not available to all disorders, they do not fit all the patients, and may only produce a partial response.

On the other hand, many different treatment approaches can alleviate symptoms and improve functioning. It is not a lost game if one doesn’t get a specific treatment or if certain treatment does not work.

And why should we have an all or nothing approach regarding treatment of mental disorders? There are many chronic illnesses that can be alleviated but not cured. An important aspect of treatment is to keep an as good balance as possible and help the patient live a good life despite of her/his illness. People don’t usually suggest that treating asthma or Parkinson’s disease or colitis ulcerosa is futile because all patients cannot be totally cured once and for all.

But maybe we, the professionals working with mental disorders, are provoking disappointment by insisting that increased awareness, prompt recognition, early intervention and psychotherapy will result in perfect cure? This may create unrealistic expectations, even a feeling of being deprived of something more effective one would be justified to obtain.

Despite decades of community care many parties also still seem to equal psychiatric care with inpatient treatment somewhere out of sight, from which the young person returns “fixed”. Thereafter family life, school and leisure time will continue “normally”. But treatment cannot be isolated from everyday life. Mental health is built in age-appropriate interaction with other people in age-appropriate activities. Treatment must support this.

Surely there is room for improvement in how the adolescent psychiatric services work. But quick fix for severe mental disorders does not exist, however much we would to have it. Treatment may take a long time and require effort not only from the adolescent and her/his primary therapist but also from the family, school and other parties important for the adolescent. An important goal is to deal with those symptoms that cannot be taken away.