Unpredictable and not not set in stone: I’d like to talk about prognoses[1] in the mental health sector.

The unpredictability of prognoses in the mental health sector. In medicine we are used to making predictions. When someone gets diagnosed with cancer, doctors can often be fairly certain about how the disease will develop. From stage one to stage two, and eventually to a possibly fatal outcome. This linear and measurable process makes it possible to make prognoses and plan treatment processes. But in mental health care this is not the case.

Unpredictable: How come?

The development of psychiatric disorders doesn’t follow a predictable path  like physical conditions do. This makes prognoses of psychiatric disorders remarkably complex and unpredictable.

Psychological conditions, like depression, psychosis, anxiety, or addiction don’t develop themselves according to fixed stages. Whilst an illness like cancer follows a progressive process, the condition of someone with a mental illness can be erratic and unpredictable. Even in situations that seem hopeless, like severe suicidal thoughts or torturing hallucinations, recovery can occur at unexpected times. In the field of mental health care it is not unusual that someone’s condition improves after suffering severe symptoms for years. This unpredictability means that the accuracy of prognoses in psychiatry is around 20 percent certain. A stark contrast with the predictive power of medical disciplines like oncology or cardiology.

Unpredictable: The misunderstanding of linear recovery processes

 A massive difference between physical and psychological conditions is that in mental health care recovery doesn’t necessarily mean that all symptoms disappear. In physical health recovery often revolves around eliminating the disease: the tumor needs to be removed, an infection needs to be fought, the heart rhythm disorder needs to be stabilised.

But in psychiatry it doesn’t work like that. For example, a patient can continue to struggle with hearing voices or anxiety, but can learn how to handle these experiences in a healthier way. This means that recovery often is associated with a shift in a patient’s relation to the symptoms. For instance, someone can learn not to be afraid of the voices they hear, or find a better way of handling their anxiety. This type of recovery goes way beyond just “removing” someone’s symptoms.

Personal recovery: reinventing yourself

In the psychiatric field, a crucial aspect of recovery is that it isn’t just about medically treating symptoms. Many people who have dealt with psychological conditions describe their recovery as a process of reinventing themselves. The can mean that they redefine their identity and life goals. Whilst their old life may not seem feasible any more as a result of the limitations of their condition, a new perspective on what is still possible can lead to a meaningful and satisfactory life. This personal recovery offers people the possibility to live with their vulnerabilities, without having to be completely ‘cured’.

The limited biomedical model

The biomedical model in psychiatry emphasises medical intervention far too often; like medication, or electroconvulsive therapy, as the solution to psychological conditions. These treatments can of course play a part, they are not always sufficient, nor what people need. Because if we look at this from a medical perspective, the more people suffer, the more help they need with enduring their condition, and with the existential process of reinventing themselves. And these are exactly the things you don’t always learn in mental health care, but you do in a recovery college or self-care centre.

What is often overlooked is that especially the people with severe symptoms benefit from developing their mental resilience, changing their relation to their symptoms, and developing new life goals, and meaning to their lives. A purely medical perspective falls short here.

Conclusion: uncertainty and unpredictability are realities in psychiatry

In mental heath care, a patient’s future cannot be predicted. It requires a different approach to it than somatic care does. Whilst a medical model often assumes progressive stages and eliminating symptoms, recovery in psychiatry is more about enduring and knowing how to handle mental challenges and finding resilience and new life goals. It is important to recognise and accept this difference to do right by the unique nature of psychological suffering and recovery. Psychiatric care requires an open mind to unpredictability, and having this it also offers hope. Even in situations that seem hopeless from a medical perspective.

[1]To understand this article it is important to understand the difference between prognosis and diagnosis; a diagnosis identifies an injury or an illness, whereas a prognosis predicts the outcome of one.

Translated from Dutch by SGM Taplin