Optimal well-being after psychopathology

Are you scarred for life if you have suffered from serious mental problems? Is it 'once an addict, always an addict'? Is a depressed person destined to remain unhappy? You can regularly come across these kinds of gloomy statements. 

But in recent years a group of researchers has come up with papers that point to a blind spot. A large proportion of people with serious psychological problems make a full recovery. But this group has remained virtually invisible until now. 

Why full-recoverers have been invisible 

Mental health researchers and practitioners understandably pay close attention to the symptoms of psychopathology. But, as some researchers have discovered, they underemphasize the good functioning of people who have had psychological complaints. And this has many consequences. 

I previously reported on research by Rottenberg et al., (2019). This study showed that a substantial proportion of people who have suffered from depression fully recover and function well without relapse. In my article I already mentioned two reasons why these full restorers normally go unnoticed by investigations: 

“The first reason is that these HFAD-ers often do not show up in research as test subjects. Researchers almost always look for subjects who suffer from depression during the study. Individuals who have suffered from serious depression only once, but who have fully recovered from it, have a smaller chance of ever being included in a study. 

The second reason is that researchers almost always tend to only measure the reduction in symptoms rather than how patients function in their lives. The third reason is that researchers have given little thought to what high functioning after depression (HFAD) looks like and how it should be measured.” 

Optimal well-being after psychopathology 

Devendorf, et al. (2022) argue that optimal functioning after psychopathology is underexposed. In their paper, they report on the prevalence of optimal well-being (OWB) after recovery from depression, suicidal ideation, generalized anxiety disorder, bipolar disorder, and substance use disorders. 

Using a national Canadian sample (N = 23,491), the researchers operationalized OWB as an absence of 12-month psychopathology and scoring above the 25th national percentile on psychological well-being and functioning. 

Here are the key findings of their research: 

1. Compared to 24.1% of participants without a history of psychopathology, 9.8% of participants with a lifetime history of psychopathology had OWB. 
2. Adults with a history of drug addiction (10.2%) and depression (7.1%) most often reported OWB. 
3. Individuals with anxiety (5.7%), suicidal ideation (5.0%), bipolar 1 (3.3%) and bipolar depression (3.2%) reported OWB less often. 
4. Having just one lifelong condition increased the odds of OWB by 4.2 times over multiple lifelong conditions. 
5. Although psychopathology significantly reduces the likelihood of OWB, many individuals with psychopathology achieve OWB 

Discussion 

The authors conclude that optimal well-being appears to be a realistic goal for some patients, particularly in the wake of alcohol use disorders or depression. Other types of psychopathology appear to be less likely to make a full recovery. But even with these kinds of complaints, this chance is not 0. Also from this category there are people who fully recover, function well and are happy. 

The challenge seems to me to be to find out which factors have made this possible, so that the percentages for these groups might also increase. It would also be interesting to conduct this type of research for a number of other disorders (e.g. eating disorders). 

The results of this study may perhaps even give a slightly over-pessimistic impression. As criterion the researchers used: score above the 25th national percentile on psychological well-being. The implication is that the percentages would have been even higher if the 50th percentile had been used. And this is still the top half of well-being individuals. Doesn't seem that bad at all to me. 

The idea that psychopathology marks you for life may be an important barrier to recovery. This is analogous to a fixed mindset regarding intelligence. If you don't think you can get any more intelligent, you don't look for a challenge and effort and give up quickly if you don't succeed. A growth mindset, the belief that you can get better, does the opposite: you commit, you persevere, seek help and try various strategies. That's how you make progress. 

Interventions aimed at creating a growth mindset about psychopathology may help to further increase the currently found percentages of complete recoverers.