“Andrea Arceneaux. Age 48. Bipolar disorder...in remission.”
That is how my nurse practitioner introduced me to her student at my last appointment. Who knew that nine letters could throw me for such a loop?
R-E-M-I-S-S-I-O-N. Remission. It’s a great word. It is the word that all cancer patients long to hear. So why did that word distract me for days?
At first, I thought maybe it was a poor word choice on her part, but then I looked up the definition. Remission is “a diminution of the seriousness or intensity of disease or pain; a temporary recovery.”
The definition is spot on. At the moment, I am doing as well as I have ever done. Thank God. But the word choice still bothered me. It took me a few days to figure out why.
There are three problems with using the word remission with someone who is mentally ill:
1. There is a set of expectations assigned to the word remission.
What is the first thing you think of when you hear the word remission? Although the definition of remission makes it clear it is a temporary recovery, the word has come to have another meaning. There is now an expectation that the illness in question may never return.
Cancer patients who hear the word remission do a happy dance because it means their death sentence has been lifted. They still carry the fear of the cancer returning, but they rejoice in the distinct possibility it won’t.
Remission has become synonymous with recovery and restoration. When a patient hears the word remission, what they hear is that it is finally time to exhale. The wait is over; they have won the battle against their disease.
2. When a certain cross-section of the mental illness community hears the word remission, they will use it as an excuse to quit following their treatment plan.
If you haven’t read my blog post about the five reasons people quit taking their medication, you should read it now. And add this as the sixth reason!
There are people looking for an excuse to quit taking their medication. When they hear the word remission, what they actually hear is that they were cured, and their diagnosis is no longer valid. The word remission gives them permission to pretend they are completely well, and there is no concern that the symptoms of their mental illness will return.
It gives them a false sense of security that they can discontinue their treatment plan without ramifications. That is a dangerous presumption that brings remission to a grinding halt rather quickly.
3. Remission is just a word. It doesn’t change the reality of the day-to-day struggles of living with mental illness.
My bipolar disorder is never going away. They can say I am in remission for the rest of my life, but nothing has changed. I will still wake up every morning and take my medication as prescribed.
Because even though my bipolar disorder is inactive at the moment, it is still lurking in the shadows. There are still intrusive thoughts to remind me not to become haughty. Suicidal thoughts still invade my mind at the most inopportune moments.
I still have days when I wake up in the morning counting the hours until I can crawl back under the covers. I still have days when the sound of my daughter’s whining voice drives me over the edge until I become that screaming, crazy mom. You know the one. Or my husband’s touch makes my skin crawl because I am all touched out and have flashbacks of the childhood sexual abuse that follows me like a scab that never completely heals.
The Bottom Line
My nurse practitioner did not misspeak when she told her student I am in remission. Technically, I am. But we live in a world where the word remission means different things to different people. A word can be used correctly but still have dire consequences for someone who doesn’t understand the nuances of that word.
I have enough insight and self-awareness to know that being in remission does not mean my bipolar disorder will be dormant for the rest of my life. I am fully aware that with mental illness, there are levels of remission.
To the world—and even to my health care providers—I may seem functional with no impairment. When in reality, the semblance of wellness may be a carefully cultivated facade of normalcy perfected through years of practice.
Not everyone is as vigilant as I am about being well. It has become my life’s work. Use the word remission with the wrong person, and the results can be catastrophic.