Maybe I need to go back to IOP.

Maybe I don’t need an intensive outpatient program. Maybe I need to check myself into a psych ward for a while. Maybe I need more therapy, more medicine, more treatment for my mental illness. Whatever I need, I need something because I can feel myself slipping.

I’ve been stable for a while. I’ve managed to hold down a job, not be overwhelmed by depression, not lose myself to the ecstasy of mania. I’ve been taking my medications, sleeping full nights, and keeping myself as healthy as I can. I’ve been in a good place. But I can feel something shifting. I can tell something is giving way. Maybe it’s that I haven’t been going to therapy. Maybe it’s missing a dose of my meds. Maybe it’s something as simple as the changing of the seasons. Whatever it is, something is moving, morphing, melting down my stability.

All the signs are there. Broken, restless sleep. Irritability. Anxiety out of nowhere. Drinking more to self-medicate. It’s harder and harder to navigate out of the dark thought that stalks my brain. This is a relapse. It sometimes happens to sick people as we get better. Cancer comes back. The white cell count goes back down. The treatment that was working flat lines. Blood sugars spike. Thyroid hormones get out of balance. Depression begins to creep back into everyday life.

This is a relapse. This is the 2 steps backward that happen sometimes (even though it feels more like 10 steps back). This is the reality of a long-term mental illness; you don’t get to a good place and then never leave. Mental health ebbs and flows. Good days and bad days. Seasons of stability and personal growth and seasons of depression and regression.

In my time in an intensive outpatient program, they warned me about relapse. It wasn’t a matter of if it was going to happen. Rather it was when it was going to happen. Relapse happens to us all. Sometimes stressful events or big life changes can trigger it. Sometimes your meds stop working or need adjustment. Sometimes there isn’t an explanation. The stability you once had slipped through your fingers like grains of wet sand. You are reminded that even though you have good days that might outnumber the bad and seasons of health, you still have diseases.

I’m going to be honest with you: relapse is hard. I’m going through it now. My anxiety spiked last week so much that I was unable to go to work. It was out of nowhere. Nothing that I know of triggered me. Still, the cycle of anxiety with a depression chaser hit me full force in the face. Sucker punch to the gut. I’m trying to recover, but it feels like this will never pass, like this is the end of my good mental health, like this is my new reality.

It’s hard to see past what is going on in your head. Hard to remember good self-care when the voices are screaming that you don’t matter, that you’re just a fuck-up, that you are incapable and unworthy. It’s difficult to find the strength to fight when you feel so weak and broken. It’s hard to keep going, step after step when the meaning is lost and you are convinced there is no point.

Relapse is dangerous and hard.

However, relapse isn’t the end of the story. It’s not as if this is the one big thing that will swallow me whole. It is simply part of my journey with mental illness. I’ve relapsed before, I’ll relapse again. Relapse is part of the cycle of mental health for me. The trick is to not get stuck, not get bogged down, not get enveloped by the relapse. No matter how it fucks up my life, I can recover. And it does mess with my life. I’ve lost jobs because of relapse. But it is not insurmountable.

What do I do now, when I am in the middle of a relapse, though? I mean, having healthy habits in place is a great thing, but preparing for relapse only goes so far. By its definition, relapse takes me to an unhealthy place, a place where I am face to face with my sickness, where I deal with the raw power of my disease. What do I do when depression is eating me alive and anxiety causes me to tremble, even after months of healthy, stable living. What do I do to survive relapse?

The trick to surviving relapse is found in the healthy times. Doing the work of practicing mindfulness, good self-care, and creating a good support system are all things we can do to brace against the storm of relapse. It may not prevent relapse, it may not ward off the slipping into depression and anxiety, but it will make the relapse more manageable. Doing the work while I am healthy means that when I am unhealthy I have habits in place to fall back on, habits that will bring me health and get me through the relapse.

So here I am, pushing hard to remember self-care, to be mindful, and to lean into my support systems. Here I am fighting my relapse. A few years ago I couldn’t have fought this. A few years ago a relapse would have destroyed me again. And they did. When I relapsed before I was always taken down into the depths of my illness. This time, however, the water is only up to my neck and I am treading well. It’s exhausting, but I’m doing it, I am surviving.

That’s called growth.

Relapse is a real thing. Don’t let anyone tell you differently. It is serious and hard and dangerous, and it is survivable. I have survived relapse in the past, I’ll survive it now. It may be part of my illness, but it doesn’t define my future. This is just part of the story and the story isn’t over.