Mental Illness or mental health
One day this week I was talking to a person I have known for some time. He had just been released from the hospital where he was treated for depression and anxiety following a suicide attempt. This man does have a history which includes deep clinical depressions – a physical/chemical inability to feel connected, joyful, hopeful or able to problem solve. Treatment with anti-depressants medication help change the chemical balance and, thus, decrease his depression. He also, however, has a history of putting himself in situations which are very stressful and which drag him into other situations which are stressful, negative, and unpredictable. His intention is to help people in this situation – people he dearly loves – but he is not strong enough to keep from getting sucked into the negativity and stress. One of these situations involve a mother and her two adult, addicted sons. The mother also struggles with addiction. In this environment one needs to be constantly on guard since it is never safe to relax. One has no way of knowing if it will be safe for ten minutes, an hour, or one day. There is no predicting the mood or the behavior of addicts.
Keeping his body at the ready to deal with potential crisis situations also increases any physical pain he is having. At some point, with or without a history of physical pain and depression anyone would find this a very depressing situation. One is powerless to stay and may feel powerless to leave. If one stays one becomes as ineffective as the other people in this situation. On the other hand, one is fearful that if one leaves someone in this situation may get hurt. This feels like a catch 22.
In the beginning of the situation the person was explaining to me that the clinical depression had gotten so bad he tried to kill himself. I said that there were several issues here including:
In other words, he has three major diagnosis:
While in the hospital, even allowing for the fact that hospitals are not necessarily restful, several things happened:
The bottom line is that if he stays in the current situation living with these active addicts he will soon be again passively or actively suicidal. He has to accept that those he wanted to help are not better and he is worse.
How chronic stress affects the body has been carefully tracked by studying those who live in active war situations either as civilians, military personnel or support personnel. The body, step-by-step, begins to break down. Eventually one’s body will quit functioning. One may first quit functioning mentally or physically but eventually all parts will shut down. The human body is not designed to live in prolonged, chronic, stressful situations. Given the marvelous design of our human body, it always lets us know when we have asked more of it than it can deliver. If one is not able to make some changes in one’s situation than the body will continue to send out mayday alerts until something changes or the body completely shuts down.
As mental health professionals or medical personnel we need to be very caution with both diagnosis and treatment. We need to distinguish between a healthy response to an unhealthy situation and a chronic mental illness. Obviously, there can be both, but my experience is that it is easy to explain all symptoms as chronic mental illness. When we do this, we are doing a disservice to the individuals. Of course, there are those situations where a person cannot remove themselves from the chronic stress and all the clinician can do is to treat the symptoms until some other option is possible.
As medical personnel and mental health clinicians specifically trained to diagnose and treat mental illness, we need to be very cautions with diagnoses. It is important to note in the medical records that one is making an educated guess based on current symptoms. The person needs to be reevaluated at a later time. Two good examples are:
Those individuals, including clinicians, trained to think in terms of systems are more likely to look at all the factors which might result in particular symptoms. Perhaps we all would benefit from respecting the ability of the body to let us know when it is having a healthy response to an unhealthy situation. This is not mental illness. There may or may not be an underlying or accompanying mental illness. Despite limitations of coding imposed by insurance companies and others, one needs to allow for these possibilities.
Written September 28, 2017
One day this week I was talking to a person I have known for some time. He had just been released from the hospital where he was treated for depression and anxiety following a suicide attempt. This man does have a history which includes deep clinical depressions – a physical/chemical inability to feel connected, joyful, hopeful or able to problem solve. Treatment with anti-depressants medication help change the chemical balance and, thus, decrease his depression. He also, however, has a history of putting himself in situations which are very stressful and which drag him into other situations which are stressful, negative, and unpredictable. His intention is to help people in this situation – people he dearly loves – but he is not strong enough to keep from getting sucked into the negativity and stress. One of these situations involve a mother and her two adult, addicted sons. The mother also struggles with addiction. In this environment one needs to be constantly on guard since it is never safe to relax. One has no way of knowing if it will be safe for ten minutes, an hour, or one day. There is no predicting the mood or the behavior of addicts.
Keeping his body at the ready to deal with potential crisis situations also increases any physical pain he is having. At some point, with or without a history of physical pain and depression anyone would find this a very depressing situation. One is powerless to stay and may feel powerless to leave. If one stays one becomes as ineffective as the other people in this situation. On the other hand, one is fearful that if one leaves someone in this situation may get hurt. This feels like a catch 22.
In the beginning of the situation the person was explaining to me that the clinical depression had gotten so bad he tried to kill himself. I said that there were several issues here including:
- A clinical depression which can be treated.
- A normal/healthy reaction to a chronically unhealthy situation.
- An increase in the extent and intensity of his chronic physical pain which in turn aggravated the depression which in turn aggravated the pain all of his physical systems.
In other words, he has three major diagnosis:
- Clinical depression which was being treated.
- Chronic pain.
- Exhaustion and an overall very unhappy body.
While in the hospital, even allowing for the fact that hospitals are not necessarily restful, several things happened:
- His medication got adjusted.
- He got some rest.
- His ate better and what food he ate metabolized more effectively.
- He was able to be more relaxed thus decreasing the physical pain.
- He was safe. Even though other mentally ill patients might be unpredictable he was not responsible for them.
The bottom line is that if he stays in the current situation living with these active addicts he will soon be again passively or actively suicidal. He has to accept that those he wanted to help are not better and he is worse.
How chronic stress affects the body has been carefully tracked by studying those who live in active war situations either as civilians, military personnel or support personnel. The body, step-by-step, begins to break down. Eventually one’s body will quit functioning. One may first quit functioning mentally or physically but eventually all parts will shut down. The human body is not designed to live in prolonged, chronic, stressful situations. Given the marvelous design of our human body, it always lets us know when we have asked more of it than it can deliver. If one is not able to make some changes in one’s situation than the body will continue to send out mayday alerts until something changes or the body completely shuts down.
As mental health professionals or medical personnel we need to be very caution with both diagnosis and treatment. We need to distinguish between a healthy response to an unhealthy situation and a chronic mental illness. Obviously, there can be both, but my experience is that it is easy to explain all symptoms as chronic mental illness. When we do this, we are doing a disservice to the individuals. Of course, there are those situations where a person cannot remove themselves from the chronic stress and all the clinician can do is to treat the symptoms until some other option is possible.
As medical personnel and mental health clinicians specifically trained to diagnose and treat mental illness, we need to be very cautions with diagnoses. It is important to note in the medical records that one is making an educated guess based on current symptoms. The person needs to be reevaluated at a later time. Two good examples are:
- A diagnosis of ADD in children. If a bright child is in a boring environment and becomes restless they do not necessarily have ADD. They are appropriately bored. This may be a healthy response.
- A person with only a day or a few days in remission from active drug abuse. Many, many clients in this situation have symptoms which mimic bipolar depressive illness. Some of them actually have a bipolar depressive illness. Many do not. Yet, I have seen many individual diagnosed and treated for bipolar illness based solely on the symptoms they have when a few days clear or sober. My overall diagnosis at this point is usually having to do with physical and emotional withdrawal or just “pissed body”.
- The man I was describing earlier who does have a history of depressive illness has also been living in an extremely stressful and depressing environment for years. Some of the symptoms are a healthy response to an unhealthy situation. Some are symptoms of clinical depression.
Those individuals, including clinicians, trained to think in terms of systems are more likely to look at all the factors which might result in particular symptoms. Perhaps we all would benefit from respecting the ability of the body to let us know when it is having a healthy response to an unhealthy situation. This is not mental illness. There may or may not be an underlying or accompanying mental illness. Despite limitations of coding imposed by insurance companies and others, one needs to allow for these possibilities.
Written September 28, 2017
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