Monday, November 15, 2010
There are a lot of misconceptions about disorders related to mental health.  And frequently, the severity of them can be dismissed in flippant comments and the passing diagnosis of a person without real pathology. 

"Just get over it.  You don't have anything to be sad about."
"That's so irrational.  Why would you worry about it?"
"Oh my gosh,  You're so bipolar."

We say some of these things without thinking about the ramifications of them, and without recognizing the suffering of people with true psychiatric disorders.  Now, I by no means am an expert on anything psychiatric.  And I have my own reservations about how certain diseases (psychiatric or otherwise) are sometimes treated.  But issues around mental health, and patients with these disorders, seem to have a hard time convincing the world that their diseases are real, and that they require treatment.  I think part of the problem getting the world to understand what depression, anxiety, schizophrenia, bipolar disorder, and others are like, is that it's extremely difficult to IMAGINE what it's like to have one of them.  Without personal experience, we don't really have a frame of reference to extrapolate from.  I may have never broken my leg, but I've injured myself before and can imagine what that pain might be like.  I've never had a small bowel obstruction, but I've been nauseous, and can imagine what it might feel like.  But I can't image what it's like to have a panic attack, or what it's like to be delusional. 

I've recently had a patient that presented with a new diagnosis of bipolar disorder.  If you've never seen someone with true bipolar disorder in a true manic episode, you can't imagine what it's like.  Prior to the last few weeks, this patient was a normal young man, functioning in his life quite well, without any problems.  He was totally "normal".  When he came in to see us, he was agitated, delusional, angry at certain people, but pleasant to us, unaware that anything was wrong, making up rap songs, sleeping just a couple hours a night, and losing weight.  If you looked at his bank account, I'd be willing to bet he's spent a ton of money on random things.  He cannot live like this.  That is real pathology.

That carries over into other diagnoses also.  Many people with depression or anxiety simply cannot get through normal daily activities.  Not because they don't want to, but because they can't.  I can't imagine how that would feel.  I also can't judge someone when they tell me that's how they feel.

I'll admit, there are many clinic situations when I have the urge to tell someone to just suck it up.  And I'm sure sometimes that's possible.  But sometimes it's not.  And just like some people with high blood pressure can fix it with exercise and diet, but some require medication, the same goes with psych issues.  Sometimes, they can be handled with therapy, but sometimes they require medication.  That's just how it is.

So next time you tell your friend with mood swings that they're bipolar, think about what it would be like if they really were, and rethink your comment.  Just tell them they're moody. 

And be glad they don't really have to cope with a mental health issue.


Alex said...

Thank you for this excellent post. The state of mental health care and the perception and stigma associated with mental health problems is terrible in this country. While I will get on my soapbox about the over-diagnosis of ADHD in children and the over-medication of people who need to make lifestyle changes, I absolutely agree that these same medications and diagnoses are vital tools that allow some people to function normally when they otherwise would not be able to. I think upper-middle class culture (TV shows, movies, etc) has begun to treat these very serious conditions as unreal ideas that are an excuse to pop pills, never realizing that this treatment is detrimental to those for whom the disorders are very real and who need the support of therapy and medication.

About Me

I am a Family Medicine intern at a community hospital in Indiana, navigating the new world of being a physician. I am privileged to work in a field I love, where every day is a new and unpredictable challenge.
I am not only a doctor, but also a cyclist, runner, DIYer in the making, lover of the outdoors, traveler, and human.
Human, MD is a glimpse into the world of a young doctor who is just trying to stay true to herself through the grueling whirlwind of residency.


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