Crazy Talk

The First Step

When talking about substance abuse, we often hear people remark that the first step toward recovery is admitting that there is a problem.  Because of denial, people have to "hit rock bottom" before they'll seek help.

While we don't usually think about it this way, often the same is true for depression and anxiety or any problem that may call for treatment with a psychiatrist or psychologist.  Largely due to stigma, I think, people do not want to face the possibility that they can be helped by a psychiatrist or other mental health professional.  The resistance is so strong that people will go to great lengths to deny that there is a problem and avoid seeking help.

To these people I just want to point out that the point of getting an evaluation is to get help and feel better.  It's not necessarily a question of needing medication or a specific treatment but exploring the possibility that one can feel better or that life can be easier.

Ultimately, some of the patients I have worked with decide to deal with things without medications, but even these individuals are glad that they found out what was available to them.  And for each person who chooses to forgo medications, many more wonder why they held off considering medications for so long because they have made such a difference in their lives.

I am not at all on a crusade to get people to take medications but my main professional frustration is how many people suffer because they can't get past what it means to have a problem and ask for help.  People don't have to admit they have a problem, but rather consider that there may be helpful treatment.

Want to learn about mental illness?

I know this posting is overdue and was intended to review exercise tips but I wanted to write a quick post to let people know about a series appearing on public television and available online that provides basic information about various mental illnesses.  I haven't watched the series yet myself but I'm hopeful that it provides impartial information that can be a starting point for understanding various mental conditions including autism, schizophrenia, bipolar disorder, depression, PTSD, obsessive-compulsive disorder, and others.  In short, it covers most major mental illness.  I hope that it takes a step toward demystifying and destigmatizing mental illnesses.

Here's the URL: http://www.wliw.org/productions/local/healthy-minds/season-two-overview/164/

It is on WLIW21 and channel 13 in NY.  The hours are early AM and later in the evening so perhaps best to watch online.

Are Medications Over-prescribed?

This is a question that I am often asked by people when they first learn that I am a psychiatrist.  If I say 'No', then I lose credibility because the person asking the question generally believes that they are over-prescribed.  If I say 'Yes', then I feed into the distortion created by partial information.

The answer to the question is 'Yes and No'.   Because of a multitude of factors including aggressive advertising by drug companies, a desire from patients to be cured quickly and easily with a 'magic pill', and a desire among doctors to want to be helpful to those in distress, medications are often prescribed when alternative treatment methods could and should be tried.  HOWEVER, only a small fraction of those suffering from treatable symptoms have access to psychiatric care.  So overall, medications are under-prescribed because most of the people who need them don't get a chance to be considered.

The solution to this problem is routine psychiatric care for all (please see my post entitled Deliver Mental Health like Dental Health from April 27, 2007)

Expert Advice

If you ask people to list the most important priorities in their lives, most would include family, friends, health, and money near the top.  Consistent with these priorities, people are willing to accept expert advice from their internist about their physical health and some will hire a trainer to maintain their fitness.  For their money, people will seek out a reliable accountant and a savvy broker.  But what happened to their relationships and their mental well being?  Why not get expert advice in these high priority areas?  If only there were relationship and mental well being experts.  Well, there are.  This is what therapists do. 

So the next time you hear about someone being in therapy, you don't have to wonder why.  Now you know they're interested in getting the most out of their relationships and finding out how to live their life in a way to maximize their well being.  When someone sees an accountant, we don't wonder 'What's wrong with that person and his money?'.  We know they're getting an experts guidance.  Finding out someone is seeing a therapist should lead to the same matter of fact response.  Unless all of your relationships are perfect and you never let stress get to you, you might wonder, if you're not seeing a therapist, what exactly you're waiting for.

Deliver mental health like dental health

Which is more important, having a white smile or the ability to concentrate, think, and live free of anxiety and depression?  Obviously, this is a loaded question. but it reflects the reality that people have internalized the idea that, starting in childhood, you should go to the dentist regularly, while the idea of assigning everyone a psychiatrist early in life seems like a bizarre idea.  If we overhear someone mention that they have an appointment with their dentist, we probably don't give it another thought or consider what it means about that person.  On the other hand, if it comes out that someone is going to see their psychiatrist, people draw conclusions from that.  It means something and that something is bad.

Now imagine that it was the norm for everyone to have a psychiatrist starting in childhood.  The expectation would be that people go in for regular checkups periodically.  Not everyone would go as often as recommended but the important difference would be in it being ok to see your psychiatrist.  The way things are, I don't see my dentist even once a year, but if I'm having a problem with my teeth, I don't hesitate to make an appointment.  Unfortunately, people don't behave the same way when they start having issues with their sleep, or mood, or anxiety.  They often compound the problem by self medicating with drugs and alcohol.  By the time patients reach my office, they have generally been suffering for years.  It just doesn't make any sense.  Psychiatric issues are not limited to "crazy" people.  Psychiatrists specialize in sleep, anxiety, depression, and substance use; the kinds of things that almost everyone deals with at some point in their lives.  What's more is that these are the kinds of things that tend to get worse and harder to overcome the longer they go untreated.  If we could somehow change society's mentality toward psychiatric care, it would remove a tremendous burden on anyone going through a difficult time by removing the stigma.  People undergoing depression are the ones who find it the most difficult to motivate to do anything.  If psychiatric care were a yearly routine, they might start getting reminder notices like we sometimes do from the dentist.  So someone who might languish and deteriorate over many years wouldn't have the chance to get worse and worse.  Their yearly screening would pick up on their depression and schedule a course of more frequent treatment for therapy or medications much the same way a dentist might schedule someone in need of a root canal for more rapid follow up.  Once the issue was addressed, they would go back to yearly follow ups.  Or someone might opt for continued therapy to address work related or relationship related questions just as someone might elect for braces or teeth whitening.  I'm certainly not downplaying the importance of taking care of our teeth, but it just seems that in choosing the area of care that has the most impact on our lives, we have our priorities mixed up.