by Grant J Everett
There are a growing number of people who believe that mental health issues are a natural and normal part of the human condition. Many academics, advocates, psychologists, average people on the street and even some doctors explain the distress, low mood and thoughts that people feel when they have a mental health issue as a consequence of things like as trauma, a difficult childhood or chronic health issues, rather than a hereditary condition or a chemical imbalance in the brain.
A mental health diagnosis is different to testing positive for a physical illness. For starters, there’s no blood test, brain scan or biopsy that can provide solid proof that a person has schizophrenia, bipolar, depression or many other conditions. Psychiatrists diagnose mental health issues based on how somebody answers a series of questions, but in addition to listening to your answers, they’ll also observe your actions and other physical signs that may indicate your thoughts, feelings and so forth.
What’s up, doc?
One thing that you’ll find general agreement about is the need to deal with emerging mental health issues as soon as possible. This may be done in a variety of ways such as counseling, seeing a psychologist, or self-help therapies. However, if you feel you’d like to take the medical path, then your General Practitioner (GP) is usually your first port of call. Some people will ask for this assistance of their own accord, while others might be prodded into it by family members, friends or work colleagues. The people who are closest to us are best suited to noticing personality changes, unusual mood swings, social withdrawal, losing interest in everything, or a thousand other tings which hint that issues are developing. Of course, sometimes we might just be having a bad week, but being alert to the possibility of a mental health issue can help a potential recovery journey start sooner.
Some GPs are good at dealing with common mental health issues themselves, but they can also refer you to a psychiatrist (just as they can refer you to any other specialist). In addition to a referral letter to a psychiatrist or psychologist and a quick assessment of your problem, GPs can also work out a mental health care plan. Note that your GP should take an interest in following up with you down the track to check how you are doing. Another thing a GP can do is rule out the existence of a physical disorder behind your mental health issues. For example, patients who are depressed may have a problem with iodine levels, so a blood test can be used to check for that.* Also, seizures and psychosis can be a result of injuries, tumours, or things like Lyme disease from tick bites. If a physical problem is behind your mental health issues, a different approach is needed to ensure the best possible outcomes for your physical health, which may then help improve the other issues.
Psychiatrists are medical practitioners who have specialised knowledge in disorders, symptoms, treatments and other aspects of mental health.
You may have heard of the DSM, the Diagnostic and Statistical Manual of the American Psychological Society. This is a handbook which may be used to help a psychiatrist with diagnosis and treatment. Ever since it first appeared in 1952 the DSM has been a kind of connect-the-dots guide for diagnosing mental health issues and personality disorders, and is basically a series of detailed checklists. It also has a bit in common with those Choose Your Own Adventure Books from the 1980s (if they hear voices, go to page 15. If they don’t sleep for days at a time, go to page 85).
Some people will disagree that they have a mental health issue at all. They may be sent to a psychiatrist – or even to a hospital – under pressure, or even force. The Mental Health Act allows for people to be hospitalised and given treatment against their will if a medical practitioner considers that NOT doing so could lead to harm, either to the patient or to somebody else. This situation, called “involuntary scheduling,” can sometimes be a matter for the courts. The people who initiate a “scheduling” will have to explain their actions later.
Doing your part
Make sure your doctor explains what their diagnosis means and how they’ve arrived at it. Ask them about everything of relevance: the nature of the condition, treatment options, and drug side effects. Learn as much as you can.
We heard of a lady recently who had been treated for Bipolar Disorder for many years, only to find a new doctor decided she had Depression, which required a very different approach. She had been prescribed drugs with major side effects, which – according to the later diagnosis – had been inappropriate. Therefore, it helps if you raise any reasonable doubts you have about your treatment over time.* Of course, if you believe that your doctor is wrong, you could get a second opinion from somebody else.
Some people are concerned that a former erroneous diagnosis will remain on their medical records and cause them trouble down the line. Getting your medical records deleted is not an easy task, unfortunately. The only people who can legally make diagnoses are doctors.
Cleopatra: Queen of Denial?
After speaking with my own doctor about this article, he thought it was very important to mention that there’s a defence mechanism called “denial” that we will often use when we are given news we don’t like. As you’d assume, denial is a complete and total refusal to accept something. After all, nobody wants to be told that they have a mental illness: these conditions can attract stigma, discrimination and other downsides.
*Additional material from Warren Heggarty and Clare Evans (thanks)