Monday, 11 August 2014

The what if challenge

The role of a psychiatrist is midway between the remit of neurologists and psychologists which are specialist areas in their own right. A neurologist looks as the genetics, physiology and how the brain actually functions in the body; whereas psychologists concentrate more on what that leads to in terms of behaviour. 

Given the human brain has over 86 billion connecting points that we know of so far, it is not surprising that it's taking a while to fathom how a brain should be functioning as the number of possible ways it could misfire, be mis-wired or be malformed it quite staggering. We should count ourselves lucky that it can function at all. Recently scientific research has revealed that the fats in our bodies produce hormones to add to the complexity of organs all contributing toward our well being or ill health. 

Psychiatrists are not the only ones to be playing piggy in the middle while neurologists try to fathom what it is that makes a person mentally well as opposed to ill - general practitioner are there too - so are we. Each and everyone of us, healthy or ill is on the receiving end of the results of all medical discoveries. We play an important part in informing medical teams about what we are experiencing even though we are hindered in that task by not using their terminology to explain things very efficiently. Even among the medical profession the same term gets interpreted in a myriad of different ways while all agree on the overall concept behind each label or phrase. 

It soon becomes apparent that medical care can and often is a very hit and miss, trial and error way affair. As patients, as human beings this is quite alarming to realise until we remember that actually life is and has always been like that and that our best option is always to go with what we know to be safest and which we know to work just as a starting point. It is far better to go with the best we know rather than to rubbish all we know and be left with nothing surely? It is better yet to build on what we know to be true which we largely do.

Here though, as many a mentally ill person can testify, lies a problem. It's the "What if" mindset that is both useful and dangerous to all.

What if previous theories are wrong? What if current forms or treatment are wrong? What if what seems to work now will be proven to cause us problems in the future?

'What if' can lead us into not trusting in anything or anyone including ourselves and our own judgement. What if includes scenarios such as "what if I am imagining the whole of my existence and what if I am an imaginary character myself?" You see the trouble it can lead to? As human beings we often get scared and confused by using 'what if' the wrong way. This results in more and more unhappy thoughts piling up on top of each other to multiply and magnify our confusion and distress - it doesn't help to use 'what if' for things that we cannot change or to speculate on how bad things could get if we don't also use 'what if' to help us.

In many forms of talking therapy this constitutes a large portion of the work undertaken. In effect, it's aim is not to give answers but to enable us to find the means by which we can find a sense of balance between all the possible outcomes there can be. Outcomes are merely the events of our lives which are made up in equal measure from the actions of others and ourselves as well as our own genetics and physiology. No outcome need be a permanent 'answer' or 'conclusion' and it is far better that it never is for something better might emerge from a disastrous situation or something truly marvellous could happen from an already stable  and nice situation.

When we dwell on analysing past events which we cannot alter we can often find ourselves missing out on the present. While it is helpful to find out what went wrong and why, it is less than helpful to dwell on such things if we learn nothing from them. 

Many a mentally ill patient finds it difficult to let go of past events when they have been traumatised by them, but sometimes some patients can be destined to be traumatised by events simply because their brains are made that way or fire off the wrong signals to produce the same effect. It becomes apparent why it is so important for neurologists, psychologists and psychiatrists to be as aware of the differences between the causes of illness as possible. While on a quest for causes though it can happen that these highly knowledgeable medical professionals can end up finding only what they expect to find or are looking for in the first place missing out on other causes which can range from social factors to simple vitamin deficiencies. 

The only way for mental health care to avoid that pitfall is for all those disciplines to always communicate and for each to challenge each other with 'what if' the cause is not just this but also a smidge of this and a dollop of that. That challenge sadly is not often seen as a call for objectivity when it comes to a mentally ill patient voicing a doubt or concern. More commonly it is seen as symptomatic of illness and a resistance to trusting their medical team. 

A good phrase for patients to use when this happens is "Excuse me for wanting you to get to root of my illness so you can get the treatment right." It must always be remembered that the mentally ill while lacking in objectivity do have an abundance of insight as a consequence of their experiences both in and outside of medical treatment. They therefore are the most important source of information to discern what the problem is and where the root causes might be. They have a voice and it is after all them who have to bear the consequences of errors in judgement from all they encounter. Nothing is of greater concern to any patient (be they mentally ill or not) than whether or not they can be well, yet how often is a focus placed on what they view as well? How often is it that any mentally ill person is encouraged to believe that they can be well? If we are brainwashed into believing ourselves incapable of improvement, what is the likely outcome in any situation?

To put it another way, if a person is never going to be responded to as if wellness is a possibility the probability is that individual will always be ill because no one ever acknowledges how much of them is well. Building upon the aspects of ourselves that are functioning healthily is vital to aid recovery from any form of illness or disease. Regrettably when it comes to mental health care, few in the field advocate let alone put this into practice. The reason is because mental health professionals are paid to concentrate on the bit that needs fixing but to the mentally ill it often comes across to them as an archaic institutional attitude that sucks is insulting and worst still, causes them more damage. The fact that most mental health teams mean no harm in some respects only serves to add to the frustrations and distress of those they care for. 

A future for what if

What if there was a greater understanding of what it is like to be on the receiving end of all these decisions about a person's mental health? What if neurologists, psychiatrists, psychologists, GPs and the patients themselves discussed and agreed upon the things that caused their illness. What if every patient was assessed by a neurologists, psychiatrist, psychology and a GP before a joint diagnosis was made... wouldn't that lead to possibilities of quicker and ever less intrusive treatments in the future? 

Here at Mindwalking we are conscious that although making steady progress, treatment and diagnosis when it comes to mental health still lacks much of what is already taken for granted in the rest of general medicine. In the future we hope diagnosing will become a joint effort to pull treatment even further away from the risk of mere opinion for such decisions. It does not help patients of any kind to be confronted with differing opinions as to what ails them - it leads to confusion and distress. Luckily most in the mental health care profession do consult and confer to agree, make sure this happens if you are ever ill.  

'What if' offers a world of possibilities but it is only really useful when it is used to aid understanding rather than generate fear and prejudice and a failure to learn or act responsibly. 

We hope you use it wisely. 


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