Muddling Myths and Diagnosis Dilemmas

There are many forms of treatment for the mentally ill now and a few do not involve medication at all; they require changes to lifestyle and how we approach life. However, it is still more common to need medication of some kind to help start this process off at the very least.

If you think in terms of mental health medication as being in two distinct categories it should help everyone be less afraid of them. There are medications used in an emergency situation, just as you might have if you are whizzed into an Accident and Emergency Department following a life threatening accident or ailment; and there are those used to prevent emergencies and help us to recover from dire events and ailments in our lives.

There is a problem though and that is diagnosis. All too often people who are not qualified at all to diagnose try to do so. Even among mental health care professionals the temptation to say that this person is presenting this symptom therefore they are suffering from this condition is huge and nigh on irresistible. To describe the symptoms to a doctor is the right thing to do, but to tell a doctor in any field of medicine that a patient is suffering from a condition you happen to be familiar with could result in that patient's death. You might think that the more experienced a member of staff is the less this would happen but during our research we have found that sadly archaic attitudes have still not left us even among medical staff.

The most common complaint of all from the mentally ill is that their thoughts and feelings have not be correctly relayed to their psychiatrist at all, and there are even examples of test results not reaching them either. This is alarming in the extreme as how can any doctor in any field of medicine be expected to diagnose and prescribe accurately if they do not have the correct information to do so? The effect on their patients is one of anger, frustration and a lack of faith and trust not only that they will be diagnosed correctly, but that they can ever be cured. There is fear that if they show such feelings they will be subjected to even more medication that is unwarranted too.

Luckily there are many diary entry and mood chart devices to help avert this happening and in the UK at least there are organisations like Mind, Rethink, Saneline and PALS for patients to find an advocate if things do go wrong. There is also the Care Quality Commission and (albeit only a handful) solicitors who specialise in representing the mentally ill. Such processes add to stress levels rather than alleviate them and things can be further complicated when the condition the patient suffers from is some form of paranoia or delusion.Additionally cases of misdiagnosis for the mentally ill can be long standing if their conditions are never reviewed. What was modern medicine 50 years ago is not the latest thing now. Shockingly due to time constraints and particularly since the recent 'austerity drive' it is all too easy for a patient seeing a new psychiatrist being assumed to suffer from the same condition as their last episode. With physical ailments we seldom have this happen unless it is for conditions such as cancer, but even then no one assumes the cancer to be in the same place, the same type or to be affecting the patient in necessarily the same way.

Patients are seldom aware of any discussion over whether their brains are misfiring due to predominantly genetic, physiological or environmental conditions, but in all cases patients can learn to manage their own health if supported sufficiently well. It will still mean a life-time in care in some cases, but for most it could well lead to a fully functioning life.

This is where we at Mindwalking firmly believe mental health care professionals need to change. A broken arm sustained as child does not lead to everyone assuming the arm is still broken once deemed healed, but a mental health condition on your files will remain uppermost on your files even if you need no medication at all. This leads to many a human resource professional and manager treating the mentally ill unfairly, denying them work in the first place or treating them as fantasists if they report problems or in any way become emotional.

Different situations cause different illnesses and given that mental health covers such a vast spectrum of maladies it seems rather odd that this attitude has not changed yet. The mentally ill have enough to contend with regarding strangers, colleagues at work, friends and family trying to diagnose them with no training whatsoever without mental health teams themselves being lazy or assuming goodness knows what. There are dreadful cases of deaths being caused because such professionals missed signs of brain tumours, brain injury, autism and many other easily identifiable conditions were it not for the assumption that they already knew what the condition was before they started and therefore the patient never got referred for the appropriate tests or to the appropriate specialist.

It can seem at times like a miracle that patients get diagnosed and prescribed correctly at all but as the decades roll by more and more mentally ill patients thankfully are. The reasons behind this are:

1. Patients are speaking out more for themselves
2. They have advocates to protect them and their rights
3. There is greater awareness of all manner of symptoms and conditions
4. Psychiatrists confer more and more with psychologists
5. Psychiatrists and neurologists are learning more about how the human brain functions
6. Medications are becoming more refined to have just the right effect on precisely the right bit of the brain
7. Medications are beginning to become less addictive and with fewer side effects
8. Many more patients than ever before are able to cope with lower doses because of complementary therapies which leads to greater success in diagnosis for others
9. Psychologists and mental health care staff are becoming more aware of the traumatic effect treatment regimes themselves can have on the mentally ill
10. Awareness of what is happening in these illnesses from those directly involved with mental illness is ever increasing.

Sadly we are still waiting for the rest of the human race to catch up with all of this. It takes years of some of the toughest and most intense training imaginable to become a psychiatrist, psychologist or neurologists so why does everyone else think they could possibly know more or better than they do? The answer lies in that part of our brain that houses our nagging doubts. It's the 'what if' pest again (see previous post last month). Yes, medical teams can and sometimes do miss things which is why it is always important to keep talking to them. If you don't tell a GP that you vomit morning, noon and night and go into see them complaining that your neck hurts, what are they likely to look at, your neck or your digestive system? Mental health conditions are notoriously difficult to diagnose precisely because the same symptoms can be present in very different health problems - hence why a person in a rage might be a victim of crime, a perpetrator of crime, bereaved, have learning difficulties, a brain tumour or a long-term mental health condition.

Please, do yourselves and mental health teams a favour (especially the psychiatrists and psychologists) assume nothing, keep sharing your symptoms and take their advice just as you would for any other form of malady.

It remains an absolute truth that to help both prevent any illness as well as aid any recovery fresh food, exercise, sleep, relaxation and laughter will always pay dividends in the end but the greatest comfort of all for the mentally ill are people who believe them to be able to be well, do things and to share their experiences with not least what they can and do accomplish so regularly and so bravely.

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. 





 

Breaking the chains of the branding irons

Perhaps the biggest hurdle yet to be overcome in mental health is the one over the labels of diagnosis itself. For the doctors to understand how a person is faulty or ill labels were designed. Historically they were never meant to be shared with those not trained which included patients and concerned family members. However, this led to misdiagnosis as no one much bothered with what a person’s upbringing was, nor the impact of a traumatic effect even from barbaric treatments. Yes, there were some rather foolish people who got the wrong end of the stick and the usual quota of corrupt people who set about just being cruel to the most vulnerable. 

What a difference for there to be more and more discussion over diagnosis from the patients themselves and with medical teams in order to get ever closer to getting things right with pinpoint accuracy! In order to do so medical teams have had to translate their grand labels into terminology that people can understand; to not do so was rather like both parties trying to negotiable with a brick wall in a bomb blast.

Perhaps the labels should now be more in the form of an assessment of things that need to be addressed under these five key headings:

• Financial abuse
• Intellectual abuse
• Emotional abuse
• Physical abuse
• Natural disasters

If any and all are assessed in this way what could happen is that the symptoms (and therefore old labels) become less important as the cures become ever more obvious. It is irrelevant in our opinion as to how a person is distressed, what matters is the WHY are they?

There are two major snags with this approach, the first is obvious, it feeds into a class structure which itself can lead to prejudice. The second is less obvious but is also based in the same prejudice, namely that no one wants to be seen as equal to everyone else. The fact that we are not and never will be we are adept at forgetting until we feel hard done by in any way. The question is do we really want to be equal to everyone else, and the resounding answer is no. We merely want an equal chance which is entirely different. We desire the opportunity to be whatever we wish to be without obstacles in our way, but the obstacles are bit by bit being kicked away by people like you. With such determination to beat what should never have been the cause of illness in our world today and with evermore people signing up to help win that battle, we can only ever succeed. 

Ten final healing things to learn

The cures are within ourselves. With the aid of medical teams we can ask the right questions, get clarification on how they are interpreting our behaviours, thoughts and feelings and ask for them to look at things on the basis of what we know has deeply hurt us. We can ask them to help us move on from ask them to help us to:-

1. Learn how to walk away and ignore all that is bad for us
2. Learn how to fill our lives with all things creative, constructive, positive
3. Learn how to dare to share and with who, when, and why to trust others, what for and how
4. Learn how to form happy, rewarding symbiotic relationships
5. Learn how to find joy and interesting hobbies and work to do
6. Learn how to prevent ourselves and our loved ones from becoming ill
7. Learn how to cope with new troubles, hurts and losses as well as new successes and nice surprises
8. Learn how to cope with old memories being raked up
9. Learn how to adapt, evolve to find ever more peace within ourselves and all that we engage with.
10. Learn how to find laughter and to celebrate safely without harm to ourselves or others
    
    

It comes down to a joint effort and lots of hard work and practise, but be assured, it is worth it. With luck you will find that more and more it will not just be medical teams that help, but friends, neighbours, colleagues, strangers (potential new friends) and of course family members. In time that will mean that fewer people will ever get seriously mentally ill as generation by generation society itself will come to learn how to look after each and every one of us far better than ever before. It’s started already but admittedly still has a long, long way to go, but with your help and perseverance it will only ever get better.

Onwards to those happiest of all our days for our children’s sake and that of our children’s children... keep fighting in that way and be assured you’ll get there. Yearn and long for it, work for it and it will surely come just as day always follows night.

We at Mindwalking have only two more postings to make before we close. Please pick up the gauntlet we have thrown down. Please take up the challenge to help educate others although this site we hope will continue to be view by another then another and another 10,000+ readers. It still has hints and tips such as The Selfish Anger Wolves and the Two Chairs exercise to draw upon if ever you are struggling. In that sense alone we will always be with you, rooting for you to continue on your own very personal, very individual journey to pastures new, bright and happy.