Mental Health

Treat the Individual - Not the Diagnosis

We live in a society of “medicating where it hurts”. We have encouraged this trend by neatly packaging our illnesses with a scientific name. We hoped in doing so, the illness magically becomes more manageable, more treatable, and that everything can be under control. Then we can go back to what we were doing before we were “so rudely interrupted” in our heads.

How do we tell “normal depression” from “chemical depression”? Stressful situations can induce a depressive state as a normal response. In time, with support and lifestyle adjustment, we may recover and be “mentally robust” again. However, we are now quick to seek medication, doctors have less time to diagnose (correctly), managed care organizations are keen on money-sparing “treatment algorithms”. We no longer treat complex individuals with complex problems. We have come to a state of reduction, a state of “take this once a day and come back in 4 weeks.” (IF your insurance covered the visit, that is!)

Mental health professionals may be pressured to prescribe the conventional, because they are liable if something goes wrong under a “non standard of care”. Insurance companies know this, thus “experts” design “algorithms” to ensure that most patients are treated “appropriately”. The current healthcare milieu makes alternative therapies risky business for many health care professionals.

Even therapy has become a game. If you recover too quickly, your therapy sessions will no longer be covered under insurance, because you are”well”. If you recover too slowly, your therapy sessions will be terminated and replaced with something “that works”, because the insurance company does not want to lose too much money on lost causes.

Many psychotropics available on market are useful. I have personally benefited from medication therapy for severe depression. I may never know whether my depression would be alleviated just as well if I had intense psychotherapy accompanied by lifestyle changes including exercise, adequate sleep, balanced nutrition, and meditation (all foreign concepts to a typical graduate student). Would all this worked just as well for my depression as a 20-milligram-per-day dose of Prozac?

I subscribe my own recovery from depression to a combination of medication therapy and psychotherapy. Did my unhealthy life situations contribute to my depression? I have no doubt of it. I wonder what would happen if we treated depression like diabetes - aggressively intervene with lifestyle changes first, before we start prescribing medications. Eat well, exercise, get enough sleep. For even better results, identify external or internal triggers and learn coping skills or eliminate those triggers altogether. Just like diabetes, if you’re in the ER because your illness has landed you in a dangerous predicament - medications are immediately used - with careful follow up and lifestyle intervention close behind, but the goal is to prevent that train wreck in the first place.

Do psychotropic drugs have value? Absolutely. Do psychotropic drugs need ten different indications? I doubt it. I believe in proactive self-education and patients taking responsibility for their own mental health management. I don’t believe we should leaving it solely to healthcare professionals to make decisions for us. We can’t expect others to help us if they can’t access inside information on our overall health and mental state of mind. We must communicate this to our physicians, and be accountable for restoring our health as well.

Many illnesses - not just mental illness - are becoming more complex, because we live in a world of accelerating paces and increasing socioeconomic complexity. Unfortunately, as a society, we have become lazy. We often allow others to decide for us rather than remain an active partner in decision making that intimately affects our lives. After all, can’t we simply sue if someone did us wrong? We’ll let money take care of our pains.

My prescription - and one that gives the consumer the greatest chance of success at finding the right treatment for their mental illness - is for the consumer (and the loved ones/friends/family) to be as involved as they expect the doctors to be in their own mental health care. We all have to take responsibility and not give up our rights to that responsibility. But it is our burden to communicate this to the physician, who is doing the best he or she can.

© 2008 by Jane Chin, Ph.D. (email) All Rights Reserved.
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