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Similarities exist between helping people manage mental illness and other chronic medical conditions, such as high blood pressure, or Type 2 diabetes. Nevertheless, psychiatry is different to other medical specialties. One reason for this is that patients’ intentions and progress tend to be less concretely defined. In the case of hypertension for example, reducing one’s blood pressure to 130/80 is a tangible target. In the context of advanced Type 2 diabetes, making lifestyle changes to avoid losing one’s foot is a specific goal.
With diseases like anxiety, depression, bipolar disorder, or schizophrenia, however, treatment is less black and white. Medication often plays a significant role. Nonetheless, as with all drugs there are side effects, and compliance is a common issue. For the most part, it’s a question of helping people maintain their optimal level of functioning, and major improvements are relatively rare in the field of mental health. Assessing suicide risk is another important consideration in psychiatry. Often, all I do is listen. Most psychiatric patients don’t progress the way ‘getting better’ is traditionally defined and measured. Huge accomplishments are somebody saying, ‘Do you remember suggesting making a list and crossing things off as I got them done? That changed my life.’ Or, someone with a long history of recurrent hospital admissions, because of repeated suicide attempts, who hasn’t been admitted for a year. Sometimes, it’s as though people find themselves in a fog. Over time, usually after several years in fact, trust and rapport are established. Eventually, there might be an opening in that fog, which we try to seize. “Don’t use your influence until you have it” has been invaluable advice thus far.
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A town of about 20,000, Collingwood, Ont. is fairly small. By comparison, Toronto—the closest, large, metropolitan city—has a population of nearly three million.
Community hospitals like Collingwood’s have many advantages. They’re relatively small, which may make them less intimidating. There’s also a sense of community. In fact, small, local hospitals can even feel friendly. However, unique challenges exist too. One of these is privacy and patient confidentiality. In Toronto, or New York City for example, it’s common to care for people and never see them again. Or, if one’s paths do cross at a later date outside the hospital setting, it’s likely that patients and care providers won’t recognize each other. With such a small population, it’s different in Collingwood. This makes protecting patients’ privacy and confidentiality that much more challenging in certain situations. For example, I often run into patients in the community, including at the grocery store, the pharmacy, the gym, or the local coffee shop and we recognize each other. This can make it difficult to separate one’s personal and professional life, because encounters like this commonly happen several times a week, or maybe even more than once a day. It’s obviously not appropriate to ignore one’s patients in the community. Nor is it proper to blur the professional line and be too friendly. Nonetheless, despite its challenges, working and living in the same small community is a privilege that’s also rewarding. Perhaps it comes down to striking a balance between being a professional, yet, at the same time, a caring, compassionate human being in the hospital, as well as in one’s community. The statement “mental illness is like any other illness” has largely become an accepted truth. This implies that mental disorders, like other medical conditions, all have biological origins.
Aside from mental health complications, because of neurological illnesses, medical conditions like Type 2 diabetes do not typically alter one’s core self significantly. However, mental disorders do by occurrences that change one’s thinking, perception and consciousness of the self, others and the world. Neuroscience advancements have taught us that several mental illnesses develop as a result of underlying biological differences. Yet, many of the behaviours and experiences that form mental disorders’ core presentations still can’t be explained by neurobiology. Even if this changes in the future, it will still be necessary to understand the experiences of people with mental illness psychologically. Likening mental disorders to medical conditions confines them to an organ, namely the brain, within one’s biology, but fails to recognize their uniqueness in terms of how they affect the self. This can’t be justified based on our current understanding, nor does it adequately serve patients, or the general public. Equating mental illnesses with medical conditions can be helpful clinically, particularly in the context of acute crises where medication often plays an essential role. This can become problematic later, however, because it often compromises compliance with crucial psychological and social treatments. The statement “mental illness is like any other medical illness” is, at its best, an over simplification of a complex human problem and, at its worst, harming patients, families and the field of mental health. Instead, this conversation needs to integrate the complexities of human thinking, behaviour and memories, including the ideas of the self and consciousness. |
AuthorDr. Clea Machold Archives
March 2016
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