Mental health and mental illness are the responsibility of a wide range of professional groups. Mental illness is a combination of psychological, biological and social factors, and the days when psychiatrists assumed a paternalistic role, steering people towards treatment has changed. Family members and professionals play an important partnership role with individuals experiencing mental distress. The aim is to help individuals as much as possible achieve a measure of control and mastery over their situation. For effective mental health care to be delivered, it is crucial that professionals are not hampered by prejudiced attitudes. It is important to examine our own attitudes and to consider how these might affect our clinical practice.
At the moment there are no tests for mental illnesses. They cannot be diagnosed by checking the blood or body fluids of the person experiencing the symptoms. A diagnosis will usually be made by an experienced psychiatrist in conjunction with other professionals. A full medical history should be taken and information about recent changes in the person’s life should be obtained from family and/or friends. It is important for the psychiatrist to eliminate other possible medical causes because some symptoms of mental distress, such as hallucinations, can also appear in other medical conditions. The symptomology given by the patient may influence the diagnosis given. Patients can overplay or underplay symptomology and this can lead to misdiagnosis. Louise Pembroke is a case in point; “I was talking to them about eating and throwing up, so I started off with an eating disorder label. When I started talking about an exorcist, they were not too sure. Then I made the mistake of telling my consultant about Fred and the snakes………and he labelled me as a schizophrenic” (quoted in the Anthology, Pembroke, page 170-172).
A professional may have to consider the impact of their life experience in relation to the revelation of personal accounts of distress. A passage in the Anthology (‘I Suffered from depression’ by a psychiatric nurse page 35-38) quotes “I regularly came into contact with many individuals suffering from depression. However in retrospect, I realise that I was totally oblivious to and ignorant of what these people, deep down were actually experiencing”. Because of the positive and negative therapeutic insights gained by mental health professionals who have either personal or family experience of mental distress, an ongoing evaluation of ones practice must be balanced with careful introspection. Therapeutic insights that might be gained from these experiences include letting go of the shame, remembering particular strengths, knowing when you have regressed, learning when to get support and learning to appreciate your talents as a mental health professional.
Mental distress is one of the least understood conditions in society. Because of this, many people face prejudice and discrimination in their everyday lives. Most people can leave productive and fulfilling lives with appropriate treatment and support. Treatments for mental distress take many different forms, including medication, psychotherapy, complimentary therapies, diet and exercise and self-help strategies. What works for one individual may not work for another. Some treatments work best in combination and sometimes an individual may prefer different treatments at different points in their life.
If we look at Lorraine (K257, module 1, section 4, page 32) there is the suggestion that she could be suffering from depression. It may be that both the psychologist and psychiatrist would agree on the diagnosis, however, the treatment prescribed would be very different. A psychiatrist would probably prescribe a drug-based treatment whereas a psychologist would prescribe individual or group therapy, looking at the cause of the depression and helping Lorraine to help herself.
“My solution is right yours is wrong” is a common scenario that has been playing out in the mental health field between psychiatrists and psychologists for most of the last century. Psychiatry is a branch of medicine and ordinarily assumes that the chemical and physical makeup of the neurones, hormones and brain control the behaviour. However, psychologists generally assume that an individual’s behaviour is a reaction to an experience either real or perceived. This is highlighted in the case of Steven (K257, module 1, section 6, page 52) the 2 psychiatrists broadly agree on the diagnosis of schizophrenia, whereas the psychologist and psychotherapist both believe that Stevens’s behaviour may have some other origin, i.e. Family dynamics, unemployment and that medicating Steven would not be the answer.
Initially when a person realises that they have been identified as having a mental health problem and are therefore different to others, a sense of loss of one’s normality often follows. This can feel very threatening and a real sense of social failure and despair can set in. Some people who have received a mental illness diagnosis welcome a medical definition of their problems. Richard Jameson (Anthology, Jameson, page 54-55) talks about the relief that medication brought him. Others like Viv Ludlow (Anthology, Ludlow, page 186-190) resent being treated in a medicalised way and feel that their problems are made worse by the treatment they receive.
To summarise, a mental health problem only becomes a serious problem when it interferes with the ability to cope or function on a day-to-day basis or when the behaviour becomes a concern for others. However, while mental distress can lead to considerable disruption and difficulty in people’s lives, many find ways of managing their problems and are able to lead fulfilling and active lives
Use of the term mental illness may be misleading if it is taken to imply that all mental health problems are solely caused by medical or biological factors. In fact, most mental health problems result from a complex interaction of biological, social and personal factors. Reaching a diagnosis of mental distress can be difficult and it takes time to be sure that the individual’s symptoms truly indicate a particular mental illness. The typically highly structured nature of assessment may restrict the information the patient provides. However, the practitioner may unwittingly engage in sense-making and interpretation in order to appease conflicting pieces of information given by the patient.
Family and friends can and should be involved, as they will be aware of details of family intimacies, cultural differences and religious beliefs. For some people, drugs and other medical treatments are helpful, but for others they are not. Medical treatment may only be a part of what helps recovery, and not necessarily the main part. Seeing someone’s problems solely as an illness that requires medical treatment is far too narrow a view. It discourages people from thinking about the many different influences on someone’s life, on their own thoughts, feelings and behaviour, which can cause mental distress. It may also prevent people from exploring the psychological treatment options that are available.
One of the most persistent complaints among service users is that professionals never listen (quoted Anthology, Ludlow, page 186-190. What people who suffer with mental distress want is a choice of good quality options. Choice, empowerment and control over a person’s life are very important to good outcomes in mental health. However, it needs to recognise that too much choice can overwhelm people, particularly when they are unwell. One way to improve the situation is to enable professionals to empathise, to put themselves in the place of the other person.
Mental health professionals who have personal or family experience with mental distress may bring a bias or suffer from counter transference, however, these individuals bring to work a unique perspective that is born from shared suffering and shared hope.
BIBLIGORAPHY
Hinsie, J & Campbell, R (1970), Psychiatric Dictionary, 4th Edition, New York; Oxford University Press
Kraepelin, E et al(1883), Lehrbuchder Psychiatrie (1883, 8th Edition 1915), Clinical Psychology
Read, J & Reynolds, J (1996) Speaking Our Minds: An Anthology, Open University Press
K257 Course Team (1997) Section 1: What is Mental Health, in The contested Nature of Mental Health, Module 1 of K257 Mental Health & Distress
K257 Course Team (1997) Section 4: Frameworks for Understanding, in The contested Nature of Mental Health, Module 1 of K257 Mental Health & Distress
K257 Course Team (1997) Section 6: Policing the Dividing Line, in The contested Nature of Mental Health, Module 1 of K257 Mental Health & Distress
