Saturday, October 13, 2007

Let Me Tell You About My Illness

So I'm standing at an event, drink in my hand. It's a work thing. I ask the gentleman next to me, "What's new?" I don't know what I expected, but there was another man next to us, someone I didn't know, and the answer I got wasn't quite what I was expecting.

"My psychoanalyst released me." Okay, I didn't know you had a psychoanalyst and I didn't know it was up for discussion, but fine, we talked about his therapy for a few moments and moved on.

It happened years ago, but I brought it up because in the comment section of some of our posts, people have brought up the issue of feeling stigmatized and discriminated against when they've talked about their mental illnesses.

I'm never sure what to make of this. I know many people who are so very successful and who suffer either quietly or rather openly from psychiatric disorders. People seem to have their own valence for privacy needs. As a med student, a professor I barely knew told me about his anti-depressant use-- he was very matter-of-fact about it. And perhaps it's because I'm a psychiatrist, but in my personal life people mention all the time that they're taking such-and-such a med or seeing so-and-so for therapy. Okay, you say, it's because I'm a shrink, but I'll tell you that they aren't always quiet about it. One friend, a well-respected physician, told me the details of his entire family's psychiatric issues while we watched an event at our kids' school. He had a rather large audience for his story and I don't think he cared. In case you missed it, Dr. X takes Celexa and is in both individual and couples' therapy. I could fill a blog with these stories.

Okay, so what about my patients? Some of them are pretty quiet about their illnesses or issues, though most tell their family members. Others are rather vocal about their issues. Does it hurt them? Do people run the other way, do jobs get lost, are they treated poorly? From what I can tell, if someone has friends when they are well, if they have a job when they're well, people are understanding.

I don't give advice on this issue: do what you're comfortable with. If someone thinks the information might be used against them, they should keep quiet about their psychiatric disorders and treatment. Obviously, there are venues in which privacy isn't a legal option-- you can't omit your treatment with medications if you're a pilot or astronaut, and the list goes on....

Here are a few factors that I think play a part in how the fact of mental illness is received by another party.

-- The other person's own experiences with psychiatric disorder. Some of my patients seem to be magnets for people with their disorders. When they tell others about their diagnosis, they aren't shunned, instead they are embraced by people who are relieved to have found someone to unload their secrets on, someone who has been there themselves. If the other person's only experience with mental illness, however, is the psychotic person who shot their mother, well.....

-- The delivery. If the person with the problem is nonchalant about it, it's a less of an issue than if they're confiding their deepest darkest secret. Of course, confiding one's deepest, darkest secret has its place, too.

--The bizarreness of the symptoms. Most people have some understanding of sadness or anxiety and can extrapolate this to a severity worthy of a diagnosis. Symptoms which are difficult for most people to relate to are more likely to get raised eyebrows. I'll hold off on examples here, but feel free to let your imagination run wild. Which leads us to....

--How much the patient's symptoms interfere with other people's lives. And for how long. So a declaration that "I have panic attacks" might be met differently by one's boss than, "I had a manic episode last week during which time I stole $40,000 from the till and spent it on a non-returnable artist's rendition of a bird's nest. " Some people suffer silently, others have symptoms that effect others profoundly.

-- Who the patient is when they're well . If a person with a psychiatric disorder is liked and respected when they're well, people are more likely to be sympathetic to diversions from their usual state, especially if they return to wellness and being that likable person.

--Any way you dice it, people are more sympathetic about Axis I disorders than they are about personality disorders.

Bottom of the fifth, Red Sox are losing 5-3.