Doctor, I Know You’re Rushed, But Patients Need Reassurance


Last week, I had a patient tell me that she had been in mental health treatment for 30 years, and no one had ever told her her diagnosis. She is a smart lady, and knew that the medication she was taking was an antidepressant, so she assumed she was being treated for depression. With a little information she had seen on the internet, she concluded that having depression meant that she was unable to live a normal life. She thought that she must be quite impaired because of the dosage of medication she was prescribed, which she knew to be on the high end. Her previous provider never challenged those assumptions, and, in fact, never talked much about the patient’s perspective at all.

I also heard a teen say that when she experienced her first episode of depression after the death of a grandparent, she was told that she had a mental “disability” and would need to take medication for the rest of her life. She had been trying to convince herself to give up on her dreams since hearing that prognosis.

What we tell (or fail to tell) people about their mental health condition alters the course of their condition. People look to healthcare providers for explanations and interpretations of the facts. We often don’t give patients much explanation, or talk about what they think their diagnosis means. Believing one is disabled or seriously impaired is likely to prevent them from trying to live a full life.

Leaving patients to Google their diagnosis for information is no substitute for hearing the opinion of their treating doctor. Who knows what information they may find? And when we do educate, we need to remember to include the bet case scenario, not just the worst. Neither of the patients referenced above were disabled or impaired. Both were responding well to treatment, and could be expected to live normal lives. They might even be expected to thrive. They both will benefit from hearing that in their future care.

And telling teenagers with stressor induced depression to expect a life of disability is just giving out bad information. Complicated grief can cause a single episode of depression, and some people only have one bout of depression.

I know time is limited, but I think we in the health professions can do better. We are burdened by administrative concerns, but we need to take a few moments to connect with our patients and give them accurate information, and reassurance.


Sept 3o

STUCK in the Sick Role: How Illness Becomes an Identity

Posted on September 25, 2017 .

5 Reasons You Need Psychosocial Rehab After a Mental Health Crisis


In mental health care, the focus is too often on managing symptoms, but not frequently enough on getting back to normal life. But mental health care needs to adopt a rehabilitation mindset, so we can restore people to health, not simply manage symptoms of illness. 

Here are 5 reasons rehabilitation is necessary after a mental health crisis:

1.     If You Wait to Until You Feel Comfortable to Return to Normal Life, You May Never Start

After a serious or disabling mental health crisis, returning to normal can feel overwhelming. It can seem like you have to take on everything at once. You need to get back to work, get back to school, pay your own bills, shop, clean, take care of your pets, and even tend your hygiene again. It all feels like too much to take on.

2.     Your Confidence is Shot

You’ve been through the ringer, and you’re left feeling incapable. “Am I a screw-up? Am I the source of the problem?” You tell yourself, “Maybe I can’t do this at all. 

3.     You’re Out of Practice

All those daunting things you need to start doing again, you feel like you’ve forgotten how to do them. It seems like forever since you were running your life successfully. Can you even remember how?

4.     You Feel Lost

There are so many pieces of life to get back on track, it’s hard to know where to start or what is most important.

5.     Because Restoring You to Health is About More Than Symptoms Management

Most of your mental health care plan has focused on getting rid of symptoms, but now it’s time to help you truly get back on your feet.


STUCK in the Sick Role: How Illness Becomes an Identity

Posted on September 18, 2017 .

Is It Possible To Advocate For More Mental Healthcare And Less At The Same Time?


Is it possible to advocate for more mental healthcare and less at the same time?

Mental health awareness and mental health advocates contend that we need more mental health care for those in need. One in four people suffer with a mental health condition, and one in five children. Anyone who would argue against the need for more is “anti.”

We need more mental healthcare resources and services. More places people can go to get help in a crisis. More and better treatments, delivered with expertise and compassion. More services for impoverished people with lack of access to care. More care for the severely ill who too frequently cannot obtain the treatments they need. More services to keep the mentally ill out of jail and more support services to prop up those with debilitating diseases to stay on their medications and out of hospitals.

But I think we also need less mental healthcare.

We need less mental health intervention for the normal-yet-squirmy kindergarten boy. Less mental healthcare for the tumultuous seventh grader with big feelings and a bad attitude. Less for the twenty-something whose plans didn't work out. Less medical treatment for the young person coping with a break-up. We need less use of antipsychotics in routine depression care, and fewer advertisements for these treatments via TV commercials.

We need to prevent suicide without medicating everyone. We need to recognize the serious signs without overreacting to the mild ones.

We need more mental health care for the sickest folks, and less for the worried well.

Why? Because we’re raising awareness and getting more and more people into psychiatric treatment, but too often they are the wrong people. The ones with the greatest need are still overlooked and underserved. And then there is harm to both groups.



STUCK in the Sick Role: How Illness Becomes an Identity

Posted on September 11, 2017 .

8 Problems in Teens and Young Adults That Mimic a Mental Health Condition, But Aren’t


Big feelings and big changes are the hallmarks of the teen and young adult years. With so much changing, the road often gets bumpy. No wonder the normal course of development from kid to adult can get rocky, and even appear dysfunctional from time to time.


1.     Staying up half the night can look like a sleep disorder.

However- Teens and twenty-somethings routinely experience sleep phase delay. This means their brains prefer to stay up until 2am and sleep until noon. It’s common, and corrects with age in most cases.

2.     Intense Moods can appear to be depression or bipolar disorder symptoms.

However- With the all the brain changes and social adaptation that occurs during these years, normal mood changes can become pretty dramatic. Moods get intense during the teen years, and sometimes that’s normal.

3.     Fear and Worry about new experiences can emulate an anxiety disorder.

However- With so many new experiences in these years, it’s common to feel overwhelmed from time to time. Anxiety is common with big life transitions, and that’s not always a sign of big trouble.

4.     Poor self-direction/motivation can be mistaken for A.D.D. or even depression.

However- Many teens are not highly motivated. We want our teen and young adult children to have a sense of impassioned motivation, but that’s often not the case. For many, motivation develops slowly through the young adult years.

5.     Unwise choices can look like personality disorders, or bipolar disorder.

However- Young people learn through experience, and the lack of experience may lead them to some problematic choices. Being questionable choice-makers is often simply part of being young.

6.     Substance experimentation can look like addiction, or the substances themselves can create symptoms such as mood changes or psychosis.

However- Experimenting with substances often begins in the teen and young adult years. Substance use is not always addictive, especially when early intervention and guidance steer young people away from continued use.

7.     Impulsive action can appear like serious mood or personality dysfunction.

However- Young people may make quick decisions, when more thought would have been advisable. This is common, and levels off with maturity.

8.     Inaccurate assumptions can look like poor judgment, a sign of mental illness.

However- Youthful exuberance and lack of experience can lead to making wrong assumptions, and then acting on wrong information. Experience is the answer for improved judgment.


STUCK in the Sick Role: How Illness Becomes an Identity

Posted on September 4, 2017 .