Allan Schwartz, LCSW, Ph.D. was in private practice for more than thirty years. He is a Licensed Clinical Social Worker in the states ...Read More
We live with diagnoses all the time. A sore throat and fever brings you to the MD and you learn you have a strep infection. Two weeks of antibiotics and you are well again. That’s an easy one to deal with. However, if you find a lump in your breast, go to the MD and learn you have a tumor its the beginning of a long period of great anxiety and foreboding as you and your family contemplate the possibility of death. That’s a profoundly and life changing diagnosis.
What if your diagnosis is mental illness? Perhaps its major depression, phobia, general anxiety disorder, personality disorder, bipolar disorder I or II, or schizophrenia? This can bring a whole host of different problems.
1. A man refuses to take mood stabilizing drugs because to do so means that he has a Bipolar Disorder. Its just too awful for him to contemplate. In his mind, the medication defines the illness. He also fears that a psychiatric disorder could compromise his work with the military.
2. A female psychotherapy patient refuses the psychiatrist’s diagnosis of Major Depression. She insists she is not “crazy.”
3. A man in this thirties refuses medication or psychotherapy for ADHD even though he was diagnosed when he was a child. His parents were opposed to the diagnosis then and he fears they will be opposed now, even though he is adult and has his own family.
4. After repeated hospitalizations for decompensation and being a danger to himself and others, the patient continues to deny having schizophrenia and immediately goes off his medication after being discharged from the hospital.
While these are disguised and fictionalized cases they represent the types of feelings people experience when they receive their diagnosis. Denial thinking often determines whether or not a person will accept any.
Why is it so difficult to accept a diagnosis?
1. For some people a behavior disorder is ego dystonic and for others its ego syntonic.
When a behavior disorder is ego dystonic symptoms are experienced as emotionally painful. For instance, obsessive compulsive behaviors and thoughts are repetitive. The individual wants to stop them but is unable to. This self awareness brings the individual to psychotherapy because they want to get rid a disorder that clouds thinking that interferes with daily functioning.
When a behavior disorder is ego syntonic an individual is unaware of their symptoms. Often, it takes a long time for a person with paranoid schizophrenia to accept the fact of their disorder. For some of these patients hallucinations and delusions are real. When asked, this individual denies “hearing voices” because they are real. They deny that their thinking is paranoid because they are convinced others are out to kill them.
Another example of a disorder being ego syntonic is when someone with an obsessive personality disorder is unaware that both their devotion to minutia and rigid thinking prevent them from getting ahead at work. They cannot complete their assignments because they get stuck on meaningless detail. As the old saying goes, “they do not see the forest but only the trees.”
It is very difficult to get someone whose symptoms are ego syntonic into psychotherapy. After all, from their viewpoint, nothing is wrong.
2. Mental illness continues to be stigmatized. Their are fears of being judged by others and the self. Receiving a psychiatric diagnosis can produce feelings of shame and humiliation. I have known those who, despite feeling depressed, refused anti depressant medication because of the fear of rejection. In these cases, it is difficult to go to psychotherapy sessions because they may be seen by friends who might ridicule them.
3. There are those for whom behavior disorders are a sign of weakness. As I have often heard people say, “Anyone should be able to solve their problems.” It’s been my experience that men have a particularly difficult time with this. There is a deeply held American value that a man should be self sufficient and independent. That means its important to not need anyone.
For those who are not in denial and experience their behavioral and emotional problems as painful, there is a willingness to seek a psychiatric or psychological consultation and accept treatment.
For those who are in denial it is often family and friends who convince them to seek help. However, it is not until denial ends that they will stay in treatment and get the help they need.
Family and friends need to use gentle persuasion to convince someone to seek help. In doing this, awareness of how difficult it is for the loved one to admit there is a problem is important. It is important to be patient, sensitive and understanding with the loved one.
Of course, there are those emergency situations where a person may be hospitalized against their will, such as when they are suicidal or homicidal. The need to protect the individual as well as others takes precedent over anything else. In these situations it is often necessary to call 911 for help.
It is important to point out that there are those people who react to a diagnosis with a sense of relief and even gratefullness to the doctor. Some people suffer emotional problems a good part of their lives, are diagnosed and take medication go to psychotherapy but experience a temporary sense of relief before suggering returns. Among these patients there are those who are treatment resistant for physiological reasons that are not well understood.
However, there are those patients whose diagnosis was inaccurate for a variety of reasons having nothing to do with incompetence on the part of psychologists and psychiatrists. For example, there is more known about Bipolar Disorder today than was known twenty to thirty years ago. Now, we are aware of Bipolar I and Bipolar Disorder II as well as A Typical Bipolar Disorder. For some people who show what seems to be treatment resistant depression actually have A Typical Bipolar Disorder. A Typical Bipolar Disorder often results in deep depression without mood swings. The correct mood stabilizing medication, such as Lamictal, relieves the deep depression experienced prior to this.
Is any of this familiar to you? Your comments and opinions are encouraged.
Allan N. Schwartz, PhD