Introduction "I want you to know what I know."
What Is It I Want You To Know?
Getting Rid of the Fears and the Anxieties about Mental Health Disorders and their Treatments!
How? First teach what is known, for knowing itself lessens suffering. Second treat based on individual needs and response.
Introduction to the series” I want you to know what I know.”
Mental Health Problems that Shouldn’t be Missed and their Treatments
The primary focus of this series is on common mental health problems, that should not be missed, because even in their mildest forms can cause a life time of needless suffering, because of causing distress and impairment. The suffering is unnecessary because these problems are easily diagnosed if you really know the basics, and because there are safe and adequate treatment that are readily available. Another reason they should not be missed is that most of these either start in childhood, sometimes infancy either as actual disorders or as traits, tendencies or symptoms, an when diagnosed and treated, at the earliest age , this offers the most hope for symptom relief, remission, and prevention of relapses and complications. Some of these problems are strongly biologically based and medication may be needed, perhaps essential, but should be used with appropriate education and psychosocial interventions. With less biological loading psychosocial interventions may be sufficient and may be the treatment of first choice. Among these treatments is using the psychology and techniques associated with mindfulness in and out of meditation, which I call applied clinical mindfulness. Mindfulness can help any mental health issues problems or not, and can by applied anywhere, by anybody at anytime. The greatest obstacles to recognizing these problems is fear and ignorance, fears of what it means to have certain mental health problems, and what treatment may entail especially the negative effects of medication. Ignorance the not knowing comes in on at least two levels, not knowing that certain traits, tendencies, symptoms, problems may be pointing to one of these problems, and secondly when you are aware of them not knowing what they mean as far as a diagnosis goes and what to do about them therapeutically especially when it comes to using medications. The goals of this series is to dispel these fears and the ignorance by teaching you what I know. As you begin to know what I know about these problems the unknowns will be made known and inaccurate information will be corrected. Special emphasis will be on using psychiatric medications. Modern psychiatric medications can be remarkable treatments. The right medication at the right dose for the right diagnoses, should be safe, effective, helping sometimes amazingly quickly with minimal to no side effects. These medications are often avoided because of concerns about what they will do to the person, will they change the person, control them, and do other strange and bad things. Properly prescribed for the right problems none of this should happen. A higher standard of care is needed when prescribing these medications so this does happen and when negative things happen it is recognized as soon as possible, and the medication adjusted and discontinued if necessary. I tell my patients the following and do whatever it takes to make sure this happens. On medicine you should be your normal self with symptom relief and now in control of your problem emotions and thoughts. Medications should not make one feel medicated, drugged, numbed, zombied out , high, low or control you. If this occurs either the diagnosis is wrong , or the medicine needs to be adjusted or stopped. One should not have to suffer through excessive negative effects to get the positive effects. The series “I want you to know what I know.” Is only a guide to help you understand, not a substitute for seeking help for yourself or others with qualified health care practitioners.
Above is the introduction more of a preamble to some of the articles in this series that summarizes some of my chief concerns, wishes and goals. I am inspired by all my patients from over the years, who have taught me what I needed to know to help others. I am motivated by a growing and increasing sensitivity to the unnecessary pain and suffering caused by these mental problems which are of an epidemic proportion. I have developed an intolerable impatience over the ignorance, the not knowing that is leading to this lack of adequate evaluation and treatment, especially when safe , quick and effective medication and other treatment should be readily available.
My hope is if you “know what I know” you will become an informed consumer of mental health services, knowing what if anything is wrong, and then know enough that you will have the choice to seek some treatment whether it is a medication approach, or a non “biological” approach such as applied mindfulness.
Applied mindfulness offers a non “biological” approach that can be leaned and applied by any one, any age, and any where that is needed to supplement medications or be treatment in itself. If nothing else its knowing teaches patience, persistence ,compassion and develops concentration, effort and mental endurance, all necessary characteristics and skills essential for successful evaluation and treatment.
I put “biological” in quotes because it is a false dichotomy the ideas of biology vs. non biology, nature vs. nurture, brain chemistry vs. mind. It not either or but always both. Medications representing the biology of brain chemistry do more than treat symptoms and problems they also have a direct and powerful effect on all aspects of mental functioning such as attitude, awareness, concentration, and emotional stability, thus the need a for higher degree knowledge and treatment in using mind altering medications and other substances. Psycho theraperutic interventions including applied mindfulness, representing the non ”biological”, have powerful biological effects on the brain.
Mindfulness changes brain chemistry as much as medications can affect the mind that uses and applies mindfulness. It takes judgment and time to know when the issues involved may be first approached with medication or with a non medication approach, depending on the urgency, seriousness and the biological loading of a problem. When I use “biological” I am referring to a significant brain chemistry biological loading that has both theoretical validity and specific medication responsiveness. This loading can also has a genetic basis thus runs in families.
Another false dichotomy is treatment focused on the individual or the more socially involving all “others” the family, loved ones, friends and others who have contact with the “patient”. Relationships effect the mind and the brain chemistry. The more the “others” know will also help in diagnosis and treatment. Simply everything is connected to everything and thus affects everything. Environment, the “others”, brain chemistry, the mind all are inter connected and help or hinder each other.
The principles, concepts and goal that are discussed for medication apply equally to psychotherapeutic treatments including applied mindfulness. I will be discussing practical clinical mental health diagnosis and medication treatment and management. In a sense I will attempt to do the same with mindfulness, a practical clinical mindfulness useful not only for mental health and its problems but also applicable to everyday living and its problems.
I want you to know what I know so that you are less afraid and have less anxiety about biologically based mental health problems, meaning having significant brain chemistry loading , their diagnoses and their treatments especially with medications. I want you to know what these problems are and what specific medication treatments can help.
There is needless pain and suffering, emotionally, mentally ,physically caused by unrecognized and improperly treated mental health problems. There is also because of this an extraordinarily excessive amount impairment, disability, directly from these problems , from psychosomatic complications, slow dying though drugs and alcohol, and death from accidents, homicide and suicide. Much of this is preventable with early diagnosis and treatment. Early means at the earliest age, many of these problems starting in earliest childhood, but are missed, and early in the course of these problems that tend to progress slowly and steadily but often episodically without treatment.
The episodic or wave like nature of mental functioning shows itself in the coming and going of mental health problems, some more than others, giving one the false impression they were “out grown” or “they gone now” or “it is just a phase”. This adds to the diagnostic confusion and therapeutic dilemmas. To treat or not to treat, and when to do it, and when to stop.
These “biological” loaded are very treatable mental health problems that are being missed, and they shouldn’t be. They are being missed because people don’t know they have a problem and if they suspect they or a love one has problem they are afraid to get an evaluation, and even more afraid of a possible diagnosis and treatment. Some of these problems aren’t missed but are misdiagnosed and improperly treated. Even when they are properly diagnosed they are not always adequately treated. Sometime when the right treatment is used the person stops the treatment, rightly so, because they have too many negative effects from the medication or not enough relief. Sometimes the medication is right, no negative effects but they stop the treatment early because nobody told them otherwise, and the symptoms come back, sometime worse with complications.
In those involved in psychosocial interventions they often don’t get the relief they should, and go one for years if not decades with needless impairment, distress and suffering, if only they really “knew” what was wrong and had some basic understanding of the biology or brain chemisty and applied mindfulness both diagnostically and for treatment assessment.
What sparked the concept of this series in me was the thought that if people could just know some of what I know about mental health problems and their treatments my job would be a lot easier and a lot more people would be taking advantage my services and similar services a lot sooner, and getting the help they need. Who are these people, they include potential patients and the “others”, their loved ones and their parents, and their teacher, and their friends, anyone who cares , including people who administer health care, and politicians who have to power to fund health care, and philanthropic people who want to help, all of these and others. If only they knew what I know, they could help themselves and others.
I have seen firsthand in over 35 years of practice as a physician who specializes in psychiatric medicine, evaluating children and adults, what early treatment can do and what further problems it can prevent. However if you are afraid or have inaccurate information you may not seek the help for yourself, your loved ones, or your children that can stop your emotional pain, offer you a better quality of life, and prevent the complications of untreated mental health problems.
Fear is when you know what it is your afraid of, anxiety is fear of the unknown. Anxiety is also a clinical symptom associated with worry. I want to help you with both fear and anxiety, by giving you the information you need, making the unknown known, and correcting misinformation about mental health problems and their treatments. Applied mindfulness in itself will reduce fear and anxiety if you practice it, as it helps you “know” what is wrong, and evaluating if it getting better or worse.
If you only did one thing mindfulness applied to breathing in and out of meditation much if not most of what you essentially need to know about your mind and mental functioning, good and bad, healthy and not healthy [more conceptual dichotomies that are not always in our best interest to hold on to], would eventually come up and would be changed and helped.
Anything experienced with mindfulness is helped, painful things become associated with less suffering, the pleasurable become more satisfying, and what seems neutral becomes more interesting and less boring.
Another issue is the stigma of having mental health problems and getting treatment. Stigma means something has a sign of social unacceptability. Why is this for mental health problems? There are at least four reasons.
[1.] Part of this is based on the fact that many people don’t see these problems as biologically based, but some sort of course, bad luck, caused by their own doings, and something to be ashamed and guilty about.
[2.] Some of this shame and guilt is based on the very nature of the problems that cause shame and guilt, and make one feel cursed, unlucky and caused by their self induced bad feelings, thoughts and behaviors. A good example is generalized anxiety, the common cold of psychiatry. Any significant anxiety disorder that if allowed to progress will eventually turn into a depressive process, whose very symptoms are the same as the stigma, shame, guilt, negativity, it is all my fault, haplessness, why am I so unlucky and why is this happening to me?
[3.] Another reason for the stigma is the enigma surrounding mental health disorders and treatment. Enigma means something in not easy to understand or interpret, having the quality of mystery and ambiguity. There is still much that is not know, and is truly puzzling and enigmatic, but there is so much that is known and needs to be shared so that people who need the help will not be afraid and anxious.
[4.] The stigma exist also because of wrong diagnosis and treatment, with people having improper evaluation leading to the wrong medication or other intervention, for the wrong problem, sometimes medication isn’t even indicated, and the medication causing more bad than good. Doing more harm than good to the most precious and important organ system , and its executive the mind. The medication or other treatment either is not helping the pain and suffering or making it worse, or adding new unwanted problems to the mind and its functioning.
Looking and considering these issues, Any wonder why there is a stigma?
Because of the very special nature of the mind, the health care practitioner who does dealing with the mind has to be held to a higher standard of care when it comes to evaluation and treatment, to be very careful, that the first dictum of medicine “primum non nocere”, first of all do no harm , is followed. Following this principle and not adding insult to injury would go far in reducing the stigma.
The word doctor come from the Latin to teach, the first duty of a physician is to teach and I want to teach you, and I want you to teach others. Secondly the physician should do no harm, and when we do treat we should treat as if we were treating our selves , wanting no harm, no negative effects if possible from our medications and other treatment or at least minimal negative effects with maximum good effects. Then to treat adequately, that is for sufficient length of time to be symptom free, prevent relapses and complications, with the end point at least when it comes to the mind and mental health of being back to ones old self, but better, with the hope of getting off the medication treatment if I could.
Lastly because of the complexity, uniqueness and wave like episodic nature of mental functioning, development, and its representation in brain chemistry any treatment or intervention must be highly individualized, and be based on responses, which may require multilple treatments and medication trials.
This is what I would want for me, nothing less, and that is what I want for you, or someone you may know who has these biologically based and sometime very treatable mental health problems. And it all starts with beginning to know what I know.
This is not a text book or a diagnostic or treatment manual. I am sharing with you some concepts, ideas, processes and things I do in my daily practice that might be helpful. What I am writing about is the problems I deal with , how I evaluate them, and what treatments especially medication treatments and applied mindfulness, at least the way I do it that can be helpful. This is meant to be a guide, to help you know and understand, and not a substitute from seeking further information and help from qualified health care professionals.