#137: For all of Mental Health Month we’ll be discussing the everyday use of words that correspond to mental health symptoms and disorders. This week we’re talking about words related to ADHD and eating disorders.
That was such a nice discussion! It gave me a lot to think on and I’m so glad we have the forum for this.
Ali, I got your back, I have heard multiple times the analogy of depression as a “common cold” even used by mental health professionals which is weird every time I hear it. I’ve also heard of Dysthimia as a “common cold” version of depression, which isn’t a good analogy because although dysthimia is a blunted version of depression, it is a chronic process that you don’t really rcover from on your own like you would a common cold.
Also, I want to thank Ali for bringing up the way depression is conceptualized by the pharmaceutical industry as well as a lot of psychiatrists and biopsychologists I have met. The idea that depression is a chemical imbalance in the brain is an outdated idea. I’ve seen many professionals use it with their patients simply because it is the simplest way of explaining and justifying pharmacological treatment. It’s easy to say “Your brain is low on Serotonin so take this SSRI and the levels will be higher and you will feel better.” It is much more complex to say “You have a vast variety of neural complexes, genetic and epigenetic factors, and biological response mechanisms that regulate your behavior and thoughts. Most of these were molded by events that have happened in your life and your reaction to them, as well as your cultural upbringing and your physical health. Many of the symptoms characteristic of depression involve serotonergic neurons which account for your SIG-E-CAPS… Taking medication will not heal those bad circuits, it will not solve your ingrained issues, but it will make it so your depression does not impair your ability to be introspective and sort your issues with a therapist.” Most people have a bias against mental health, and on top of that have a bias against medication as it is seen as “taking the easy way out” or “treating the symptom and not the disease”. So some specialists feel its necessary to portray a false interpretation of how things work in order for patients to readily accept treatment. Patients are more likely to accept meds if you tell them the meds will fix the problem in your brain at its source. This narrative does more damage than good. I think I’m going to post a link to this article written by a psychiatrist on how psychotherapy is the biological treatment for some mental illnesses, because it addresses the mechanism from which these problems tend to surface.
Josue mentioned how the word Neurotic is still used an how it’s an archaic term. The psychiatric community discarded the concept of Neurosis on the release of the DSM III. Previously you could divide mental illness in two categories. You were either psychotic, which means you were out of touch with reality (a concept we still use in the field) or neurotic, meaning that you were connected with reality but your nerves were hyper-sensitized to specific experiences. Neurotic diseases included anxiety, depression, OCD ect. It’s interesting how nerves, was used interchangeably with nervous system or brain. That’s why we still say we feel nervous, implying that our nerves are sensitive and we might react to things erratically. Even to this day, in the DSM there is a culture bound syndrome known as ataque de nervios (AKA Puerto Rican syndrome, which stands from Attack of the nerves or nervous attack) and it is a diagnosis that is separate but similar to panic disorder.
Lastly, I love how you guys addressed how depression could be an expression of an exaggerated healthy reaction and how you used Inside Out as an example. Indeed most mental illnesses can be conceptualized as excessive expressions of forms of self preservation, wether it be introspection in depression, sympathetic response in anxiety, perception in psychosis or prevention of withdrawal in substance use.
…I just wanted to say I got so excited when you mentioned ataque de nervios, because we actually talked about it in one of my classes! It makes sense that you know what it is, since you’re from Puerto Rico, but out here in California it’s not something we talk about. I think it was in a cultural competency unit in psychopathology.
To be honest I didn’t learn it in medschool or by actually seeing a patient with the diagnosis. I learned it because I had to give a presentation on Panic disorder once and I wanted to add a few slides on the historical background and i stumbled upon the cultural syndromes. However ataque de nervios is a a very common term used casually amongst the more traditional or rural dialects of puerto rico. I didn’t know it had a legitimized use in the DSM.
I’ve definitely read more than one news article referring to depression as “the common cold of mental health.” You’re not the only one to hear that phrase used, Ali.
I have a diagnosis of Major Depression, which I got from my therapist a couple (ish) years ago, but I’ve had pretty much my entire life. I refer to myself as “depressed” when I notice myself feeling and/or behaving the way I know I do when I’m having an episode, regardless of severity or symptoms. So, I might use “I’m depressed” to refer to feeling sad or down, but it just depends on what my depression happens to bring.
Usually, I just say “I’m not feeling well.” If further explanation is needed, I might say, “I’m having a depressive episode.” Or, if they’re a millennial, I’ll tell them I’ve got a dementor sucking on my soul and hope they get the Harry Potter reference, haha.
Thank GT Radio for an excellent episode! Very insightful look at depression, its meaning, and how it can present differently.
It’s even pushed me to reexamine my current mental health because for the past few months I’ve definitely had “I’m not depressed enough to be depressed” running through my head. It hadn’t occurred to me that depression can manifest itself in various ways or that worrying about not being depressed enough can be telling on its own.
@Gianminni
I appreciate your 2nd point! In my experience general practitioners cut straight to medication to help rather than suggesting a therapist or an expert to talk to instead/as well. I would like to read the article that you are referring.
I opened a separate thread for discussion on the mental health category.
On of the main issues with general practitioners is that unless you work in a hospital you have to go out of your way to implement interproffesionalism in your practice. In medschool we are not taught to consider all specialities and how it might be helpful to implement them in your practice. We are not taught to begin networking when we establish our own private practice and learn what good psychs are in the area, nutritionists, labs, ect. So in the end its up to general practitioners to have the insight of thinking that maybe it would be useful for the patient to see a psych.
Furthermore from a medical standpoint the weight of therapy is always on the doctor so when someone comes by with depression the logical assumption is that the best thing I can do for my patient is deal out a prescription without reffering for additional services. Also some other physicians dont have a list of psychologists that work in the area. So when patients come asking for help they sometimes just mention the possibility of seeing a psych instead of orienting patients on where and how they can have access to those services.
The issue I see is that doctors assume that the patient has a depressive disorder without a proper diagnosis. I can’t get new glasses with the same prescription I got three years ago but I can tell my family doctor that I’m depressed and have pills in an hour.
I had a mentor who is a family practitioner, I remember talking about a patient who was had been struggling with smoking cessation after having an osteoporotic fracture(smoking is a risk factor). He straight out told me he was going to prescribe antidepressants. I was taken aback and I asked what criteria she showed and he responded: “You just know when somebody is depressed, I can do a psychiatrist’s job better than a psychiatrist. If someone is depressed they are just depressed, there’s no need to go around it.”
I remember how much I just wanted to say something, but I also saw how annoyed he was with the conversation and he was going to evaluate me at the end for proffesionalism. What adds insult to injury is that he knew I wanted to be in psych.
I’m kidding. I was giving Ali a hard time on the show but I’ve heard it too.