I wish treating mental illness could be like taking an aspirin for a headache or an antibiotic for an infection. Unfortunately, it is not that simple. To the ordinary individual, treating mental illness seems more like a roll of the dice because there are no specific tests available to diagnose mental disorders. An acquaintance of mine often says, “Mental health is an art, not a science.”
Matthew Standford, PhD, nationally known researcher and speaker on aggressive and impulsive behavior, would disagree. He states that, while there is no scientific test such as a mental blood test that determines (for instance) that depression exists, mental health professionals do use scientific principles when they diagnose patients. Stanford acknowledges, however, that an accurate evaluation depends on the expertise of the attending provider.
Here is what Stanford writes: “Mental disorders and traditional medical diseases are diagnosed in a very similar manner, using a set of scientifically derived symptoms or criteria. Blood tests and brain scans are often used to rule out potential causes of mental illness (e.g., infection, brain tumor, epilepsy). Psychiatry and psychology aren’t voodoo; they are science. And science insists on verifiable data. That being said, even science can be abused and misused, so the accuracy of the diagnosis will always be contingent on the quality and training of the mental health care provider.” [Matthew S. Standford, Ph.D., Grace for the Afflicted (Paternoster Publishing, Colorado Springs, CO, 2008) 64.]
A psychiatrist must first sort through a long list of symptoms and behaviors to identify the illness, experiment with medications, and then carefully monitor the patient for months or years. Complicating the issue of reaching a correct diagnosis is the fact that the same behaviors and symptoms can be present in a variety of mental illnesses. For example, in the manic phase of bipolar disorder, the patient might experience hallucinations similar to a patient with schizophrenia. Or, a person who is clinically depressed might have similar symptoms as in the depressive stage of patient suffering from bipolar. In addition, everyone has a unique chemical makeup so treatments can produce different results from one individual to another.
To confuse matters further, patients often have a dual diagnosis. Consequently, reaching a definitive diagnosis often involves a lengthy investigative process. Only those who have gone through this ordeal can identify with the anxiety it causes for patient and family. Sadly, some patients give up and find another doctor before the diagnostic process is complete. Then the cycle begins again.
When a patient has enough stamina to get through the process and the doctor reaches a correct determination, the drug trials begin. Drug trials sometimes go on for years before reaching the right combination for a patient. With the introduction of each new drug, it often takes two months to determine if it is effective. Discovering the right combination of medications for a patient brings unbelievable relief for both patient and caregiver.
Mental stability, however, is illusive. Just when the disorder is seemingly under control, a drug might suddenly become ineffective, serious side effects might occur, or increased stress might throw the patient into a new tailspin. If switching medications can be done through outpatient services, it relieves much of the trauma for the patient, but often, at this point, they must be carefully watched in a hospital environment.
Perhaps someday, we will be able to look at an image of a brain, make a diagnosis in a matter of hours, prescribe the perfect medicine/treatment, and send the patient home to recover and lead a normal life – much like taking an antibiotic for an infection. For now, that is just a dream for one in four people who suffer from a brain disorder and for their families.
Dorothy Ruppert, author of “God Placed Her in My Path – Lessons Learned from the Furnace of Bipolar Disorder”