Just like you, I keep a tally of the number of years I have been doing my job. Each year, for the past two decades, I have been working with children, adolescents and adults, who have asked for professional help:
“After his brother was killed, my youngest son began to smoke pot, drink beer and fail school — please help him.”.
“My husband lost his job. Since then, he is a man I do not know: bitter, negative, withdrawn. Can you help him?”
“One night, my daughter was walking from her college dorm to the library and was sexually assaulted. Please help her get over this.”
All three of these families understood that through no fault of their own, a family member had become severely depressed and traumatized. All three families sought and received professional care, thus ensuring that the health of a loved one would be restored.
Good story so far, right? Yes, it is until you see this disturbing fact: For every single patient who is successfully treated for a psychiatric illness, there are four who never seek care. This one in four ratio means that, just like an iceberg, the clear majority of people suffering from a submerged and hidden PI, will live and die with an undetected brain-based illness.
Adding salt to the wound is the additional fact that all PI’s degrade and erode one’s quality of life. Unlike other diseases, psychiatric disorders impact every domain of life — friendships, romantic relationships, family connections, job, spiritual, health and the deeply personal relationship you have with yourself.
What stops people from seeking professional care for a PI? (Hint — it’s not money, lack of insurance or availability of professionals). The following stories illustrate each barrier which stops people from seeking treatment.
1. No awareness that they suffer from a PI. Sheri, 31: “I simply did not know I was depressed. Yes, I had sleeping problems, anger explosions and a sense I deserved blame for my many failed relationships. But never once did I think maybe I’m clinically depressed.”
2. The symptoms of a PI look just like the symptoms of another disorder. Robert, 26,: “For 10 years, I had been suffering from severe back pain. Even when I was 16, and was on the track team, my back hurt. I did not know that my anger, which I swallowed and held inside of my gut would eventually build up and cause a clinical depression. I believed that my deep anger and resentment were normal for men. I did not know that back pain could be generated by repressed anger.”
3. No prior experience of basic feeling states such as happiness. Shelia, 42: “ I have never been happy. As a young child, I was plagued by excessive worry — will my mother leave me, will my father beat my mother? My parents, both alcoholics, fought from the first day I was born. My heart was filled with fear. There was never room for joy, fun or happy feelings. How could I have known I was depressed?”
4. Clinical depression creates a false belief that one is unworthy. This causes self-hate and self-punishment. Nathan, 59: “I have never liked myself. When I was 6, my father became ill and never regained his health. I was the only boy on our family farm and got up at 4:30 each day to do the farm chores and then walked to school. All that time, my dad, sick in bed, never told me he was proud of me. I began to believe things like, I’m stupid, lazy and worthless. I’d set goals I could never reach. I got so used to self-punishment, I began to like it. I was worthless and deserved to be punished, so why would I seek treatment?”
5. Emotional Super-Sensitivity. Susan, 39: “Around age six, I began to have terrible nightmares and I feared leaving home. My sensitivity was so severe. To cope, I isolated myself and read books. I was severely depressed and anxious from age 6 to 15. I never told anyone. I feared if I asked for help, I would be rejected. As I became older, I took everything personally as if others disliked me. I never confronted anyone. At 20, I tried to kill myself.”
For each patient, I see, there are four I will never meet. Today’s column was written for them. There are many ways to seek help for a PI. Friends, family and ministers/clergy can be asked for help. Here is another way: Michael, 21, came to the office to seek help and advice for his “best friend”. Treatment was successful. On his last office visit, Michael said, “We both knew I was not here for my best friend.”
Your “best friend” could be how we describe the very private relationship we have with ourselves. If your best friend needs help, so do you.
The content of this article is for educational purposes only and should not be used as a substitute for treatment by a professional. The characters in this story are not real. Names and details have been changed to protect confidentiality.
Dr. Richard Elghammer contributes his column each week to the Journal Review.
