Introduction
The Twelve Myths about “mental illness” are the actual concerns expressed by my patients over the years. These factual answers are the ones that helped my patients to understand and treat their problem. No other human illnesses create so much misunderstanding and fear as psychiatric disorders. It is hoped that this will help others to better understand causes and treatment off mood disorders.
Twelve Myths about Mood Disorders
Myth Number One: People with mood disorders are “mentally” ill.
Fact: People with mood disorders are not “mentally” ill; they have a treatable physiological disorder of the brain.
This myth is especially confusing because most of us don’t make the distinction between “mind” and “brain.” The dictionary equates the word “mental” with the word “mind.” So, naturally we think of mental illness as a disorder of the mind. But most of us tend to think of mind and brain as the same thing. The mind is not actually a physical structure in any one part of the brain but rather is a group of the brain’s functions.
The mind is the mostly conscious part of our brain where we think, feel, and record and react to our experiences.
The brain is indeed where the mind resides. But the brain is the source of control for a many of our body’s functions which the brain controls without our awareness. For example the brain controls breathing and heart rate, hormone regulation, growth, appetite, sleep and many other functions. The brain also exerts controls over the mind including control over mood.
When an abnormal mood develops and persists, it is because there is a physiological disorder in the nerve cell areas of the brain that control mood.
We now know that mood disorders are (treatable) physiological disorders of the brain, just as diabetes is a treatable physiological disorder of the metabolism.
We believe that once a mood disorder develops-whatever the cause- it is because the brain has developed disturbances in the way particular groups of nerve cells function.
Many factors contribute to this physiological disorder of the brain. We now know that sudden or prolonged stress in our lives affects brain function. Stress can come from our efforts to cope with difficult medical problems, or relationships at work or home. Some of us have a family history of mood disorders and are more predisposed to the effects of stress. We call this a “genetic predisposition” to mood disorder.
Once a mood disorder does develop, it affects feeling, thinking, and even behavior. Medications help restore normal physiological function to the nerve cells, and counseling helps with better coping skills to deal with stress.
Myth Number Two: “I don’t want to tell anyone about my problem because
it seems like I am the only one with this problem.”
Fact: You are one of about 10% of all Americans who have or will have depression, anxiety, or mood swings. Some vital statistics are listed below. Some of these vital statistics show how long it takes most people with mood disorders to get a correct diagnosis. In many cases it takes even longer to get the proper treatment.
But the longer you delay getting an evaluation for treatment the greater the chance that your problem will interfere with your life and will make the recovery process more difficult.
Vital Stats:
Myth Number Three: “Everyone gets depressed or anxious from time to time.
Does that mean that I should be on a medication every time that I have those problems?”
Fact: Everyone does get depressed or anxious from time to time. That is a normal part of our range of emotional expression. That is not what defines a mood disorder. The acid test of development of mood disorders is functional impairment: the feelings of depression or anxiety interfere with our ability to function normally much or most of the time; and that the decrease in functioning affects our relationships, work, or the ability to enjoy ourselves. There are also often problems with eating and sleeping too little or too much.
Myth Number Four: “My family or friends will think I’m ‘crazy’ if I see a psychiatrist to get treatment.”
Fact: Most friends and family need not know about your decision to seek care. Your health decisions are a personal private matter. A trusted friend or family member should know if you are taking a medication, no matter what the nature of the medical problem. In the unlikely event of a problem with medication they can assist you with accessing care. Your trusted family or friend will respect you for your decision to help yourself by getting treatment and won’t think that you are “weird” or “crazy”. Most trusted friends and family can relate to mood symptoms because most people have experienced anxiety, depression, or elevated moods at times in their lives, even if those moods have not been severe enough to need treatment.
Myth Number Five: “I feel like I am weak or that I have a character flaw because
I have to see a psychiatrist to get help for my problem.”
Fact: That’s called shame and self-blame. We don’t blame ourselves when we have medical problems that affect other areas of our body.
Illnesses that affect the brain and therefore our behavior or emotions are the same as those that affect other areas of our body. Like high blood pressure or diabetes, illnesses of the brain are caused by complex biochemical changes. We call those physiological changes because there are alterations in the functions of the cells. Biochemical imbalances cause mood disorders. We believe that those biochemical imbalances are caused by one or more stressors like physical illness, emotional stress, or genetics. The idea that mood disorders are due to character flaws is a myth that comes from societal attitudes that developed before we had modern brain imaging techniques that show the physiological changes in the brains of people who develop mood disorders.
Myth Number Six: “I have always heard that the treatments make you feel like a ‘zombie’ and I
have to work, and a family to take care of, I can’t be unable to function.”
Fact: Modern medications used for the treatment of mood disorders have far fewer side effects and are generally well tolerated. It would make no sense to give you a medication that would itself cause a problem functioning when the whole purpose of treatment is to restore normal functioning. Whenever a medication for a mood disorder is by itself causing a problem it must be carefully re-evaluated. Nobody should be taking a medication that is causing a problem functioning or making them feel worse.
The very reason for frequent visits to the psychiatrist while you are being stabilized on a medication is to give the doctor and opportunity to carefully watch for the emergence of any problems associated with the use of medication.
Myth Number Seven: “Of course you are depressed; anyone would be depressed if they
had something like that happen to them. You should just get over it!”
Fact: Many people share this misconception: that your depression is a condition that is understandable so you should “just get over it and get on with your life.”
No one would apply this kind of thinking to a problem in another part of their body. For example, if you broke a bone would you- or anyone else- say: “of course you broke your arm; you fell off that chair, now go home and just get over it”
Just because the cause of the mood disorder is understandable doesn’t mean that it shouldn’t be treated. The reasons that physicians treat disorders are that: 1. they cause pain; 2. they cause loss of function; 3. they pose a risk to the rest of our health. Shouldn’t we treat mood disorders if they cause emotional pain, or decreased function, or if they pose a risk to the rest of our health?
Myth Number Eight: “I don’t want to become dependent on a pill to make me happy.”
Fact: It would be nice if there were a pill to make us happy, unfortunately no pill can make us happy- that comes from within ourselves. Medications for mood disorders work by controlling the physiological imbalances in the particular nerve cells that affect mood. When the chemical imbalances are corrected, the mood disorder is controlled. This removes the obstacles to functioning normally again. However happiness only comes from doing the things that make us happy.
Myth Number Nine: “I heard that you become addicted to the medications that
treat depression and anxiety; that you have to take them the rest of your life.”
Fact: Nothing could be further from the truth. Antidepressants are not addictive and they are the treatment of choice for depression and anxiety disorders. Most people who are correctly treated for mood disorders are able to achieve complete remission of their symptoms and are able to stop taking medications after a year or less of treatment. Some people with mood disorders, especially those people who have had their mood disorders for many years and, or have had a strong family history of mood disorders may need to be on medication longer.
Myth Number Ten: “This is how I’ve been for a long time. I thought it was just part of ‘me.’
I knew that something was wrong but I didn’t think that anything could be done about it;
how can you change who you are?”
Fact: No one should have to suffer from the effects of mood disorders on their day-to-day lives even though that is often exactly what happens when people don’t get treatment. Human beings are extremely adaptive and when we develop mood disorders, we learn to adjust to the limitations in our functioning, especially when those limitations develop gradually over time. This adjustment to a decreased quality of life does after a while seem like it is “just the new me.” People who feel this way come in for treatment only when their quality of life gets so much worse that they, or their family, can no longer accept the limitations in functioning.
Yet mood disorders are, in the right hands, among the most treatable of all medical problems.
Myth Number Eleven: “A doctor gave me a pill for depression once and I took it
for a while and it never helped so I stopped taking it, I’m not convinced that
these (medications) even work.”
Fact: Treatment of a mood disorder is complicated process. The right medication has to be chosen based on the history and the problem. It’s not like taking a Tylenol for a headache. The doctor should monitor the response to the medication and help the patient to know what to expect. The medication dosage may need adjustment to obtain an optimal response. If the problem is not improving as expected, the medication may need to be changed. The whole process should be designed around helping the patient to understand what is wrong with them and what will be done to help them to get back to normal functioning. Education, medical teaching, and counseling play critical roles in the process of recovery.
Myth Number Twelve: “I thought that you just take a pill and then it makes
you better, why is therapy or counseling necessary if this is a chemical
imbalance in the brain?”
Fact: Medical teaching, education, and counseling are critical in the treatment of many medical problems. In the treatment of Diabetes, medication corrects the insulin deficiency and the glucose levels, but life style changes are critically important in order to control this life threatening problem. No medication will help Diabetes if the patient eats the wrong foods or doesn’t learn to eat the right foods, get exercise, and loose weight. The same is true of mood disorders. Medication corrects the chemical imbalance, but coping mechanisms for dealing with stress are essential to controlling mood disorders and restoring optimal functioning.
The Twelve Myths about “mental illness” are the actual concerns expressed by my patients over the years. These factual answers are the ones that helped my patients to understand and treat their problem. No other human illnesses create so much misunderstanding and fear as psychiatric disorders. It is hoped that this will help others to better understand causes and treatment off mood disorders.
Twelve Myths about Mood Disorders
Myth Number One: People with mood disorders are “mentally” ill.
Fact: People with mood disorders are not “mentally” ill; they have a treatable physiological disorder of the brain.
This myth is especially confusing because most of us don’t make the distinction between “mind” and “brain.” The dictionary equates the word “mental” with the word “mind.” So, naturally we think of mental illness as a disorder of the mind. But most of us tend to think of mind and brain as the same thing. The mind is not actually a physical structure in any one part of the brain but rather is a group of the brain’s functions.
The mind is the mostly conscious part of our brain where we think, feel, and record and react to our experiences.
The brain is indeed where the mind resides. But the brain is the source of control for a many of our body’s functions which the brain controls without our awareness. For example the brain controls breathing and heart rate, hormone regulation, growth, appetite, sleep and many other functions. The brain also exerts controls over the mind including control over mood.
When an abnormal mood develops and persists, it is because there is a physiological disorder in the nerve cell areas of the brain that control mood.
We now know that mood disorders are (treatable) physiological disorders of the brain, just as diabetes is a treatable physiological disorder of the metabolism.
We believe that once a mood disorder develops-whatever the cause- it is because the brain has developed disturbances in the way particular groups of nerve cells function.
Many factors contribute to this physiological disorder of the brain. We now know that sudden or prolonged stress in our lives affects brain function. Stress can come from our efforts to cope with difficult medical problems, or relationships at work or home. Some of us have a family history of mood disorders and are more predisposed to the effects of stress. We call this a “genetic predisposition” to mood disorder.
Once a mood disorder does develop, it affects feeling, thinking, and even behavior. Medications help restore normal physiological function to the nerve cells, and counseling helps with better coping skills to deal with stress.
Myth Number Two: “I don’t want to tell anyone about my problem because
it seems like I am the only one with this problem.”
Fact: You are one of about 10% of all Americans who have or will have depression, anxiety, or mood swings. Some vital statistics are listed below. Some of these vital statistics show how long it takes most people with mood disorders to get a correct diagnosis. In many cases it takes even longer to get the proper treatment.
But the longer you delay getting an evaluation for treatment the greater the chance that your problem will interfere with your life and will make the recovery process more difficult.
Vital Stats:
- The National Institute of Mental Health estimates that depression afflicts 9.5 percent of adults in any given year, or about 19 million.
- The Journal of the American Medical Association study estimates that depression costs U.S. employers $44 billion yearly in absenteeism and lost productivity, $31 billion more per year than related costs from non depressed workers.
- More than half of patients nationwide are getting inadequate therapy, a new study suggests.
- The findings suggest that while the stigma of mental illness may be easing, many doctors may not be aware of treatment advancements, and many patients may be seeking unproven therapies, said Harvard Medical School researcher Ronald Kessler.
- Treatment was considered adequate or adhering to accepted guidelines in only 21 percent of patients with recent depression.
- Unfortunately a lot of people with this illness are going to their doctors and being put on some anti-depressant maybe for an inadequate dose for inadequate time.
Myth Number Three: “Everyone gets depressed or anxious from time to time.
Does that mean that I should be on a medication every time that I have those problems?”
Fact: Everyone does get depressed or anxious from time to time. That is a normal part of our range of emotional expression. That is not what defines a mood disorder. The acid test of development of mood disorders is functional impairment: the feelings of depression or anxiety interfere with our ability to function normally much or most of the time; and that the decrease in functioning affects our relationships, work, or the ability to enjoy ourselves. There are also often problems with eating and sleeping too little or too much.
Myth Number Four: “My family or friends will think I’m ‘crazy’ if I see a psychiatrist to get treatment.”
Fact: Most friends and family need not know about your decision to seek care. Your health decisions are a personal private matter. A trusted friend or family member should know if you are taking a medication, no matter what the nature of the medical problem. In the unlikely event of a problem with medication they can assist you with accessing care. Your trusted family or friend will respect you for your decision to help yourself by getting treatment and won’t think that you are “weird” or “crazy”. Most trusted friends and family can relate to mood symptoms because most people have experienced anxiety, depression, or elevated moods at times in their lives, even if those moods have not been severe enough to need treatment.
Myth Number Five: “I feel like I am weak or that I have a character flaw because
I have to see a psychiatrist to get help for my problem.”
Fact: That’s called shame and self-blame. We don’t blame ourselves when we have medical problems that affect other areas of our body.
Illnesses that affect the brain and therefore our behavior or emotions are the same as those that affect other areas of our body. Like high blood pressure or diabetes, illnesses of the brain are caused by complex biochemical changes. We call those physiological changes because there are alterations in the functions of the cells. Biochemical imbalances cause mood disorders. We believe that those biochemical imbalances are caused by one or more stressors like physical illness, emotional stress, or genetics. The idea that mood disorders are due to character flaws is a myth that comes from societal attitudes that developed before we had modern brain imaging techniques that show the physiological changes in the brains of people who develop mood disorders.
Myth Number Six: “I have always heard that the treatments make you feel like a ‘zombie’ and I
have to work, and a family to take care of, I can’t be unable to function.”
Fact: Modern medications used for the treatment of mood disorders have far fewer side effects and are generally well tolerated. It would make no sense to give you a medication that would itself cause a problem functioning when the whole purpose of treatment is to restore normal functioning. Whenever a medication for a mood disorder is by itself causing a problem it must be carefully re-evaluated. Nobody should be taking a medication that is causing a problem functioning or making them feel worse.
The very reason for frequent visits to the psychiatrist while you are being stabilized on a medication is to give the doctor and opportunity to carefully watch for the emergence of any problems associated with the use of medication.
Myth Number Seven: “Of course you are depressed; anyone would be depressed if they
had something like that happen to them. You should just get over it!”
Fact: Many people share this misconception: that your depression is a condition that is understandable so you should “just get over it and get on with your life.”
No one would apply this kind of thinking to a problem in another part of their body. For example, if you broke a bone would you- or anyone else- say: “of course you broke your arm; you fell off that chair, now go home and just get over it”
Just because the cause of the mood disorder is understandable doesn’t mean that it shouldn’t be treated. The reasons that physicians treat disorders are that: 1. they cause pain; 2. they cause loss of function; 3. they pose a risk to the rest of our health. Shouldn’t we treat mood disorders if they cause emotional pain, or decreased function, or if they pose a risk to the rest of our health?
Myth Number Eight: “I don’t want to become dependent on a pill to make me happy.”
Fact: It would be nice if there were a pill to make us happy, unfortunately no pill can make us happy- that comes from within ourselves. Medications for mood disorders work by controlling the physiological imbalances in the particular nerve cells that affect mood. When the chemical imbalances are corrected, the mood disorder is controlled. This removes the obstacles to functioning normally again. However happiness only comes from doing the things that make us happy.
Myth Number Nine: “I heard that you become addicted to the medications that
treat depression and anxiety; that you have to take them the rest of your life.”
Fact: Nothing could be further from the truth. Antidepressants are not addictive and they are the treatment of choice for depression and anxiety disorders. Most people who are correctly treated for mood disorders are able to achieve complete remission of their symptoms and are able to stop taking medications after a year or less of treatment. Some people with mood disorders, especially those people who have had their mood disorders for many years and, or have had a strong family history of mood disorders may need to be on medication longer.
Myth Number Ten: “This is how I’ve been for a long time. I thought it was just part of ‘me.’
I knew that something was wrong but I didn’t think that anything could be done about it;
how can you change who you are?”
Fact: No one should have to suffer from the effects of mood disorders on their day-to-day lives even though that is often exactly what happens when people don’t get treatment. Human beings are extremely adaptive and when we develop mood disorders, we learn to adjust to the limitations in our functioning, especially when those limitations develop gradually over time. This adjustment to a decreased quality of life does after a while seem like it is “just the new me.” People who feel this way come in for treatment only when their quality of life gets so much worse that they, or their family, can no longer accept the limitations in functioning.
Yet mood disorders are, in the right hands, among the most treatable of all medical problems.
Myth Number Eleven: “A doctor gave me a pill for depression once and I took it
for a while and it never helped so I stopped taking it, I’m not convinced that
these (medications) even work.”
Fact: Treatment of a mood disorder is complicated process. The right medication has to be chosen based on the history and the problem. It’s not like taking a Tylenol for a headache. The doctor should monitor the response to the medication and help the patient to know what to expect. The medication dosage may need adjustment to obtain an optimal response. If the problem is not improving as expected, the medication may need to be changed. The whole process should be designed around helping the patient to understand what is wrong with them and what will be done to help them to get back to normal functioning. Education, medical teaching, and counseling play critical roles in the process of recovery.
Myth Number Twelve: “I thought that you just take a pill and then it makes
you better, why is therapy or counseling necessary if this is a chemical
imbalance in the brain?”
Fact: Medical teaching, education, and counseling are critical in the treatment of many medical problems. In the treatment of Diabetes, medication corrects the insulin deficiency and the glucose levels, but life style changes are critically important in order to control this life threatening problem. No medication will help Diabetes if the patient eats the wrong foods or doesn’t learn to eat the right foods, get exercise, and loose weight. The same is true of mood disorders. Medication corrects the chemical imbalance, but coping mechanisms for dealing with stress are essential to controlling mood disorders and restoring optimal functioning.
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By Dr. Craig Alan Brown
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