Mental illness is not ‘all in the mind’

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Psychiatry is a profession supposedly there to help people with mental health issues such as anxiety, depression and schizophrenia. That’s the idea anyway. I say this because, in reality, it’s not the most effective of disciplines, I think. The drugs often don’t work too well, and usually come with significant side effects too. If I had my time again, there’s no way in the world I would choose to be a conventionally practising psychiatrist.

In my view, one of the major deficiencies of psychiatry is how it views almost all mental illness as a problem which originates in the brain. The psychiatric model of illness is generally based on the idea that brain function goes awry when brain chemicals (neurochemicals) become imbalanced. For example, depression is seen very often as a result of not having enough serotonin. So, drugs that elevate levels of serotonin then become the mainstay treatment for this condition.

Over the years, though, I’ve seen quite a lot of people in practice who seem to have or have been formally diagnosed with some form of mental illness, who actually turn out to have their problem rooted in issues that fall, strictly speaking, outside the brain. Here are a few examples:

1. people with mood swings caused by fluctuation in blood sugar levels

2. people with depression who have low thyroid function

3. people with low mood who have iron deficiency and/or anaemia

4. people with low mood/depression who have weakened adrenal gland function

5. people who have low mood/depression as a result of food sensitivity issues (often wheat, by the way)

6. people who have the symptoms of bulimia nervosa (binging and purging) as a result of blood sugar fluctuation

7. people who have anxiety/depression as a result of a deficiency in omega-3 fats

8. people who have anxiety/insomnia as a result of low levels of magnesium

The important thing is that when the underlying nature of these issues are rectified, the mental state of individuals usually takes on a completely different complexion.

Most psychiatrists, I think it’s fair to say, will generally not entertain such thoughts. This is, to a large part I think, a product of their schooling. If every psychiatric journal and psychiatry conference bangs on about the neurochemical basis of mental illness, it’s perhaps no surprise that many psychiatrists will not have a mind to look further and deeper than this. However, not all psychiatrists are of this persuasion, it seems.

I was very interested this week to come across this article on line in the Wall Street Journal. The article is about the book Unmasking Psychological Symptoms: How Therapists Can Learn to Recognize the Psychological Presentation of Medical Disorders by US psychiatrist Barbara Schildkrout. The book’s not out yet, so I haven’t read it. But even without the detail, I wholeheartedly support the sentiment of the book. It’s essentially urging psychological therapists to be alive to the fact that their patients may have mental symptoms as a result of pathology the origin of which is not the brain, but the body. Should be compulsory reading, I think, for all psychiatrists keen to do the best for their patients.

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