Similarities exist between helping people manage mental illness and other chronic medical conditions, such as high blood pressure, or Type 2 diabetes. Nevertheless, psychiatry is different to other medical specialties. One reason for this is that patients’ intentions and progress tend to be less concretely defined. In the case of hypertension for example, reducing one’s blood pressure to 130/80 is a tangible target. In the context of advanced Type 2 diabetes, making lifestyle changes to avoid losing one’s foot is a specific goal.
With diseases like anxiety, depression, bipolar disorder, or schizophrenia, however, treatment is less black and white. Medication often plays a significant role. Nonetheless, as with all drugs there are side effects, and compliance is a common issue. For the most part, it’s a question of helping people maintain their optimal level of functioning, and major improvements are relatively rare in the field of mental health. Assessing suicide risk is another important consideration in psychiatry.
Often, all I do is listen. Most psychiatric patients don’t progress the way ‘getting better’ is traditionally defined and measured. Huge accomplishments are somebody saying, ‘Do you remember suggesting making a list and crossing things off as I got them done? That changed my life.’ Or, someone with a long history of recurrent hospital admissions, because of repeated suicide attempts, who hasn’t been admitted for a year.
Sometimes, it’s as though people find themselves in a fog. Over time, usually after several years in fact, trust and rapport are established. Eventually, there might be an opening in that fog, which we try to seize. “Don’t use your influence until you have it” has been invaluable advice thus far.