Growing up I often overheard my family discussing how certain aunts or uncles were “nervous” or had “bad nerves.” To this day, some of my relatives, including the educated ones, still use such terminology. In addition, I have also unfortunately heard all too often how people, particularly former veterans, were described as “crazy or odd.” As a child, I had no idea what they meant nor did I ever hear them use words such as therapist, psychiatry, or depression for that matter. It was not until medical school that I realized they were discussing mental illness but in the most rudimentary and crude fashion. Recent events in our nation as it relates to gun violence perpetrated by mentally ill individuals, have caused us as country to dialogue more about this hot topic.
Depression is a disorder of the brain that affects mostly women and usually begins between the ages of 15 and 30. More than 20 million people in the United States suffer with depression. Individuals with depression do not have fleeting emotions of sadness. Depression interferes with their daily lives and can include symptoms such as low energy, poor appetite, insomnia, lack of concentration, and sometimes, suicidal ideation.
Besides women, the CDC reports that people who are unemployed or unable to work, blacks or Hispanics, individuals who lack insurance, or people with less than a high school diploma, tend to be most depressed. In my practice, these patients often times do not even recognize that they are exhibiting signs of depression. They present with somatic complaints such as back or neck pain, inability to stay asleep, or headaches. They are shocked when I ask if they are depressed.
In my experience, people of color are often extremely resistant to therapy. “I don’t want people in my business!” “God will deliver me from this!” “So, you think that my pain is in my head?” These are all comments that I hear frequently. I spend a lot of time explaining that mental illness is no different than diabetes or hypertension: it’s a medical condition that needs treatment. A horrible stigma exists in our communities that inhibit active participation in cognitive behavior therapy (CBT) which then results in family instability. I speculate that our urban children’s test scores would improve if their parents received regular CBT and obtained the appropriate medication to treat their various mental conditions and addictions thereby resulting in a home environment conducive to studying.
I knew nothing about bipolar disorder when I was younger but I could definitely recognize people in the church who were flamboyant one Sunday but depressed the next and who always seemed to go from 0 to 60 in only a few seconds. Bipolar disorder usually appears in the late teens or early adulthood and is characterized by severe mood swings. However this emotional lability is not your typical everyday highs/lows people feel. Individuals with this disorder have extreme changes in energy, sleep, activity, and behavior. These mood swings can progress from mania to depression causing work and marital conflict. I have known patients, when manic, to spend thousands of dollars within hours and get involved in multiple extramarital affairs.
Typical symptoms during the manic phase of this disorder include racing thoughts, starting simultaneous projects but without completion, and exaggeration of one’s ability. I recall one patient during my training who wanted to quit his good paying job to pursue a career as a professional Frisbee player. This patient would stay up all night and would talk nonstop. He was totally unaware of his strange behavior.
The other aspect of mental illness that is often overlooked is its effect on our children. For example, when a child’s behavior dramatically changes, something has happened in that child’s life. A home environment disruption, a death of a family member or close friend, sexual or mental abuse, or being the recipient of bullying are all situations that are common occurrences amongst our children. For the most part, kids will not walk up to you and proclaim that they are depressed or hearing voices. The adults around them must recognize the warning signs: a drop in grades, difficulty sleeping, excessive counting or checking locks, withdrawal from social function, or inattention to personal hygiene. Furthermore, anyone making comments about “not wanting to be around anymore” or “life would be better without me in it,” need to be taken seriously. We must not assume they are joking!
If you or your loved one suffers from mental health issues, please seek help immediately. Do not wait until a catastrophe happens. The stigma associated with mental illness will end when we as a community accept the notion that the state of our mental health is no less important than other disease states we may face.
Yours in Service,
Denise Hooks-Anderson, M.D.
Assistant Professor
SLUCare Family Medicine
yourhealthmatters@stlamerican.com
