You are NOT CRAZY

The dreaded "C" word ... No one wants to see a psychiatrist or therapist for fear that he or she will be deemed crazy. Even the Merriam-Webster dictionary app defines the word "crazy" within its stigmatizing framework as one who is "not mentally sound: marked by thought or action that lacks reason." But I am here to tell you that I don't treat crazy people. I treat children and adults struggling with profound sadness and despair, paralyzing anxiety, difficulties at school or on their job, in the aftermath of devastating trauma, or reeling from failed relationships. Sometimes the individuals I treat suffer from serious mental illness like schizophrenia, a neurodegenerative disease characterized by hallucinations, delusions, and disordered speech or behavior. But never do I treat crazy people.

Here are 5 reasons why seeking mental health services makes you courageous not crazy:

1) Your brain is part of your body

Sometimes we create an imaginary line between our head and neck as if to separate our brain from the rest of our body - like our thoughts and emotions are somehow cut off from our heart, lungs, and limbs. However, our brains our incredibly powerful. We can live without some parts of our bodies like our appendix and gall bladder; and, through organ transplantation, physicians can replace almost every organ in our body (skin, kidneys, liver, heart, lungs, even cornea).  But you cannot live without your brain and brain transplants do not yet exist. Our brains function as big computers controlling everything we do from speaking and reading to walking and breathing. Our brains also control our emotions, our memories, and our sensory perceptions. Each of these neurobiological tasks are accomplished through an intricate array of neurons (nerve cells) and synapses that transmit information between the brain and other parts of the body. The brain and body are inexplicably linked which means that our thoughts and feelings are as integral to our existence and identity as the beating of our hearts, breathing, and eating.

2) Ignoring emotional symptoms rarely leads to their resolution

Stress happens. Negative emotions arise - sadness, disappointment, anger, rage, frustration, guilt, fear, worry ... they happen to the best of us. While I certainly don't advocate losing control and allowing our emotions to dictate our responses to life's challenges, I also don't recommend burying painful feelings either. With patients, I often compare stuffing our emotions to a volcano that swells and swells until it explodes, pouring molten lava onto the surrounding expanse, scorching everything in its path. The stress that comes from the difficult situations we experience in life tends to build rather than dissipate if you don't properly address it; and, at some point, you will explode and the fallout could have devastating consequences.

3) Mental illness is a complicated interaction between genetics and the environment

In healthcare, we often discuss risk factors. A risk factor, as defined by the World Health Organization, is "any attribute, characteristic, or exposure of an individual that increases the likelihood of developing a disease or injury." Common risk factors for mental illness include genetic predisposition or family history of psychiatric illness and environmental factors such as childhood trauma (physical or sexual abuse, neglect), poverty, substance abuse, medical illness and poor physical health, poor nutrition, lack of access to healthcare services, exposure to violence, gender inequalities, and discrimination and racism.

We can't choose to whom we are born, no one decides to develop a mental illness, and the circumstances in which we may find ourselves are sometimes completely outside of our control. Don't blame those struggling with Major Depressive Disorder, Autism, Schizophrenia, or other psychiatric disorders for their illness. Poor choices alone rarely lead to the disease state.

4) Prolonged and/or recurrent emotional instability is never a normal response to life stressors

In an attempt to normalize agonizing emotional responses or perhaps even to avoid difficult conversations, people often say things such as, "Of course you're depressed, you just got _______________ ." Fill in the blank - divorce, cancer, job loss, etc. This notion is frankly incorrect. The development of a mental illness is not an expected response to life's challenges. You might feel sad or disappointed or even anxious in the face of struggles, but that does not constitute Major Depressive Disorder or Generalized Anxiety Disorder.  Bad feelings and psychiatric diagnoses ARE NOT synonymous.

Conversely, recognizing the difference between an expected reaction to a stressful event such as grief vs. a mental illness like Major Depressive Disorder is critical.  Crying at a funeral is strikingly different from the inability to maintain employment because you cannot get out of bed, no longer bathe, and are having suicidal thoughts after the death of a loved one. Failure to acknowledge these discrepancies can lead to a lack of appropriate treatment, worsening symptoms, and debilitating outcomes.

5) There is no health without mental health

Numerous studies document the bi-directional relationship between physical illness and mental health, especially with chronic medical illnesses such as diabetes, cancer, cardiovascular disease, and Chronic Obstructive Pulmonary Disease (COPD). Individuals with chronic medical illnesses have a higher risk of depression compared to the general population. People with chronic disease and co-morbid depression often have worse health outcomes secondary to poor adherence to treatment and self-care practices, greater symptom burden, and more problematic lifestyle choices (smoking, lack of consistent exercise, poor nutrition). The Centers for Disease Control (CDC) published an issue brief in October 2012 that noted 3 findings I found striking:

  • Depression co-occurs in 17% of cardiovascular cases, 23% of cerebrovascular cases, 27% of people with diabetes, and >40% of those with cancer
  • The cost to treat chronic diseases makes up around 75% of the total national health expenditure
  • Depression leads to 200 million lost work days annually and costs employers from $17 - $44 billion

My charge to you is PRESERVE YOUR MENTAL HEALTH! Get help - this does not make you crazy.  The preservation of your mental health allows you to take care of yourself and your family, work and make a meaningful contribution to society, find purpose for your life, and engage in fulfilling relationships.