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Mental Health and Mental Illness

Updated: Jun 30, 2023

In the middle of May, the mental health awareness month, I went to a fantastic lecture on mental health by Ross Szabo, the wellness director at Geffen Academy at UCLA, who was diagnosed with bipolar disorder at the age of 16 and survived a suicide attempt in his senior year of high school. This very eloquent speaker was brought into our kids' high school after the school was rocked by 3 back-to-back suicides in the months preceding May. Mr. Szabo ended his talk on mental health with an emphasis for us to speak up and speak out about mental health and mental illness, to share our story.

By talking about our personal experiences with mental illness, we can help dispel that stigma that comes with being "crazy", and we can break that unspoken taboo that forces us all to hide our private pain and anguish from even our family and friends. Because why should disorders of moods and thoughts like schizophrenia, bipolar, psychosis, and neurosis be treated any differently than disorders of the vascular, pulmonary, intestinal, endocrine, or any other physical systems in the body? If we can talk about a problem, we can identify it. Once we identify the problem, we can seek out a solution. But the first step in the journey through mental or physical illness and healing is to tell someone how crappy you feel.

My own personal experience with anxiety and depression can hardly be called illness, more like a gentle hike through a slot canyon than a bizarre and harrowing journey through a truly dark and twisted cave system. However, my daily encounters with patients over the past 30 years have provided me with a wealth of discovery and learning. Just like cave explorations, if you have the courage and the curiosity, the deep dive into the black box of the mind can be endlessly fascinating and enlightening.

There is this giant book that sits in the office of every psychiatrist called the DSM-5 which stands for Diagnostic and Statistical Manual for Mental Disorder that lists all the phobias and spectrum disorders and delusions and personality disorders and what have you's. I glimpsed through it once during my psychiatry rotation at Olive View Medical Center. If you're a glutton for punishment, or if you're a Hermione Granger type, you could order it online and read through it. But I'm a simple soul and I like things basic and pragmatic. Thus I have long ago simplified most of the mental illnesses in my mind into Categories that allow me to figure out which treatment is best for each person.

The first division is Disorders of the Mood vs Thoughts (or the Heart vs the Mind).

Within the Mood disorders lies all those emotions that neither the body nor the mind can control. These are the bipolar disorder; which vacillates between extreme hyperactivity and deep despair, milder anxieties and depression, fears and anger, insomnia and PMS, etc..

Mood disorders can be controlled through psychotherapy, cognitive behavioral treatments, with anti-depressants, anti-anxiety, or mood-stabilizing medications. Believe it or not, we still use electroshock therapy for very severe life-threatening depression. There is even a home treatment using a band of electrical stimulation that seems to work for some patients. If you're into alternative treatments, I find valerian root to be calming, st. john's wort to be stabilizing, and moringa to be energizing mentally, for the milder cases of mood disorder.

Within the Thought disorders are schizophrenia, paranoia, psychosis, and personality disorder. Psychosis is defined as someone losing touch with reality so that they are hearing and seeing things that are not real, these are called auditory or visual hallucinations, or they are believing in things that are not true which are called delusions.

In general, auditory hallucinations are associated with schizophrenia while visual hallucinations are associated with physical illnesses like delirium (which are caused by acute stress, infection, drugs, strokes, or seizures). So if a schizophrenic patient tells me that the voices in her head are back or getting louder and meaner, I can increase her antipsychotic medications. But if my hospitalized patients are seeing animals running around the room, then I may have to order lab tests or a head CT before concluding that it's just hospital psychosis or sundowning (which is the mental confusion that comes with being in a strange environment when the twilight sets in).

The treatment for delirium is to treat the underlying medical disease. The more serious thought disorders are treated with antipsychotic medications but psychotherapy cognitive behavioral therapy may help in some personality disorders.

Then there are the subdivisions within each categories. One of the most interesting categories of thought disorder is Psychosis and its subcategories Hallucinations and Delusions.

I think the most entertaining and most difficult to treat of the psychoses are delusional disorders. The more common of these delusions are Parasitosis, Alien Abductions, and the End of the World. It doesn't matter how much time you spent talking and explaining. It doesn't matter how many specialists you send them to or how many tests or examinations or biopsies you do, you can never convince a delusional person that what they believe is not true.

I saw my first alien abduction patient when I was a medical student. He was a businessman who operates a small business in the Valley. His family dropped him off at the clinic because he has become so obsessive about the abduction episode that he could not work or function in society. He knows that they implanted little antennas in his nose and biopsied his neck. While I examined and ordered head CT scans and scheduled counseling sessions for him, my attending psychiatrist watched it all with a knowing smirk on his face. I think he knows I must learn for myself the futility of trying to convince a delusional person. Eventually, I convinced the patient to try a little Haldol so that he can at least stop obsessing over his encounter and go back to his wife, children, and business.

The last parasitosis case I saw was just last week. She came in with little lint balls pulled from her hairbrush and little specks of dirt pulled from her fingernail, preserved in little plastic bags as evidence that parasites are coming out of her head and skin. Surprisingly, the patient was not asking for any treatments, she only implored me to believe her since the dermatologist and the gastroenterologist are just morons who could not find the parasites in her skin and intestines. I explained to her that it doesn't matter what I believe when the issue at hand is what she believes and why she thinks that she can make a self-diagnosis and expect us all to fall in line and believe her despite all of our years of studies and knowledge and experience, and despite all the exams and findings.

It still didn't matter, she left unhappy that she did not convert me to her belief system. And I was frustrated that I could not convert her.

We see hundreds of mental illness patients every year. The vast majority of them are completely functional except for those brief episodes when the illness flares out of control. This is typical of any chronic medical illness from inflammatory bowel disease to rheumatoid arthritis. The most important thing is that they acknowledge their disease and sought help to control it.

May the month of June brings more bright sky and less sadness than the May-gray days we've been having here in LA. I'm looking ahead and starting a high-tech muscle-building, fat-burning therapy in my office. Will bring you more news on that in next month's blog.

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