Although May is close to being over, it is one of the most educational starts to the summer due to multiple campaigns, websites, supporters and advocates, professionals, and even celebrities focusing on and promoting Mental Health Awareness Month. In fact, May is also Children’s Mental Health Awareness Month where multiple child and adolescent agencies circulate education on developmental and behavioral disorders. May is a great time to truly hone in on the mental health issues and lack of awareness that continues to plague our society. For many people, some of the most common mental health challenges include: insurance and meeting the medical necessity criteria to continue receiving services, poor geographical access to mental health services (which typically occurs in the inner-city or urban and rural areas), perpetual financial stability, bed availability for long-term program such as placements or hospitals, and family education about coping with a loved one. Another common issue emphasized during the month of May is the process of determining what should or should not be categorized as a mental health condition.
When I meet with families for their first family session, I often hear the following: “Our family doctor diagnosed her as depressed and put her on antidepressants, but I don’t think she is!” or “why was my daughter diagnosed with anxiety disorder and sent to a psychiatrist to be medicated without anyone taking into consideration that we are a military family who has moved around a lot?” While I am a big proponent of bringing awareness to severe and untreated mental illness, I am also a big proponent of the correct identification of mental illness and the careful evaluation of typical life problems. In other words, I support the idea that we don’t always have to pathologize every “symptom” of life. A black and white perspective not only pathologizes people who don’t need to be treated with therapy and medication, but it also takes attention away from the people who truly need psychiatric support. If we’re not careful, we (as a society) will develop a black and white perspective of mental illness (“you do or you don’t”), without considering that there is often a lot of gray in this life.
As a result, I have put together a short list that outlines reasons why certain experiences should not be labeled as a mental health condition without careful evaluation:
- Anxiety: Life is full of anxiety and it’s a very normal part of existence. Can you think of a time when you were very anxious about life and your future? Some people say “that’s all the time!” For young people, anxiety is typical during early adulthood when college, relationships, and seeking employment are the main stressors in life. Even those of us who are therapists struggle with anxiety. The work we do, the people we see, the world-wide complexities we ponder, and the schedules we have are all a recipe for anxiety. There’s always something to be anxious about such as financial concerns, safety, family, employment, health, your children, your spouse, etc. Life is going to be filled with worry and anxiety. Who said it wouldn’t or shouldn’t be? None of us will escape this. Just because you are anxious does not mean you need medication or a diagnosis. Anxiety only becomes a clinical problem when it is difficult to control and results in psychological symptoms (feeling stressed or fatigued and depressed), behavioral symptoms (neglecting responsibilities or engaging in avoidance or using substances to cope), or physiological symptoms (vomiting, nausea, shaking, muscle spasms, etc). Even if you must reach out to a therapist or doctor, that is okay too!
- Restlessness or hyperactivity: How many times have you heard someone say that “hyperactivity and restlessness means you have ADHD?” How many people have you heard say that your child is “overly hyperactive?” We are in the ADHD-age. Everything from forgetfulness to hyperactive behaviors are all instantly characterized as ADHD. It’s okay to have energy, it’s okay that your child bounces all over the place (he’s a child!), and it’s okay that you are forgetful at times. ADHD-like symptoms only become a problem when, again, it interferes with daily life. If you are forgetting that you left the door to your home unlocked, are so inattentive that you are extremely disorganized, or are so hyperactive that you are offensive to others and cannot slow down your pace, you might indeed have some ADHD symptoms.
- Depressed/sad mood: Just like with anxiety, depression or low mood is often a normal occurrence in many situations. Life can sometimes hit us hard with unexpected things such as speeding tickets, fines, or fender benders, loss of employment, having to move, or the death of a loved one or severe illness. Depressed mood or sadness is likely to occur during these times and it’s expected to happen. However, depressed mood or sadness that results in loss of appetite, poor sleep patterns, anhedonia or loss of interest in things once enjoyed, substance use, or irritability should be diagnosed as clinical depression. Depression is diagnosed when it interferes with the normal flow of life.
- Grief: Grief is very complicated. In fact, there are multiple studies on grief and therapy groups providing support to grieving individuals to help us understand what it is and why it is different from depression. There have been major “arguments” in the field of psychiatry/psychology over what grief is and the fear that the DSM will pathologize normal grief. It’s important that we understand that grief does not have a time-frame of when it will disappear. Someone can grieve deep down inside for decades, but this doesn’t mean they are depressed. It will take a meticulous and knowledgeable therapist and psychiatrist to tease depression and normal grief apart. But it is important that I mention that grief can certainly turn into depression.
- Rigid beliefs/behaviors: As a therapist, I often see parents and families who come to me asking for help for their child or adolescent who “seems to have autism.” When I ask parents to elaborate on the type of “symptoms” they believe characterizes an autism spectrum disorder, I often hear parents say: “Johnny is so rigid and will throw a major tantrum if things change around the house” or “Bobby only wants to play with kids who enjoy what he enjoys.” The reality is that many of us are this way, not just kids with autism. Many of us would only socialize with people who think like we do, view life as we do, and have similar goals. Many of us would also only find pleasure in discussing the things we find most interesting. It’s very difficult for families to tease apart inflexible, autism-like behaviors from normal behaviors. Most kids will only be screened for autism if they show a constellation of symptoms. Inflexible behavior alone is not enough to suspect autism.
- Fear: Unfortunately, most parents become very concerned when their child develops a host of irrational fears and often questions a mental health professional about disorders that can highly stigmatize a young person. For example, I’ve had clients in the past who were extremely afraid of animals and would cry, scream, or run at the sight of a small dog or cat. For some parents, this behavior would be alarming, especially if the animal is a family pet or friendly pet. However, it is important to consider the history and temperament of the child. Was the child attacked (or witnessed someone else attached) by an animal? Is the child exposed to animals on a regular basis? Does the child just simply not like small crawling creatures? Is the child high-strung? Could the child have anxiety that increases their fear of animals? Essentially, it’s important to keep an open mind about fear because it doesn’t always mean that an individual has a diagnosable disorder. In fact, fear can be very healthy as it alerts us to what can negatively affect us in our environment.
- Reduced interest in social relationships: Some people have struggled their entire life with relationships and get to a place where they don’t want to deal with the stressors that often accompanies a relationship. Some examples include: misunderstandings and arguments, jealousy in romantic relationships, commitment (which can be scary for some people), or sharing. For other people, relationships are extremely important to them but they just can’t seem to make or keep friends. Does this truly mean the person has a psychological problem? Not necessarily. We all have preferences, we all have fears, and we all have challenges. Your challenge may be facing your boss everyday, while someone else’s challenge might be making or keeping friends. If the inability to keep or maintain friendships and other relationships interferes with daily functionality, then the person might want to speak with a therapist to explore whether this truly is a problem.
- Difficulty learning certain subjects: Whether you believe it or not, some kids (including adults) struggle with subjects that most of us think all of us should know. For example, many adults struggle with mathematics or grammar. Using numbers and language in daily life is important but many kids struggle and even adults. This doesn’t always mean the person has a learning disorder. In fact, some kids and adults are gifted and require a certain type of teacher, are better in certain subjects than in others, or are simply more technical than academic. There are a variety of things that should be taken into consider such as:
- How well you were taught in your school or how well the school understands you, socio-economic status, trauma history, frequent relocation of schools, abuse or neglect history, a mental health condition that interferes with concentration, etc.
Determining whether someone needs help often gets easier when the individual self-evaluates or the illness is to obvious that everyone can see it. Because of this, I encourage most people, primarily families, to be observational and tap into their intuition. We know when something isn’t right, we just need to accept that we see what we see.
As always, I wish you well
Photo by Orangeadnan