A
Anxiety:
Anxiety is among the most common disorders that I see clinically. The object of the fear varies: it can be death or illness, making a fool of yourself, flying, spiders, going crazy, heights, rejection, germs, inclosed spaces, or something going wrong.
Fear is a normal (and adaptive) human emotion and thus to be diagnosed with an anxiety disorder the fear has to significantly impair your general functioning. For example, if you have a fear of snakes but live in Sydney and therefore don’t encounter snakes and your fear doesn’t stop you from doing things like going on a holiday in Alice Springs, there is little sense in diagnosing and treating you for a snake phobia. However, if you get stationed in Darwin and don’t sleep for weeks out of fear of snakes in the house treatment would probably be advisable.
When our brain detects danger, the emergency response – the so-called flight/fight/freeze response – is activated. This response is designed for a rapid reaction to danger not to longer-term on-going stress (Think: a bus coming towards you on the road not impending deadlines and too much to do week after week).
The activation of the flight/fight/freeze response inhibits the maintenance systems (the so-called rest and digest response) in the body (survival trumps maintenance) and leads to stress hormones being released. However, long-term exposure to stress hormones can damage some brain structures (i.e., high levels of cortisol inhibits new learning thereby leading to neuronal atrophy).
The point is that human beings have a highly developed system for dealing with acute stress (a good thing) but ongoing activation of the emergency system undermines general maintenance functions (not so good) and can lead to physical and mental illnesses.
The good news is that psychological treatment really helps and in particular CBT (see next entry) has been found to be highly effective in treating anxiety disorders.
B
Brain:
The human brain is an incredibly complex organ and we’re a long way away from fully understanding it, but here are a few facts that I think are useful to know:
1) The human brain has the capacity to change and adapt (i.e., neuroplasticity) thought out the lifespan. This is contrary to what we believed up until a decade ago when we thought the brain stop growing in early adulthood. Basically, it turns out that you can teach an old dog new tricks.
Which is really good news because people often come to therapy because their old ways of doing things (i.e. their old tricks) are either not working or getting them into all sorts of trouble.
2) New research suggests that exercise not only has a powerful positive effect on mood but also influences the ability for new learning and the capacity to store knowledge. We still don’t understand the mechanisms underlying this but I’ll keep you updated as the scientists untangle this. Suffice to know this: exercise appears to improve learning and memory (i.e., has a direct impact on neuroplasticity).
C
CBT (Cognitive Behaviour Therapy):
CBT is a popular treatment is psychology for many disorders including depression and anxiety. CBT is made up of two main components: 1) The cognitive element is focused on changing people’s unhelpful thinking. For example, people with depression often have a bias towards negative thinking (i.e., the glass is half empty rather than half full) and people with anxiety often jump to the worst possible conclusion. The goal of cognitive therapy is to make people aware of these biases and teach them how to replace the unhelpful thinking patterns with more helpful – and realistic – ones. 2) The behavioural component of CBT addresses problematic behavioural issues like poor sleep, social isolation, avoidance, lack of exercise, too much drinking, a failure to do enjoyable things etc. Basically, it’s about helping people do things that is good for them and stop them doing things that are harmful to them.
Some psychologists like to talk about CBT like it’s this special, secret knowledge that we possess, but the truth is that the strategies in CBT are pretty commonsense and their power lie not so much in the actual strategies (although they are helpful and most people benefit from them) but in how and when they are taught in therapy.
D
Diagnosis:
Most mental health clinicians use the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (the DSM-IV) for diagnosing mental health disorders. The DSM-IV is a big book that provides standard criteria for classification of mental disorders.
Basically, if it’s in the DSM you can suffer from it and if it’s not you can’t.
There are many problems with the DSM-IV and there is currently hot debate in the field because another edition (the DSM-V) is due to be published in 2013. This may seem a little academic and irrelevant to you but consider that up until fairly recently homosexuality was included in the DSM. Which meant that it was considered a mental illness and presumably that it could be treated.
Some people that come and see me find it comforting to finally be able to name what’s troubling them whereas others feel overwhelmed by a diagnostic label. Thus, if asked I’m happy to share my thought regarding diagnosis but most often I find it more helpful to discuss the problem and what to do about it without necessarily applying a psychiatric label.
I generally include a diagnosis in the letter to your GP if you’re on a mental health plan because this is needed in order to access Medicare. A psychiatric diagnosis is best thought of as an educated guess about what’s troubling a person but in itself it gives you little idea about any specific individual. Consider a person who presents with lack of sleep, poor appetite and weight loss, agitation and pacing, lack of concentration, anger outbursts and thoughts of killing themselves and another who cries all the time, sleeps too much, has gained a significant amount of weight, has no sense of pleasure in anything and is tired all the time. Both of these people will get a diagnosis of major depression but clearly they present very differently and treatment will have a different focus.
So, although diagnostic labels can be helpful as a sort of shorthand between health professionals, I tend to agree with the clinical psychologist Robert Akeret who writes: “ Almost invariably, the diagnostic psychiatric labels that are used to classify people leave me cold and uninspired. Such labels obscure – even destroy – who an individual is as a unique, living reality.”