Misdiagnoses

Recently I heard one of my friends complain about a doctor he felt was misdiagnosing people. This particular friend of mine is extremely wary about what he sees as ‘the fashion for depression’ (see this article http://blogs.telegraph.co.uk/news/brendanoneill2/100253335/its-become-fashionable-to-be-depressed-this-is-dangerous/

for a summary of that line of thinking). “The doctor just pops people on pills the second they come in feeling sad,” my buddy said. “He should be called on breaking his Hippocratic oath.”

It’s fascinating to me, this idea that people can be misdiagnosed because of the way depression is sometimes glamourised in our culture.

I find it interesting because my family comes from a culture where diagnosis of mental illness was used in the opposite way – it was used as a tool by the authorities to silence opinions that went against political orthodoxy. One of my aunts (we called her ‘auntie’ though there was no biological link) was placed in institutional care during Soviet rule in Eastern Europe when she was a young girl, because doctors believed she was schizophrenic. Much later it came to light that this was probably a misdiagnosis. Her issues were ordinary growing pains. This is borne out both by her and by people who knew her closely at the time.

My aunty had a bunch of older siblings who were busy with their own problems and struggles, so they popped her into an asylum. The interesting thing about it is that it did not look strange or unusual – everyone who was there at the time found something they liked in the decision.

My poor aunt! I can see why it happened to her. She was the only sensitive young woman in a hardy country family, surrounded by soccer-loving boys and soil-tilling men with calloused hands. I’ve visited that home in the Bulgarian countryside – in every old photo Aunt Ana stands half-obscured by the others. She is an afterthought: a figurine placed in a convoy of boys that swept through the town in the sixties, fueled by boiled sweets, soccer fanaticism and Zagorka beer. Like any sculpture in transit she was rattled, often forgotten, though no one was sure what to do with her anyway.

I’ve seen the way men in Bulgarian families interact: their banter, which mystifies listeners with its in-jokes; the honour codes, which a cryptographer couldn’t decipher; the way they’ll unite as a phalanx on the soccer field, striking their way to victory, or sink one-by-one into despair and lose. The construction projects! During summers in the Sofia Valley I watched greenhouses and sheds rise to the sky through the labour of dedicated male hands. How easy it would be for an ‘outsider’ – someone who doesn’t fit in that world, like an anxious young girl – to get lost.

Stories of men pulling together in difficult times (war, say, or occupation) easily become legends. We have this in Australia too – think of the public reverence for soldiers returning from duty (remember this incident?). This level of respect is not granted to anyone else in our society: not thinkers, not scientists, certainly not politicians, not celebrities, not even our beloved sporting heroes.

The solidarity of my ‘uncles’ in Bulgaria kept their family going, I know that. Could they have accommodated their sister? Maybe not. They put her in the ‘too hard’ basket.

In the Soviet Union you could get yourself a schizophrenia diagnosis just by attempting to emigrate, or having a prohibited book on your shelf. Participation in civil rights actions or forbidden religious activity could also earn you a stint in an asylum. It’s really no wonder that it was so easy for that family I knew to find a doctor who would say ‘schizophrenic!’ and haul their daughter off. They were handing those diagnoses out like they were census documents.

Mental illness is politicised in the West too, perhaps in a subtler way. Think about it – what do we have here? 24-hour television programming fare that might as well be titled ‘The Glamorous Lives of Others’. Media images whipping people’s imaginations into a storm of envy, materialistic striving and misguided careerism. A faltering economy. Toxic work cultures. A self-help industry that will give you five tips about how to succeed, then take your pennies and sell you another book to deal with your low self-esteem (you’ll need it when the five steps inevitably don’t work). Don’t even try complaining about all this either. The doctor will tell you you’re anxious, write you a prescription, and send you back to the office. Big Pharma and the government are so tight in each other’s pockets it’s sometimes hard to tell them apart. It’s gotten worse since Thomas Szasz wrote his book The Therapeutic State in the ’60s.

I sometimes get very fearful when I think about mental health and all the mixed messages people receive about this issue. Between the cohort that glamourises depression and the stern-faced cohort who stigmatise mental illness and the people who genuinely just need medication to live normal, productive lives… I really don’t know what to think anymore.

I think the easiest way to ensure that nobody is abandoned or misdiagnosed is to give people the resources to help themselves. I would encourage anyone who in tempted to go on medication to read about it extensively and listen to a variety of opinions. Above all, remember that this is your journey – nobody else’s opinion about your mental state is a final sentence. Read extensively, then trust your gut and trust your instincts.

Image: Martin Cathrae

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