Can you tell which of these people has depression?
Half of these people have a history of mental illness, but can you pick it?
Half of these people have a history of mental illness.Source:BodyAndSoul
The short answer to the question above is “not easily”.
Diagnosing mental illness is a complex process. Unfortunately, psychiatry does not have objective tests that are critical diagnostic tools in other areas of health. There is no blood test for depression, no ECG for schizophrenia – so the diagnosis and then the subsequent treatment is made by a trained clinician taking a detailed longitudinal history from the patient and family and ruling out physical and other causes for the symptoms.
In a new show on SBS, How ‘Mad’ Are You?, the question of whether it is possible to diagnose mental illness without the usual clinical information is tested.
Is there a personality type who gets depressed? Depression can happen to anyone but some people are more prone to being generally depressed. Someone who has had a tough early life without good nurturing and validation can be less resilient when later life crises hit. A person who finds it hard to speak about emotional issues may struggle more with depression. However, there is no exclusive ‘depressive personality’ that helps to predict or diagnose depression in an individual. An individual personality style is helpful to understand in working through therapeutic strategies that will best suit them and maximise their outcomes.
As the psychiatrist on the expert panel in this show, I felt like a blindfolded high-wire trapeze artist with both legs bound together, working without a net!
Making a diagnosis of mental illness without taking a clinical history, having information about the person’s functioning, full physical health story and speaking to their family was a very fraught experience. The expert panel was given bits of film to watch where the participants performed unusual tasks or did parts of psychological testing. We did not meet and speak with the individuals in the way we normally would if working in our usual roles. Importantly, mental health experts do not go around ‘diagnosing’ individuals in the general community – but rather, we provide diagnosis and treatment for people who request help or are experiencing difficulties and need psychiatric or psychological help.
Professor Jayashri Kulkarni (far right) and Professor Tim Carey, Jan Macintire were 'flying blind' without patients' medical history.
Image: Supplied. Source:BodyAndSoul
To diagnose depression in someone who wants help, it is usual that the patient will say they feel ‘down’ in an ongoing way, may have sleeping, appetite changes, problems with slowed thinking or difficulty concentrating, can feel angry and irritated, lose perspective on issues, feel guilty for no real reason, have lots of different aches and pains or other body concerns and can be anxious and agitated. Thinking about or planning or attempting suicide is a tragic part of major depression. These symptoms are part of an episode of major depression, but there are other forms of depression that can be much more subtle, due to specific events (eg: after childbirth), or more long term but not severe enough to impair functioning. Men and women can present differently with depression, and some people hide their depression by drinking too much alcohol or using other substances. Depression can be expressed differently across age groups and cultures. There is a great deal of variation in the experience of depression and hence the detection of it.
It's nearly impossible to pick someone with mental health issues from a line up. Image: Supplied.Source:BodyAndSoul
An interesting 'tool of the trade' in diagnosing depression is to use one’s own mood state – that is – do you feel the person’s sadness when you are with them? Obviously, this relies on the clinician being in a neutral mood state themselves and being able to empathically receive the patient’s communicated sadness. This does happen, but usually when the person is severely clinically depressed.
The biggest reason to diagnose depression in someone is to help them feel better and improve their functioning. As an illness, depression can be treated by many different approaches – it is not only about antidepressants. Understanding what is happening is an important step towards recovery. But – the diagnosis of depression, especially if it is not in a severe form – is difficult and needs time, expertise, lots of information from various sources, observation and ruling out of other conditions.
An important message from this show How ‘Mad’ Are You? is that people with a mental illness are not easily detectable, so it is OK to seek help for depression and other conditions because once helped, you can blend in to the ‘normal’ population. I have enormous respect for all the participants in the show, especially those with mental ill health, who bravely put themselves and their stories into the public domain. Their efforts are important to show that people with mental ill health can live happy, fulfilling lives and not carry obvious ‘labels’. It is critical to encourage people to seek help early for help with mental illnesses.