FreePsychArticles #2:  When’s the right time to see a psychiatrist?

There are probably thousands, or tens of thousands of people suffering from problems involved in their thoughts, feelings, behaviors or relationships that secretly wonder if they should seek professional help.   It is a serious question that deserves investigation and evaluation.

Like in the decision to visit your medical doctor for physical ailments, there are some basic rules or guides to follow.  When you have physical problems that lasts at least a couple weeks and appears to be worsening, in spite of any home remedies tried,  a prompt visit to a doctor is usually in order.   Fevers, sudden changes in weight, inability to eat, sleep, speak, see, hear, or feel, breath well, acute changes in balance or ambulating, severe pains, changes in skin coloration, injuries, especially that cause limitation in movement are a list of findings, that covers many of the body’s conditions warranting a visit to an appropriate medical practitioner.

Meeting with a professional mental health clinician can be an even more dramatic decision since it implies one is loosing one’s mind or going “crazy.”    In many circles seeing a psychiatrist is considered a weakness or admission of insanity.   One might think crossing over the doorstep on the psychiatrist’s office represents a departure from the world of being “normal” with, perhaps no return.

To leave it at that, with this set of assumptions, is settling on a narrow, stereotypical view of the healing art and science of psychiatry.   Even the words, “crazy. loosing your mind, and insane” have no place in the practice of an ethical and experienced psychiatrist. Rather the terms come from popular literature, the media or legal definitions and have nothing to do with the practice of medical psychiatry.

The basic desire to change or grow occurs through two basic mechanisms of human experience.    If everything is really going well there seems to be little reason to change it.  But when things start going badly and our lives become unruly, difficult or painful we begin to suffer.  Sometimes we notice others are becoming concerned or alarmed about we have changed, seem different, are behaving or treating ourselves or others while we personally feel like there are no problems.

In the case when we feel unable to assume a normal, happy state of mind we should realize we are suffering.   Suffering is one of the two main reasons ones seeks change and when all our abilities to reduce our suffering seem exhausted a request for a psychiatric or psychological consultation may be in order.   But not before one tries to express the current concerns with someone well-trusted to have an empathic, compassionate ear.  A meeting should be set up with serious attention to time and place.   Rather than just drop in on someone or use the moment in a casual encounter, a discussion of what is really bother you should be pre-arranged to avoid interruptions or distractions.   It is not necessarily for advise or direction but merely to be able to speak out your heart to a non-judgmental listener.

Certainly most of us have a pretty good idea who could hear us out without getting overly disturbed or excited.   An old friend, relative or member of the clergy are excellent choices to talk and get your concerns off your chest.    One reason is the basic need to talk out your problems routinely, advise found immortalized in the words of King Solomon thousands of years ago.

If the moment is critical and you feel desperate or that the problems are too great for anyone you know to hear, there are many crisis telephone exchanges, suicide hotlines or similar services to call.   More often than not people are able to ventilate their feelings and gain some perspective that can change everything and bring on new strength and awareness of ways of coping better.    Reaching out to others should be strongly encouraged when ever one is beset with difficult emotional periods in life.   I’ve heard it said more than once, “If everyone spent one hour a week just talking out problems with a trusted friend, it would reduce the need for professional mental health services in half.”

SO, the first thing that drives one to want to change is suffering.    Unfortunately there are many long-suffering people who don’t seek change in spite of their suffering.   The remarkable thing is how much suffering people are capable of.    Since often suffering arises slowly and quietly it kind of moves in to one’s life before we realize it’s there.  We may think somehow we deserve to suffer for things we’ve done of have neglected.  Or something happens that causes pain, like a loss of a loved one, or a job or friend, and we assume the suffering is inevitable and part of the natural process.

When suffering does not seem serious enough to bring about a desire to change oneself the “other motivator” for change becomes available.   I’m talking about following the advise or guidance of others.    We are often in the middle of unsurmountable difficulties and utter chaos living in contemporary times.   Some people seek solutions to their needs in ways that only worsen their need for answers.   This comes from moving away from simplicity and direct experience in one’s day to day life.   Unlike animals, we have the strange tendency to seek objects or experiences we think will help but have nothing to do with our real needs.

For example, if an animal is cold, it seeks warmth.  If hungry, it seeks nourishment. Companionship if it’s lonely.  But humans often seek out things of a different order then the simple need.   So we eat when we’re lonely or scared or drink alcohol or other substances when we have needs that are not physical.   Picture a successful 50 year old man with a good living, normal children and all one needs to be comfortable.  But he’s not happy and doesn’t know why.   All too often he’ll set his sights for his discontent, wrongly, on his wife.  He’ll decide he needs ‘a change’ and divorces his wife.   This is a tragedy because he’ll be even more unhappy with a new wife while causing so much pain for his loved ones.

The emptiness that drives people to fill in all sorts of alterations in their lives has been called by Rabbi Dr. Twersky “Spiritual deficiency.” I will be talking more about this in future posts but the important point is how talking with others or taking advise by one well-versed in guidance can help unearth some of the problems not necessarily within the grasp of the psychiatrist.   If others close to you have tried to tell you there was something wrong and recommended you seek professional help, maybe you’ve been avoiding it?   If you heard it more than once or twice in a short period of time it’s really worth considering, at least for a consultation.   There are many individuals who simply ‘can’t see’ their own symptoms in spite of the fact almost everyone else does.  When they’re fired or laid off, lose friends or spouses, or even have involuntary hospitalization, they are still unable to realize it could be related their nervous condition.    And as difficult as it may be, a great deal of personal suffering cold be spared by taking the advice of others.

So how does one decide to go to see a psychiatrist?    If you find yourself suffering and find no obvious reason and talks with friends doesn’t help clarify things you should consider seeking professional help.   The period of time to decide really depends on the situation.   If there are problems in the basic areas of life lasting at least two to four weeks most of the day or night with no sign of improvement consider it.  Some major areas of concern are summed up in the following list:

1. Alterations in sleeping or eating patterns.

2. Dramatic changes in one’s behavior

3. Feelings of loss of control or thoughts of extreme actions, like suicide, destruction of property or harming others.

4. Persistent negativity or thoughts of worthlessness or hopelessness.

5.  Hearing voices or seeing things other’s near you can’t see that are distressing and disturbing.

6.  Fear of going outside that worsens and causes social isolation.

7.  Hoarding things because you can’t throw anything away, that causes your living quarters to be increasingly cramped.

8.  Uncontrollable concern with germs or infection with excessive hand washing or the need to repeatedly count or check on things several times or more a day.

9. Loss of ability to perform the normal activities of your daily living or work because of mental interferences.

10. A temper gone out of control, or aggression with words, or violence towards oneself or others.

11. More than one person who cares for you has advised you seek a consultation  even though you just don’t see it.

This list gives some of the most obvious signs and symptoms that point to the likely benefit of seeking professional help to further explore changes that can improve your life to be more comfortable, happy and fulfilling.

If you found this article helpful please forward it to others.   I review the comments and will respond per email time allowing.

Gershon Freedman, MD