Columns

Depression seems to be very common to older and middle aged men and is a cause of grouchy behavior. Apparently, many men who have become depressed when older refuse to seek or accept help for their condition. Also, many persons who are not seniors and who have some type of disorder, but who are nominally functional in life, do not always know whether or not to seek treatment for their problems.  

In my case and in that of many other severely mentally ill people, getting treatment is absolutely necessary, and it prevents a situation of extreme mishaps. When someone is severely psychotic, treatment is necessary and not optional. If someone is depressed to the point of suicidality or to the point where gravely disabled, (e.g.; they can't take care of their basic needs) that person needs treatment, needs help, and should seek it.  

However, if you have some amount of depression, or some amount of emotional pain in life, but it seems bearable, it might be better to seek alternatives, such as meditation, psychotherapy, or a self-help group.  

Don't get me wrong; mental illnesses are diseases that require treatment. If someone is sick, they are likely to need medicine. This week's column is not an invitation for persons with mental illness to go off medication. But, to address people who are not severely mentally ill who could realistically get by without medication--more power to them. Medication isn't a "good thing" rather it is sometimes a necessary and unpleasant thing.  

Psychotherapy is usually a part of the package deal that comes with inpatient and outpatient institutionalization. Psychotherapy can get a person more in touch with their emotions. This is fine if you have a lot of stored pain and you need to get some of it released.  

However, being more in touch with emotions might be counterproductive if you are a "corporate" person, e.g., someone who lives on stress, and for whom too many emotions would hamper job performance. Getting more in touch with feelings can raise the volume level of emotions and can make a patient feel worse in the short term. In the long-term, presumably if the therapist is good and is a match, it can be an essential piece to the jigsaw puzzle of getting better.  

If more people sought psychotherapy to deal with problems instead of alcohol, our society would be better off. …but I'm getting off track.  

If one has been diagnosed with severe mental illness of some kind, and if one is already fully involved with the mental health treatment system--if you have reached that point, then the more assistance you can get from the system, the better off you may be.  

On the other hand, if you were a successful businessperson who had occasional panic attacks, you would probably want to get help in a fairly discreet way. Those with whom you do business might not want to deal with you if they knew you had problems.  

Medication might interfere with waking up at 5 am, and with performing demanding job duties. Psychotherapy may make a person too emotionally sensitive to continue having that meanness that helps some businesspersons succeed. You might not have time for regular meetings with a psychiatrist, trips to the pharmacy, and group therapy. The mental health treatment system would put you at a psychological wavelength in which you can not be a high level businessperson.  

"Successful" people with mental illness who are not disabled by their illness do not usually go the institutional route for their treatment. Exactly how they receive their treatment is beyond where I have knowledge. In my case, I have worked at part-time jobs and sometimes succeeded, but have only been able to work fairly minimally. I have gone the institutional route, and I am not sure if this has helped or interfered with my work attempts.  

While you might think it just doesn't happen for a person with mental illness to be a successful professional and to have all of the trappings of success--you would be wrong--it does happen. When someone is materially successful and at the same time mentally ill, 99 percent of the time, the illness is never heard about. For example, some ultra-famous movie stars. We have just learned that Richard Dreyfuss is bipolar, and a few years back we heard the same thing about Katherine Zeta Jones. These people came out of the closet only after establishing illustrious careers. The bipolar wasn't revealed until the actors reached a point where it couldn’t damage their careers.  

In my past, one employer as well as one prospective employer disclosed to me that they had a mental illness. Both were successful entrepreneurs whom I met in the course of my working at jobs. Neither of these people would have become an infantilized, systematized mental health consumer. Whatever treatment they received was such that they could continue functioning as heads of two different companies.  

On the other hand, since my wife and I are medicated and involved in the full deal of being treated for a mental illness, it has become quite challenging to live in society at large. The mental health treatment environment, the illness, the medication, and perhaps some amount of burnout have made work at a regular job a near impossibility. At this level, more help with day-to-day living would be welcome.  

My wife and I are on a level where our illnesses are chronic and disabling, we are middle-aged, we are dependent on services from the mental health treatment system, yet we are intellectually unimpaired and can live independently. This category of people is right in the middle, and we don't fit in very easily with most treatment classifications. 

However, there just isn't a lot of help out there for mental health consumers who are treatment compliant and doing well. The focus of the mental health treatment system is that of dealing with the problem people who are less functional and who require more maintenance. The ones who don't do as well are using up most of the money and resources of the mental health treatment system, and this leaves people who are doing better to be left pretty much on our own.