What Makes Mental Illness Bad?

So why is it that some people have a psychiatric disorder and they bounce back and it's not a big deal, while others struggle terribly? For the unlucky ones, mental illness defines them.

Here are some factors that affect how much impact psychiatric illness has in a person's life:
(Note to Roy: did I get the effect/affect thing right here?)
1) The severity of the symptoms.
Any way you dice it, mild-to-moderate anxiety can often be hidden and isn't as disruptive as an episode of psychosis with hallucinations and paranoid delusions.
Just to give an example.

2) The duration of the episodes.
So a chronic depression or severe obsessive compulsive disorder may be more disabling than a brief episode of psychosis.

3) The form of the symptoms.
Some symptoms are intrinsically more public than others, or more difficult to bounce back from. In terms of "Can I be a doctor if I have bipolar disorder?," one episode of walking around the hospital naked may be all it takes to get sent home.

Form and severity of symptoms, and the duration of the episodes, are likely to be intrinsic to the disease and not something the individual controls.

4) How responsive the illness is to treatments.
Some people have very severe symptoms that are very responsive to treatment.

5) External support systems: access to good care, chicken soup, and TLC. Job flexibility may enable some people to quietly take time off when the going gets rough. Understanding friends & family-- these are all good things.

6) Individual personality features that support good coping. This is vague and I just made it up, but it's the best I can do--- maybe 'resilience' is another term for it.

7) Individual special features which help a person compensate. So being extremely intelligent, or extremely efficient and diligent, or very charming and charismatic, may make everything else a bit easier.

8) Stress load. This is hard to say for all people--- many people really struggle when things go wrong, and not all people with psychiatric illnesses relapse under severe stress, but all things being equal, it's probably better to not have a lot of loss and stress in life if one is trying to cope well with mental illness.

9) Co-morbid substance abuse. People with psychiatric disorders and drug or alcohol addictions just don't do as well. Often, it's a toxic combination.

10) Co-morbid medical disorders.

11) A willingness to devote time, energy, money and resources to a healthy lifestyle.
(It can't hurt)

What'd I miss?

Prison Poetry

Recently there was a little problem in one of our local facilities. Nobody died, but the incident caused the officers in my facility to reminisce about fights they've had to break up in the past. I overheard some of the conversation and the result is this poem, direct from the officers' mouths:

Two of You and the Gate is Locked

200 guys in the yard, two of you and the gate is locked
You had two fights over here, three fights over there, it was like May Day...
It wasn't against us, it was BGF but we still had to stop it
It was over something small, one guy had a beef
That's when the weapons came out
The officer opened the gate to let him out
"I couldn't stand there and see the guy stabbed up"
They kicked the gate open
That's how the fight got to the compound
You gotta contain it
The gates lock you ain't going no where
They hit the doors, you contain it
You ain't going no where
You in there

Meditation: Does it Do Anything?

Meditation sounds like a great idea from the perspective of a psychiatrist: anything that calms and focuses the mind is a good thing (and without pharmaceuticals: even better!).

Personally, I tried Transcendental Meditation as a kid...more to do with my mother than with me...and found it to be boring. I have trouble keeping my thoughts still. They wander to what I want for dinner and should I write about this on Shrink Rap and will Clink and Victor ever eat crabcakes with me again and did I remember to give my last patient informed consent and a zillion other things. Holding my thoughts still is work.

The New York Times Well blog has an article on Meditation and Brain Changes. In "How Meditation May Change the Brain," Sindya N. Bhanoo writes:
The researchers report that those who meditated for about 30 minutes a day for eight weeks had measurable changes in gray-matter density in parts of the brain associated with memory, sense of self, empathy and stress. The findings will appear in the Jan. 30 issue of Psychiatry Research: Neuroimaging.

M.R.I. brain scans taken before and after the participants’ meditation regimen found increased gray matter in the hippocampus, an area important for learning and memory. The images also showed a reduction of gray matter in the amygdala, a region connected to anxiety and stress. A control group that did not practice meditation showed no such changes.

-------Lower stress, lower blood pressure, higher empathy.... I may have to give meditation another try. The cartoon above, by the way, shows Roy leading a meditation session. Now there's a thought.