Recognizing mental illness when it first emerges can be extremely difficult, even for family members who are so familiar with the personality and character of their suffering loved one. This can be an agonizing and fear-inducing predicament for obvious reasons. What makes the recognition of mental illness so challenging can be blamed on several factors.

Firstly, the average person is not expected to be educated about mental illness, unless they already have someone in their life with a well-established mental illness. Some cultures make people extraordinarily uncomfortable with even speculating that a family member could be ill and they procrastinate in seeking out professional help or even discussing it privately. Because there is a lot of stigma associated with mental illnesses, both the sufferer and their family may want to assume anything else could be going on besides a diagnosis which can alter a person’s life forever and profoundly.

When mental illness first manifests, if the person experiencing it is young, like a teenager, their odd behaviors and symptoms could be hastily written off as the result of teenage hormones. Young males especially can engage in risky, aggressive, or manic behaviors that are misinterpreted precisely because of their youth and immaturity.

Because of the prevalence of drug abuse in our society, it’s also a common reflexive response for family members to think that their ill child or sibling may be acting strange and unpredictable because they are under the influence of drugs or alcohol. In fact, even when we suspect that a person may have psychological issues, we still consider the possibility that their most disturbing symptoms could be caused by self-medicating with drugs. During one of my own son’s longer hospitalizations, I was stunned to find out he was not under the influence of street drugs when he committed some very anti-social behaviors.

Another reason why it is so hard to recognize emerging mental illness is because some people are actually fairly good at hiding it for a while, intentionally or not. Parents are often told to notice if their child suddenly withdraws from their friends, starts doing poorly in school, or seems to have a sudden personality shift.  These are important clues, but some kids or young adults can still pretend they are doing fine when they are not, until something really dramatic or explosive happens, taking everyone by surprise.

We also need to separate out what may be defined clinically as a personality disorder or a mood disorder, compared with full-blown serious mental illness.   For example, anxiety can be very concerning and debilitating.  Some behaviors associated with anxiety can even reveal and underlying psychotic process. But there is a world of difference between general anxiety disorder and schizophrenia.

There are clinical descriptions of what constitutes a mental illness, but some of those behaviors and symptoms need to occur continuously over at least a six month period of time before it can be confirmed. It is also very common for diagnoses to change as more and different symptoms emerge. Psychiatrists do their best to be accurate, but they do not have any type of physical examination to determine a mental disorder. In fact, sometimes they can only come to conclusions based on what the mentally ill person admits to them. When a person with a thought disorder relays their own symptoms, their perceptions and memories could be far from accurate or objective.  Further, it is also common for people to have a co-occurring diagnosis. For example, a person may have both anxiety and depression.  A person diagnosed with both schizophrenia and a mood disorder is referred to as schizoaffective disorder. The term “dual diagnosis” now implies a mental illness along with a substance abuse disorder.

Some medications address targeted issues, but with a misdiagnosis the side effects can be substantial.  For instance, if a person initially acts depressed, they may be prescribed an anti-depressant. If the person actually has bipolar disorder, the anti-depressant could propel the person into a manic episode. Most of us have heard the commercials on TV with the long list of scary side-effects from medications. The wrong prescription could increase a person’s symptoms or cause completely different ones, including suicidal ideation.

Roughly 20% of the general population will experience some form of psychological stress at points in their life which is significant enough to warrant professional help. Being depressed over genuinely stressful life events like divorce or job loss will eventually subside when circumstances improve and when temporary therapy or other treatments are utilized. Serious mental illness, however, needs to be managed for a life time, often with unsatisfactory results.

One thing for sure is that the more we openly discuss mental illness, the less stigmatized it will become. In turn, more people will seek out treatment sooner and compliance to medication or therapy will also be more successful.

Author: Kartar Diamond

From the Noah’s Schizophrenia Blog Series

Photos by Maximo