Day: December 16, 2010

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The Presence of Stress Doesn’t Make the Disease Process Any Less Important

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Self-Care Tip #135 – If it’s medical, call it medical and not stress.  Be a friend to yourself.

New to me, Stacy came because of her problems with violence.  She was enormous.  5’11” and 200 pounds, she was just too big for her parents to handle her any more.  She was precious to them, their only child.

Taking Stacy’s history, I asked, “Does your family have a religion you practice at home?”  Stacy’s parents were giving her history since Stacy was disabled and used very few words.  Mom looked at me, and asked, “Why?  Why are you asking about our religion?”  She was sensitive.  Worried that I was packaging her up in a religion-box, she personalized my question.  I explained that religion is part of family culture and the question was simply part of getting to know them.  She relaxed a little and then said, “We have more of an ‘Autism’ home-culture these days!”

Mom looked tired although still very much engaged in her daughter’s life.

It often happens, when someone see’s me in clinic for the first time, that my questions take them by surprise.  They aren’t used to someone so directly and objectively asking and speaking about them and to them.  So it went with Stacy’s mom.  Question after question, she seemed to be in a mild state of wonder.  It wasn’t gun fire but she might have felt like it was.

“Does anyone in your family have emotional illness?  Any depression, anxiety, suicide, drugs, alcohol…?”  Why do I want to know about the family? her face said.  “No!  No one.”  I was just ready to move on to further history when she said, “Well I… I have been depressed a little on and off but I don’t have depression.  Who wouldn’t feel depressed with this stress?!”  And then Stacy’s case manager said, “Who wouldn’t feel stressed in your situation?!” and smiled and laughed with her to put her at ease.  Stacy’s case manager is a nice person.  She is bonded to the family and cares about each of them.

We completed our history and formulated a treatment plan together.  Stacy had sat mostly quietly through the hour and her parents were now at ease.  Before they left, I was able to share with Mom a couple of sentences on taking care of herself.  On seeing herself as important and in doing so, was giving Stacy the best gift she could.

What I would like to say to Stacy’s mom and to her case manager is that thinking depression is because of stressors is a great lie.  There might be some initial correlation but it is often not the point .  The real issue is medical.  I wanted to tell Stacy’s case manager that she should know better than to promote this.  I wanted to tell Stacy’s case manager that helping Stacy’s mom not minimize what she was going through was friendlier.

Stacy’s mom is not my patient, but I did pick up that she is sad, fatigued, personalizes things that aren’t about her, anxious, a little hypervigilent and suspicious, and that something biological was likely going on.  Everyone has stress, but not everyone reacts the same way.  Some of us get ill for biological reasons.  Using the stressors as decoy to the disease only preserves the state of suffering.  And it affects everyone.  Mom was part of Stacy’s recovery too.

Question:  How do you see the relationship between stress and mental illness?  Please tell me your story.

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