Diabetes vs. mental illness

Sorry, I don’t mean to make that sound like a WWF smackdown. Actually, I’m very interested in what reader WmJm has to say about his experience as a person both with a mental illness and with diabetes. Diabetes is the illness that consumers (like me) often come back to for clarification to the layperson: Having X is like having diabetes. You take the medication, you manage it, it’s chronic, but it’s livable.

WmJm takes this one step further to talk about his life with both. My favorite line: “So in the psychiatry-pharmacology vs. anti-psychiatry debate this demonstrates a win for both, together, when stitched with humanity in between.”

This is long, but it’s worth reading. If you want to see the post this comment arose from, it’s pro-psychiatry vs. anti-psychiatry. The dialogue there is really interesting.

WmJm’s story
I’d like to share briefly the current, ongoing tale of a good support system provided by the often-maligned insurance industry. So: an abbreviated history of my physical illness, which in the whole person framework includes mental illness.

- insulin dependent diabetes mellitus as a teenager, 4 decades ago (no family history known, but hey! everything has to start SOMEwhere, right?)

- about 35 years later I had become depressed but didn’t know it. I blamed it all on my longtime, increasingly ‘brittle’ (insulin-sensitive) diabetic metabolism.

A family friend, a psychologist-family therapist, spotted it in its rather advanced state & got me into some professional help right away. Although I’m certain that it saved me from suicide, that experience with a psychiatrist (introductory dose of SSRI and some talk appointments) was either wrong or just inadequate and things went rapidly downhill as I quit making appointments and ‘confidently’ quit the meds.

Part of our own failing was the inability or unwillingness of my spouse and me to learn about and critically assess this new condition in my health. We, or certainly I, didn’t know: was I acting strangely because I was slipping into another acute depressive episode or was my much more familiar insulin-dependent life? Until it became really disabling I kept chalking it up to diabetes.

[Because sometimes illnesses do fight like cats and dogs, photo by Jacob Dockendorff.]

Another lucky intervention came when a close family member visiting from far away saw my state and got me linked up with CBT (cognitive behavioral therapy) and they put me through a rigorous diagnostic procedure and therapist matchup. This evidence-based logic worked wonders for me – it reeked of clarity and purposefulness! A life raft (with a searchlight and a rudder) in my sea of molasses. I was to be the motor and the captain (NOTE: these are literary allusions of the moment, not referents during therapy!).

And thus the ‘label’ ACUTE CHRONIC DEPRESSION was announced and it helped immensely. I now read about depression, about the SSRI drug families and mechanisms, about the newer combination therapeutic approaches, the ‘case studies’ told by sufferers, and the range & balance from the marvelously varied internet. Without CBT and the Internet’s information, I feel sure I would have assumed that it was I who was failing rather suddenly, despite the evidence of a successful and happy life which included four decades of superbly managing my voracious life-partner – my ‘juvenile’ diabetes.

This was far better care. So different from that first year with the psychiatrist! I was treated like a whole person – I got a referral to a psychiatrist MD who prescribed a different drug, after having me undergo more diagnostic questionnaires & interviews and after communicating with my CBT therapy team. This drug + therapy combo (SSRI + cognitive behavioral therapy) worked well for me.

So now it is time for some comparison between my life of diabetes management and of depression.

IDDM is much more mechanistic – the insulins today combined with the ‘instant’ BG meters make physiological corrections immediately available if one is prepared / equipped and trained in the basic glucose metabolism physiology.

SOCIAL
When in social situations (at work, home, in a movie, wherever) IDDM is ‘easy’ to deal with. “I can’t go the the meeting/drive the car/answer the phone just now because I’m checking my glucose/dosing some insulin/having a low …”. Treat, recover, move on. The label meant everything: simply mention it and people widely form an idea of how to interact that is usually quite appropriate. And it gives me a teaching opportunity on behalf of diabetes education.

DEPRESSION is far more difficult – weeks transpire between onset and response to a change in meds or other therapy modification, to the degree that the ‘label’ is absolutely useless, in my view, in helping on a day-to-day or week-to-week basis. The label works over the longer view, and mentioning it doesn’t really give others knowledge of how to behave with me.

SOCIAL
When you’re walking around or in your office or home no-one knows you are horribly depressed unless it is one of those under-the-covers episodes. And even if you can respond to self-diagnosis (Oh, I’m slipping into real trouble; need to step back and realize I didn’t make this happen; it is not my ‘fault’) you may be unable to get out of that hole on your own.

With Type 1 diabetes no label is needed internally, because the physiologic response is both readily apparent and immediate.

MEDICAL CARE

IDDM enables you to call the endocrinologist or non-MD diabetes care professional and discuss problems or adjust dosage or combinations of insulins on the phone and know insurance will cover it, or that those few minutes of expert advice may be freely given. A diabetes emergency virtually always is safely treated by administration of glucose (by mouth or by glucagon shot) which anyone can do if so informed – wristbands, medallions, wallet cards and even signs on the bus instruct anyone that this is absolutely the safe route to follow if there is even a suspicion of diabetic hypoglycemia.

MENTAL ILLNESS of course is the forlorn stepchild. Is it typical for a distressed patient to *only* have a suicide prevention number to call in an analogous emergency? Does any average person know the safe way to ‘administer life support’ to the suicidally depressed person? No, they don’t, and even worse – the label ‘mentally ill’ doesn’t yet help them to do any better than the lack of it does. The argument voiced by earlier posters doesn’t address the critical need for a socially-understood ‘label’ in the societal embracing of those with and those directly affected by this disease of mental illness.

WHOLENESS + WELLNESS
Now, the good news (and I want to mention a proprietary program now). Out of the blue one day I got a call from Personal Choice’s Health Connection nurse. This is a ‘health maintenance’ program for subscribers with chronic illnesses. Perhaps my records with them clued them in that I might find use in this service, or perhaps I had checked a box on a billing statement or something.

It worked for me, and has continued to work. My ‘health connection’ knows what I said or did or faced in our prior call so there is seamless continuity. The caller either calls at a specific time or interval, or I call them and ask for my HC. One can imagine that this could become either onerous or so unengaging that it is specious. But if it isn’t working then I can change it in any way: cancel, reschedule, choose a different HC, increase the time per call or shorten the interval between calls.

It is almost like talk therapy, almost like a caring parent, almost like an understood social rule (e.g. no jaywalking in busy city streets, shouting wildly in the mall, no diving into the garbage can at the school cafeteria for that uneaten roll). It is a conversation between equals – one of mutual respect: I respect the remoteness & inability of the HC nurse to act like one of my doctors and my HC respects my need to manage without the HC program at any point I choose.

So in the psychiatry-pharmacology vs. anti-psychiatry debate this demonstrates a win for both, together, when stitched with humanity in between. Science really tries to develop useful tools, alternative therapists try to match society’s demand for scientifically-consistent procedures. Mechanisms like progressive health insurers or governments foster *whole person* well being when they suit any case without incurring too great a cost.

I think the “pro-psych” atmosphere is actually what the public came to demand after centuries of snake-oil salesmen giving home remedies a bad name (for the sake of profit). So now it is the job of holistic therapies to convince society that the new shysters have to be set aside. We can do it, too! In recent years American med schools have come to require holistic medicine classes, to mandate courses in communication and ‘bedside manner’. Big insurers are initiating new programs like Health Connection and are covering more ‘preventive’ care just as they tighten their drug formularies to reduce costs. Maybe these are little indicators of an improved delivery of healthcare.

liz | 1:48 PM | Uncategorized