Recently I read a quote from a celebrity, I think on Facebook, saying that he has been "struggling" with anxiety and depression for at least 7 years. I was puzzled by this, because there's no reason for anyone to struggle with anxiety or depression for that length of time. There are numerous treatments for depression and for anxiety disorders. Most people with depressive or anxiety disorders are able to resolve their symptoms or at least tolerate them, if they get the appropriate treatment.
I wondered whether the celebrity had really been diagnosed with bipolar disorder or borderline personality disorder, but was afraid to say so, because these conditions are far more serious and he thought it would be too stigmatizing to admit he had them. It's also possible that his treatment professionals told him that he had "anxiety and depression" when in reality they had diagnosed him with borderline personality disorder or possibly even with bipolar disorder, without telling him. In other words, it's possible his treatment professionals lied to him, to avoid upsetting him (and potentially losing a high-paying patient). It's also possible the celebrity was misdiagnosed or was receiving inappropriate or inadequate treatment, or that he has been noncompliant with treatment. All I know is that something was missing from the picture.
This scenario and its possible behind-the-scenes factors illustrate some of the pitfalls of our "Information Age" in which people are inundated with "information" from the internet and especially from social media. It also may illustrate the continuing stigma relating to mental health conditions, as well as the general difficulties people may encounter getting correct diagnoses, information and treatment for their conditions.
I have learned that it is important to tell people what their diagnoses are. When I was in graduate school, some of my professors minimized this educative component of treatment. Many colleagues I've had believe that patients can fixate on diagnosis, or that diagnoses are controversial or often inaccurate. Although I agree with those colleagues that there are many potential problems involved in telling patients that they have a condition such as borderline personality disorder, antisocial personality disorder, or another stigmatizing condition, I now believe patients have a right to know and I feel comfortable making such diagnoses when I have the required evidence.
I saw numerous comments on the actor's Facebook page from fans stating they too had been struggling with depression or anxiety and depression for years. I didn't see any comments from people speaking about how they recovered from their conditions. No one seemed to be questioning whether they had been given the correct diagnosis or the right treatment. This is sad. With only a couple of exceptions that I can think of, every patient I've worked with who had a depressive disorder or an anxiety disorder as their primary diagnosis got much better, sometimes with therapy alone and sometimes with a combination of therapy and medication. In the two cases that spring to mind in which the person did not get better, I strongly suspected the patients were not compliant with their medication and in one case, the person was using drugs. I also had one patient who didn't recover from severe depression until she had treatment with a brain stimulation method that at the time was only available in Canada ( I believe it is now approved in the US). The medications she'd previously tried had been ineffective. It may take some time to find the correct treatment regimen for someone's condition. But there is no question that depression and anxiety can usually be resolved. The treatment of a condition such as borderline personality disorder is far more difficult and perhaps I'll discuss this in a later post. Bipolar disorder is incurable but can be managed with medication.
I commend public figures for speaking about their personal problems in an attempt to destigmatize those problems, but this is only useful if what they are saying is the truth. It's sad that both patients and their treatment professionals are still sometimes victims of the fear of stigmatization. Perhaps one day our society will acknowledge that there's no such thing as perfect mental health and that we all have problems.
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