Lets discuss "the case of high blood pressure".
Imagine Scott. He is your typical middle-aged man with a mortgage and a demanding job. He is married, he has "two and a half" kids and a dog. Scott is also suffering from high blood pressure, and his measurement values are concerning. The doctor is exploring various blood pressure medications to normalize his numbers. Risks and side effects are causing concern for Scott. Before medication is indicated, Scott should try making some lifestyle modifications.
Reflecting on his family history, Scott acknowledges that both his dad and grandparents suffered from high blood pressure, suggesting a possible biological component. However, if Scott were to:
Start exercising regularly.
Normalize body weiht
Avoid salty food and improve his diet.
Reduce stress by finding a less intense job and improving his marriage.
Cut out alcohol and/or smoking…. Etc.
With out a doubt his blood pressure might improve or even normalize on its own. Unfortunately, it's challenging for Scott to achieve all this quickly, given his demanding job as a consultant with extensive travel and work-related dining and drinking. Financial responsibilities, including a mortgage and family care, limit his time. Scott recognizes the need for therapy with his wife but faces delays.
If the blood pressure numbers are too high, Scott may not have the time for these changes, risking a stroke or heart attack. Treatment is needed urgently.
Now, consider Scott suffering from anxiety, panic attacks, depression, insomnia, or organization, attention and concentration issues that are affecting his parenting style, his marriage and his work to the point of risking a divorce or a job loss. Isn't this akin to the Scott with high blood pressure risking a heart attack? Once we consider all the things Scott must deal with and the various losses and stressors Scott previously experienced and currently deals with in his life, even if it is easy to understand why Scott is struggling, this understanding does not really make anything better.
Scott can and should develop better coping mechanisms, reduce stress and improve his relationships, increase physical activity, reduce stress etc and yes that would probably result in him feeling better. The situation painfully comparable to the blood pressure Scott... the improvement is not happening fast enough. With low energy, ongoing bad mood, exhaustion, insomnia, and with clouded thinking expecting Scott to miraculously overcome it all on his own simply by using the strength of will power and discipline is not only a bit unrealistic but also unfair.
Scott needs help now. His functioning is impaired and he is suffering. His capacity and his will power for action that will lead to required change are reduced. It is all very similar to someone with high blood pressure yet for some reason most of the people are more likely to accept a blood pressure medication then the medication for sleep, anxiety, or depression. There is this idea that somehow it is very different then treating a more “medical” problem. That mental health treatment indicates weakness and that you should just suck it up and try harder. Wrong perception that by accepting help somehow you are admitting the defeat.
Unfortunately, I face similar discussions almost every day. Scott needs to make that crucial first step towards health and happiness and it is not like he does not know what he is "supposed" to do but all of the above is way easier said than done. My hope is that Scott will reach out to me and for all of us my hope is that we will see a future without stigma, where mental suffering is equated with physical suffering. We're not there yet.
Dr Starovic
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