Something can always be done to help? Really?

I have been challenged on this assertion in several settings such as teaching, by students and also by families who are torn apart by psychiatric disorder. Having this statement as a final line to the introduction was intended to say something about expectation but clearly it seems to touch on a core problem.

It could be the challenge does indeed reflect experience.

The first step is to make a diagnosis, which in Psychiatry means “what is most likely” and what are the alternatives. I was going to say best guess, but guess is exactly what it is not. It is a careful evaluation of all the information available. This then leads on to a plan of action. I emphasise the importance of a methodical, scientific approach, reviewing interventions appropriately and then fine tuning the treatment plan.

A few examples:

“If he (or she) doesn’t stop drinking they will die of liver failure (or I will divorce them, or they will lose their job)”.  Addictions can be challenging that is true, but why has treatment not been helpful? What has been missing from the assessment? Let us try a different approach. Maybe it is time for an admission to hospital.

“I’ve been told to pull myself together and man up”. Anxiety is one of the most misunderstood labels.  It is a symptom as well as a diagnosis. In severe cases, initially the individual is too ill to undertake any form of Psychotherapy. When treatment appears unsuccessful this leads to the patient feeling even more miserable.

It is true that at the moment, the underlying process of dementia cannot be changed. However, there are many ways of ameliorating the consequences. Why not try them at least?

Perhaps then, Psychiatrists should be more assertive when we say “there is always something that can be done to help the situation”, because it is true.