Chronic Health Condition

healthA woman who works in the health care field came in for a visit with us today.  We’ve been seeing her for about five months.  She had a problem with depression and then developed a hypomanic episode.

She has continued to have mood cycles for the last several months. It’s now clear that she has developed a bipolar type of depression.

She is not only bright, but super effective at work and extremely charming.  She is one of the most positive people we see in our practice – always talking about how important it is for her that she has found such a good group of clinicians.

We were wondering why, despite being so enthusiastic about working with us, she had completely dropped the ball several times.

  • running out of her medications three times without making any effort to get refills,
  • forgetting to make appointments that were necessary.
  • forgetting to get lab tests that were ordered.

This seemed so out of keeping with everything else that we know about her.

When we asked her about what was going on we came up with three possible explanations:

  1. Sometimes when she felt good (energized and mildly hypomanic) she began to feel that maybe her problems weren’t really serious enough to warrant heavy duty treatment with medications. She began to feel that perhaps the problem was that her husband was overreacting, labeling her as mentally ill for his own reasons. And as a result she would sometimes run out of her medications and not refill them.
  2. On the other hand, when she got depressed she tended to feel overwhelmed by the idea of having bipolar, and, even though her mood cycles were not that severe and with treatment would probably not affect her life very much, she felt very worried…. In fact, so worried that she almost unconsciously began to block the thought out of her mind…. with the result that she forgot to make appointments… or get lab tests done.
  3. Underlying all of this, though, was the difficulty adjusting to the reality that she now had a chronic health condition. She had always been extremely healthy, able to stay up all night, partying and taking stimulants or ecstasy, and then go to work the next day and function well in a demanding job. When she got sick, which was very rare, she went to the doctor and got something to take that took care of the sickness. In other words, she felt, as most of us do when we are young, that perhaps she was never going to have a serious health problem. Suddenly she had a problem that required ongoing treatment and attention.

For many people moods and mood disorders are the first potentially serious chronic health condition they have. It requires some time to adjust to the idea that there can be a health problem that requires ongoing attention, that doesn’t entirely go away, and yet that doesn’t have to have a huge impact on one’s life if it is given the appropriate attention. During the process of adjusting to that new idea, it is not uncommon for people to alternate between denial or avoidance, and feeling overwhelmed, in a way that can represent a real barrier to getting and staying well.