The Mental Aspect

DepressionOne of those things.

It’s usually just swept under the carpet until the pile of crap under the carpet is just too noticeable to be ignored.

I don’t know what the current statistics are, but those dealing with a chronic condition such as diabetes are more likely to experience clinical depression. It’s something like two to four times more likely to be diagnosed with clinical depression than the average population.

I would venture to guess that this would be true for nearly any chronic condition.

But maybe diabetes is a bit different in this respect – it is said that we are in control of how things turn out. If we do “good” and follow the “rules”, we shouldn’t have many problems. On the other hand, if we do “bad”, disregard the “rules”, we are destined to live a life full of “self imposed” complications. We all know it’s not quite that simple, but that is often how the medical community makes it seem.

How can those demands not have a boatload of mental health issues tied to them?

But this fact is something that, in the typical clinical setting, is not talked about until it’s at a point where it’s demanding some attention.

I don’t think that is a good approach.

Maybe it’s because most of our medical professionals are only comfortable dealing with whatever they specialize in?

But why is that?

Wouldn’t it seem like a better approach to open the communication channels early on in the game? To help the one diagnosed to find some healthy ways to cope with the constant demands we are faced with?

I have been in a couple different types of practices. One where there is a team effort – all the “specialists” in the same general practice. A handful of endos, nurse educators, trainers, dietitians, and if you’re lucky a person qualified to work on mental health issues. Those are pretty nice. It’s all in the same office, all appointments are handled by the same scheduler, one copay, all that nice stuff. Those seem to be the exception though.

The other types of practices I’ve dealt with, everything is separate, and the task of pulling in all the right players is on me. In one way that is nice, you have more flexibility in your team members, but it sure is a lot of work. There is also a lot less communication between team members, unless you take action to tie it all together. This has been more common for me.

I feel that when you discover (or admit) that you need help, it is an especially tall task to be faced with – that of deciphering the mental health support network in your area, trying to figure out if your health insurance will cover any of it, and if not, can you afford it? Can you afford not to afford it?! Where do you go? How do you start? What do you mean the first available appointment is in THREE MONTHS?!

How very frustrating.

Why is it such a separate thing for so many clinics? The mental ability to deal with diabetes vs. the physical actions and endocrine stuff? It’s my view that they go hand in hand! And they should NOT be so ignored!

Build a strong foundation, right from the start. Wouldn’t that work so much better?

And it’s usually pretty difficult to find a good therapist. That has always been my biggest problem area – if they don’t really know diabetes, how can they possibly understand my issues, and why certain things bother me?

But is that necessary? I’m not sure. Do all the different issues I have boil down to acceptance and denial? If that is so, can those basic issues be addressed by a good therapist that may not know diabetes very well? Again, I’m not sure.

And what about the physiological changes that happen in our bodies when our BG’s are high or low? And how those changes have an impact on our ability to make good decisions? Might it take a therapist knowledgeable in diabetes to understand those issues? I have found, that for me, I need someone that knows diabetes, as well or better than I do.

I had a really hard time tracking down the therapist I’m currently seeing.

I have written about that before.

I wish to encourage healthcare professionals to open up to the idea of integrating some mental health resources in your therapy plan. Don’t ignore it just because you don’t specialize in it. Help that patient have a support system in place when he/she needs it, rather than watching them scramble for help when desperate.

Better yet, help that person start to work on the mental aspect of dealing with diabetes BEFORE they are blindsided by clinical depression.

How nice would it be to see your patient successfully dealing with the stages of grief, working through their emotional and mental issues, working through the denial that many of us deal with in one way or another, and coming to really accept their diabetes and the work that comes along with it. How nice would it be to see all of that without having to watch them struggle through depression.

For you parent of kids with diabetes – don’t wait for your kids to grow up without introducing them to the idea of talking with someone about how diabetes makes them feel. To acknowledge that aspect of things early in the game will help them tremendously.

If you deal with diabetes yourself, and do not have anyone in your care team that you can work with on the mental aspect of it, I encourage you to explore the idea of adding a therapist to your team. If nothing more than to have a resource available if you ever feel you need one.

The mental aspect of successfully dealing with diabetes is just as, if not more important, than the physical aspect of it.

Take care of it, along with everything else.

Be well. Focus on progress versus perfection.

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7 thoughts on “The Mental Aspect

  1. I’m almost two and a half years late to this party, but I felt compelled to comment. I’m a therapist, and it’s my goal to provide services to diabetics. I frequently scour job listing sites for anything that would allow me to practice as part of an integrated group/diabetes-care center as you described. I would gladly pack my bags, put my house on the market, and move for such a job. The jobs don’t seem to exist, but I keep looking. Ironically, I stumbled upon this dusty, but still pertinent post, by googling “diabetes mental job”. I don’t know how common it is for therapists to be interested or knowledgeable about diabetes. There are some of us out here though, waiting for the medical community to wake up and recognize they can’t meet the diabetes community’s needs without people like me. I wish I felt more encouraged that that time was near. The reason I threw my hat into the blogging ring is because I was so indescribably frustrated about wanting to make a difference, but no one seems interested. I haven’t figured out how to fix the problem, but at least I can share my thoughts about it now.

    If you ever have occasion to post the ‘best of’, I do hope you’ll bring this one back, Scott.

  2. Well said,i applaud your blog, mental health consumers are the least capable of self advocacy,my doctors made me take zyprexa for 4 years which was ineffective for my symptoms.I now have a victims support page against Eli Lilly for it’s Zyprexa product causing my diabetes.–Daniel Haszard

  3. I’ve been thinking about this post since I first read it last week and meaning to comment all weekend, but then life has consistently conspired against me.

    I agree whole-heartedly with you. Therapists should be part of your team. Yet like everyone else who has tried (yourself excluded, it seems) it is damn near impossible to find a therapist that specializes and understands the mental/emotional toll diabetes can have on one’s life.

    I’ve already told you about my experience trying to find a therapist and how it failed (miserably), but Minnesota Nice summed my experience up nicely: there are indeed aliens among us. (One therapist I tried had 13 cats and told me that they communicate with her telepathically – I kid you not).

    And I rather liked your suggestion to parents of diabetics introducing therapy to their children. But then I thought about it some more and my parents had tried to do that to me, but I was so damn stubborn as a child (okay, perhaps the past tense isn’t exactly appropriate in this sentence) and didn’t want anything to do with it.

    Like any other personal change, you’ve got to want it to make it happen. It’s all up to you. You know, “You can lead a horse to water… but if you can get it to float on it’s back – then you’ve really done something.”

    Anyway, parents trying to force therapy on a rebellious teen-ager will most often be a complete failure, I suspect. Perhaps an earlier introduction is what’s required? I don’t know.

    But like usual, I find your posts dead on and hitting freakishly close to home. Thanks for putting to words these vague thoughts that bounce around my head every once in a while.

  4. Therapists that understand D? (they actually exist?)
    I think the OC has done a much better job w/support of this darn disease then any therapist ever did.(although, medical school residents can hardly be called skilled) I wouldn’t know where to start looking for a competent one,anyway.
    The mental aspect is much more difficult then injecting,testing bsl’s 6-10x a day, carb counting, etc.. that’s what’ll give one gray hairs in a hurry.(I’ll bet that’s another complication, PWD probably get them sooner then other folks)
    Good therapists are scarce, we need to get support from whatever source we can.

  5. Scott,
    I recently thought I’d try a therapist who didn’t specialize in diabetes per se, but rather eating disorders. When we met I told her that I took 4-6 injections per day and she replied “ok, 46 injections – that makes about 2 per hour” and proceeded to document it in the chart. Then she asked me to spell “insulin” and said “that’s an amino acid, right”……….??????????? I don’t know what planet this lady was from, but the aliens are among us.

  6. Bravo to you for sticking it out and finding a good therapist.

    I’m not even going to go into the jokers at McClinic, who promised to call the psychologist for me and never did (but wouldn’t give me her number so I could call her directly). And they say they have mental health services on their website. Sigh.