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Be discerning about diagnoses

Parents are understandably shocked by the statistic that ten percent of children aged 5 to 16 have a clinically diagnosed mental disorder (Mental Health of Children and Young People in GreatBritain2004). Naturally, if our children show signs of mental ill health, we feel we must go to the doctor for a diagnosis to provide a pathway to treatment.

It is well established that early intervention is valuable fora full and sustained recovery from mental health issues, and to reduce or avert the risk of chronicity, complications and comorbidities (the simultaneous presence of two chronic diseases or conditions). But medicalising through diagnosis brings its own challenges. Once we get a diagnosis we may feel that it is the responsibility of clinicians to fix the problem, just as they would if they diagnosed appendicitis or a broken leg. We might expect to watch passively from the sidelines, missing the opportunity for effective family-based, proactive self-care. Our children may experience their own sense of impotence, as they are labelled with what can feel like a permanent condition (on social media an increasing number of young people list diagnoses, such as ‘OCD’, ‘anxiety’ and ‘bipolar’ as if they are permanent descriptions that define them).

Mental health is as important as physical health, but it is not the same. Indeed, there is a strong argument against using the term ‘diagnosis’ at all in mental illness, since they are largely descriptive categories that clinicians use as shorthand to refer to their perception of patterns of symptoms. They are not equivalent to a blood test or a biopsy result.

Early in Lizzie’s recovery journey my wife and I decided that we would never describe her as ‘an anorexic’. She was Lizzie, a unique and beautiful person. Yes, she was living through an eating disorder, but there was much more to her than just this illness, and she had her whole life ahead of her. The diagnosis was indeed helpful in providing a pathway to treatment, but it did not define her.

Be confident in your capacity

Research increasingly shows the value of self-help for mental health, especially within a context in which family members have been equipped with the skills to provide appropriate support. For example, the UK government’s Transforming Children and Young People’s Mental Health Provision said: “Evidence-based treatments for mild to moderate levels of mental health disorder can be delivered by trained non-clinical staff with adequate supervision, leading to outcomes comparable to those of trained therapists.” It went on to say: “The evidence highlights the important role of the family in ensuring successful interventions, with parental involvement improving the outcomes of many interventions.”

One of the key skills we learned as we supported Lizzie through this illness was how to act like coaches, believing in her and encouraging her that she could overcome the eating disorder. This wasn’t easy for me, in particular, because I am naturally a ‘fixer’. I couldn’t fight the illness for her. I had to love her, believe in her and help her believe in herself again. It was Lizzie who had the lead role in fighting this illness; I was just a supporting actor. But I still had a vital role to play.

This coaching stance was informed by the principles and practices of cognitive behavioural therapy (CBT), which recognises that our thoughts, feelings and actions are intimately linked. Therefore, helping people challenge and reassess their thoughts can produce positive changes in their feelings and behaviour.

Remain full of faith

Recent research from the Royal College of Psychiatrists found that “about half of our patients with a mental health condition are turning to spirituality and religion to help them get through their mental health crisis”. Indeed, the college now has a ‘Spirituality and Psychiatry’ special interest group. This is such an encouraging change from the1970s, when I was studying psychology and was disappointed to discover that psychiatry and faith largely saw each other as enemies rather than allies.

There is a growing body of research into the mental health benefits of spirituality and religion. A systematic review of 22 research studies regarding eating disorders concluded that: “Strong and internalised religious beliefs coupled with having a secure and satisfying relationship with God were associated with lower levels of disordered eating, psychopathology and body image concern.”

In Lizzie’s case there were certainly significant steps forward in her recovery journey when we helped her see the illness through the eyes of her faith. In her recent book, Life Hurts: A doctor’s personal journey through anorexia (MD Publishing), she writes about a time when she was very ill in hospital: “Dad always carried a Bible in his jacket pocket and, as he sat on the bed, he would ask me if I wanted to read some of it with him and to pray. I always said yes, and one of those readings was another little insight for me. Dad read from John’s Gospel (chapter 10) in which Jesus said: ‘The thief comes only to steal and kill and destroy; I have come that they may have life and have it to the full.’ I recall, after he read that verse, how he stopped and read it again, slowly and thoughtfully. We talked about it for quite a while and I remember it dawning on me that anorexia was like a thief, stealing my happiness and killing my joy. That night I wrote in my diary: ‘I must stop, otherwise the thief will destroy my life. This is not fair. God and my family love me and that’s all that matters.’”

Hang on to hope

When Lizzie was very ill, my wife and I felt as though we were in a dark tunnel without any hope. In fact, the tunnel felt so dark and long that we were tempted to despair, as if it were a cave with no exit. But the evidence shows that hope for recovery is a significant factor in helping people who are on a journey through a mental health condition. So how do we maintain hope when we feel despair?

True stories of other people’s recovery journeys can help, which is why Lizzie wrote her book. However, we must remember that every person is different. Each individual has a personal journey into and out of a mental health condition (indeed, the same ‘diagnosis’ can describe many different types of underlying issues).

For those of us who believe that the Bible can speak to all people, there are biblical principles that can offer practical advice. I found Psalm 30 a particular help. It contains a great promise: “Weeping may stay for the night, but rejoicing comes in morning.” I wrestled with that promise in the darkest moments of Lizzie’s illness. I kept asking God when that morning of rejoicing would come. But as Lizzie gradually progressed through the illness, I discovered that I should not be living for one sudden morning of great joy. Rather, there were many mornings of small joys, and I learned to be thankful for each one. I celebrated each little step along her recovery journey, and I held on to the faith that there was hope and a future.

 

You can read more of their story in Life Hurts: A doctor’s personal journey through anorexia by Elizabeth McNaught.

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