The watershed moment! The point at which you become ill.

So often we, the mentally ill, are asked when did we become ill and so often do I hear the response; I got sick when I was 14 or 2 years ago… or whatever

But really is it as clear cut as the world would like, can you really put a date on it?

Well I have often pondered this about my own life, when did I get sick, when did it all start and the reality of diagnosis and the changes to that diagnosis; I have had over the years so many theories you might loose count, for instance did I get sick:

Age 24 when I was diagnosed bi polar

Age 17 when I was diagnosed unipolar depressed

Age 15 when I started seeking medical help

Age 13 for a long while first remembrance of a hallucination

Age 10 currently the first remembrance of a hallucination

Or I was born like it and many would say blame everything on genetics, particularly if most of their immediate family are also just as ill as them.

Well I’m not convinced I was born like it particularly as the genetic risk factors don’t really apply. There is so little mental ill health in my family you could say I was the only one, certainly of my immediate family but still the question remains. When did I or when did anyone else for that matter get sick?

This article in the guardian Vaughan Bell: from the borders of mental illness it talks about two trains for thought on diagnosis, and how they overlap but most strikingly it points to an overlapping in the different diagnosis’ and of no discreet etiology of disease. And for those of us without a great understanding of words it means that there is no single cause or path from well to any of the different recognisable mental illnesses. And it quotes

Professor Michael Owen, a psychiatrist and researcher from Cardiff University's School of Medicine, has been at the forefront of these new genetic discoveries. "It is no longer tenable," he wrote recently, "to regard these as discrete disorders, or sets of disorders, with specific causes, symptoms and consequences." Despite a scientific conclusion that some might find uncomfortable, he is upbeat about its implications. "I think that psychiatry's acknowledgement of its diagnostic shortcomings is a sign of its maturity," he says. "By acknowledging the shortcomings of our current diagnostic categories we are recognising the need to treat patients as individuals."

Something that for many of us has been quite apparent for years however as I remind myself feeling that something is so, does not give it an evidence base to provide confidence for others and policy is made because of confidence and therefore evidence. You think this is a circular argument and does not need to be pointed out twice. Well maybe but as the article above shows people do not necessarily see the big picture and focus on one half of a problem not realising that it could prove the opposite is true.

For instance the article quotes

This new realisation rests on evidence that genetic factors initially associated with, for example, schizophrenia have now been recognised as equally important in raising the risk for several other problems including epilepsy, attention deficit disorder, autism and learning disability.

In fact to my mind it just goes to show that we are sadly lacking in good quality research into mental illness and their treatment something that has been known for many years without much changing. Unfortunately it also shows that we still have very little knowledge about what may cause mental illness or how to define when someone has become ill.

So is there a watershed moment when someone becomes ill?

Some how I doubt it, when there is no clear path from good health to bad how can anyone really be sure that they are? However to try and make order out of chaos is something I feel we all need and particularly scientists so when faced with the problems of mental ill health that’s exactly what we attempt to do, find order and part of that is defining the problem. Problem is I just don’t think we’ve got it right and I’m certainly not sure that the ever expanding diagnostic bible is the way to go however without some guidance how can anything be achieved.

In fact my biggest fear is that we know far too little and that there is no chance of the knowledge base increasing in the near future. Far too many of the studies have focussed on too narrow a brief to ever get to the bottom of the problem.

Plus there is a vacuum of thought that has prevented people from even considering what may be good for their mental health and a reliance on the fact that they have coped without ever considering how well they are. They also suppose that people who don’t carry on regardless are the ill ones when in fact I am far from convinced that they are right.

In fact maybe we should stop worrying about whether someone is ill or not and start thinking about how best to help people cope, help people deal with the rigors of living in this society where poverty, work related stress and crime are rive. In short start taking maintaining our own good mental health more seriously.