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As a psychiatrist in private practice, I've found that there’s a predictable sequence of events that finally lands people in my office for a consult. These events occur in 5 stages:
- Stage 1: "Who, me?" This stage is characterized by denial and minimization of the problem: anxiety, depression, insomnia, whatever. Behaviorists refer to this as precontemplation. Listen to these rationalizations: "Oh, everyone going through what I'm going through would feel the same way," or "I'm not crazy, just stressed"
- Stage 2: "Well, maybe I have a problem" This is the stage of ambivalence, of contemplation. You might agree that there's a bit of a problem, but you put it off for another day because you're too busy dealing with the very things that make you stressed and anxious. Most people who eventually seek help can spend years in this stage.
- Stage 3: "I have a problem, but I can fix it." You begin to concede and make tiny changes in your routine, you experiment with supplements, you consider diet and exercise. But, after months or years, still not better.
- Stage 4: "Ok, I'm gonna need some help here." At this stage you concede. How? By asking family and friends, "Do YOU think I have a problem?" You might even take a specific action and seek professional help, typically through "unstigmatized" channels: chiropractic, accupuncture, your primary care physician. The vast majority of people NEVER get beyond this stage.
- Stage 5: "We're gonna need a bigger boat." You make the ultimate concession on the advice of a family member or loved one, you finally seek help from a mental health professional. But by this time, the problem--anxiety, depression, stress--has grown. Sometimes to the point of being "treatment resistant," unresponsive to first-line therapies such as medication or talk therapy.
Earlier this week, Lily announced that their drug Symbyax had received FDA approval for "treatment-resistant depression." An interesting marketing ploy and play on words here.
You see, It’s not the disease that's treatment resistant; it’s the patient.
So I ask: How’s your strategy working for you?