The Mental Aspect
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 health care 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.