Limbs like lead. Blurry vision. Suddenly ravenous. Then, without having eaten, nauseous.

I’m repeatedly mystified by the symptoms – even though they occur multiple times a week, and even though, without fail, they end in a migraine.  So how can I be so dumb as to forget, or even flat-out deny, the most likely explanation for what’s going on?

Improbable as it sounds, it’s really, really easy to misinterpret or dismiss symptoms, even of a condition you’ve experienced over and over. Until I learned to be more aware of the early stages of my anxiety, I tended to do the same. I’d forget or deny what was going on until the panic became ever-present, and too awful to ignore. Then I’d curse myself for not having recognized it earlier.

Maybe I’m just specially naive or prone to self-delusion. But interviewing young people with long histories of psychiatric conditions, I’ve been repeatedly struck by how commonly they attributed their creeping symptoms to something besides their disorder.  Surprisingly often, they managed to deny the symptoms altogether.

Here was a group of people who you’d think would have been trained from a young age to identify signs of a relapse or a rough patch, and to take preventive steps to avert a full-blown psychiatric crisis. Yet they were blindsided again and again.

There are good psychological reasons for denial, of course. In this case, you can’t live your life constantly cowering in fear of a relapse, so you learn to put it out of your head. You come to consider yourself healed. If you’ve been dealing with psychiatric issues since you were young, you tell yourself you’ve matured past the troublesome symptoms. This allows you to function.

But this self-protective attitude also has serious consequences for treatment, especially when that treatment consists of medication. Psychotherapy has the advantage of including an outside observer, someone who can notice a recurrence. Even if the therapist doesn’t notice, at least the self-reflective nature of therapy is likely to make you take of stock of how you’re doing.

Swallowing a pill, by comparison, doesn’t have the same built-in reflection mechanism. In addition, the kind of 15-minute med checks that constitute typical psychiatric care don’t give prescribing doctors much time to gauge what’s going on.

It’s easy, therefore, to take your daily dose and be done with it. To recognize a relapse requires acknowledging your current regimen isn’t working. That, in turn, is likely to remind you that it’ll probably take a lot of trial and error to find something that does work. Neither of these realizations is particularly pleasant to consider.

Plus, this kind of self-monitoring comes perilously close to wallowing in your problems. But it’s important to figure out how to toe that line. With many conditions, like depression and bipolar disorder, the more relapses you have, the more likely it is you’ll experience others. Without living like a psychiatric hypochondriac, it pays to try to forge ahead, but to stop and change treatment strategies if you recognize something amiss.

image credit:  Miguel Angel Pasalodos

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From Psych Central's website:
Are Meds in the Eye of the Beholder? | My Meds, My Self (December 30, 2011)

    Last reviewed: 29 Nov 2011