How people answer this question might predict their mental health outcomes

"Do you know what we're treating you for?"

That's one of my favourite questions to ask the people I see in the course of my work. I tend to get two common answers. One answer is, "No, what?" And the other is something along the lines of, "Um, mental problem?"

Neither of these two answers is particularly encouraging. The first one indicates complete cluelessness about what the problem is. The second is an example of the misconception that mental disorders are one big amorphous group of health conditions. (See my thoughts on that in a previous post: We talk about mental disorders like white people talk about Africa.)

But both answers suggest an even more important problem. To understand why, we need to remember one thing:

What I learned about mental disorders from my mechanic

Allow me to use an analogy. I'm not keen on visiting my mechanic. It's stressful to get to his place, plus I know I'm going to spend money one way or another. But even before he fixes stuff in my car, I will typically ask him what the problem is and what he thinks it's best to do about it. And when he's done, he'll usually show me the part he replaced (if replacing was the solution or at least demonstrate to me that the problem is no longer there).

The reason I do this, of course, is simply so I have a better idea how my own car works. And it's helped me more than a few times too: over time, I've developed a better sense of what might be wrong when there's a problem, and that's helped me know how much I should be worried, or whether I need to call my mechanic ASAP.

The thing, though, is I don't believe this behaviour is unique to me. You do it too, I'm sure. Most of us do. Except, it seems, when it comes to our own bodies.

Because again and again, I find that many people getting treatment for mental disorders (and long-term illnesses in general) don't have a clue about:

  • What diagnosis they are being treated for
  • The names and doses of the medication they are are supposed to be using, and how long they can expect to use it for
  • What their meds are supposed to do and potential side effects
  • What changes to expect about in their condition over time, good or bad

The problem with this comes down to something really important about long term medical conditions: it's those with enough knowledge to be in charge who are most likely to rise above it.

Let me try to unpack that.

With short-term (known medically as acute) medical conditions, the doctor can easily take charge, and often does. Take malaria as a very common example. You show up at your doctor's with complaints of a rising temperature, splitting headache and joint aches, he thinks you've got malaria fever, and takes blood samples to do a couple of tests while initiating treatment. He may not explain a whole lot at that moment about the tests he did, or the medication he prescribed (although you really should ask), and it probably doesn't matter much. In fact, in a sense, it's fine that the doctor takes over your care at that point, sort it out and let you get back to work.

But when what you have is something that takes more time—we're talking years and months (what in medicine is called "chronic")—it's not even realistic to expect someone to take charge for that long. For the simple reason that they can't be there all the time. If you should run into a crisis and you're by yourself, you'll be in real trouble if you don't know what to do.

And that's the thing…

You can't "rise above it" if you don't know what "it" is… (Tweet this!)

Knowledge is power. Whoever first said that knew what they were talking about. Like I like too say to my patients:

I'm the expert in your mental illness, but you're the expert on you. If we can bring our areas of expertise together, we can make things happen. (Tweet that!)

It's true. The people I've known who've risen above their health conditions to the fullest have been those who knew it almost as well as their doctors. I tell people they should know about their condition because for them, it's beyond even theory and practical, it's part of their everyday experience.

  • They know the diagnoses they're being treated for—the symptoms, the early signs, what to expect over time, and what treatment options are available.
  • Those on medications know what their meds are called and even the different brands available. They know what the meds are supposed to do for them, what side effects they experience and how they can work around them.
  • Conversations during follow-up visits can be a kind of mutual negotiation, where both doctor and patient consider available options, as equals with different areas of expertise: the doctors on the health conditions and the patients on their own selves and experiences.

When people get to this point in their health journey, you can be pretty confident of much better outcomes on the whole. Of course there are other factors involved, the most important being that this places a lot of responsibility on the person with the medical condition. And sometimes they've been ill for so long that they can't as easily support themselves. Pretty often though, there's another problem: we Nigerians (and maybe Africans in general, but I'm not so sure) don't ask questions of our doctors.

It's weird, and I see this even among the well-educated who you'd expect to know better. I'm not sure why, maybe it's an ingrained belief that the doctor knows what he's doing, or that it's not their place to ask. But again and again, I meet people who can't answer the question. Sometimes they say they actually asked and didn't get an answer.

So ask again. I know we doctors often tend to be economical with information. That's largely a residue from back when information was something people hoarded. And yes, part of that was because it might have been dangerous to put too much of it out there in a time when it could easily get into the wrong hands. But not anymore: there isn't only more info out there than ever before in human history, it's also easier than ever before to fact-check. So ask. And expect an answer. And if you don't get one, ask again. Because you really need to know.

It's your body, after all, and your health. You can't afford not to know what's up with it.

I wonder, do you think this could happen anytime soon in Nigeria? Or elsewhere? Speak out in the comments!