Electroconvulsive Treatment (ECT)
Diagnosis of a mental health condition
A psychiatrist or a GP usually diagnoses a mental health condition. This is done by asking a patient questions (‘taking a medical history’), observing them, and comparing what they find to a ‘diagnostic criteria’. It is possible that an underlying physical condition can cause mental health problems like depression, or that depression can present with physical symptoms so other kinds of hospital doctors may be involved in diagnosis too. Getting a diagnosis was not a straightforward process for many of the people we spoke to. Indeed, some had never received an official diagnosis. Tracy said that even though she knew she had postnatal depression, no one told her this diagnosis, yet they gave her ECT. Sometimes people couldn’t really recall being told their diagnosis, and only found out that they had been diagnosed by reading their medical notes.
Most people had had a diagnosis of depression – including major depression, psychotic depression, bipolar disorder or postnatal depression. Many had received other diagnoses too such as anxiety, OCD (obsessive compulsive disorder), PTSD (post-traumatic stress disorder), personality disorders and schizophrenia.
Yvonne had had various diagnoses. She says she’s more “clued up” now and finds she’s able to understand how people work.
Yvonne had had various diagnoses. She says she’s more “clued up” now and finds she’s able to understand how people work.
Nowadays I’m more clued up, but I don’t think I would be clued up if I hadn’t gone through it. I think I would have still been one of these people that you know, just didn’t understand. So it makes me glad I’ve gone through it, because it makes me more tolerant of people. It makes me understand how people work better but my current diagnosis is chronic post-traumatic stress.
Dafydd thought his wife had minor episodes of depression through her life, but it got much worse after she retired. Eventually she was diagnosed with clinical depression.
Dafydd thought his wife had minor episodes of depression through her life, but it got much worse after she retired. Eventually she was diagnosed with clinical depression.
And when she became severely depressed of course we had to try and get some help through the local health service and initially through the GP who referred her to the local psychiatric department where she was interviewed and then it progressed from there. She seemed to get progressively worse and diagnosed with severe clinical depression but for no obvious reason and it seemed to have come on without any incidence apparently to spark it off it was not as the result of anything happening but the from my point of view I couldn’t explain what I’d said or what I’d done in order to trigger it off but it could be quite explosive reactions and obviously part of the illness.
Receiving a diagnosis could be a relief if people felt the label helped things “fall into place”, or gave their particular kind of suffering better recognition. It took some time for Tristan’s wife to be diagnosed with psychosis as she mainly showed symptoms of depression. After his wife was diagnosed with psychosis, he felt that he could start to understand what was happening. Sheila found it useful when the psychiatrists explained her husband’s OCD (obsessive compulsive disorder) and why it might cause him to want to kill himself (see for more ‘Depression, psychosis and anxiety’). Having been told she was a disruptive adolescent, Catherine Y said her diagnosis of depression “undid that” and she felt better about herself, understanding that she wasn’t a disruptive person, and “wasn’t trying to do it on purpose”.
Although Cathy says labels aren’t always helpful, she found having a diagnosis could help her make sense of things she was going through.
Although Cathy says labels aren’t always helpful, she found having a diagnosis could help her make sense of things she was going through.
And what sort of experiences did it help you make sense of?
Well, I mean when somebody says you’re suffering from depression and anxiety, I mean it, these days it’s easy, you just Google it and find out all the information and all. But we didn’t have the Internet then. And I, I mean I’m sure we must have looked it up in books and things and sort of found out, you know, what it was all about and, and just making sense of how things were and explaining it all. But I mean over the years I’ve had many labels and some have been helpful and some haven’t.
Although Tania was initially diagnosed with depression she was later found to have ‘bipolar affective disorder’. For Tania, her diagnosis helped her understand why she could feel depression and joy at the same time.
Although Tania was initially diagnosed with depression she was later found to have ‘bipolar affective disorder’. For Tania, her diagnosis helped her understand why she could feel depression and joy at the same time.
I talked to my family, and brother at that time was a psychiatrist. He’s a lot older than me and he was already a psychiatrist and I told him what was happening. I said, I can’t understand what’s going on. And then he said to me, “You know,” he said, “I think you might have depression” and I was actually really shocked, because I didn’t, I didn’t really know anything about it. But just it sounded, actually then, you know, it sounded quite frightening and I thought ‘what’s that?’ I knew it was an illness but I didn’t really know. And he urged me to go and see a doctor. And at that point my Mum actually told me that my Grandma had had very severe depression. That she’d had, in those days, what they called ‘a couple of breakdowns’. I knew nothing about it. I mean I don’t think anyone knew. She’d kept it secret and it was back in the kind of 50s, or 60s, or 40s, and they didn’t tell anyone. Only the immediate family knew. So I didn’t know anything that my Grandma had a history, but apparently she did and I went to the doctor and I told him what was happening to me and he asked me about family history and I said, “Well yes apparently my Grandma.” So yes, they thought that’s what it was, depression. And we tried, you know, he put me on some antidepressants, and. But it didn’t work, nothing worked and he tried various ones.
But it just got worse, everything got worse and I pretty soon, I started to think, it just came into my head, the idea of killing myself and then it wouldn’t go, and it just, I couldn’t stop thinking about it all the time. It just dominated every moment of my thinking
And yes, in hospital they couldn’t really work out what was going on because I didn’t show any of it on the surface at all. And, and there was nothing wrong in my life. I had a really lovely family, you know, I was, I was, I had everything really. I had a great supportive family. I had a lovely boyfriend. You know, done well academically, was at the university I wanted to go to, was doing really well in my studies, had loads of friends, I just had everything really going for me. And I’d always had a really happy go lucky personality as well. I just was, and even when I was depressed, I smiled. They called it ‘smiling depression’.
I now know that I have bipolar disorder and actually it was a mixed state when you experience depression and elation at the same time, but at the time, no one, it’s one of the things which is never, it takes years before people diagnose that because it’s something that really confuses people, because you feel full of energy and you maybe seem on the surface quite happy and almost elated but you’re suicidally depressed at the same time.
It was some time before Catherine Y received a diagnosis of ‘depression’. At first she was relieved, but then she didn’t know what it meant, or what treatment might be available.
It was some time before Catherine Y received a diagnosis of ‘depression’. At first she was relieved, but then she didn’t know what it meant, or what treatment might be available.
Although Sunil was bipolar, he also had an under active thyroid, a possible physical cause of depression. He was given lithium for the bipolar, but thought this interfered with his thyroid problem.
Although Sunil was bipolar, he also had an under active thyroid, a possible physical cause of depression. He was given lithium for the bipolar, but thought this interfered with his thyroid problem.
So I was put on thyroxine, replacement therapy. I was given the thyroxine hormone as a treatment. But despite that, they actually also tried me for a period on a drug called lithium. Which is used to stabilise the mood in people with bipolar disorder. And, I think one of the main, one of the very well-known side effects of lithium is interference with the thyroid gland. And, in retrospect I feel that keeping in mind they had already discovered that I had a severely under active thyroid gland, the one drug that they should not have given me is lithium. But I was given lithium.
Some found receiving a diagnosis was upsetting, particularly when they felt the diagnosis was serious or something that did not represent what they were experiencing. When David Y first heard that his partner had schizophrenia, he had held stereotyped views that people with schizophrenia were very violent. This didn’t fit with his wife’s behaviour, and the medical professionals explained it could actually mean her being very withdrawn.
Some were worried about how others would react to labels. When a medical professional announced at a child protection meeting that Cathy had schizophrenia, she said her in-laws were “absolutely horrified.” They said she shouldn’t be allowed to look after her son. Kathleen, who had trained as a GP, was eventually diagnosed with depression, but she herself felt “ashamed of being ill”.
Jenny found it hard being given a label of ‘Personality disorder’. She sees psychiatry as inconsistent because the treatments she received don’t relate to that diagnosis.
Jenny found it hard being given a label of ‘Personality disorder’. She sees psychiatry as inconsistent because the treatments she received don’t relate to that diagnosis.
People who had been diagnosed several decades ago were not always told directly about their diagnosis. Most felt that mental health problems were less understood then. When Helen had an unwanted baby that was put up for adoption in the 1970s, she suffered from postpartum psychosis. In response, her family married her off, and a doctor advised her to have another baby because they thought she wasn’t coping.
Albert wasn’t told he was schizophrenic and only found out when he was asked to sign a paper and saw the diagnosis there.
Albert wasn’t told he was schizophrenic and only found out when he was asked to sign a paper and saw the diagnosis there.
Sometimes people we spoke to were very unwell when they were first diagnosed with a mental health condition. Because of this, it could be difficult to properly take in information about a diagnosis. People had often come across the terms ‘depression’ or ‘anxiety’ in general conversation before their diagnosis, but had inaccurate or little understanding of what the terms meant. Finding out more about a diagnosis was important to some people, as they wanted to know what they were likely to experience, what treatments were available, how to help themselves, and the extent to which they could hope to get better. Carers and family and diagnosis
Some carers felt they had been “side lined” and not given enough relevant information to understand the diagnosis. When Carys’s daughter was diagnosed with a serious mental health condition twenty years ago, she got out books from the library to learn more. However, the books weren’t written for lay people and were hard to understand (for more see ‘Caring for someone having ECT’).
Steve googled his wife’s condition and found that things listed for ‘the signs of depression’ were similar to his wife’s illness. He found internet forums for carers interesting.
Steve googled his wife’s condition and found that things listed for ‘the signs of depression’ were similar to his wife’s illness. He found internet forums for carers interesting.
Last reviewed January 2018.
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