So, You Think You’re Crazy?

Story Jason Browne

Well, you’re not alone. What’s your brand? Anxiety? Depression? Bipolar? Attention deficit? Post-traumatic stress? Maybe the problem is outside of your head: Family problems. Relationship problems. Work problems.

No shortage of diagnoses exists for the individual who believes he or she has a mental disorder. And no shortage of information is available to aid in self-diagnosis. But the critical question when it comes to mental problems — because everyone’s got one to some extent, right? — is “Do I need therapy?”

David Johnson, director of Baptist Behavioral Health Care at the Willowbrook facility, an extension of Baptist Memorial Hospital-Golden Triangle in Columbus, has been in the field 30 years. He’s worked with all populations as a licensed counselor and has spent the last 15 years working as an administrator. He can tell you if you need therapy. But since Johnson can’t evaluate everyone individually, he’s offered some tips — general guidelines to help you determine if you should seek professional help. And while Johnson won’t go as far as recommending everyone seek some degree of therapy, he says it couldn’t hurt.

Johnson’s first indicator that you may need therapy: If everyone else thinks you need therapy. “When those who know you best think you need to talk to someone, that’s a good indication,” he said. Indicator No. 2: If the problem won’t go away. “If typical life experiences such as feeling down in the dumps or anxious become prolonged and the person is unable to shake that, it’s probably an indication of a need to talk to somebody.” And finally: If the problems produce drastic changes. “People may notice a change in your demeanor. There may be a change in sleeping pattern, eating habits, school or work performance. When feelings, thoughts and behavior begin to interfere with daily living, that may be an indication of a need for therapy.” Depending on the individual, one or any combination of the above indicators may be enough to convince someone to seek help.

Some people will never admit they need help. But once an individual does seek help, several options exist. An individual may choose one-on-one counseling or group therapy. Couples counseling may be more appropriate if the problem exists within a relationship or marriage. Regardless of what route an individual or couple chooses, Johnson believes it’s critical to choose a counselor or therapist with whom they feel comfortable. Although, he admits that can be difficult depending on the patient’s health insurance or financial resources.

The basic course of treatment in each case, before medication is introduced into the equation, is talk therapy. “If there’s anything special about this therapy,” said Johnson. “It’s when an individual hears himself say out loud what he’s been thinking about. “So many times an individual will tend to think ‘If people knew the kinds of thoughts or feelings I’m having, they would think I’m crazy.’ When they talk to a professional and realize that a clinician has heard those things many times before, that in and of itself can begin the healing process.”

It’s that dynamic, says Johnson, which provides an atmosphere of safety for patients, even those who have experienced severe emotional trauma. And while a good clinician can craft a healthy rapport by knowing when to talk and when to listen, patients must enter the relationship with realistic expectations.

“So many people want someone to tell them what they need to do. They want a clinician to be directive,” said Johnson. Only, that’s not their job. Nor is it to provide instant relief or immediately prescribe medication.

Johnson says many individuals find themselves disappointed in talk therapy because it doesn’t provide magical solutions. On the flip side of that coin, many patients who know talk therapy is just that – talking – find themselves disillusioned and begin to believe their problems are bigger than simple conversation can solve.

And most of the time, says Johnson, if you don’t believe therapy can be effective for you, you’re probably right. “There are few things more powerful than our beliefs,” he said.

The point of talk therapy, after all, is less about curing a patient’s problems than about providing tools and methods the patient can use for life to control symptoms. Sometimes, however, the chemical imbalances which cause the majority of behavioral disorders are too strong to be overcome by talk therapy. And that’s when medication comes into the picture.

“Situational or reactive problems really wouldn’t indicate a need for medication,” said Johnson. “For some others like depression and anxiety, the best approach is a combination of medication and cognitive behavioral therapy. Medication can help take the edge off and the person is then more capable of clearly thinking through and working through problems.”

While psychotropic medications are better than ever and getting better every day, clinicians still must be wary of prescribing drugs too quickly. Many patients can be helped without drugs while others submit to therapy with the sole intention of securing a prescription.

For those in legitimate need of help with chemical problems, Willowbrook accepts whatever payment a patient can provide, as long as he or she is making an effort to defray the cost of treatment.

“Anyone suffering from chemical dependency, in my opinion, should be able to get the help they need,” said Johnson. “It’s unfortunate that sometimes individuals who are willing to get help cannot because they have no means to pay.”