Are self-help books based on idealism

Books on anxiety and panic attacks

Preface

“It is not possible to explain something about what you are suffering from, but it is mainly due to the fact that everyone around you has no idea about such a disease,” wrote the writer Ingeborg Bachmann in the mid-1960s. It was a time of depression and anxiety for her. More than fifty years have passed since then. Did Bachmann's findings turn out differently today? That is not said. Although the World Health Organization (WHO) assumes that depression will take first place among all widespread diseases by 2030, there is still a reluctance to talk about these or other mental illnesses. Often the silence results from a lack of knowledge. But only an open, informed approach to mental illness can prevent the stigmatization of those affected, which is unfortunately still far too often the order of the day.

As the head of the largest psychiatric clinic in Berlin, I deal with people every day who, in a mental crisis, have the courage to say: I need help. And this help is there. Based on the two most common mental illnesses in Germany, depression and anxiety disorder, I would like to use this book to provide reliable information about their development, their course and, above all, about their effective treatment. I let myself be guided by the questions that patients and relatives have asked me again and again in the thirty years that I have worked as a psychiatrist.

At the same time I would like to try to give some insights into the everyday life of a psychiatric clinic. A place that many people think of with suspicion or fear. I hope that making him a little more accessible by telling him - for example by precisely describing life and the processes on the ward - can, I hope, help a little to correct prejudices or even to get rid of them entirely. So that people are a little less reluctant to seek help in a clinic if they are not feeling well.

In contrast to all other medical disciplines, psychiatry is always in close contact with current social or political developments. As the former president of the German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN), I was able to discuss some of them in an exchange with politicians and colleagues from all over the world: What effects do the rapidly changing living and working habits have on mental health? Are mental disorders increasing in our increasingly confusing world? How can you continue to guarantee good care given an overall increasing need for help? Exciting tasks and great challenges await the subject in the coming years.

However, the focus is always on the individual. His life, his story, his health. It is one of the most beautiful moments of our profession to build a sustainable relationship with the patient and to meet each other on an equal footing. The patient stories in this book are intended to tell of such encounters that are always new and surprising.

Physical fitness is important, but maintaining mental balance and health is no less important. There are early warning symptoms that can indicate a possible mental disorder. Whoever knows how to protect himself from excessive stress is less likely to fall ill. With a few practical tips at the end of the book, I would like to encourage every reader to do something for their psychological resilience and thereby stay in a balance that allows them to go through everyday life with confidence and without fear.

Iris Hauth, January 2018

 

 

Chapter 1

You have to love people, otherwise you can't be a psychiatrist

The desire to help

I was six years old when my mother had her first asthma attack. A seizure like this can be quite threatening, and not just for a child who's witnessing it. Those affected find it difficult to breathe, but it is even more difficult for them to breathe out again. A feeling of tightness takes hold of them, they are afraid of choking and are shaken by coughs. My mother's seizures increased over the years. My father was overwhelmed by the situation and fled the house when the time came again. But I stayed.

In the mid-1960s, there were no special drugs that could help asthma sufferers quickly and effectively in an emergency. When my mother asked me to bring her something to drink, I went to the cupboard and, because I couldn't find anything else, got Togal, even though it was completely ineffective. But that didn't matter. I made her coffee and sat next to her, even if the whistling of her breathing and the sight of her cramped body frightened me so much. I stayed with her and endured everything. And after a while it actually got better. My mother recovered and was able to breathe normally again.

During these hours I experienced for the first time what psychologists call “self-efficacy”, that is, the certainty based on experience that I can handle even difficult situations through my own initiative. Unlike my father, I hadn't run away but was able to help. My staying there, my perseverance, and my calming speech had helped alleviate my mother's plight.

Today I am convinced that these early experiences marked my later career path. They made me want to help other people and, if possible, heal them. I briefly considered studying psychology, but then decided to become a doctor. I wanted to be familiar with both the body and the psyche.

During my medical studies I strayed a little from the traditional path here and there. I also looked around in other fields. I was interested in gynecology. I imagined giving birth to babies very nicely. Working as a family doctor and being able to accompany people in their everyday life appealed to me, and I completed a corresponding internship. But when at the end of my studies I had to choose a third subject in addition to the compulsory subjects of internal medicine and surgery, I decided to go into psychiatry. The circle had come full.

 

My career

I was lucky and found a job straight away after graduation, which wasn't so easy at the beginning of the 1980s. I ended up in psychosomatics. At the time I thought it was just a whim of fate, now I'm not so sure anymore. In view of the experiences with my sick mother, it does not seem entirely coincidental to me that I dealt intensively with the interaction between physical and mental illness. Or more precisely: with physical complaints that also have a psychological background.

The ward where I worked mostly consisted of patients with eating disorders. Mostly it was young women. Some of them weighed less than forty kilos, the most seriously ill were now close to death. I began to work psychotherapeutically with these women. Right from the start, I considered psychotherapy to be of existential importance, even when it was not yet integrated into psychiatry. I couldn't imagine just giving medication. I always wanted to enter into a relationship with the patients, talk to them and meet them on an equal footing in order to find a way out of their suffering together with them.

At that time the title of specialist in psychosomatics and psychotherapy did not yet exist; there was only a specialist in psychiatry or neurology. It also included training in neurology, for which I am very grateful. I got to know the human nervous system systematically from the physical, the somatic side. The patients came, I examined them, tapped them with the reflex hammer, and depending on the complaints they reported, I could systematically assign them to individual nerves or to the consequences of a herniated disc. The symptoms of Parkinson's disease or multiple sclerosis could also be easily identified. Everything was so clear. In order to rule out an inflammatory disease, a cerebrospinal fluid puncture was performed, i.e. the removal of cerebrospinal fluid. And if you wanted to look at the brain, computed tomography helped you get a more detailed picture. Because I was staying in a small clinic, I was able to accompany the entire process, from the physical examination to the imaging. Today, as the individual departments in the hospital work independently of one another, that would no longer be possible.

For me, the job of a psychiatrist has always retained this appeal of diversity. Apart from that of general practitioner, I cannot think of any other medical activity with a similarly large field of activity. And in contrast to psychologists, psychiatrists are doctors. They can diagnose and treat physical illnesses and, thanks to their training, also prescribe medication without having to forego the other pillar of healing, namely speaking. We wear the white coat, so to speak, for everything medical, but in psychotherapy we take it off and go into an interaction from person to person, in which you can use your knowledge and experience, but also with your own person, with the what humanity you bring in, what you can do and what you can achieve.

 

The psychiatry dilemma

A psychiatrist colleague once told me about a patient who, after several weeks of intensive, not least psychotherapeutic treatment, exclaimed impatiently: "Well, now I would like to finally speak to a psychologist!" A story to smile about, but that different image of both professions illustrates. Psychiatrists, it is often said, lock people away or at least give them drugs that make them addictive, sedate and / or change their personality; whereas psychologists devote themselves entirely to talking to the patient. And conversations are more important than tablets.

Therefore, I am not unhappy when I am occasionally asked about lighter topics in interviews, such as how you can spend your vacation meaningfully, what lovesickness can cause in the body or how you survive Christmas when you are all alone. Rather mundane things, of course, and you'd think a psychiatrist shouldn't bother with that sort of thing. But it is good and important that we also take a stand on such everyday issues. This gives us the opportunity to get psychiatry a little out of the dirty corner, in which for many it is still stuck.

Psychiatry is not only the diagnosis and therapy of an individual mental illness. She has the big picture in mind, because mental illnesses always arise in a psychosocial context. In doing so, they refer to a person's living conditions and the social trends that influence them - be it the everyday conditions in the big city, be it the effects of digitization on the world of work and leisure, the consequences of demographic change or the challenges posed by immigration.

Hardly any other medical subject deals with social issues with such intensity. And none at all is entrusted with regulatory tasks like psychiatry. Because that is the balancing act that our subject has to manage and which is probably also responsible for the bad image it has for many. We should and want to help the individual, but on the other hand we should also avert dangers for the public, which is associated with high social expectations.

We always get into this dilemma when patients fail to recognize their environment due to a serious illness, feel persecuted or threatened and react tense, sometimes even aggressively, to their fellow human beings out of fear. In such an acute phase of illness, these patients are no longer self-determined. We then have the legal obligation to have them placed in our clinics. This double requirement profile brings with it a special responsibility. No other doctor has to deal with questions of placement or treatment against a patient's stated will.

That is why we will always be concerned with questions of ethics. Almost ten percent of all patients do not come to the inpatient area voluntarily, but are brought to the clinic against their will because they endanger themselves or others. Their treatment often leads to a difficult trade-off between the patient's autonomy and the task of psychiatry to take care of the protection of the individual and the general public.

Mental health, prevention or healing aspects are often marginalized in the face of these tasks, which are received with great interest by the public and the media. Forensic psychiatry in particular comes into focus again and again. It deals with the culpability of offenders who committed their act as a result of a mental illness. The reports prepared by the psychiatrists form the basis for the courts to decide whether someone should go to prison or, due to lack of culpability, to a forensic clinic, i.e. to the penal system. Any misjudgment can have fatal consequences, such as the repeated act of a patient who was released from the penal system with an erroneously favorable prognosis.

The psychiatric clinic also occupies a peculiar place in the public eye. There are a lot of horror stories and speculations about them. For many people it is a gloomy place charged with negative fascination. Once you're in, the cliché goes, you won't get out for a long, long time. You just disappear and nobody cares. The walls in the clinic are bare, the patients sit around indifferently and with dull eyes all day long unless they are being shooed around by the rabid nursing staff. Time goes by painfully slowly. You regularly get injections and far too strong tablets, which make any protest against the inhumane conditions seem pointless. If you try anyway, you will be fixed, strapped to your bed, and evil doctors will give you electric shocks until you sneak through the corridors like a zombie.

These are ideas that seem to be deeply anchored in the collective memory. They are based on films like One flew over the cuckoo's nest with Jack Nicholson, but also on critical, sometimes sensational reports on television and newspapers. There is almost never any report on what has been successful in the clinics, the normal everyday life, the good and effective work of doctors, nurses and therapists. Readers and clicks are much more likely to be generated by sensationally presented individual cases. Gradually, the negative impressions solidify into prejudices that are difficult to dispel. The fatal thing is that they are not only directed against psychiatric clinics, but also in general against mental illnesses and, even worse, against the sick people, who urgently need understanding and support.

 

Mental illnesses are common diseases

Hardly any patient or family member enters a psychiatric hospital with a light heart. Something has shifted for those who come to the clinic as a patient. He has fallen out of what we usually call "normality" without really thinking about it. Whatever “normality” may mean - an agreement on how to live, smooth functioning, an independent mastery of everyday life.

Above the entrance to the Alexianer St. Joseph Hospital in Berlin-Weißensee, which I have been managing for twenty years, a glass artist has put neon writing: “The wild goose is gradually moving towards the plateau”. They are words from Taoism, that ancient Chinese religion, which is about inner peace, the right path and harmony with nature. At the entrance to a Catholic clinic in the middle of Berlin, for me the sentence does not only stand for a coexistence of life plans, world views and religions. There is also comfort and confidence in him. The way to the south, towards the plateau, is long, but it is possible to reach your destination if you rely on yourself. And you can get help along the way. The wild goose never flies alone, but finds company and protection among their own kind. This is how people should feel when they come to our clinic.

One thing is certain: Those who seek help from us may be in a minority. But a damn big one. The psychiatric clinics in Germany count over 800,000 patients year after year. Another number is far more impressive. Every third person in Germany is affected by a mental illness once a year, for example depression or an anxiety disorder, to name just the two most common. Every third.So you could count it in the family, among friends: one, two, THREE ... Everyone can be affected. The husband, the sister, the colleague, the neighbor.

The direct costs incurred in Germany due to mental illnesses amounted to 44 billion euros in 2015. This money was used to secure the treatment and rehabilitation of people with mental disorders, but also to take preventive measures. Only circulatory and digestive diseases caused higher costs. In addition, the number of people who can no longer work due to a mental disorder is increasing. Their share of all early retirement due to illness was 43 percent in 2016. Ascending trend.

These are just numbers, alarming, but what they say remains abstract. Only when you realize that there are millions of individual fates hidden behind the numbers do the statistics become clear. There is marriage, which experiences an immense stress test due to the illness of a partner. There is the professional dream that suddenly comes to nothing because the illness makes it impossible to carry out the tasks set. There is the family that is slowly falling apart because everyday life is out of joint. And no matter how much the mental disorders differ in terms of symptoms and severity, there is always subjective suffering and a noticeable impairment of the ability to cope with life. Sometimes the impairment is felt to be so severe that those affected decide not to go on living. There are 10,000 completed suicides in Germany every year. Ninety percent of these are committed by people with mental illness.

 

Stigma

Mental illnesses have long since become widespread diseases, such as diabetes or back problems. Only nobody wants to belong to this people. If someone at a party confesses that they are receiving medical treatment because of their back, the interest and sympathy of the bystanders are certain. Very, very rarely, however, you will hear someone say at the same party: "I have just been in psychiatry for four weeks because of my depression." If he did, the reactions would almost certainly be a whole lot different.

For most of them, being mentally ill means fear, as well as the immense pressure of suffering that the illness brings with it. Afraid of the reaction of others. How will the environment behave, the family, the boss, the best friend? The mentally ill are still stigmatized. In ancient times, the stigma, a sign that was visible from afar, was burned directly into the body. The public should be warned about the bearer of the mark. Literally branded, he, be it a criminal or an escaped slave, would in future be an outcast who was avoided by the people.

Today the stigma is more subtle. How imperceptible a move away from friends; People who suddenly keep their distance; a crooked look while doing sports; excessive consideration; supposedly well-intentioned, but in truth only patronizing advice; a transfer or even dismissal from the workplace, because nothing is expected of someone who has long since recovered. All of this amounts to a condemnation to which the sick person reacts with feelings of shame and self-reproach. He looks for the guilt in himself, believes that he is not strong enough, that he does not pull himself together or that dramatizes. No wonder that people prefer to remain silent rather than talk, prefer to play with hidden cards rather than open cards. This is just as unsuitable for the prevention of mental disorders as it is for the very specific course of the illness in the individual. Who likes to run the risk of being avoided? “A mental illness is like a hand grenade in a résumé,” wrote the author Jana Simon once. Unfortunately she is right.

The feeling of exclusion and stigmatization is not just a purely subjective matter for those affected. There are studies that show that little has changed for the better in this area in recent decades. On the one hand, knowledge of the causes of mental illness has increased significantly, whether it is biological, psychological or social in nature. The results of this research have also reached the public. In addition, the acceptance of professional help that can be used has increased. Only the sick have none of it. The numbers are clear.

Negative attitudes towards people with mental disorders have not changed since 1990. Maybe you have to be happy that the numbers stayed about the same with the depression. When it comes to schizophrenia, public opinion has actually deteriorated. “Would you like to have someone with schizophrenia as a neighbor or work colleague?” A third of the respondents shook their heads and waved them off. More than half of them could not imagine being friends with a person suffering from psychosis. Too dangerous, too scary, too strange. Better to keep your distance.

One is afraid of those who are often enough themselves nothing but fear. The prejudices persist and it looks like they won't go away anytime soon. Schizophrenia, that “is” the violent criminal, the person running amok, the strange man who runs through the city, babbling to himself and no longer seems to be approachable. And if we need confirmation for this cliché, the thriller at prime time delivers it to us almost every Sunday. The image of the unpredictable, aggressive “madman”, driven to murder by his illness, remains in the viewer's mind, even after the credits have been running for a long time.

The label “mental illness”, which is increasingly being used to label socially undesirable behavior in public, relieves the burden. Terrifying acts can thus be explained, the perpetrators excluded and given to psychiatry. Questions about possible social conditions or even undesirable developments then do not even arise. Who is surprised by the suspicion with which the public looks at the mentally ill, the uncertainty with which they are met, and the shyness of those affected about their illness talk?

As always in such cases, direct contact is the best way to reduce fears. If you listen to someone tell you what it really means to be mentally ill, and if you take a closer look at behavior that initially seems so strange, some of the clichés quickly dissolve into approval.

It is almost as helpful to provide information. To impart knowledge. Over and over again. Ignorance is the ground on which prejudice can thrive. We must not stop explaining things, correcting things, communicating. With every knower who comes, there goes an anxious one. In the case of cancer, it has been very successful in recent decades, not least with the help of awareness-raising campaigns, to get the disease out of society and to create public awareness of early detection and forms of therapy. In the meantime the disease has lost the disreputability that had attached to it for a long time. Maybe one day we'll do just as well with mental illness.

 

One sees clearly only with the heart

It is quiet in the garden of the Alexian St. Joseph Hospital with its narrow paved paths between the lawns, the old trees and the park benches, from which you can see the mighty main building with its reddish bricks. So quiet that it is sometimes hard to believe that only a few meters away from the clinic premises, traffic flows day and night on Berliner Allee, which, coming from Prenzlauer Berg, cuts through Weissensee.

I still remember how I absorbed the atmosphere of the garden for the first time in 1998, which enables city dwellers to breathe a sigh of relief and a relaxing reduction in stimuli. Before that, I had worked for two years at the state hospital in Teupitz, Brandenburg, and now here I was, a young chief physician who had socialized deep in the West and who had to deal with people who had lost an entire country that they might loved, perhaps hated had.

If I walk from the parking lot through the garden to my office in the morning, there is always an opportunity to meet patients. Some are still tired, some smoke the first cigarette of the day, and still others are almost in a hurry because their therapy session is about to begin. I really like this morning mood. It is best when a conversation arises spontaneously. Easily said, but never superficial sentences that express normality in the best sense of the word. Patients with psychosis in particular do not care too much about etiquette or empty phrases, but rather confront one directly with what they perceive: “Oh, you are wearing a nice dress today!” Or also: “Man, you look bad today ! ”They are short conversations that go beyond ward rounds and therapeutic dialogue. They show that there is not just a disease and a therapy plan, but in spite of everything there is always a room, however small it may be, in which two people can meet and respect each other, with a nod, a smile.

When I was still at the very beginning of my professional career, I received a copy of the from my head physician at the time Little Prince and a small figure, a fox. As is well known, the fox plays a decisive role in Saint-Exupéry's book, because in a dialogue with the Little Prince he creates a teaching of friendship and mindfulness: “You can only see clearly with the heart. The essentials are invisible to the eyes. ”Sentences that have become famous and that can be effortlessly, that's what Dr. Make Faber aware of his gift, and let it be carried over to the relationship between doctor and patient.

You have to love people, otherwise you can't be a psychiatrist. Even if someone seems difficult to access, you have to try to get in touch with them and develop a positive relationship with them. And you have to love yourself, have a positive internalization. Only then can you manage to deal with sometimes difficult or aggressive situations with a certain degree of calm. Only then can you give something to the other person. Last but not least, hope.

Yes, mental illness is common. Anyone can get it. And they're often bad, sometimes very bad. But they can be treated, especially with psychotherapy, but also with medication. In addition, a lot is happening in research at the moment. Care for the sick is also being rethought. We are well on the way to being able to treat mental illnesses even better and more individually. There is hope. We don't have to be afraid.