By Dr. Michael J. Salamon
The daughter of my patient* called to speak with me about her mother’s treatment. Her mother had signed a release at the beginning of treatment granting me permission to speak with her husband, two sons and this daughter, should the need arise. On occasion, the patient brought some of these family members to the therapy room with her. It was not uncommon for them to call and ask how they might assist in helping their mother overcome her anxieties, fears and depressive symptoms.*
My patient was doing well, following through with her regular therapy and medication regimen. Additionally, her family’s support was a good part of the reason for her well-being.
At first, when I heard Judith*, the daughter’s voice, I feared that her mother may have had an unanticipated setback. She sounded pressured, out of breath and fretful. She was! But her mother did not have a recurrence; in fact, her mother was doing very well. She had resumed all of her previous functions and obligations, she was performing well at work, she had gone back to doing her charitable activities and was socializing regularly. Judith’s concerns were more personal.
Judith has several children in their mid to late teens. All of them are well behaved, doing well in school and are socially active. None of them have any signs of any illness, physical or psychological. Judith, however, was very anxious about their future well-being. She was not worried about them in the present and she was not especially worried about their physical health in the future. What Judith was worried about was for them to have the stigma of having a grandparent with a certain diagnosis.
Judith was concerned that having a certain diagnosis in the family would impede her children’s success in marrying into the best family. A diagnosis of a mental health problem, she explained, was tantamount to limiting the potential pool of spousal choices to “a less desirable level” to select from. She wanted me to change her mother’s diagnosis to something less “frightening” to her. Her mother’s diagnosis was Major Depressive disorder. Judith wanted me to call it anxiety and mild depression.
This was not something I had not heard many times before. (After all, I authored the book The Shidduch Crisis: Causes and Cures.) I told Judith that her concerns were understandable, but that denying reality is unhealthier. There is no reason to advertise the diagnosis, but there is no reason to deny it either. There is a general rule in emotions and in healthcare that goes: “If you can name it, you can tame it.” Altering the name could make it difficult to treat a problem in the future.
Without getting into the halachic issues of being honest when approaching these matters, the practical concerns need to be understood. Foremost among them is the fact that, without a proper diagnosis, it is extremely difficult to get the proper care and treatment. Judith’s mother did not have anxiety nor was her depression mild.
I asked Judith: If her mother had diabetes, would she be as concerned and call the endocrinologist to alter the diagnosis? She said that she wouldn’t because diabetes was “a more acceptable thing” to have. I then asked her if her mother had a diagnosis of cancer, would she call the oncologist with the same request? Once again, she said no. I suggested that we are now where we are with mental health diagnoses where we were about 30 years ago with cancer diagnoses. The community has developed enough to see that there is no benefit to hiding a diagnosis of cancer and that it is best acknowledged for what it is.
The stigma of having a mental health diagnosis is based on the same erroneous fears and misunderstandings that were attached to other diagnoses in the past. There is nothing to be gained by hiding the correct label, and even much to lose. In fact, her children should be informed of the correct diagnosis should a problem arise, so that the treating doctor can get a good family history.
There has been concern that Bipolar disorders tend to run in Jewish families, and as a result, few people have been willing to acknowledge that it exists in theirs. More current research – studies that could only have been conducted because families have been willing to accept an accurate description of the ailment – have shown that. while there may be a genetic predisposition, Bipolar disorders are not endemic to Jewish families.
I don’t know how Judith is handling talking with her children about their grandmother’s diagnosis and treatment. What I do know is that I cannot change the reality or the diagnosis. Children are much more aware of what is happening within their families than parents are willing to recognize. It is my hope that Judith’s mother continues to do well – as she is currently doing, mostly because we named it, and are therefore able to tame it.
*Details have been altered to retain confidentiality.
Dr. Michael J. Salamon is a fellow of the American Psychological Association and the author of numerous articles and books, most recently, Abuse in the Jewish Community (Urim Publications).