Patients Concealing Anxiety and Depression
I’ve observed that a lot of the patients could openly talk about their physical medical conditions (and Diabetes), but are reluctant to talk about Depression or Anxiety. They might even “lie” about feeling happy and calm, which was contrary to the notes in the patient file which indicate a prescription for antidepressants and sometimes note “panic”, “sadness about [XXX incident] happening”. I’ve already memorized some facial expressions and certain body postures of NTs which typically imply certain feelings, so I try to observe the “upset” one in the patients when seeing them speak. I was told by a friend (who is NT and usually sees patients with me) that mental health and psychiatric conditions are often stigmatized by the majority of society and tend to get hidden away should it be regarded as a “personal failing” or a “mental weakness”, and that they chose to be depressed/anxious.
Furthermore we were taught in a tute that to perform a Depression screening, you have to ask questions which sound like they’re not related to Depression, but are actually factors of it, as many of the patients apparently don’t like to be confronted with the direct question “Are you depressed?”. Eg
“How has your sleep been recently?”
“How’s your appetite?”
“Are you looking forward to anything after leaving the hospital?”
“Do you still enjoy [YYY activity] these days?”
and in the worst case scenario, you may ask “Do you ever feel life isn’t worth living anymore?”
I find it disappointing that society at large seems to stigmatize mental health/Psychiatric conditions and perpetuates the pressure on people with Depression, Anxiety etc to hide how they truly feel and act cheerful and complacent just to keep up appearances and not “ruin the atmosphere”. I wouldn’t be surprised that such suppression of how one truly feels for fear of ostracism/”punishment” upon open expression would exacerbate their mental health conditions even more. It’s also possible that some people feel that Anxiety and Depression is something to be ashamed of and it’d hurt their pride if they revealed it and/or it'd affect how people viewed them, but I feel that society’s prejudice plays a factor into this impression. Apparently this phenomenon is even worse in Asian countries, where society is more hierarchical and conformist and there’s a greater lack of mental health and psychiatric services.
Other Notable Patient Encounters (fake names used)
“David” (dead son has undiagnosed Asperger Syndrome): David was in the hospital waiting for an operation. After asking him about his history of presenting complaints, I asked about his family. He said that he had a son who left the home and committed suicide at age 41. I told him that I’m sorry to hear about that, and asked if he happened to know why his son committed suicide. He then said that his son said he “couldn’t take it any longer” and that his son displayed all the clinical traits of Asperger Syndrome.
I told him that I had been diagnosed with Asperger Syndrome and asked him numerous questions regarding his son’s childhood and adolescent years (with his consent). His son had a mild speech delay, narrow interests, and would spend hours upon hours reciting scripts from Shakespeare at the age of 8, could do calendar calculation, hated eye contact and soft touch, and had difficulty forming reciprocal friendships with NTs. His son got bullied a lot at school, and even when sent to a boarding school where there was routine, got ostracized by other NT students. He also went to TAFE but dropped out due to not being able to tolerate the social atmosphere.
I explained to him that Asperger Syndrome was a relatively recent diagnosis (introduced in DSM-IV in 1994), and that the concept of an Autism Spectrum was very unheard of prior to the late 80’s/early 90’s, and that the clinical definition of Autism was much stricter prior to that time (predominantly classifying Classical/Kanner Autism), hence most people who now have Asperger Syndrome went undiagnosed throughout their childhood and young-middle adult years and deemed as “weirdos” or “nerds”, or they get misdiagnosed with Schizophrenia, Childhood Schizophrenia, Bipolar Disorder, Borderline Personality Disorder etc and get medicated/treated incorrectly, to further detriment of their cognitive functioning and emotional wellbeing. I told him that due to the huge lack of awareness of high-functioning Autism and Asperger Syndrome before that period, it wasn’t his fault nor his son’s fault regarding the tragic suicide, and that had his son been born much later (circa 1995), he would’ve easily received the Asperger Syndrome diagnosis by age 15 and received the appropriate support and accommodations at school.
David understood everything that I told him regarding this issue and didn’t say he was offended or upset about it. He understood that it was just bad luck that the condition wasn’t known then, and that to grow up and live as an adult with all these social stresses and being constantly pressured to put up a façade of “NT normality” even though that’s against his pure behaviour, difficulty with executive functioning, multiple phases of unemployment due to constant workplace bullying by intolerant NTs and not knowing what the cause was, would be traumatizing and lead to suicide.
For me, the death of David’s son was concerning as this was an example of the reputed “Middle Age Autistic Burnout” where an unsupported ASD individual is typically pressured on a daily basis at work (at a workplace with superiors who are unaware or intolerant towards ASDs), with “friends” or in public to be a “square peg in a round hole”, to fake their social skills and behaviour to primitively simulate an NT to avoid bullying, discrimination and getting fired for trivial issues not directly related to the work. It eventually becomes too cognitively exhausting and their coping mechanisms are eventually insufficient, so they reach an episode of severe depression and fatigue, and are no longer able to work in such oppressive/conformist environments anymore, and often quit their job, become really sick or very reclusive, or commit suicide. Sadly, modern research seems to be woefully inadequate in regards to studying the needs, prognosis and mental health of adults on the Autistic Spectrum.
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