Diagnosis Of The Mind And Heart

October 10, 2007
By

Dr. Denis Mee-Lee chats with Jhoeann Borce

Are there any psychiatric conditions that can’t be helped with any treatment or medication?

Not every condition is curable, so it’s not easy to completely get rid of a number of the conditions that we treat. But like a lot of illnesses that physicians treat, what cannot be cured can be controlled so that they can be kept at a level where the individual can cope with life. So in those cases it may be necessary to continue to take medications indefinitely.

What is the most challenging aspect of your profession?

One of the most challenging or even frustrating aspects of psychiatry is that many of the psychiatric conditions and illnesses are not accepted by the individual as an illness, and they do not see the need for treatment. So there are many individuals in the community who have a psychiatric problem who do not get treatment. It might be a very real, troubling situation to family members or work associates, but to get the individual to see that their alcohol problem or their depression or their psychotic condition could benefit from treatment is often not easy to convey to a person.

Besides talking with the person whom you feel has a psychiatric condition, what other legal-type measures can you take if you feel that he/she is potentially dangerous?

If an individual is substantially dangerous either to him/herself or others, the law provides for commitment of the person to a hospital for evaluation or treatment. But that requires first the finding of a doctor, and then by a family court judge that the person is dangerous. So prior to that level of dangerousness there’s not really a way of forcing someone to get treatment except through persuasion, which is usually what families really have to do.

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You took the stand to testify in the Byron Uesugi case. Was that the most public case that you’ve worked on?

I’ve been what they call an expert testifier for a number of cases, but I guess that case was one of the most horrific cases that we’ve had in the state. My evaluation of the defendant would probably be considered the most notorious case I’ve been involved in.

For parents with children and teenagers, what would you say are some red flags to look for?

I think most parents will recognize unusual behavior - behavior that’s different from other children - whether it’s being more withdrawn or carrying out behaviors that are destructive. Probably the biggest thing for parents to look for is a change of behavior in a child. Sometimes even the psychotic disorders start in the teen years and even earlier. I think parents just need to be aware of changes that a child manifests in a way that interferes with their lives and try to seek some help.

What’s the most common condition that you come across with your patients?

Depression is really very prevalent, at least one in 10 of us have depression every year. It’s a very common condition. Of course, we all get depressed or sad at some time, but usually we don’t make a diagnosis for clinical depression or major depression until it’s been there every day, most of the day for at least two weeks.

Are there studies that show that different genders or ethnicities are more commonly affected by mental illnesses?

There are definitely studies for each diagnosis, and there are definitely conditions that are more frequently women and more frequently men. For example, women tend to have a higher rate of depression than men. There’s not as big a difference as we often think. Many of the conditions are fairly even between men and women. Among ethnic groups there’s not a lot of differences.

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Do you ever feel that your job is dangerous, being that you often work with unstable individuals?

Of course, if you look in general over the field of psychiatry and psychiatric facilities, there are incidents that occur that reflect dangers. But in general, psychiatric patients are less dangerous than the general population. If you look at most psychiatric conditions, they actually cause the person to be more withdrawn. There’s a few notable exceptions, where the individuals are using stimulating drugs, or there’s some of the psychotic conditions where people believe that people are out to get them or hurt them. But it is true that when you work in this profession you can run into those kinds of patients who are potentially dangerous. I’ve always believed very strongly that the best protection to that is to be even more caring and more interested and warmer and more loving.

This information is provided as educational and is not intended as a substitute for consultation with a physician. For questions, consult your physician or call the Honolulu County Medical Society, of which Dr. Denis Mee-Lee is a member, at 536-6988.