Behavioral Health Minute

October 2009 - Don't shoot the messenger: Using patients' symptoms to direct life changes

The short summary

Behavioral health symptoms can be unpleasant but important messengers that patients need to make some changes.

The modestly longer reflection

Behavioral health symptoms like anxiety and depression are, of course, unpleasant.  No one in their right mind would wish to be anxious or depressed.

If you look at the context in which people report such symptoms, however, it is often the case that these symptoms function as “messengers” that life is out of balance and something needs to change.

Acute pain is an unpleasant but extraordinarily important messenger that you really need to take your hand off of the hot stove.  Inflammation from an ankle sprain is an unpleasant but important messenger that you should rest the joint while it heals.  The mechanical analogue I use with patients is that the “check engine” light in your car is an unpleasant but extraordinarily important messenger that you really need to stop driving and address what is wrong.

Similarly, many behavioral health symptoms are unpleasant but important messengers that a) there are too many challenges and too few supports in people’s lives, and/or b) people’s coping with whatever challenges they face is insufficient.

If you rip the wires to the check engine light out from underneath the dashboard and keep driving, you lose the opportunity to fix the problem before your car catches on fire.  If you focus mainly on trying to make behavioral health symptoms go away, you may lose the opportunity to focus life or learn some coping approaches that can be helpful with health and well-being long-term.  Perhaps learning to simplify life and focus on what is important. Perhaps making some changes that would result in more meaningful activities or social connections.  Perhaps learning to “let go” a little better.

Clinically, the strategy is to “widen the lens” and see what else is going on in the life of someone who presents with behavioral health symptoms.  Some questions that may be helpful:

• What is your life like overall at this point?
• What is your sense (or “theory”) about what’s going on with this?
• What is your sense (or “theory”) about why [anxiety, depression etc.] is in your life right now?
• If [anxiety or depression] were telling you something, what would it be telling you?

As you get a feeling for what the “message” may be, you can encourage patients in changing their life circumstances, learning to cope better with their life circumstances, and taking time to pursue practices that will help them to be healthier overall.

Follow-up

Think about the larger picture of the changes in circumstances or coping that behavioral health symptoms may be prompting.

Fred Craigie, PhD