The Diagnosis

Awareness of mental health issues may be increasing, but it can still be incredibly difficult to access support. That’s partially because of the difficulties in getting an accurate diagnosis. Thoughts and emotions aren’t exactly the easiest things to measure and classify.

We know that the causes of mental illness can be complex. There’s often an interaction between biology and environment that is hard to quantify. Things like brain structure, hormone levels and genes may put you at risk, but often it’s your experiences that trigger the illness. And if you can’t figure out the causes, it can be very difficult to formulate an appropriate treatment plan.

Some conditions are simpler than others. If a person experiences a traumatic brain injury and their personality completely changes afterward, it’s a safe bet what’s causing it. To check, you can use scans to take a look at the brain and see the damage. Treatment may include medication or surgery, then various rehabilitative therapies (both physical and mental) to manage long-term symptoms, or relearn how to function.

We know that for some conditions, like schizophrenia, you’re more likely to develop them if you have a close family member with the same condition. That strongly suggests a genetic component. Scientists have even managed to conduct genetic studies to identify the genes most associated with schizophrenia. That doesn’t, however, explain exactly how they work.

It’s made more difficult because in cases of family members with the same mental illness, it can be difficult to separate genes and environment. Perhaps you had similar traumatic experiences in early life, or perhaps you were exposed to the same toxins in your local soil or water. There’s a complex interplay between nature and nurture, and scientists still don’t know exactly how to separate the two.

(The best way to test the difference is to study identical twins who were raised apart as they have exactly the same genes but different life circumstances. Obviously, this gives you a pretty small candidate pool.)

When a doctor suspects you may have a mental health condition, they also have to rule out other potential causes. They’ll do things like give you a blood test to check your hormone levels and make sure you don’t have any infections. Diagnosis can be as much about excluding conditions as it can identifying them, which means lots of medical and neurological investigations.

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